No abstract

Through-and-through gunshot wounds of the foot present the unique problem of needing to fill a defect while at the same time providing coverage of the dorsum and plantar surface of the foot. A series of 5 patients from 2 institutions is presented. These patients all sustained gunshot wounds that penetrated the forefoot, leaving a rim of uninjured soft tissue and bone around the periphery. All patients were reconstructed with free-tissue transfers, but no bone grafting was required to replace missing bone. One patient did have an arthrodesis and wedge osteotomy to help with walking mechanics. Soft-tissue reconstruction only is adequate to restore the foot sufficiently to allow the patient to walk satisfactorily.

Postoperative intra-abdominal adhesions are associated with significant morbidity and mortality. In this study, the effect of topical fibrin glue (FG) on adhesion formation in a rat model was investigated. Forty Sprague-Dawley male rats underwent midline laparotomy. Bilateral peritoneal-muscular abdominal wall defects were created and then replaced with premeasured soft tissue Goretex patches. Rats were randomized to FG sprayed over the patches or to a control group. Two observers blinded to the randomization assessed the severity of adhesions to the patch by scoring the density of adhesions (grades 0–3) and the percentage of the patch area covered by adhesions (0–100%). The mean percentage of the patch covered by adhesions was 32.8 ± 6.1 per cent for the FG group versus 57.9 ± 6.7 per cent for the control group ( P < 0.01). The mean density of adhesions for the FG group was 0.95 (±0.17) versus 2.0 (±0.21) for the control group ( P = 0.001). Topical FG reduces the severity and density of intra-abdominal adhesions in a rat model.