Erhan Coskunol

Effects of platelet-rich plasma on nerve regeneration in a rat model

OBJECTIVE The aim of this study was to determine whether platelet-rich plasma has a regenerative effect on a sciatic nerve injury model in rats. METHODS A sciatic nerve cut model was created in 24 nerves of 12 rats. All nerves were repaired with epineural sutures by the same surgeon. Rats were randomly divided into two groups; platelet-rich plasma was applied to the injury site in the platelet-rich plasma group and saline only to the same area in the control group. Motor and electromyographic assessments were performed at the end of 12th postoperative week and all rats were euthanized for histological specimens. RESULTS Motor recovery was significantly better in the platelet-rich plasma group than the control group. The differences in electromyographic and histomorphometric findings between the groups were significant (p<0.05). CONCLUSION Our experimental study demonstrated positive effects of platelet-rich plasma on nerve regeneration.

The effect of excisional arthroplasty with palmaris longus tendon on carpal height ratio in Stage 3 Kienböck’s disease

OBJECTIVE Treatment methods in Kienböcks disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a palmaris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height. METHODS In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienböcks disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienböcks disease. The mean duration of follow-up after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height. RESULTS According to the Nakamuras scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant difference was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant. CONCLUSION According to patient satisfaction rate and clinical results, the outcome of excisional arthroplasty with palmaris longus tendon ball in Stage 3 Kienböcks disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.

Tumeur à cellules géantes de la main: Résultats du traitement : 5 cas au recul moyen de 7,8 ans

PURPOSE OF THE STUDY Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. CASE REPORTS Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. RESULTS Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. DISCUSSION Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation.

An alternative approach in the treatment of Dupuytren's contracture skin defects: first dorsal metacarpal artery island flap.

Skin defects are often present following surgery for Dupuytrens contracture. The first dorsal metacarpal artery island flap (FDMA) has been used by others for soft tissue reconstruction about the radial and dorsal aspect of the hand, thumb and fingers. We have used it successfully to fill the skin defects often seen following palmar fasciectomy for Dupuytrens contracture. The thin nature of the flap makes it suitable for this application. The FDMA arises from the radial artery just before the radial artery enters the first dorsal interosseous muscle and divides into three branches: 1 to the thumb, 1 to the index finger (radiodorsal branch) and a muscular branch. It is the radiodorsal branch that supplies the skin over the index finger. The island flap based on this artery includes the dorsal terminal branches of the radial nerve and venae comitantes. The flap is formed to include the fascia of the first dorsal interosseous muscle to avoid injury to a possible deep artery and to yield sufficient fat to promote venous drainage. The flap is passed subcutaneously through the first web space and sutured in place to cover the skin defect in the palm. A full thickness skin graft is used to cover the defect over the proximal phalanx of the index finger.

Fracture bilatérale de l'os pisiforme

Resume L’os pisiforme est tres rarement fracture par rapport aux autres os carpiens ; la lesion est souvent meconnue en urgence a cause de l’anatomie complexe de la region carpienne. Chute au sol poignet en hyperextension, accident de la voie publique et traumatisme direct sont les circonstances habituelles de la fracture. Le but de ce travail etait de presenter un cas de fracture bilaterale de l’os pisiforme, rare par le mecanisme etiologique et la bilateralite. Une patiente âgee de 34 ans s’est presentee avec des douleurs sur les bords ulnaires des deux poignets suite a une chute. Le mecanisme fracturaire avait ete un traumatisme direct sur les deux mains etendues en inclinaison radiale. Le diagnostic en a ete tardif et le traitement conservateur, apres une immobilisation simple de six semaines, le resultat clinique et fonctionnel a ete excellent. La situation anatomique du pisiforme fait qu’il est expose aux traumatismes et un diagnostic tardif pourrait exposer a des sequelles arthrosiques sur l’articulation pisotriquetrale.

Comparison of single event vs multiple event soft tissue surgeries in the lower extremities with cerebral palsy

UNLABELLED In children with spasticity of multiple muscle groups, the need for repeat surgical interventions increases with advancing age. AIM The present study aimed to investigate retrospectively whether there are any clinical and functional differences between single-event multilevel surgeries and multiple surgical events at a single level. METHOD The medical records of 109 patients with cerebral palsy (CP) were used. The patients, who met the inclusion and exclusion criteria, were assigned into following 4 groups based on the surgical procedures. The Gross Motor Function measure-88 (GMFCS) and Functional Independence Measure for Children (WeeFIM) were used for assessments. RESULTS When compared to groups, there was no significant difference. This study showed that both surgical techniques resulted in improvements in GMFCS and WeeFIM levels.