Injury
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Over recent years, hand surgeons in the Middle East and Arabic region have particularly had to deal with an increasing number of war blast injuries to the upper extremity, in the acute, subacute and chronic phases. Many have been referred from War Zone countries such as Iraq and, more recently, Syria, where the resources to treat such complex injuries are scarce. The present article is a comprehensive review of the basic principles of management of blast injuries based on the available literature merged with the authors' personal experience of these injuries. The state of the art in treatment of blast injuries to the hand, from ammunition physics and wound ballistics to radiological investigation and, ultimately, the principles of surgical management are discussed.
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Injuries that cause soft tissue defects could threaten the function and viability of the involved digit. Reconstruction of such defects can be challenging and requires careful consideration in restoring both the aesthetic and functional deficit. The purpose of this review is to describe appropriate reconstructive technique using various free tissue transfers. ⋯ Composite tissue including bone may be required in selected cases. Additional procedures, such as secondary skin graft or division of the flap, should be done after several weeks of the first operation. Refinements and improvements in free tissue transfer allow an expanse of reconstructive options for soft tissue defect in the digit.
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Obstetrical branchial plexus paralysis is a serious and possibly disabling disorder. While thoroughly described as a clinical entity, much concerning its pathogenesis is still unknown. Basic science studies alongside with studies on functional neuroanatomy of peripheral and central nervous system and their interactions lead to deeper understanding of its pathology. ⋯ Research indicates that both this entity and organism's response are much more complicated than previously believed. Current treatment options include microsurgery and palliative surgery but their improvement is possible by focusing on central nervous system. Current report discusses these topics and tries to reach useful conclusions.
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Large bone defects in the upper limb pose many challenges in reconstructive surgery. Conventional and innovative methods have been described, employing the use of microsurgical and non-microsurgical techniques to overcome both bony and soft tissue defects. This article reviews the success and pitfalls of different techniques of reconstruction of large bone defects in the upper limb, including microsurgical transfer of the free vascularised fibula graft as a diaphyseal bone replacement and as a hemivascularised joint transplant, and non-microsurgical options using conventional bone grafting, the induced membrane technique and the role of callotatic distraction-lengthening procedures.
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The improved short and long term survival rate of individuals with large burn injuries has made rehabilitation for optimal recovery of the patient increasingly important. Burn injury to the hands worsens the prospect of functional recovery and good quality of life in single events, especially when included in larger burns. ⋯ The model of health described by the World Health Organisation provided the framework for the review, to structure the review in the domains of body structures and body functions, functional activities and participation in life roles. The lack of consensus in the burn literature regarding the most appropriate outcome measures and interventions necessitates futures research and long term outcome studies to identify, predict and prevent the difficulties patients may face over their lifespan.