M. CASE REPORTS
CASE REPORTS
Case Report 1.
A 44-year old male patient was admitted to the emergency room with an avulsion of the pulps of the 4 fingers of his dominant hand (Fig. 1). The exposed distal phalanxes were covered with 4 digital island flaps (2 reversed and 2 direct) (Fig. 2 and 3). Venous congestion was seen one day post-operatively and leech therapy was initiated. Leeches were applied once daily for 3 days until the venous congestion was improved. Two months post-operatively the patient regained full function of his fingers/hand (Fig. 4) including a normal handwriting, allowing him to go back to his work as a schoolteacher [18].
Case Report 2.
An eight-year old girl was admitted to the emergency room with amputation of the pulp of the right dominant thumb, after a door was closed on her thumb 2 hours earlier (Fig. 5). The pulp was sutured back to the right thumb in the ER as a composite flap, but underwent gradual necrosis during the next 10 days with exposure of most of its distal phalanx.
To avoid skeletal shortening, a thumb reconstruction was performed, using a free flap taken from the lateral hemipulp of the ipsilateral big toe (Figs. 6 and 7). The free hemipulp flap was congested on post-operative day two, and it was treated with 1 leech daily for post-operative days two, three and four (Fig. 8). Under this treatment regimen, the flap congestion resolved, and the patient was discharged with a viable flap on post-operative day eleven. At 6 months, the function and sensory function of the thumb was normal (Fig. 9) allowing a normal handwriting [18].
Case Report 3.
81-year old female patient who received a graft after removal of tumor from her left chick. The appearance of the graft before and after treatment with leeches.