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The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging.Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared.The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression.Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up.Diagnostic, IV.

Skin-only avulsion is a particular type of avulsion surgery. In this type of injury, tendons, bones, and joints maintain their integrity. In this report, we aimed to report the promising results of replantation in seven fingers with total skin-only avulsions. From 2007 to 2015, 6 patients with a mean age of 34.6 (20–52) who underwent replantation surgery for total skin-only avulsion injuries distal to metacarpophalangeal (MP) joint were evaluated according to the injury type, etiology, level of repair, and the repaired structures. Seven fingers of 6 patients were evaluated. The mean repaired artery and vein number were 1.5 (1–2) and 3.8 (3–5), respectively. The mean percentage of partial necrosis in the three fingers and an amputated finger was 25.70%. Three fingers survived completely, whereas three developed partial necrosis which were managed by debridement and full thickness skin grafting. Mean static and dynamic two-point discriminations were 6 mm and 3.83 mm, respectively. The mean ROM degree of PIP/IP joints and DIP joints was 74.1 (60–85) and 56.6 (40–70) degrees, respectively. The mean follow-up was 28.3 months (24–36). Skin-only avulsions are a particular type of avulsion injury and very challenging to treat. In order to avoid from the partial necrosis due to the vascular deprivation of perforating branches of the proper digital artery, we recommend repairing both arteries in this type of avulsion. Skin-only replantation results can be successful when several technical details are observed. Level of evidence: Level V, therapeutic study.

Introduction : The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch. Methods : Two fresh frozen hand cadavers were used for the study. The motor branch of the first palmar interosseous muscle of the ulnar nerve was identified and dissected. Thenar branch of the median nerve was dissected from its insertion site. The motor branch of the first palmar interosseous muscle of the ulnar nerve was transferred to the thenar motor branch of the median nerve. Axon counts were examined histopathologically. Clinically this nerve transfer was performed for two female patients with a high-level median nerve injury. Mehta opposition scores were 21 and 20, respectively and the results were satisfactory six months after the surgery. Discussion : Although exploration and repair are recommended as the first treatment for median nerve injuries, the waiting time until the motor branch is reinnervated is critical in high level lesions. Nerve transfers become very important for fast recovery. Conclusions : This new nerve transfer proposal may be an important step in nerve transfer surgery.

Introduction Flexor tendon repair techniques that can resist active forces are widely accepted. Despite that many suture techniques have been described, the "perfect repair" for flexor tendons cannot be achieved yet. We aimed to compare a new loop suture technique with commonly used flexor tendon repair methods biomechanically in hen tendon. Method We used 25 hen flexor tendons for each group (4-strand modified Kessler, grasping cruciate, Tsuge, and new technique groups). After the tendons were divided into 2, they were repaired according to these 4 techniques, were subjected to the initial stretching of 0.5 N, and pulled in the opposite directions. When a gap of 2 mm occurred, the test was terminated and the forces at that time were recorded. These strain forces were compared and evaluated statistically. Results New technique had the best tensile strength results statistically. Modified Kessler and grasping cruciate took the second place and Tsuge repair gave the worst strain forces results. Conclusions With loop suture, 4 strands can be obtained with only 2 passes of the needle, and we think that much more tensile strength can be achieved because of the vertical transition and locking configurations of the new loop suture technique.

WOS: 000452890300002, PubMed: 30541231, Background/aim: Temporomandibular joint (TMJ) internal derangements consist of reduced and nonreduecd disc dislocations and are often diagnosed by magnetic resonance imaging (MRI). The main symptom of these derangements is TMJ pain. This study aimed to evaluate whether there is a correlation between TMJ pain and disc dislocation. Materials and methods: One hundred and four patients experiencing pain were evaluated retrospectively with the examination charts that we use routinely in our clinics and MRI. Patients were separated into two main groups as MRI(+) and MRI(-) groups according to their internal derangement findings in MRI. Mean VAS levels were compared between these two groups. Results: There were no significant differences between the MRI(+) and MRI(-) groups and no differences between the reduced disc dislocation group and nonreduced disc dislocation group. Conclusion: Although pain is maybe the most irritating symptom for TMJ patients, it cannot take the diagnostic place of MRI and MRI is still the gold standard method to make the exact diagnose of internal derangement.

Background High-pressure injection injuries of the hand are rare severe injuries. This study aimed to present a retrospective analysis of current and possible prognostic factors, treatment modalities and evaluation criteria. Methods Ten patients who had high-pressure injection injury to their upper extremity between 2005-2018 were included in this study. All patients were evaluated for the compartment syndrome; if exists fasciotomy and wide debridement were performed. After the first debridement, the second debridement was considered within the first 24 hours. Results In this study, 10 patients (mean age: 30) were evaluated retrospectively. The injected materials were the animal vaccine, thinner, oil, diesel, water, plastic and paint. Preoperative and postoperative mean WBC levels were 14.73 K/µL and 9.62 K/µL, respectively. Preoperative and postoperative mean neutrophil levels were 11.4 K/µL and 6.49 K/µL, respectively. Conclusion Early and serial debridement and compartment syndrome evaluation are required. Despite these cautions, amputation may occur. Material, injection force and the time elapsed are the main determinants in prognosis. Aggressive debridement is required in high-pressure injection injuries. However, the adequacy of debridement should be evaluated because it is mostly impossible to completely clean the tissue from diesel or thinner. According to the experience of 10 cases in our series, when clinical and macroscopic debridement adequacy was observed, a decrease in WBC and neutrophil levels was observed simultaneously. For this reason, WBC and neutrophil levels may be an indicator of the adequacy of debridement, although these injuries are very rare, larger series are needed for this interpretation.

WOS: 000500336000002, PubMed: 31799405, Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the "unrepaired artery group" (UA) and 24 patients in the "intact artery group" (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

WOS: 000440304500009, PubMed: 30023975, Objective: Foreign-body and penetration injuries of the hand are common emergencies. Metallic foreign bodies are common among all foreign masses; however, the examination of huge bodies differs from that of other metallic masses. The purpose of this study was to clarify an algorithm for the management of the huge metallic masses via our therapeutic approaches for metal-penetrating injuries. Material and Methods: Seven patients who had a huge, metallic object-penetration injury to their upper extremity were included in our study. Patients were classified according to the age, injury type, character of metallic body, injury zone, diagnostic methods, anesthesia type, and treatment received, and an algorithm to approach the management of foreign metallic bodies was clarified. Results: The causes of injury were knitting hook, iron fence, mixer, and metal nail. Plain radiography was performed for all patients. Prophylactic tetanus was administered and urgent exploration in the operation room under tourniquet followed by foreign-body extraction through cutting and not pulling were conducted. No residue was retained. Conclusion: Many patients referred to emergency services with foreign bodies. For diagnosis, the patient's history and a minimum of two-way radiograms are crucial. For treatment, we recommend surgical exploration under general anesthesia and tourniquet and extraction of the metallic body by cutting and not pulling without retaining any residual mass in the operation room.

WOS: 000480728400010, PubMed: 30994490, Introduction: Hand photography is effective and advantageous for assessing functional deficits and improvements related to surgery. In this study, it is aimed to investigate whether the correct active range of motion (ROM) is masked by the passive ROM in a wrist joint. Method: Eleven patients who were treated for unilateral wrist fractures were included in the study. Photography was performed in all patients by the same surgeon according to the conventional hand surgery photography approach and the active ROM photography approach. Differences between the noninjured side and injured side were assessed. Results: No differences were found between the active ROM and passive ROM during the extension and flexion movements in the noninjured side group. However, in the injured side group, the results from the photographs obtained with the conventional method were significantly better than the results from the photographs obtained when the wrist was actively moved. Conclusion: These findings suggest that photographs of wrists during passive motion may affect the results of a treatment or study by showing false positivity. We propose obtaining images of active ROM instead of passive ROM in hand photography.

Epidermoid inclusion cyst in palmar localization is very rare. We present an unusual case of palmar epidermoid inclusion cyst which causes Dupuytren-like contracture in hand. A 32-year-old male patient was complaining of the traction feeling of the mass. The mass was excised surgically, it was a hairy nodule like structure and reported as epidermoid inclusion cyst. Cystic lesions are very common masses. However epidermoid inclusion cysts in the palmar region are important because they may arise from the eccrine ducts and may be relevant with HPV infections. Thus, HPV screening should also be done in such a case. [Hand Microsurg 2018; 7(3.000): 170-172]

WOS: 000434152500003 PubMed ID: 28972286 IntroductionThe deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap. Patients and methodsThe free vertically designed DIEP flaps (VDIEP) were used in eight patients (7 male, 1 female) whose age is in a range of 20-66 years for soft tissue reconstructions in the ankle and foot region over a five-year period. The range of defects' size was from 8 x 5 cm to 15 x 7 cm and the causes were electrical burn, trauma and diabetic foot infections. ResultsFlap dimensions varied from 10 x 6 cm to 17 x 9 cm. All the flaps had two or more perforators, and all flaps survived completely. There were no early or late complications. We followed up the patients for 10 months in average. We observed no functional problems, especially in main motions of foot and ankle like eversion, inversion, flexion or extension except one patient. Donor site scars were acceptable in all patients. ConclusionsThe VDIEP flap may be an option for selected lower extremity soft tissue reconstructions, and it may be an alternative to classically designed abdominal flaps.

Objectives: Adhesions around the flexor tendons block tendon gliding. The most common problem in secondary surgery is inadequate and ineffective tenolysis. Local anesthesia facilitates patient comfort and early active mobilization, which is very important after tenolysis surgery and even surgery without tourniquet. This study presents a tenolysis series managed with local anesthesia. Methods: We performed 22 tenolysis surgeries for zone 1 and zone 2 tendon adhesions under local infiltration anesthesia. If active flexion was achieved due to unblocked motor function, we removed the screen between the surgery area and patient to allow the patient to view their own movement. Results: There was 1 relapse. However, the results of the remaining patients were good or excellent. Discussion: This anesthesia technique enables comfortable surgery without tourniquet, unblocked motor function, and less postoperative pain. Preserving motor function is crucial for evaluating the adequacy of tenolysis intraoperatively. We recommend local infiltration anesthesia for suitable patients undergoing tenolysis. [Hand Microsurg 2017; 6(2.000): 58-61]

In reconstructive hand surgery, flaps and therefore microsurgical techniques are inevitable to provide the best functional and aesthetic results. There are various complications of defect repair with microsurgical methods. We aimed to classify subacute and late unexpected complications that develop after defect repair by microsurgical methods and to present the management. Patients who underwent microvascular flap surgery for upper extremity tissue defects between 2014-2018 were included in the study. Complications other than total flap loss were retrospectively investigated and recorded. 8 patients (6 Male, 2 Female) were included to the study. 5 left and 3 right hand defects were detected. 3 fingers, 3 hand dorsum, 1 wrist and 1 forearm defects were detected. 2 marginal necrosis, 2 partial flap loss, 1 venous insufficiency, 1 nonunion, 1 skin contracture and 1 burn were the determined complications. Most defects present with different traumas in hand. The trauma zone is almost always close to the area of microvascular repair, moreover the recipient artery may not always be intact. How the bone fixation is performed is very important, covering the bone should be provided with well-blooded tissues. While providing all these, this coverage should not be bulk and should not restrict the range of motion in the hand. Having grasping function necessitates a repair that puts the function in the foreground compared to other areas in the body. Subclinical infections of hand in patients presenting with post-traumatic defects may cause nutritional problems, which may impair wound healing. Such a problem can also be confused with the arterial deprivation of the flap. The absolute sense requirement distinguishes the hand area from the reconstruction of many areas. All these are challenging difficulties in choosing flap for defects in the hand. [Hand Microsurg 2021; 10(2.000): 116-126]

Despite scaphoid fractures are common, simultaneously bilateral scaphoid fractures are rare cases. Most fractures of the scaphoid, especially the nondisplaced fractures of the waist and distal part, are able to heal spontaneously with proper casting. Although the scaphoid fracture is commonly seen among patients who fell on their outstretched hands, those with a history of falling on both hands are rarely seen and bilaterality should not be overlooked. It may be necessary to review the treatment plan once again in bilateral cases. A 48-year-old male patient was referred to our hand surgery clinic with below elbow thumb spica cast on his right hand 3 days after trauma. When the detailed history was questioned, it was observed that the patient fell from a height of 8 meters, there was pain in his right hand when he was in the emergency room, and pain in his left hand began after he had left the emergency room. The patients X-ray and CT images for his both hands were obtained. Bilateral acute simultaneous nondisplaced scaphoid waist fractures were diagnosed and bilateral compression screw fixation was planned. However, patient didnt accept the operation and bilateral below elbow thumb spica casts were applied. Complete union and normal wrist range of motion were achieved. The major challange of this case is the treatment because applying bilateral cast causes difficulties in performing his daily activities besides loss of work hours. Although, most of nondisplaced waist fractures can be treated with proper casting in bilateral cases surgical treatment is considered one step ahead from casting. [Hand Microsurg 2021; 10(2.000): 164-168]

Osteoarthritis of the hand is rare; however, the most retained joint after the distal interphalangeal joint is the first carpometacarpal (1. CMC) joint. Pain in the rest and increased pain with opposition is the most serious symptom, which significantly decreases the quality of life. The aim of these patients is to obtain a painless and stable thumb. Experience of trapeziectomy and ligament reconstruction tendon interposition technique for a Stage III patient was shared and diagnosis and treatment were discussed through the relevant literature. A 53-year-old female patient was admitted with complaints of pain in the right hand thumb root and unable to open the jar lid. In direct radiography, narrowing in the 1. CMC joint space and osteophytes were detected. After the trapeziectomy, 1st and 2nd metacarpals were fixed with K wire. Flexor carpi radialis tendon was passed from the first metacarpal base to the second metacarpal base in the form of a distal-based tendon flap to mimic the beak ligament. There was no pain at the postoperative 6th month, and the Kapandji opposition score was 10. When diagnosing 1. CMC osteoarthritis, pain during opposition and circumduction movements that is not relieved with analgesics and rest is the most important symptom for a clinician to look for. Many treatment principles have been defined according to the staging for the postdiagnosis period, despite the diagnosis is a challenging process.

Objective: Placing gold implants in the upper eyelids is a widely accepted method in lagophthalmos treatment. Gold can be obtained as custom-made or from medical firms, as well as from jewelers. This review intends to share the algorithm applied in our clinic, to help avoid undesirable postoperative results. Material and Methods: Between 2012 and 2014, seven patients were planned to undergo gold implant surgery for lagophthalmos. In each of the seven cases preoperative weight tests were performed in upright-seated position, incision site and implant weights were measured, and the determined weights were tested twice, sterilization was applied. Results: None of the patients showed any early or late complications. Complete closure of the eyelids was achieved. Aesthetic evaluations of the patients were found to be better than the physician’s evaluations. Conclusion: The weight of the gold is the most important factor that determines the success of the implant treatment. It is possible to reduce postoperative morbidity and increase success by adhering to simple preoperative criteria when gold is obtained from jewelers, a cost-effective method that yields high patient satisfaction.

Trigger finger is a disorder that presents with a blocking feeling and pain during finger movements. This condition more commonly occurs in the 2nd finger with involvement of multiple digits being extremely rare. There are very few known cases in which trigger finger was developed in all ten fingers. Here, an unusual case of ten-digit finger trigger is presented. A 44-year-old female housewife visited our clinic with painful blocking feeling in her hand. Her examination was compatible with trigger finger. Her hands were operated on in different sessions and A1 pulleys of all fingers were released. After the operations, blocking feeling and pain during flexion disappeared and normal range of motion was obtained. On the occasion of this very rare case, the etiology and approach for multiple trigger fingers is discussed. [Hand Microsurg 2016; 5(2.000): 84-87]

Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the reports in the literature are mostly case reports for upper extremity. Case Series: 7 patients, who were treated between 1999 and 2015 in our clinic with the diagnosis of cutaneous anthrax in their upper extremity, were included to our study. 3 patients applied directly to plastic surgery, others were consulted from the infectious disease clinics. Reconstructions were done with skin grafts or secondarily. Discussion: Anthrax causes cutaneous, gastrointestinal and inhalation forms of the disease. Despite being very rare in Europe and US, in Turkey there are many reported anthrax cases. However, cutaneous anthrax of upper extremity is reported rarely in the literature. Painless papule and vesicles are well defined as clinical findings. In anthrax, the excision of skin lesions or biopsies is contraindicated because of the risk of systemic spread. Conclusion: Despite cutaneous anthrax of the hand and upper extremity is very rare, the diagnosis is easy because of the typical presentation and history. Once the definitive diagnosis is set, the treatment is effortless with the antibiotherapy and first steps of the reconstruction ladder.

Tuberculosis (TB) is a disease that mainly affects the lungs and is primarily caused by Mycobacterium tuberculosis bacteria. However, the hand involvement is extremely rare. Diagnosing the tenosynovitis due to the tuberculosis is the main challenge for the surgeons. It is aimed to present a case of Mycobacterium tenosynovitis of the hand and outline the treatment protocol for its diagnosis. 46-year-old male patient was presented with swelling in his right hand. Physical examination revealed no pathology except for swelling in the right thenar region. Magnetic resonance imaging (MRI) revealed chronic tenosynovitis. Synovectomy was planned for the patient, and following the thenar incision, mass formations in the form of pale-yellow rice grains were found inside the thickened sheath of the flexor pollicis longus. Since these formations suggested TT intraoperatively, the intraoperative wound culture, samples for acid-resistant staining, TB DNA, and TB culture, as well as pathology samples, were taken. Intraoperative suspicion of TT is extremely important in order to prove the diagnosis. Although TB that affects the hand is rare, it is an element of tenosynovitis that must be kept in mind in areas where TB is endemic. Rice bodies are important guiding agents for intraoperative diagnosis and subsequent treatment.

Calcaneus is a unique-shaped hindbone, therefore the reconstruction of complex osteocutaneous defects of heel-calcaneal area remain challenging. Management of a complex defect in the complicated calcaneal area with allogenic tibia and free anterolateral thigh flap is presented. A 37-year-old male patient was presented with a heel defect after a mine injury. The patient underwent serial debridement, thereafter allogeneic proximal tibia defect was properly shaped, hammered and forged into the tibia medullary defect without any fixation material. The graft was covered with free sensate anterolateral thigh flap. The most important disadvantage of allogeneic bone grafts is the lack of blood supply. In the presented case, the blood supply of the bone graft was provided thanks to the blood supply from the medulla of the tibia. Therefore, it was possible to pass the blood inside the allograft. It can be predicted that this intramedullary vascularization also carries stem cells into the medium, further triggering recovery and regeneration.

WOS: 000428237600009, PubMed: 29350367, Our objective was to compare the outcomes of dorsal hand defect reconstruction using a posterior interosseous artery flap (PIAF) and a reverse adipofascial radial forearm flap : From 2008 to 2013, 23 patients who underwent hand soft tissue defect reconstruction with PIAF (11 patients) and patients) were included in this retrospective study. Reconstruction methods were compared in terms of functionality with disability of the arm, shoulder, and hand (DASH) score and range of motion (ROM) and aesthetically with scar assessment. Operation times, length of hospital stay, and donor site problems were compared. RESULTS: We found no statistically significant differences between PIAF and RARFF in terms of ROM, DASH score, and length of hospital stay. Statistically significant differences were found in operation time, scar assessment, and donor site problems between PIAF and RARFF patients. : RARFF showed better results than PIAF in dorsal hand defects, but in RARFF, the major arteries of the hand are sacrificed., Bu çalışmadaki amacımız el dorsumundaki defektlerin posteriyor interosseöz arter flebi (PİA) ve ters akımlı adipofasyal radial önkol (RRÖF) ile onarım sonuçlarını kıyaslamaktır.Geriye dönük olarak dizayn edilen bu çalışmaya 2008–2013 yılları arasında, PİA ile (11 hasta) ve RRÖF ile (12 hasta) el dorsumundaki yumuşak doku defektleri onarılan 23 hasta dahil edildi. Onarım yöntemleri fonksiyonel olarak kol, omuz ve el sorunları anketi (DASH) skoru, eklem hareket açıklığı (ROM) ile; estetik olarak skarın görünümü ile değerlendirildi. Ameliyat süreleri, hastanede kalış süreleri ve donör alan problemleri kıyaslandı. Posteriyor interosseöz arter flebi ve RRÖF arasında ROM ve DASH skorları ve hastanede kalış süresi açısından istatistiksel açıdan fark saptanmadı. Ameliyat süreleri, skar değerlendirmesi ve donör alan problemleri açısından ise istatistiksel açıdan fark saptandı.Dorsal el defektlerinde RRÖF sonuçları PİA’dan daha iyidir, ne varki RRÖF elin ana bir arterini sakrifiye etmektedir.

WOS: 000492876500001, PubMed: 31667349, Foreign bodies are common entities found in hand surgery practice. However, they are a very rare cause of the acute cubital tunnel syndrome. A 48-year-old male patient was consulted for cubital tunnel symptoms after 2-day unconscious state in the intensive care unit. The ulnar nerve was explored, a piece of glass was removed inside the cubital tunnel, and the nerve was repaired. However, compression neuropathy symptoms due to the acute trauma are interesting. Nerve laceration with a foreign body should be considered in acute-onset cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot be determined explicitly.

Objective: Lipomas are the most common type of soft-tissue tumor found in the body. Very few of the benign tumors of the hand are classified as lipomas. Also, giant lipomas of the hand are extremely rare. The goal of this study was to present the cases of patients suffering from giant lipomas of the hand. Methods: 5 patients (3 females and 2 males) with giant lipomas of the hand were treated in our clinic between January 2012 and April 2014. Patients with lipomatous tumors of the hand having diameters equal or greater than 5 centimeters were included in our study. Both preoperatively and postoperatively, physical examination and magnetic resonance imaging (MRI) were used for diagnosis and determination of any residual mass. In the first month, the patients' satisfaction rates were evaluated. Results: All 5 patients were operated upon. The mean age was 60.6 years. Postoperatively (1st month), no residual masses were found. The satisfaction rates of all patients in the 1st month were 100%. Conclusion: Giant lipomas of the hand are very rare and may cause compressions and other complications. Thus, they require a careful preoperative evaluation in order to make a proper differential diagnosis. [Hand Microsurg 2015; 4(1.000): 8-11]

Self-inflating tissue expanders have been used successfully in breast reconstruction, alopecia, scars, and anophthalmos. The expanders contain an osmotic active hydrogel and a silicon shell. The purpose of this study was to analyze our clinical experience using self-inflating tissue expanders in the treatment of alopecia and cleft palate defects in pediatric patients. Twenty-eight self-inflating tissue expanders were used in 13 patients with alopecia or large cleft palate defects. Expander dimensions were determined by the size of the defect in the scalp and by using a sizer for the palate. In some patients, it was necessary to use more than one expander. A visual analog scale (VAS) and Children’s Hospital of Eastern of Ontario Pain Scale (CHEOPS) were used to determine pain levels. Sufficient tissue was gained in nine patients (69.2%) and 11 of the 16 defects were repaired successfully (68.75 %). We observed four implant extrusions as a major complication (14.2 %). Three of these four extrusions were seen in cleft palate expansions. Pain levels were as low as 5 points with CHEOPS in patients younger than 5 years old and 40 mm with VAS in patients older than 5 years of age. Self-inflating tissue expanders comfortably ensure sufficient tissue in patients with alopecia; however, there is high risk of extrusion in cleft palate applications. Level of Evidence: Level V, therapeutic study.

WOS: 000387039400009, PubMed: 28825000, Introduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

Pseudoaneurysms involving the leakage of blood between the arterial wall and the peripheral parenchyma can occur as a result of an artery's perforation. In this case report, we present a repair, using a vein graft, of a thrombosed pseudoa- neurysm that developed in a radial artery after a single puncture to obtain a sample for the determination of arterial blood gases. A 56-year-old female patient was admitted with a mass in her left wrist on the radial side. Upon examination, a sen- sitive and mobile mass was detected by palpation. The patient had no fever or any other symptoms of inflammation. Her detailed anamnesis revealed that the mass had developed after a puncture to obtain a blood sample for an arterial blood gas measurement. By using magnetic resonance imaging the mass was determined to be a thrombosed pseudoaneurysm. The mass was excised and the gap that had developed in the radial artery was repaired with a vein graft obtained from the forearm. Magnetic resonance angiography imaging after 1 month confirmed the vein graft's patency. Cannulations for blood monitoring, blood gas analysis and interventional radiological procedures are indispensable processes used in medicine; however, they are not risk-free. Following these procedures, thromboses and pseudoaneurysms can develop. A number of treatment options exist, including bandaging, percutaneous thrombin injections, and surgical treatment for complicated cases. For pseudoaneurysms that create a mass effect, as in our case, surgery is needed. Such complications after interventional procedures involving the radial artery should be kept in mind. [Hand Microsurg 2016; 5(1.000): 26-28]

WOS: 000428690900001, PubMed: 29600277, Buschke-Loewenstein tumor (BLT) is a giant condyloma acuminatum which is very rare and commonly affects the anogenital region. The malignant transformation and localization in penis is very rare. This article aims to present a case with BLT with malignant transformation in penis. A 59-year-old male patient was referred, who has have been suffering from a cauliflower-like lesion in the penis for 8 years. Biopsies revealed a BLT with malignant transformation. The lesion was excised largely and reconstructed with local flaps and skin grafts. Defined by Buschke and Loewenstein in 1925, giant condyloma acuminatum is a rare and important disorder because of the sexually transmitting capability.

For syndactyly repair, several delicate, well-planned flap combination techniques have been reported. This study presents technique details with functional and aesthetic results of a dorsal rectangular and volar V-Y advancement flap combination for web reconstruction and S incisions for finger separation in patients with syndactyly.Ten patients with 16 syndactyly webs were treated. Patients were examined in terms of function and aesthetic. Evaluation criteria included the Vancouver Scar Scale, range of motion, degree of web creeping, parent's satisfaction rates, and finger abduction. During the initial period, vascular compromise of fingers, haematoma, infection, seroma, flap necrosis, or graft failures were not noted in any patients. No patients required revision surgery. During the later period, parent satisfaction scores were excellent or good, finger function was complete, and the Vancouver Scar Scale showed that two webs had hyperpigmented areas and two had supple pliability.This simple syndactyly release technique can provide a low rate of web creep, good scar quality, and optimal functional results.

Purpose Endoscopic treatment of maxillofacial fractures is a different way of performing open reduction and internal fixation. This report presents a case series of mandibular subcondylar fractures performed with combined endoscopic transoral and transbuccal approaches and the results. Materials and Methods Sixteen patients with mandibular condylar fractures were preoperatively assessed for risk and underwent open reduction and internal fixation with the endoscope-assisted transoral approach. Duration of hospital stay was recorded and patients were followed for an average of 17 months for possible complications. Results No major complications were encountered in any patient. Minimal angulation was observed in 3 patients. One patient had late complaints of temporomandibular joint pain. Conclusion Endoscopic-assisted mandibular condylar fracture repair includes special surgical equipment and manipulation not used in classic methods. With this approach, subcondylar fractures can be more readily manipulated through a transbuccal puncture with appropriate fixation achieved.

Thermal burns often occured accidentally and patients rarely can tolerate the heated materials. In this report, two cases where the patients put heated materials on their hands in order to relieve their hand pain as a traditional method were presented. A 54-year-old female, who was otherwise a healthy patient had a wrist burn due to the hot melted tar which she had used to relieve her carpal tunnel pain and a 13-year-old female patient was admitted with a finger burn, due to a hot onion in order to relieve her paronychia. Thermal burns are rarely self-inflicted. These traditional pain control methods caused serious burns. The patients detailed medical history and other medical conditions underneath the hand burn should be revealed. [Hand Microsurg 2018; 7(2.000): 98-100]

[Hand Microsurg 2015; 4(3.000): 88-88]

Objective: As an Islamic ritual, every year during the celebration of the Sacrifice Feast, animals, like cows, sheep or goats, are sacrificed and their meat donated to poor people. In this study, we present the cases of hand injuries that occurred during the Sacrifice Feast, along with their corresponding etiological and demographic information, and evaluate the surgical management of these hand injuries. Methods: 62 patients, who were referred to the Hand Surgery Division of our Plastic, Reconstructive and Aesthetic Surgery Department from the emergency room between 15-18 October 2013 and 04-07 October 2014, were included in our study. A total of 62 patients were classified and evaluated according to age, gender, etiology, date of injury, hand lateralization, injury type, level of injury and type of anesthesia. Results: All 14 female patients (100%) were injured by knives. A total of 7 of 13 pediatric patients (53,8%) were injured from meat grinders. Thirteen patients were injured by cleavers; all of them (100%) were male and were injured on the first day of the feast. A total of 47 of 62 patients (75,8%) and 45 of 48 male patients (93,7%) were injured on the 1st day of the feast. A total of 12 of 14 female patients (85,7%) were injured on the 2nd, 3rd and 4th days of the feast. A total of 39 of 62 patients (62,9%) injured their nondominant hands. Isolated tendon injuries were the most common injury type (29%). Conclusion: Although festivals are celebrated with much enthusiasm, carelessness or neglect may lead to undesirable results. Keeping children away from danger should be made a top priority during Sacrifice Feasts. In addition, not only should precautions be more intensively emphasized by the written and visual media, but special regulations should be implemented involving the transporting of amputated limbs. Furthermore, in some regions, many people, who are inexperienced butchers, sacrifice animals themselves, leading to numerous hand injuries. Consequently, in order to reduce the number of these hand injuries, animals should only be sacrificed by professionals. [Hand Microsurg 2015; 4(2.000): 28-31]