Mr Arvind Mohan

Firework related blast injury to the hand and treatment algorithm

Firework injuries, which most commonly affect hands, are increasing in frequency and severity. We present a pictorial case of a devastating hand injury following a firework explosion in a young male patient. The blast resulted in splaying of the hand with multiple fractures, neurovascular compromise and soft tissue loss. Reconstruction involved a third-ray amputation, fracture fixation, nerve and soft tissue repair resulting in an adequate hand with near-normal appearance. Firework- related hand injuries pose a significant surgical challenge due to the combination of burn and blast forces that can compromise the function of intact vessels and nerves making salvage and reconstruction particularly difficult. Here, we propose a treatment algorithm based on current literature. Our case demonstrates, what initially appeared to be an unsalvageable injury can be reconstructed to produce a functional hand if appropriate surgical measures are taken.

Strattice reconstructive tissue matrix to maintain nipple projection—what do patients think?

Background One of the main challenges in nipple reconstruction is achieving and maintaining nipple projection. We describe a novel use of banked Strattice to provide an internal scaffold and improve long-term projection following nipple reconstruction. We assess patient and partner satisfaction with the technique compared with routine reconstruction. Methods All patients who underwent nipple reconstruction in our unit by a single surgeon between 1/1/11 and 29/4/16 were identified retrospectively and asked to complete a satisfaction questionnaire relating specifically to their reconstruction. Those who underwent reconstruction with Strattice were compared with those that had local flaps alone. Results Sixty-four patients and 73 nipples were reconstructed during the study period. Eighteen nipples were reconstructed on 14 patients using Strattice. Fifty-seven patients responded to the questionnaire (90.5%). One patient developed an infection requiring removal of the banked matrix. Patients had a statistically significant increased degree of satisfaction when Strattice was used to augment their reconstruction (Mean ± SEM score 8.06 ± 0.20 versus 5.83 ± 0.16 for no Strattice; p < 0.0001). This was also the case when undressed (7.59 ± 0.15 vs 5.69 ± 0.16) but did not reach statistical significance when the patient was dressed (6.85 ± 0.19 vs 6.44 ± 0.11; p = 0.08). Patients’ partners also rated the reconstruction more highly when Strattice was used (7.71 ± 0.14 versus 6.33 ± 0.19 for no Strattice). Conclusions Our study demonstrates that the use of Strattice in nipple reconstruction can lead to significantly increased rates of satisfaction among women undergoing the final stage of breast reconstruction. Level of Evidence: III Therapeutic study.

Drunk carpenter's hand split in TWO after lit firework exploded

WARNING, GRAPHIC CONTENT: The 30-year-old, who is thought to be British, had to have his right hand sewn back together and was left with four fingers following the horrendous accident.