Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division.Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test.Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17–243 days) for large flaps and 42.81 days (range, 20–130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34.Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

Glacial acetic acid is a high-purity acetic acid that is mainly used as a solvent in chemical production and for various purposes in the food and pharmaceutical industries. It is safe enough to be used for chemical peeling when diluted, and has been used in folk remedies for warts, athlete’s foot, and eczema. Indeed, such conditions are the most common reason for exposure to glacial acetic acid. In the present report, we describe the case of a 10-year-old girl who presented with pain and necrosis of the distal phalanx of her left index finger. Two days prior, her fingers had been wrapped overnight with a paste of flour mixed with glacial acetic acid to treat warts. We irrigated the affected area with normal saline, applied a mupirocin ointment, and administered prostaglandin E1. However, the necrosis progressed rapidly. After 10 days, the girl’s fingertip was amputated, and a hypothenar free flap was performed. The case represents a severe chemical burn resulting from the misuse of glacial acetic acid, requiring surgical treatment.

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Purpose: The indications for surgery in patients with acute closed sagittal band injuries are still undecided. The purpose of this study is to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injury, and to present treatment plans and surgical methods.Methods: Twenty-five patients who had undergone surgical exploration for closed sagittal band injury between January 2011 and December 2020 were included in the study, comprising of 17 patients with acute injury within 3 weeks, four patients with chronic injury, and four patients who underwent surgery because symptoms did not improve during conservative treatment were included. Patients with laceration, fracture, and rheumatoid arthritis were excluded. Results: Sagittal band injury was classified into two groups: superficial sagittal band (SSB) injury and proper sagittal band (PSB) injury. SSB injury was observed in 75.0% of spontaneous rupture cases and PSB injury was observed in 66.7% of traumatic rupture cases. SSB injury was observed in 83.3% of Rayan and Murray classification type II cases and PSB injury was observed in 61.5% of type III cases (p=0.041). All four patients who failed conservative treatment and underwent surgery had PSB injuries.Conclusion: We successfully corrected the sagittal band injury with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injury can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. Surgical method and treatment plan can be chosen based on this.