Usage of Dermal Substitutes for Hand Coverage and Reconstruction

Background Hand coverage and reconstruction gives a challenge for plastic surgery. In this study we introduce a method for hand coverage and reconstruction by dermal substitutes which easy and simple to use. Objectives The aim of this study is to know the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients and Methods This was a cohort study conducted on 20 patients with hand tissue loss; to evaluate the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients attending El Helmeia armed forces hospital (plastic and reconstructive department) & Ain shams university hospital with follow up duration up to 6 months. All patients had clean wound & complex hand defects with exposed tendon and/or bone, Defects post trauma and after tumour excision and Post burn hypertrophic scars, keloid or contractures. Results We found that; the mean age of all patients was (23.5 ± 8.82) years. Regarding gender of the patients, the majority (80%) of patients were males; while (20%) were females. Regarding side of raw area; (55%) of patients had Rt-sided raw area, and (45%) had Lt-sided raw area. Regarding site of raw area; (20%) of patients had Finger-tip raw area, (20%) had Palm raw area, (10%) had Volar surface of little and ring raw area, (10%) had Volar surface of little finger raw area, (25%) had Dorsum raw area, (10%) had Dorsum of lateral 4 fingers raw area, while (5%) had Dorsum of middle finger raw area. Regarding Etiology of raw area; (70%) of raw areas caused by Trauma, (15%) caused after burn keloid removal, (10%) caused after burn contracture, and (5%) caused by donor site. Regarding Intervention data; (50%) of patients used Integra dermal substitute; and (50%) used Pelnac dermal substitute. Regarding follow up data; the average Time of removal was (3.65 ± 0.49) weeks, and the average Time for follow up was (3.25 ± 1.12) months. Comparative study between 20 hand tissue loss patients revealed; highly significant increase in Post-operative STSG satisfaction rate (70%); with highly significant statistical difference (p < 0.01), highly significant increase in Post-operative STSG good movement (80%); with highly significant statistical difference (p < 0.01). Conclusion The use of dermal substitutes cons gives an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.

GTL1 is required for a robust root hair growth response to avoid nutrient overloading

Root hair growth is tuned in response to the environment surrounding plants. While most of previous studies focused on the enhancement of root hair growth during nutrient starvation, few studies investigated the root hair response in the presence of excess nutrients. We report that the post-embryonic growth of wild-type Arabidopsis plants is strongly suppressed with increasing nutrient availability, particularly in the case of root hair growth. We further used gene expression profiling to analyze how excess nutrient availability affects root hair growth, and found that RHD6 subfamily genes, which are positive regulators of root hair growth, are down-regulated in this condition. On the other hand, defects in GTL1 and DF1, which are negative regulators of root hair growth, cause frail and swollen root hairs to form when excess nutrients are supplied. Additionally, we observed that the RHD6 subfamily genes are mis-expressed in gtl1-1 df1-1. Furthermore, overexpression of RSL4, an RHD6 subfamily gene, induces swollen root hairs in the face of a nutrient overload, while mutation of RSL4 in gtl1-1 df1-1 restore root hair swelling phenotype. In conclusion, our data suggest that GTL1 and DF1 prevent unnecessary root hair formation by repressing RSL4 under excess nutrient conditions.

ADIPOFASCIAL FLAP FOR BONE DEFECTS COVERAGE IN COMPLEX HAND INJURIES: A CASE REPORT AND LITERATURE REVIEW

INTRODUCTION Hand injuries are often accompanied by defects in bone, tendon, and neurovascular structures that require complex repairs and an adequate skin coverage. Occasionally, this requires using different reconstructive techniques. Reverse flow adipofascial flaps are an option for the coverage of dorsal defects of the hand and fingers, basically. Its vascular supply allows to prevent, in case of fractures or bone defects, subsequent complications (osteomyelitis, pseudoarthrosis or adhesions). MATERIAL AND METHODS We present a patient with complex saw wounds in hand with extensor tendons injuries of the 4th and 5th fingers and an intercalary bone defect measuring 1.3cm x 0.9cm at the base of the proximal phalanx of the 4th finger, which is stabilized with Kirschner wires and cement. This structure is covered by an adipofascial flap based on 2nd, 3rd and 4th intermetacarpal dorsal perforators. Additionally, literature review was conducted in PubMed database with the search terms "Adipofascial flap AND ostheosynthesis". RESULTS Bone stabilization and coverage is achieved without any problems. Subsequently, bone cement and wires are replaced by an autologous radial graft and by plate and screws. Six articles are reviewed that reported the capability of these flaps to prevent bone infections, adhesions and nonunions. CONCLUSION Adipofascial flaps are a safe, low-morbidity and versatile reconstructive option to take into account for urgent or delayed reconstruction of complex dorsal hand defects. These dońt require microsurgical techniques and resources that may not be available in many centers and dońt sacrifice main vascular axis or future reconstructive options.

Retrospective Study of 20 Patients that has Treated with Pedicled Groin Flap in Reconstruction in Hand Injuries

Pedicled groin flap has long been playing an important role in reconstructive hand surgery. This flap is a reliable method for closing the defects of the soft tissue loss of the hand and is used in many clinical conditions. This study aims to evaluate the epidemiology and geographic aspects of the patients that required the treatment with pedicled groin flap and to assess the outcomes achieved by the Children’s Surgical Centre to help guide the future practice. We studied of 20 patient that has treated with pedicled groin flap reconstruction of the hand injuries between 2009 and 2019 at the Children’s Surgical Centre, Kien Klerng, Phnom Penh, Cambodia. In this study pedicled groin flap was used in 20 patients aged between 7 to 56 years, with a mean of 31 years or 40 % of all patients. The sex ratio M/F was 1.5 which was 12 male patients (60 %) and 08 female patients (40 %). The main cause of patient hand defects was from contracture related to burn sequelae which is 70 %.

Hand Surgery in Saudi Arabia

Hand surgery is a unique field that incorporates multiple specialties, aiming to provide the patient with a best possible functional and aesthetic results. Hand surgeons deal with different pathologies that require skills in several aspects of surgery. The field of hand surgery has evolved significantly over the past decades across the globe. This specialty has also been evolving in Saudi Arabia over the past 25 years. Some of the services offered to patients include specialized centers for brachial plexus, peripheral nerve, and pediatric hand surgery as well as centers for work-related hand injuries. There has also been significant contribution to the hand surgery literature from the hand surgeons working in Saudi Arabia, with hundreds of papers published in journals pertaining to hand surgery, orthopedic surgery, and plastic surgery, as well as the publication of several novel mutations causing congenital hand defects in journals concerned with genetics. The recent approval of a hand and microsurgery fellowship program in Saudi Arabia will also help boost this field in the country and the region.