HAND AND FOREARM REPLANTATION

(1)

NTIFIC MANIFESTATIONS 1

A B S T R A C T B O O K

(2)

Editura „Victor Babeş”

Piaţa Eftimie Murgu 2, cam. 316, 300041 Timişoara Tel./ Fax 0256 495 210

e-mail: [email protected] www.umft.ro/editura

Director general: Prof. univ. emerit dr. Dan V. Poenaru

Colecţia: MANIFESTĂRI ȘTIINȚIFICE

Coordonator colecţie: Prof. univ. dr. Danina Muntean

Referenți ştiinţifici: Prof. univ. dr. med. Octavian CREȚU Prof. univ. dr. med. Radu Cristian JECAN

ISBN 978-606-786-274-4

Reproducerea parţială sau integrală a textului, pe orice suport, fără acordul scris al autorilor este interzisă şi se va sancţiona conform legilor în vigoare.

(3)

COMBINATION WITH HY TISSUE MICROGRAFTS ... 61 PANCHE TASKOV¹, ANDA RADULESCU¹, DANIELA CORODATI¹, ZORIN CRAINICEANU¹ CLOSING AND RECONSTRUCTING – NEGATIVE PRESSURE WOUND THERAPY AND NEGATIVE PRESSURE WOUND THERAPY WITH INSTILLATION AND DWELL IN A NATIONAL REFERENCE CENTER ... 62

OLGA MARIA POPESCU¹, ILEANA CARMEN BOIANGIU¹, DIANA CANTACIOIU¹, SORIN VIOREL PARASCA¹

VERSATILITY OF NEGATIVE PRESSURE WOUND THERAPY IN MANAGEMENT OF SOFT TISSUE DEFECTS ... 64

RUXANDRA - MARIA ILIESCU¹, ANDREEA GROSU-BULARDA¹, ANDRA-LUANA LAZARESCU¹, ALEXANDRU-CONSTANTIN CARAP², CRISTIAN SORIN HARIGA¹, RAZVAN NICOLAE TEODOREANU¹

PRESENTATION AND SURGICAL MANAGEMENT OF PERINEAL LANGERHANS CELL HISTIOCYTOSIS AND HIDRADENITIS SUPPURATIVA ... 65

NOEMI KRISTO¹, NICOLETA-SARA BANEU¹, GABRIEL VERDES², ENIKO CHRISTINE HORDOVAN¹

NEGATIVE PRESSURE THERAPY: A NOVEL ADDITON TO THE TREATMENT OF CHRONIC VENOUS ULCERS REQUIRING SKIN GRAFTING ... 66

ADELAIDA AVINO¹, DANIELA-ELENA GHEOCA-MUTU ¹, DANIELA ION ², ABDALAH ABU-BAKER², LAURA RADUCU¹, CRISTIAN-RADU JECAN ¹

VAGINAL RECONSTRUCTION IN PATIENTS WITH MAYER–ROKITANSKY–

KÜSTER–HAUSER SYNDROME ... 67 ADELAIDA AVINO¹, DANIELA-ELENA GHEOCA-MUTU¹, GABRIELA ALEXA¹,

LAURA RADUCU ¹, CRISTIAN-RADU JECAN ¹

SCAR REVISION - WHAT CAN PLASTIC SURGERY OFFER IN THE PUBLIC

HEALTH SYSTEM? ... 68 IOANA GHIURCO¹, ANDREI POROȘNICU¹, VLAD PETRE ATANASESCU¹,

ȘTEFANIA MIHAELA RIZA¹, RUXANDRA DIANA SINESCU BĂLTĂȚEANU¹

MANAGEMENT OF SOFT TISSUE INFANTILE HEMANGIOMAS – IMPACT OF BETA- BLOCKER USE AND COVID 19 PANDEMIC ... 69

ENESCU DAN MIRCEA¹, SIMONA STOICESCU¹, DAN IONIȚĂ², MARIA TOMIȚĂ², IULIA NACEA², RALUCA TATAR¹

(7)

PECTORALIS MAJOR FLAP COVERAGE OF PRESTERNAL RADIOTHERAPY

INDUCED ULCERATION – A CASE REPORT ... 70 ABDALAH ABU - BAKER¹, DANIELA ION¹, DANIELA GHEOCA-MUTU¹, ADELAIDA AVINO¹, LAURA RADUCU¹, RADU-CRISTIAN JECAN¹

PROSPECTIVE STUDY – WIDE AWAKE, NO SEDATION DAY CASE SURGERY ... 71 TITUS-ANDREI GRECU¹, ROXANA CRISTINA TOTOREAN¹, VLADISLAV GYEBNAR¹,

MIHAELA MASTACANEANU²

ORGANIZING A BASIC MICROSURGERY WORKSHOP ... 72 ANDREI MARIN¹, ELENA BURLACU¹, MIRELA TENE¹, CARMEN GIUGLEA¹ ...72 THE USE OF PROTEOLYTIC ENZYMES IN THE CONSERVATIVE TREATMENT OF PATHOLOGICAL SCARS. ... 73

DANA CEBOTARI¹, ZABUTNAIA MARIA¹, STOIAN ALINA², CIRIMPEI OCTAVIAN¹, VEREGA GRIGORE³

KEYSTONE PERFORATOR ISLAND FLAP FOR AXILLARY, INGUINAL AND

SACROCOCCYGEAL SOFT TISSUE DEFECTS ... 74 TIMEA VIRAG¹, ALEXANDRU GEORGESCU¹

COMPARTMENT SYNDROME FOLLOWING TIBIAL FRACTURES AND TYPE 1 DIABETES MELLITUS. CASE REPORT... 75

ALINA STOIAN¹, RODICA IORDACHESCU², VIORICA MIHALUTA³, DANA CEBOTARI¹, ELEONORA BORS⁴, GRIGORE VEREGA¹

HALLUX MACRODACTYLY : MANAGEMENT OF A RARE CASE ... 76 MIHAIL ROZNOVANU¹, ANDREEA CARMEN MERUTA¹, DIANA GEORGIANA CINTACIOIU¹ ORTHOPLASTIC APPROACH TO ACHILLES TENDON SEVERE COMPLICATIONS AFTER SURGERY: THE LADDER TECHNIQUE ... 77

PASQUALE TEDESCHI¹, MICHELE MARUCCIA¹, GIUSEPPE GIUDICE¹, ROSSELLA ELIA¹ ACHILLES TENDON RECONSTRUCTION USING A COMPOSITE ALT WITH TENSOR FASCIA LATA FLAP IN A PERONEAL MAGNUS ARTERY PATIENT -

CASE REPORT ... 80 AUTHORS: ROXANA TOTOREAN¹, OANA MIȘCĂ¹, SARA BANEU¹,

ALEXANDRU MIHALACHE¹, VLAD BLOANCA¹, ZORIN CRĂINICEANU¹

A CASE REPORT OF GIANT SCROTAL LYMPHEDEMA: A MULTIDISCIPLINARY APPROACH ... 80

PASQUALE TEDESCHI¹

LYMPHATICO-VENULAR ANASTOMOSIS IN THE TREATMENT OF SECONDARY LYMPHEDEMA. INITIAL EXPERIENCE IN ESTABLISHING A LYMPHEDEMA

PROGRAM IN A TERTIARY CANCER TREATMENT CENTER. ... 82 ALEX ORADAN¹, ALMA CORPODEAN, MAXIMILIAN MUNTEAN,

PATRICIU ACHIMAS-CADARIU

TREATMENT OF SEVERE DEBILITATING LYMPHEDEMA OF THE LOWER LIMB USING CHARLES PROCEDURE: CASE REPORT ... 83

DIANA GEORGIANA CINTACIOIU¹, SORIN VIOREL PARASCA¹, ANDREI DUMITRESCU¹ PREPECTORAL BREAST RECONSTRUCTION: AN IDEAL APPROACH TO

BILATERAL RISK REDUCING MASTECTOMY ... 84 PASQUALE TEDESCHI¹

PROPHYLACTIC MASTECTOMY AND IMMEDIATE IMPLANT BREAST

RECONSTRUCTION FOR PTOTIC BREASTS ... 87 GRUJIC DACIANA¹, HORIA CRISTIAN², FADI AL KHAMIS¹, VLAD POPESCU¹,

TEODORA HOINOIU¹, FABIANA SIMION¹

(8)

MALIGNANT CUTANEOUS MELANOMA - "MEPHISTO’S DISEASE (GOETHE-NIAN) - SURGICAL AND CLINIC DATA FROM OUR CLINIC- ... 88

NODITI GHEORGHE¹, ZORIN CRAINICEANU¹, PATRICIA CRISTODOR²,

ROXANA SCHEUSAN³, PETRA CURESCU³, DANA-PETRONIA ULITA¹, ENIKO HORDOVAN¹, WAEL ELAMINE¹

ZOSTERIFORM METASTATIC SKIN CANCER – 4 CASES REPORT AND

LITERATURE REVIEW ... 89 GRUJIC DACIANA¹, FABIANA SIMION¹, FADI AL KHAMIS ¹, VLAD POPESCU¹,

HORIA CRISTIAN², CRISTINA OPREAN³

NASOLABIAL INSULAR FLAP FOR ALAR RECONSTRUCTION AFTER EXTENSIVE NON-MELANOMA SKIN CANCER REEXCISION – A CASE PRESENTATION ... 90

DANIELA ION¹, AVINO ADELAIDA^1,2, DANIELA - ELENA GHEOCA - MUTU ^1,3, ABDALAH ABU - BAKER¹, LAURA RĂDUCU^1,2, CRISTIAN RADU JECAN^1,2

CUTANEOUS MELANOMA OF THE BREAST – ONCOPLASTIC APPROACH AFTER WIDE LOCAL EXCISION AND AXILLARY SENTINEL NODE BIOPSY ... 91

ȘTEFANIA RIZA¹

MYELOID SARCOMA WITH MEGAKARYOCYTIC DIFFERENTIATION PRESENTING AS A SUBSCAPULAR MASS ... 92

GABRIELA ALEXA¹, PETRU GROSU, THEODOR MAREȘ, ADELAIDA AVINO, LAURA RĂDUCU, CRISTIAN RADU JECAN

UNUSUAL PAINFUL GIANT CUTANEOUS METASTASIS OF LUNG

ADENOCARCINOMA IN AN UNCOMMON LOCATION ... 93 LUIZ - SORIN VASIU¹, RAZVAN DANCIU, CORINA STEFAN, LAURA RADUCU,

CRISTIAN RADU JECAN

IMPACT OF COVID-19 PANDEMIC ON CUTANEOUS MELANOMA-RELATED

HOSPITAL ADMISSIONS IN OUR PLASTIC SURGERY DEPARTMENT ... 94 LUIZ - SORIN VASIU¹, DANIELA GHEOCA-MUTU, ADELAIDA AVINO, LAURA RADUCU, CRISTIAN RADU JECAN

FACIAL SKIN CANCER SURGERY– A CHALLENGE UNDER LOCAL ANESTHESIA 95 IRINA MIHAELA ZAHARIA¹, ANCA BORDIANU^1,2

REAPPRAISAL OF GIANT BASAL CELL CARCINOMA: CLINICAL FEATURES AND OUTCOMES ... 96

TITUS GRECU¹, DEEMESH OUDIT¹, HOANG PHAM¹

RADIOTHERAPY FOLLOWING ONCOPLASTIC SURGERY: A CHALLENGE IN BREAST RECONSTRUCTION ... 97

GRUJIC DACIANA¹, FABIANA SIMION¹, VLAD POPESCU¹, FADI AL KHAMIS¹, CRISTINA OPREAN², HORIA CRISTIAN³

MANAGEMENT OF SKIN NECROSIS IN IMPLANT IMMEDIATE BREAST

RECONSTRUCTION ... 98 ANDREEA CARMEN MERUTA¹, MIHAIL ROZNOVANU¹

TIPS AND TRICKS FOR SUCCESSFUL RESULT OF BREAST RECONSTRUCTION IN IRRADIATED CASES WITH LATISSIMUS DORSI FLAP AND IMPLANT ... 99

INA PETRESCU¹

CASE REPORT – RARE COMPLICATION AFTER BREAST TISSUE EXPANDER

PLACEMENT POST-MASTECTOMY ... 100 NIKOLAS POPA¹, CHRISTIAN VIOREL POPA¹

(9)

THE IMPORTANCE OF HAND THERAPY AND IMMEDIATE POSTOPERATIVE SPLINTING FOLLOWING OPEN PALM TECHNIQUE FOR DUPUYTREN’S

DISEASE. ... 101 ANDREEA TOTOK¹, ALEXANDRA MARIA CHIȘ, NINA MAINOV, OANA MARIA MIȘCĂ, AMINA TINA SHAMMAT

RECUPERARE POST FRACTURĂ CU DEPLASARE FALANGĂ PROXIMALĂ DEGET II PRIN ORTEZARE ȘI KINETOTERAPIE – STUDIU DE CAZ ... 102

LARISA-MARIA CÂMPEAN-GRANCEA¹, LUCIAN GALOSI¹

WHAT WE KNOW AND WHAT WE SHOULD KNOW ABOUT HAND FUNCTION:

HAND THERAPIST POINT OF VIEW ... 103 OLARIU OCTAVIAN¹, GALOȘI LUCIAN, GEORGESCU ALEXANDRU

THERAPEUTIC APPROACH IN KIENBOCK SYNDROME ... 104 ANDREEA TRUSCA, LUCIAN GALOSI

EVALAURE FUNCTIONALA IN MANA TRAUMATIZATA ... 104 LUCIAN GALOSI¹, OCTAVIAN OLARIU²

RECUPERARE IN FRACTURA DE EPIFIZA DISTALA DE RADIUS. ... 105 ANDREEA BOTA¹, LUCIAN GALOSI¹

EARLY ACTIVE RESISTED ROM OF ZONE 2 FLEXOR TENDONS INJURIES

FOLLOWING ‘PULL OUT’ TECHNIQUE, HAND THERAPIST PERSPECTIVE. ... 106 OLARIU OCTAVIAN¹, GEORGESCU ALEXANDRU, IRINA CIURA-CAPOTĂ, ILEANA MATEI, FILIP ARDELEAN

EVALUATING THE LEVEL OF POSTTRAUMATIC STRESS IN PATIENTS

HOSPITALIZED WITH HAND INJURY ... 106 ROXANA GOGA - VIGARU¹

REGENERATIVE PLASTIC SURGERY (RPS) APPLIED IN TREATMENT OF A

PATIENT WITH LINEAR SCLERODERMA IN INFERIOR 1/3 OF THE FACE ... 107 DANA MIHAELA JIANU¹, STEFANIA ALEXANDRA STOICA

THAT SMALL NASAL DORSUM HUMP FOR NATURAL LOOKING DRIVE THE

PATIENTS CRAZY... 108 FODOR LUCIAN¹, RALUCA SOBEC¹, DINU DUMITRASCU¹

DOUBLE LEVEL OSTEOTOMIES: A USEFUL TOOL IN CROOKED NOSE ... 109 SERBAN PORUMB¹, SORANA PORUMB¹

RHINOPLASTY PHOTOGRAPHY: ENHANCING PICTURES OR ENHANCING

RESULTS? ... 110 SERBAN PORUMB¹, SORANA PORUMB¹

FACIAL VASCULAR MAPPING USING THERMAL SCANNING AND DOPPLER ULTRASONOGRAPHY FOR PERFORMING COMPLICATION-FREE DERMAL

FILLER INJECTIONS ... 111 DANIELA ELENA GHEOCA MUTU¹, LAURA RADUCU^2,3, ADELAIDA AVINO^4,3,

CRISTIAN RADU JECAN^2,3, FLORIN MIHAIL FILIPOIU⁵

CASE REPORT – DRAMATIC COMPLICATION FOLLOWING BLEPHAROPLASTY.

MANAGEMENT AND FINAL RESULT ... 112 NIKOLAS POPA¹, CHRISTIAN VIOREL POPA¹

MODIFIED INTERNAL MASTOPEXY TECHNIQUE IN MUSCLE SPLITTING

BIPLANE BREAST AUGMENTATION ... 113 HORIA - REMUS SICLOVAN¹

(10)

LONG TERM RESULTS IN SUBFASCIAL BREAST AUGMENTATION... 115 HORIA - REMUS SICLOVAN¹

THREE INNOVATIVE STEPS FOR OBTAINING STABLE ROUND SHAPE IN THE BREAST PEXY/ REDUCTION - OPTIMISATION OF A CLASSICAL TECHNIQUE ... 116

DANA MIHAELA JIANU¹, ANDREI MARIN¹

BREAST IMPLANTS‘ SECONDARY SURGERY; SOME IMPORTANT CONCLUSIONS IN A PERSONAL SERIES OF LONG TERM PATIENTS... 117

DANA MIHAELA JIANU¹, IOANA GHIURCO²

TRANSAXILLARY ENDOSCOPIC BREAST AUGMENTATION (TEBA):

CONCLUSIONS AFTER 15 YEARS OF EXPERIENCE ... 118 SERBAN PORUMB¹, SORANA PORUMB¹

BREAST IMPLANT ILLNESS: A STEP FORWARD IN UNDERSTANDING THIS

COMPLEX ENTITY AND THE IMPACT OF SOCIAL MEDIA ... 119 DANCIU RAZVAN¹

FAST RECOVERY BREAST AUGMENTATION: THE SMART MASTOPLASTY ... 120 PIERFRANCESCO BOVE¹, RAFFAELE RAUSO, GRIGORE VEREGA

INJECTION OF AQUAFILLING® FOR BUTTOCKS AUGMENTATION – FROM

COMPLICATIONS TO RESOLUTION – A (HAPPY) CASE REPORT ... 121 VIOREL TEODOR PANAZAN¹, PARASCA SORIN-VIOREL^1,2, BRINDUSA-RENATA CIOBANU¹, ANDREI DUMITRESCU¹, OLGA-MARIA POPESCU¹, MIHAI-CRISTIAN MARIN¹

MODERN APPROACH TO GYNAECOMASTIA TREATMENT-COMBINING THE BODY CONTOURING PRINCIPLES OF HIGH DEFINITION BY LIPOSCULPTURE AND LIPOPLASTY WITH OUR NEW CLASSIFICATION OF THE 6

GYNAECOMASTIA TYPES ... 122 MIHAI CHERTIF

COMPLICATIONS AFTER BUTTOCK AUGMENTATION WITH POLIAMIDE BASED GEL ... 122

SORIN VIOREL PARASCA¹, ANDREEA CARMEN MERUTA¹, TEODOR VIOREL PANAZAN¹, ANDREI MUSETEANU¹, ILEANA CARMEN BOIANGIU¹, CRISTINA ARIANA BREZEANU¹ HORIZONTALLY INSERTED ANATOMICAL BUTTOCK IMPLANT: IS IT A GOOD CHOISE?... 123

SORIN VIOREL PARASCA¹, SIMONA MANEA¹, LETITIA URCAN¹

TOTAL BODY LIFTING AFTER POSTBARIATRIC SURGERY, A CHALLENGING TEAM OPERATION ... 124

INA PETRESCU¹

SHORT-TERM ADVANTAGES AND LONG-TERM COMPLICATIONS FROM

BUTTOCK AUGMENTATION BY INJECTED POLYACRYLAMIDE HYDROGEL ... 125 ZABUTNAIA MARIA¹, CEBOTARI DANA², STOIAN ALINA³, CIRIMPEI OCTAVIAN⁴,

VEREGA GRIGORE³

COMPLEX CRUSH-AVULSION INJURY OF THE RADIO-CARPAL JOINT AND TENARIAN REGION WITH COMPLETE DISSOCIATION OF THE CARPAL BONES AND HEAVILY CONTAMINATED WOUND IN A 32 YEARS OLD PATIENT- A

MULTISTEP MANAGEMENT ... 126 CRISTIAN VINTILA, CRISTIAN TRAMBIȚAȘ, DORIN CONSTANTIN DOROBANȚU,

ANDREEA-CAMELIA DAVID, GRAȚIANA LATEȘ

BACTERIOLOGICAL PROFILE OF INITIAL SCREENING IN BURN PATIENTS FROM A SPECIALIZED INTENSIVE CARE UNIT ... 126

TIBERIU PAUL NEAGU¹, MIRELA ȚIGLIȘ, IOAN LASCĂR

(11)

RECONSTRUCTION OF TRICEPS TENDON RUPTURE USING GRACILIS TENDON AUTOGRAFT ... 127

CAMELIA - ANDREEA DAVID¹, CRISTIAN TRÂMBIȚAȘ¹, DORIN DOROBANȚU¹, CRISTIAN VINTILĂ¹, GRAȚIANA LATEȘ ¹

COMPLEX WOUND MANAGEMENT FOR AN EXTENSIVE TORACIC WALL DEFECT - CASE REPORT ... 128

VLAD PETRE ATANASESCU¹, STEFANIA MIHAELA RIZA^2,1, ANDREI LUDOVIC POROSNICU¹, IOANA GHIURCO^1,2, RUXANDRA DIANA SINESCU^1,2

MANGLED UPPER LIMB – WHETHER TO APPLY OR NOT SEVERITY SCALES .... 129 ELENA PRUTEANU¹, ELENA DRAGU¹, BOGDAN CHIOARU¹, IOAN LASCAR¹

GOOD OUTCOME TO POLLICIZATION OF FOURTH FINGER AFTER A

TRAUMATIC THUMB AMPUTATION ... 130 COSMIN MIHAI PETREA¹, CRISTIAN VINTILA¹, ORSOLYA BALINT¹, GEORGETA CIF¹, CRISTIAN TRAMBITAS¹, DORIN DOROBANTU¹

ISCHIAL OSTEOMYELITIS MANAGEMENT IN A YOUNG WHEELCHAIR BOUND PATIENT-CASE REPORT ... 131

ANDREI POROSNICU¹, STEFANIA MIHAELA RIZA^1,2, IOANA GHIURCO^1,2, VLAD PETRE ATANASESCU^1,2, RUXANDRA DIANA SINESCU^1,2

THE TREATMENT OF THE DIAPHYSEAL BONES DEFECTSOF THE LOWER

LIMBUSING THE METHOD OF THE INDUCED MEMBRANE ... 132 VLADIMIR STRATAN¹, RADU BÎRCA¹, GRIGORE VEREGA¹, MIHAIL CRUDU¹,

VIOREL NACU¹, DUMITRU CHELBAN¹

CLINICAL EXPERIENCE WITH THE USE OF NEGATIVE PRESSURE WOUND

THERAPY ... 133 GRATIANA LATES¹, CRISTIAN TRAMBITAS, DORIN DOROBANTU, CRISTIAN VINTILA, CAMELIA DAVID

THE USE OF THIN SPLIT-THICKNESS TOENAIL BED GRAFT TO COVER NAIL BED DEFECT AFTER SUBUNGUAL EXOSTOSIS EXCISION ... 134

ORSOLYA BALINT¹, MÓNIKA SZILVESZTER, IULIA COMAN, CĂLIN ȘUTA, DÉNES MÁRTON, TÍMEA PAP

INFRARED THERMOGRAPHY IN THE DETECTION OF PERFORATORS FOR

FOREARM PERFORATOR FREE FLAPS ... 135 MAXIM MELENCIUC¹, OLESEA CATARAU¹, SERGHEI SUMAN²

COLOR DOPPLER ULTRASOUND IN THE MAPPING OF PERFORATORS FOR

ANTEROLATERAL THIGH FLAP ... 136 OLESEA CATARAU¹, MAXIM MELENCIUC¹, SERGHEI SUMAN²

WIDE-AWAKE SURGERY WITH LOCAL ANESTHESIA IN HAND SURGERY ... 137 OLESEA CATARAU¹, MAXIM MELENCIUC¹, ANATOLIE CALISTRU¹

CHRONIC TIBIALIS ANTERIOR TENDON RUPTURE – A CASE REPORT OF

DELAYED RECONSTRUCTION WITH AN EXTENSOR HALLUCIS LONGUS TENDON TRANSFER ... 138

RADU-ADAMESTEANU MADALINA-OLIVIA, BORDEANU-DIACONESCU ELIZA MARIA, CAPRARU FLAVIAN PETRE, BURNEI GHEORGHE CRISTIAN, TEODOREANU RAZVAN NICOLAE, KHALID AL-FALAH, ANDREI MIHAELA CRISTINA, RADU DAN-ANDREI, LASCAR IOAN

(12)

ACRAL ISCHAEMIA AS A REFLECTION OF SARS-COV2 ENDOTHELIAL MECHANISM

GRUJIC DACIANA¹, SIMION FABIANA¹, NARAD GAURAV¹, AL KHAMIS FADI¹, POPESCU VLAD¹

1 “Pius Branzeu” Emergency County Hospital, Plastic surgery, Timisoara, Romania

Objectives

Endothelial cells have recently been nominated as the primary cell type involved in the initiation and propagation of ARDS caused by SARS COV 2, consequently implying a severe endothelial injury and hypercoagulability state across vascular beds of different organs. Acral ischemia is one of the visible manifestations related to this thrombotic microangiopathy, causing loss of digits and severe impair of hand function. In order to prevent this scenario, it should be imperative to recognize its early signs and furthermore, aggressively managed. Presently, there is a paucity in literature detailing the clinical course and management of digital ischemia in COVID-19 patients. Herein, we report our experience with 3 cases of digital necrosis in patients with confirmed SARS Cov 2 infection.

Materials

During the first 18 months of COVID -19 disease we admitted in our clinic 3 cases with complete digital necrosis - one case was discharged directly from intensive care unit and 2 cases developed necrosis 3-4 months after covid disease.

During the COVID 19 pandemic, we evaluated 3 patients with clinical signs of digital ischemia. All of them were mentioned with recent history of SARS-CoV-2 infection. 2 patients presented with dry gangrene, the 3rd one with pale atrophic skin, moderate edema of the digit and distal phalanx bone exposure. One of them reported also previous self-limiting Raynaud episodes, with digital pain and discoloration, triggered by cold temperature and improved with hand warming. All 3 patients had preserved major peripheral pulses (radial and ulnar artery), revealed elevated D-dimer and fibrinogen serology, lacked improvement following standard vasospasm and anticoagulation medications and the involved digits needed amputation. Also, each one of them had preexisting conditions such as hypertension, obesity, and diabetes, which are all associated with endothelial dysfunction, thus being more susceptible to an adverse course of COVID-19.

Results and discussion

On admission, laboratory investigation showed elevated levels of inflammatory markers, chest X rays and pulmonary CT showed only in one case sequelae after bilateral pneumonia. After delimitation of the necrosis area, a necessary amputation of the phalanges was performed, the local evolution was favorable, the wounds healed in14 days

COVID -19 theories include hypoxia-induced microvascular damage, endothelial shedding, cytokine inflammation-mediated damage. Still is unclear the association between COVID-19 coagulopathy and antiphospholipid antibodies.

Though digital /extremity ischemia is routinely seen in ICU/ critically ill patients we had cases with digital necrosis without respiratory or other significant symptoms

While the exact mechanisms are still under debate, SARS CoV2 affecting endothelial cell function has found its proof in the widespread systemic manifestations related to both a hypercoagulability and pro-inflammatory state. The vascular endothelium represents the critical interface between the blood compartment and tissues, and displays a series of remarkable properties that normally maintain homeostasis. Cytokines, pro-inflammatory and pathogen-associated molecules, serve as key danger signals that shift endothelial functions from the homeostatic into the defensive mode, activating the coagulation storm and producing one of the most potent vasoconstrictors known, endothelin-1. Acral ischaemia in patients with COVID-19, reflects the pathogenic endothelial mechanism of the virus in a series of findings: histological ones – artery biopsy showing features of microthrombosis and

(13)

endotheliitis, serological ones – hypercoagulability was suggested by elevated D-dimers and lack of improvement following standard vasospasm treatment, patients’ associated conditions, related to endothelial dysfunction – Raynaud disease, hypertension, diabetes, prophylactic anticoagulation therapy recommended by the guidelines showing beneficial and protective outcomes.

Conclusions

Due to the unique risk of both hypercoagulability and vasoconstriction in COVID-19 patients, promptly fast diagnosis and management of digital ischemia are highly recommended to prevent digital necrosis and finger loss. Progression of acral ischemia despite on time aggressive anticoagulant and vasodilatative therapy, stresses the need for a targeted therapy to combat the catastrophic microangiopathic response induced by SARS-CoV-2: ARDS, multiorgan failure, and death. Therefore, the discovery of new clinical targets to treat endothelial dysfunction is currently an urgent unmet clinical need.

Keywords

Acral ischemia, digital necrosis, endotheliitis, thrombotic microangiopathy, COVID-19 infection, SARS-CoV2 mechanism

References

1. Wang J.S.,Pasieka H.B., Petronic-Rosic V., et al. Digital Gangrene as a Sign of Catastrophic Coronavirus Disease 2019-related Microangiopathy, Plastic and Reconstructive Surgery, July 2020 - Volume 8 - Issue 7 - p e3025

2. Shih L, Ferry AM, Gravina PR, et al. Acute Digital Necrosis in a Patient With Raynaud's Phenomenon and COVID-19 Infection. Am Surg. 2020 Dec 19:3134820979788.

3. Lorini FL, Di Matteo M, Gritti P, et al. Coagulopathy and COVID-19. Eur Heart J Suppl. 2021 Oct 8;23(Suppl E):E95-E98. doi: 10.1093/eurheartj/suab100. PMID: 34650364; PMCID: PMC8503535.

4. Gladka MM, Maack C. The endothelium as Achilles' heel in COVID-19 patients. Cardiovasc Res. 2020 Dec 1;116(14):e195-e197. doi: 10.1093/cvr/cvaa327. PMID: 33167001; PMCID: PMC7717148.

5. Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J 2020;41:3038–3044 6. Calvão J, Relvas M, Pinho A, et al. Acro-ischaemia and COVID-19 infection: clinical and

histopathological features. J Eur Acad Dermatol Venereol. 2020 Nov; 34(11):e653-e754. doi:

10.1111/jdv.16687. Epub 2020 Jul 15. PMID: 32488910; PMCID: PMC7300677.

7. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet

2020;395:1417–1418.

HAND AND FOREARM REPLANTATION

VLAD PARVANESCU¹, RAZVAN MERCUT¹, CRISTIANA DOBRE², CICERONE RADULESCU², POUYA POURGOULAFSHAN², MARIUS-EUGEN CIUREA¹

1 SCJU NR 1 CRAIOVA - UMF CRAIOVA, PLASTIC SURGERY, CRAIOVA, Romania

2 SCJUC NR 1 CRAIOVA, PLASTIC SURGERY, CRAIOVA, Romania

Correspondent author: [email protected] Objectives

Replantation is the gold standard surgical treatment of amputations of the upper limb. It represents the reattachment of a severed body part woth attempts to restore neurovascular and musculoskeletal integrity, function and aesthetics.

(14)

Materials

A total number of three patients reported with amputations at the level of the hand and of the forearm, which received upper limb replantation. Surgery included debridement of the amputated segment and recipient’s strumps, bone fixation, arterial and venous anastomosis, nerve sutures, tendon sutures and skin closure. The handling of this type of injuries included meticulous preoperative management, microsurgical experience and continuous postoperative care.

Results

Two cases of replantation at the distal level of the forearm and one at the level of the hand were included. One at the level of the distal forearm was unsuccessful with failure of the vascular anastomosis. The other two were efficient, with well restored circulation and sufficient regained function and sensation. To improve functional results, these patients needed further reconstructive surgeries.

Conclusions

Upper limb amputation is one of the most challenging trauma presentations in plastic and reconstructive surgery, both from a technical and a recovery standpoint. The most important factors that influences the results are the type and the level of injury. Proper postsurgical care and rehabilitation are crucial for an optimal outcome.

Keywords

amputation, hand, forearm, replantation, hand surgery, microsurgery, trauma References

1. Archives of orthopaedic and trauma surgery 140 (9), 1141-1147, 2010 2. Hand clinics 35 (2), 119-130, 2019

3. Ono S, Chung KC. Efficiency in Digital and Hand Replantation. Clinics in Plastic Surgery. 2019 Jul;46(3):359-370. DOI: 10.1016/j.cps.2019.03.002. PMID: 31103081; PMCID: PMC6527348.

4. Noh K, Hacquebord JH. 50+ years of replantation surgery experience: are we progressing or regressing?

Plast Aesthet Res 2020;7:50.

SOME FEATURES OF REPLANT MANAGEMENT DISTAL POLICE PHALANGE

VLADIMIR STRATAN, ANATOLIE CALISTRU, VLADISLAV GLADUN, VASILE ROŞCA, ALINA PANCIUC

THE MANAGEMENT OF BONE DEFECTS RESULTED AFTER EXCISION OF ENCHONDROMA OF THE HAND. COMPARING THE TECHNIQUES

OF AUTOLOGOUS BONE GRAFT OR BONE SUBSTITUTE

DORIN SUMANARU¹, PETRU CIOBANU², STEFANA LUCA², MARIAN BAETU², ALEXANDRU AMARANDEI², MIHAELA PERTEA²

1 SF. SPIRIDON IASI, CHIRURGIE PLASTICA, IASI, Romania

2 SF. SPIRIDON IASI, CHIRURGIE PLASTICA, IASI, Romania Correspondent author: [email protected]

(15)

Objectives

Enchondroma is the most common benign bone tumor of the hand. The diagnosis of the enchondroma is established frequently by an accidental X-ray or due to local pain, swelling or a pathological fracture. Surgical excision of the tumor using curettage and filling of the remaining cavity with autologous bone or bone substitute is the treatment of choice.

Materials

This retrospective study includes 20 patients diagnosed with solitary enchondroma in the hand bones:

ten cases with type A (central), four cases with type B (eccentric) and six cases with type D (polycentric) according to Takigawa classification. The aim of this study was to compare the course and outcome in the three patient groups treated by curettage associated with natural consolidation of the bone defect, autologous bone graft or injectable synthetic bone substitute in association with plate and screw osteosynthesis. In 11 of the 20 cases, the procedure was performed under regional anesthesia with a bloodless operative field by exsanguination and the use of a pneumatic tourniquet.

The other nine cases were performed under local anesthesia using the WALANT technique (Wide Awake Local Anesthesia No Tourniquet), using a solution of 1% Lidocaine with Epinephrine in a concentration of 1:100,000

Results

Outcomes were assessed using the DASH score (mean score 3) and TAM score (excellent in all patients) with no significant functional differences between the three groups. Defects managed with k-IBS® injectable (Hydroxyapatite and β-Tricalcium Phosphate) bone substitute were associated with shorter operating time, simpler surgical technique and less postoperative pain assessed by VAS score.

Conclusions

In the case of solitary enchondromas of the hand, the results do not show major differences in their excision, but there is controversy over the method of filling the remaining defect. Although the autologous bone graft still meets the gold standard criteria, the injectable bone substitute gains ground against the autologous graft, demonstrating greater efficiency and accessibility through shorter operating time and lower postoperative pain. The Takigawa classification could predict the optimal treatment option.

Keywords

enchondroma; bone defect; autologous bone graft; injectable bone substitute; hydroxyapatite;

tricalcium phosphate; chitosan References

1. Gaulke, R. The distribution of solitary enchondromata at the hand. J. Hand Surg. Br. 2002, 27, 444–445.

[Google Scholar] [CrossRef] [PubMed]

2. Lubahn, J.D.; Bachoura, A. Enchondroma of the Hand: Evaluation and Management. J. Am. Acad.

Orthop. Surg. 2016, 24, 625–633. [Google Scholar] [CrossRef] [PubMed]

3. Shibuya, N.; Jupiter, D.C. Bone graft substitute: Allograft and xenograft. Clin. Podiatr. Med. Surg. 2015, 32, 21–34. [Google Scholar] [CrossRef]

4. Gaulke, R.; Suppelna, G. Solitary enchondroma at the hand. Long-term follow-up study after operative treatment. J. Hand Surg. Br. 2004, 29, 64–66. [Google Scholar] [CrossRef]

5. Fraquet, N.; Faizon, G.; Rosset, P.; Phillipeau, J.; Waast, D.; Gouin, F. Long bones giant cells tumors:

Treatment by curretage and cavity filling cementation. Orthop. Traumatol. Surg. Res. 2009, 95, 402–406.

[Google Scholar] [CrossRef]

(16)

EVALUATING THE LEVEL OF POSTTRAUMATIC STRESS IN PATIENTS HOSPITALIZED WITH HAND INJURIES

ROXANA - PETRUTA GOGA - VIGARU¹

1 Spitalul Judetean de Urgenta Craiova, Clinica de Chirurgie Plastica, Craiova, Romania

Stress is a psychological factor to which a person is exposed when hospitalized, especially when being under the risk of temporary or permanent disability, abandonment, pain, loneliness, as it is the case of patients with hand injury. Our objective is to evaluate the level of stress of the patients with complex hand injuries by taking into account the symptoms of PTSD and, also, to describe the degree of personal, social and professional integration.

Materials

Fifty patients with complex hand injuries were included in the study and they all signed informed written consent. They were given the PTSD Checklist for DSM-5-Standards and asked to choose one of the five possible answers. After gathering all the data, we established the percentage of the patients meeting the criteria for PTSD and, also, analysed, the answers of those just facing symptoms.

Results

Two patients met the criteria for PTSD, meaning 4% of all patients; forty-two patients experienced symptoms, but did not meet the criteria and eight patients experienced no symptoms of PTSD.

Conclusions

In this study, despite a limited evidence base, the test results may detect only a low percentage of patients with PTSD, but a very high number of patients facing symptoms, such as disturbing memories, avoiding thoughts and feelings, sleeping disorders.

Keywords

stress, PTSD, hand injury, psychological factor References

1. Doron, L., Parot, F. Dictionary of Psychology, Humanitas Editorial Planeta S.A., Bucharest, 2006 2. DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Bucharest: Callisto, 2016 3. Oddoux, L. The five dimensions of stress, House of Guides Publishing Group, Bucharest, 2012 4. Weathers, F. W., Litz, B. T., Keane, T.M. et. Al (2013). The PTSD Checklist for DSM-5 (PCL-5)-

Standard

DAY CARE HAND SURGERY IN MARTINIQUE IN COVID ERA

MĂSTĂCĂNEANU M, STRATAN L

SOS Main, Orthopaedics department, CHU Martinique Introduction

Day care office hand surgery is increasingly popular, based on new concepts (local anaesthesia without sedation, field sterility). The great flexibility of procedures in hand surgery is a big advantage, especially under the impact of Covid-19 pandemics.

(17)

Material and method

We analysed the patients operated in our unit in 2021. Our unit is the only public service for hand surgery in a territory with a population of 358.749 inhabitants. There exists also a private facility, but they don’t perform emergency cases.

Results

There were 2059 patents presented in emergency in SOS Main. From those, 1315 (63.9%) were operated in local anaesthesia without sedation and without hospitalisation, and 449 (21.8%) were hospitalized and operated in the regular theatre. Planned day surgery cases were 700 patients, out of which 448 (64%) were operated in local anaesthesia without sedation in office surgery and 252 (36%) were hospitalized and operated with general anaesthesia / sedation in the regular theatre.

Discussions

The number of planned surgery cases was severely reduced because of suspension of regular theatre activity due to resource allocations to fight Covid. If you do not use sedation, the patient can go home immediately after the procedure. As shown in the literature, the field sterility in office surgery is safe and cheap.

Conclusions

Many procedures in hand surgery can be performed in office surgery, both in emergency and in scheduled cases. Patients’ satisfaction is high and complication rate does not increase.

NERVE COMPRESSION DUE TO GANGLION CYSTS OR BENIGN TUMORS IN THE UPPER LIMB-CASE SERIES

ANDREEA GROSU - BULARDA¹, RAZVAN NICOLAE TEODOREANU1, MARIUS POPESCU¹, FLORIN-VLAD HODEA¹, ALEXANDRU STOIAN¹, CRISTIAN SORIN HARIGA¹

1Clinical Emergency Hospital Bucharest, Romania, Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, , Bucharest, Romania

Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts and benign tumors. The purpose of this study was to present a series of patients which suffered nerve compressions secondary to presence of benign lesions, with improvement of clinical symptomatology in each of the presented patients after adequate surgical treatment.

Materials

We present a case series of six patients with peripheral nerve compression in the upper limb due to tumor or cystic masses- ulnar nerve compression in the Guyon’s tunnel due to a ganglion cyst, large median nerve schwannoma compressing anterior interosseous nerve and median nerve, voluminous lipoma compressing median nerve in the proximal forearm, two cases of superficial branch of radial nerve compression by synovial cysts and elbow region lipoma compressing radial nerve.

Results

In the beginning, those benign lesions are asymptomatic but, as they continue to grow adjacent to a peripheral nerve clinical manifestations appear progressively as compressive neuropathies. All the patients have received surgical treatment-excision of the compressive masses with consecutive

(18)

releasing of the nerves with very good clinical results in terms of symptom remission and functional recovery if the lesion is treated before severe functional impairment is installed .

Conclusions

After a preoperative imagistic analysis, tumor resection with careful dissection, in order to preserve the neurovascular structures, is the elective surgical procedure in order to obtain an optimal functional recovery.

Keywords

upper limb, lipoma, schwannoma, ganglion cyst, nerve compression References

1. Sluijmer HC, Becker SJ, Ring DC. Benign upper extremity tumors: factors associated with operative treatment. Hand (N Y). 2013;8(3):274-281.

2. Adani R, Tarallo L, Mugnai R, Colopi S. Schwannomas of the upper extremity: analysis of 34 cases. Acta Neurochir (Wien). 2014;156(12):2325-2330.

3. Kwak KW, Kim MS, Chang CH, Kim SH. Ulnar Nerve Compression in Guyon's Canal by Ganglion Cyst. J Korean Neurosurg Soc. 2011;49(2):139-141.

4. Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG. A series of 146 peripheral non-neural sheath nerve tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg. 2005 Feb;102(2):256-66.

5. Lifchez SD, Dzwierzynski WW, Sanger JR. Compression neuropathy of the radial nerve due to ganglion cysts. Hand (N Y). 2008;3(2):152-154.

6. Balakrishnan C, Bachusz RC, Balakrishnan A, Elliot D, Careaga D. Intraneural lipoma of the radial nerve presenting as Wartenberg syndrome: A case report and review of literature. Can J Plast Surg.

2009;17(4):e39-e41

A PROSPECTIVE STUDY OF EXPANDING THE INDICATIONS FOR THE SUPERCHARGE CONCEPT FOR SEVERE

OR RECURRENT CUBITAL TUNNEL SYNDROME

MIHAI CHERTIF¹, CONSTANTIN CHERTIF

1 Clinica Cosmedica, Chirurgie Plastica, Baia Mare, Romania

The supercharge technique of transposing the anterior interosseous branch from the median nerve in an end-to-side fashion to the motor branch of ulnar nerve was already described years ago, in an attempt to maintain the end motor plates of the intrinsic muscles of the hand in case of a severe or recurrent cubital tunnel syndrome. However, there are a lot of situations when we have to deal with a partial laceration of the ulnar nerve that we think we can cope with and resolve easily with a few fine stitches. The truth is that by the time we can examine the patient thoroughly, there can be some intrinsic muscles’ activity that is already lost.

Materials

Thinking about the patients that had a proximal partial laceration of the ulnar nerve along with the ones with a severe or recurrent cubital tunnel syndrome, we decided to conduct a prospective study on the next 10 patients with proximal partial laceration of the ulnar nerve and also on next 10 patients with severe or recurrent cubital tunnel syndrome. The study was achieved after 5 years, between January 2015 and January 2020. The assessment of the study was done after 2 years for each patient.

(19)

Results

At 2 years, 80% of the group of patients with severe or recurrent cubital tunnel syndrome had a huge improvement in the intrinsic muscle function and 60% from the proximal partial laceration of the ulnar nerve group had a significant improvement on the affected intrinsic muscle function, related to different specific movements provided by the motor branch.

Conclusions

We strongly believe that beside the severe or recurrent cubital tunnel compression neuropathy, the proximal ulnar nerve injury patients in which incomplete regeneration is anticipated, a supercharge end-to-side nerve transfer may be useful to augment the regenerating nerve with additional axons and to more quickly reinnervate target muscle.

Keywords

AIN, supercharge, ulnar nerve, cubital tunnel, References

1. Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234:5–10.

2. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome: A metaanalysis of randomized, controlled trials. J Bone Joint Surg. 2007;89:2591–2598.

3. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow.

Cochrane Database Syst Rev. 2012;7:CD006839.

4. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: A meta-analysis. J Hand Surg Am. 2008;33:1314.e1–1314.12.

5. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: A prospective randomized study.

Neurosurgery. 2005;56:108–117; discussion 117.

6. Izadpanah A, Gibbs C, Spinner RJ, Kakar S. Comparison of in situ versus subcutaneous versus

submuscular transpositions in the management of McGowan stage III cubital tunnel syndrome. Hand (N Y) E-published ahead of print March 24, 2019.

7. Power HA, Sharma K, El-Haj M, Moore AM, Patterson MM, Mackinnon SE. Compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome. J Bone Joint Surg Am.

2019;101:730–738.

8. Power HA, Kahn LC, Patterson MM, Yee A, Moore AM, Mackinnon SE. Refining indications for the supercharge end-to-side anterior interosseous to ulnar motor nerve transfer in cubital tunnel syndrome.

Plast Reconstr Surg. 2020;145:106e–116e.

9. Domeshek L, Novak CB, Patterson JMM, et al. Nerve transfers: A paradigm shift in the reconstructive ladder. Plast Reconstr Surg Glob Open. 2019;7:e2290.

10.Haase SC, Chung KC. Anterior interosseous nerve transfer to the motor branch of the ulnar nerve for high ulnar nerve injuries. Ann Plast Surg. 2002;49:285–290.

11.Flores LP. Comparative study of nerve grafting versus distal nerve transfer for treatment of proximal injuries of the ulnar nerve. J Reconstr Microsurg. 2015;31:647–653.

12.Barbour J, Yee A, Kahn LC, Mackinnon SE. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation. J Hand Surg Am. 2012;37:2150–2159.

13.Isaacs J, Allen D, Chen LE, Nunley J II.. Reverse end-to-side neurotization. J Reconstr Microsurg.

2005;21:43–48; discussion 49–50.

14.Isaacs JE, Cheatham S, Gagnon EB, Razavi A, McDowell CL. Reverse end-to-side neurotization in a regenerating nerve. J Reconstr Microsurg. 2008;24:489–496.

15.Kale SS, Glaus SW, Yee A, et al. Reverse end-to-side nerve transfer: From animal model to clinical use. J Hand Surg Am. 2011;36:1631–1639.e2.

16.Farber SJ, Glaus SW, Moore AM, Hunter DA, Mackinnon SE, Johnson PJ. Supercharge nerve transfer to enhance motor recovery: A laboratory study. J Hand Surg Am. 2013;38:466–477.

17.Fujiwara T, Matsuda K, Kubo T, et al. Axonal supercharging technique using reverse end-to-side neurorrhaphy in peripheral nerve repair: An experimental study in the rat model. J Neurosurg.

2007;107:821–829.

HAND AND FOREARM REPLANTATION

A B S T R A C T B O O K

ISBN 978-606-786-274-4

TABLE OF CONTENTS

ACRAL ISCHAEMIA AS A REFLECTION OF SARS-COV2 ENDOTHELIAL MECHANISM

HAND AND FOREARM REPLANTATION

SOME FEATURES OF REPLANT MANAGEMENT DISTAL POLICE PHALANGE

THE MANAGEMENT OF BONE DEFECTS RESULTED AFTER EXCISION OF ENCHONDROMA OF THE HAND. COMPARING THE TECHNIQUES

OF AUTOLOGOUS BONE GRAFT OR BONE SUBSTITUTE

EVALUATING THE LEVEL OF POSTTRAUMATIC STRESS IN PATIENTS HOSPITALIZED WITH HAND INJURIES

DAY CARE HAND SURGERY IN MARTINIQUE IN COVID ERA

NERVE COMPRESSION DUE TO GANGLION CYSTS OR BENIGN TUMORS IN THE UPPER LIMB-CASE SERIES

A PROSPECTIVE STUDY OF EXPANDING THE INDICATIONS FOR THE SUPERCHARGE CONCEPT FOR SEVERE

OR RECURRENT CUBITAL TUNNEL SYNDROME