Teanoosh Zadeh

Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures: A Systematic Review

Background: Tendon-related complications after plate fixation of distal radius fractures can cause significant morbidity in the patient. This retrospective systematic review aims to report and compare the current rate of tendon rupture and tenosynovitis complicating the operative management of distal radius fractures. Methods: A systematic literature search was performed to identify relevant articles reporting tendon complications after operative management of distal radius fractures. The search included published articles in three electronic databases—Ovid MEDLINE, EMBASE, and the Cochrane Library—starting from the establishment of each database to February of 2016. Results: A total of 56 studies met the inclusion criteria, including 6278 patients. Overall tendon-related adverse events were reported in 420 patients (6.8 percent). The incidence of tendon rupture was 1.5 percent with volar plates and 1.7 percent with dorsal plates. The incidence of tenosynovitis was 4.5 percent with volar plates and 7.5 percent with dorsal plates. Individual tendon complications were reported with volar and dorsal fixation, respectively: extensor pollicis longus tenosynovitis (0.3 percent and 1.1 percent), extensor pollicis longus rupture (0.8 percent and 0.3 percent), flexor pollicis longus tenosynovitis (1.3 percent and 0 percent), flexor pollicis longus rupture (0.6 percent and 0.2 percent), flexor digitorum profundus/flexor digitorum superficialis tenosynovitis (1.2 percent and 1.3 percent), flexor digitorum profundus/flexor digitorum superficialis rupture (0.1 percent and 0 percent), extensor digitorum communis tenosynovitis (1.7 percent and 5.9 percent), and extensor digitorum communis rupture (0.05 percent and 1.3 percent). Conclusion: This systematic review provides an update on the literature regarding tendon-related complications in the management of distal radius fractures.

Heparin-induced thrombocytopenia and thrombosis as an under-diagnosed cause of flap failure in heparin-naive patients: a case report and systematic review of the literature.

Heparin‐induced thrombocytopenia and thrombosis (HITT) is an immune complex mediated and potentially devastating cause of flap loss in microvascular surgery. HITT may be an under‐reported cause of early‐flap failure due to subclinical manifestations at the time of flap loss. A case report of a patient presenting with HITT‐related flap failure and the results of a systematic literature review of the clinical presentation of HITT in microsurgery are presented here.

Restoration of shoulder motion using single- versus dual-nerve repair in obstetrical brachial plexus injury

OBJECTIVE The purpose of this study was to compare shoulder abduction and external rotation (ER) after single-nerve repair of the upper trunk alone versus dual-nerve repair of both the upper trunk and the suprascapular nerve. METHODS A retrospective chart review of a single surgeons experience repairing obstetrical brachial plexus injuries between June 1995 and June 2015 was performed. Eight patients underwent repair of the upper trunk alone, and 10 patients underwent repair of the upper trunk and the suprascapular nerve. Shoulder abduction and ER ranges of motion (ROMs) (in degrees) were recorded preoperatively and postoperatively. Postoperative ROM and the difference in ROM gained after surgery were compared by independent t-test analysis. RESULTS The mean follow-up time was 161.4 weeks (range 62-514 weeks, SD 124.0 weeks). The mean patient age at the time of surgery was 31.3 weeks (range 19.9-47.0 weeks, SD 6.9 weeks). The mean postoperative shoulder abduction ROMs were 145.0° (range 85°-180°, SD 39.4°) after single-nerve repair and 134.0° (range 90°-180°, SD 30.3°) after dual-nerve repair (p = 0.51). The mean postoperative shoulder ER ROMs were 67.5° (range 10°-95°, SD 28.8°) after single-nerve repair and 72.0° (range 10°-95°, SD 31.3°) after dual-nerve repair (p = 0.76). CONCLUSIONS The authors found no difference in shoulder abduction and ER between patients who underwent single-nerve repair of the upper trunk alone and those who underwent dual-nerve repair of both the upper trunk and the suprascapular nerve.

Free Flap Failure Associated with Heparin-Induced Thrombocytopenia: Is It Preventable?

Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of unfractionated heparin, particularly in the setting of microsurgery, with a reported salvage rate of <25% of free flaps. HIT presenting as venous thromboembolisms (VTEs) can be a more challenging problem to the reconstructive surgeon. The hematology literature reports a prevalence of HIT as high as 12% among patients presenting with VTEs. Complications associated with HIT are preventable if a high index of suspicion is maintained and proper treatment is implemented. A 68-year-old man with VTEs who failed a parascapular fasciocutaneous flap to the forearm secondary to undiagnosed HIT is reported. The authors propose an algorithm to approach such a dilemma and implement adequate treatment measures before commencing any microsurgical procedures in patients to minimize any untoward consequences.

“Donʼt Let Your Flap Get HITT”: A Case Report and Systematic Review of Heparin Induced Thrombocytopenia and Thrombosis

IntroductIon: Heparin induced thrombocytopenia and thrombosis (HITT) may compromise the success of microsurgical procedures. In 2009, the Plastic Surgery team at the Montreal General Hospital treated a patient suffering from a chronic 8x9cm wound of the right medial malleolus. The wound was treated with a left anterolateral thigh perforator free flap complicated by multiple thrombotic events. Despite multiple salvage attempts including thrombolysis, popliteal AV loop, and a second free flap procedure, all microvascular attempts at correction failed. HITT was diagnosed six days postoperatively, and due to the significant impact of HITT on this flap, we reviewed literature and found few reports describing HITT in microsurgery. We present a comprehensive review of HITT in microsurgery and how HITT might be identified earlier to promote improved flap viability.

Treatment Modalities for Stenosing Tenosynovitis: A Systematic Review and Meta-Analysis

80 concluSIon: Partial fasciocutaneous flap loss can be avoided with the routine application of intraoperative tissue perfusion imaging, such as fluorescent indo-cyanine green angiography. This technology can also aid the reconstructive surgeon in the operative decision to perform surgical delay, preventing perfusion related complications. At our institution, it has provided us the opportunity to maximize flap size while minimizing morbidity for complex extremity war wound reconstruction.

Replantation surgery in Quebec: The bottlenecks to rapid care.

INTRODUCTION Time delays resulting in prolonged ischemia have a significant impact on the successful reattachment of amputated body parts. No studies have addressed the issues surrounding delays from the time of the accident to the start of replantation surgery. The present paper identifies the bottlenecks that prolong the time before patients are able to gain access to a replant team. METHODS A total of 50 patients underwent microsurgical replantation, because of traumatic amputation, at a university-based hospital from 1996 to 2003. The charts were analyzed to ascertain individual time intervals from the onset of injury until the beginning of replant surgery. RESULTS The average length of time for patients who came directly to the replant centre was 3 h 40 min before surgery began. In contrast, for those referred from outlying hospitals, the elapsed time was 6 h 21 min. CONCLUSIONS Two major bottlenecks were found. First, for patients who were referred from other health centres, delays were due to a lack of information as to where patients could receive appropriate replant surgery. Second, delays at the replant centre were primarily due to insufficient physical and human resources in the operating room.