Faculty Bibliography

PURPOSE/OBJECTIVE:Suture technique, suture material, and the number of strands all play critical roles in achieving optimal strength of flexor tendon repairs. We evaluated the contribution to the tensile strength of flexor tendon repair using the strongest suture material, Fiberwire, and the best surgical technique (locking configuration) using 2- and 4-strand core repair to see what factor played the most important role in tendon repair. METHODS:Human cadaver flexor tendons were harvested and repaired in a randomized fashion using locking configuration as derived from Pennington's report. Ten tendons per group were repaired using either 4-0 Fiberloop, 4-0 Fiberwire, or 2-0 Fiberwire. During load-to-failure testing, visible gap force and maximum tensile strength were statistically analyzed. RESULTS:All flexor tendon repairs failed by suture pullout. The 4-strand 4-0 Fiberwire double-Pennington repair was found to be significantly stronger than the 4-strand 4-0 Fiberloop single-Pennington repair. When the 2-strand repair (2-0 Fiberwire) was compared to the 4-strand single-Pennington repair (4-0 Fiberloop), there was no significant difference found. CONCLUSIONS:The suture strand configuration rather than the strict number of strands or the strength of the suture material yielded the maximum tensile strength with reduced gapping at the repair site.

BACKGROUND:It is well known that hydrogen peroxide ingestion can cause gas embolism. OBJECTIVE:To report a case illustrating that the definitive, most effective treatment for gas embolism is hyperbaric oxygen therapy. CASE REPORT/METHODS:We present a case of a woman who presented to the Emergency Department with acute abdominal pain after an accidental ingestion of concentrated hydrogen peroxide. Complete recovery from her symptoms occurred quickly with hyperbaric oxygen therapy. CONCLUSION/CONCLUSIONS:This is a case report of the successful use of hyperbaric oxygen therapy to treat portal venous gas embolism caused by hydrogen peroxide ingestion. Hyperbaric oxygen therapy can be considered for the treatment of symptomatic hydrogen peroxide ingestion.

PURPOSE/OBJECTIVE:Several recent studies showed an increase in methicillin-resistant Staphylococcus aureus (MRSA) hand infections. The purpose of this study was to determine the prevalence of community-acquired MRSA hand infections in an urban setting and to determine independent risk factors for such infections. METHODS:A retrospective chart review of patients with hand infections was performed from 2002 to 2009. Those with community-acquired hand infections who had surgical irrigation and debridement and intraoperative culture were entered into the study. Patient demographics-including age and gender; mechanism of injury; infection risk factors (diabetes, chronic hepatitis, intravenous intravenousdrug use, and immune-compromised conditions); place of residence/housing status; history of hospitalization, prior antibiotics use and surgery; and culture results, erythrocyte sedimentation rate, C-reactive protein, and white blood cell count-were extracted from the medical records. Regression analyses were performed to identify significant risk factors for MRSA infection. RESULTS:A total of 102 patients met our inclusion criteria. The MRSA organism was identified in 32 patients. In the analysis of all the potential risk factors, only intravenous drug use showed significant correlation with MRSA infection. CONCLUSIONS:In our patients, only intravenous drug use correlated with community-acquired MRSA hand infections. Patient education about intravenous drug use and empiric treatment with MRSA-appropriate antibiotics for intravenous drug users presenting with hand infections are recommended. TYPE OF STUDY/LEVEL OF EVIDENCE/METHODS:Prognostic IV.

BACKGROUND:Hepatic artery aneurysms are the second most common visceral aneurysms. The natural history of hepatic artery aneurysms typically results in enlargement, rupture, and life-threatening hemorrhage. Atherosclerosis, traditionally, has been the most common cause of hepatic artery aneurysm. OBJECTIVE:A case of a hepatic artery aneurysm invading the stomach is presented to draw attention to the clinical presentation of this potentially catastrophic entity. CASE REPORT/METHODS:A 74-year-old man presented to the Emergency Department (ED) with hematemesis. He was hemodynamically stable with a hemoglobin of 10.5. Abdominal CT imaging revealed a hepatic artery aneurysm that eroded into the stomach. The erosion was successfully repaired operatively and the aneurysm was embolized. CONCLUSION/CONCLUSIONS:The most common symptom is epigastric pain. The clinical and radiological findings of a hepatic artery aneurysm eroding into the stomach with subsequent upper and lower gastrointestinal hemorrhage, as highlighted in the case reported, have received little prior attention in the medical literature.

Handlebar hernia, caused by low-energy impact against a handlebar, is a localized abdominal wall hernia that is blunt enough not to penetrate the skin but severe enough to cause the disruption of abdominal wall musculature. In 1964, Roberts (Br J Surg 1964;51:153) reported the first case of a traumatic abdominal wall hernia that occurred in a 9-year-old boy after a fall upon a bicycle handle. Since then, 12 other cases have been reported. To the best of our knowledge, the case described here is the first documented case of an incarcerated handlebar hernia associated with a small bowel perforation and mesenteric disruption.