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PurposeThe treatment of Fournier's gangrene (FG) includes aggressive debridement of the affected necrotic area, broad-spectrum antibiotic therapy, and reconstructive procedures, respectively. One of the main reasons of unfavorable outcomes in FG surgery is that the dead space occurs in the perianal region because of destruction of fascias and soft tissues. In this study, we aimed to evaluate the results of gracilis muscle flap transposition to fill the FG-associated perianal dead spaces.MethodsPatients treated for FG-associated dead spaces in their perianal region between the years 2017 and 2021 were included in the study. The patients who underwent the pedicled gracilis muscle flap surgery were included in group 1, whereas group 2 consisted of the patients with no additional surgical procedure for dead spaces but only the reconstruction of the soft tissue defects. Demographic data (age, sex), comorbid diseases, localization and length of perianal dead space, and management method for the soft tissue defects and complications were noted. The length of hospital stay and discharge day after surgery were also recorded.ResultsIn group 1, the mean duration of hospital stay was 23.5 ± 5.0 (range, 14–48) days, whereas the mean period between the surgery and discharge was 5.1 ± 2.2 (range, 3–12) days. These numbers were 31 ± 8.3 (range, 19–58) days and 12.7 ± 6.1 (range, 7–22) days in group 2, respectively. Statistical comparison of the periods between the surgery and discharge was found to be significantly different (P = 0.022). The duration of hospital stay was also shorter in the patients with gracilis muscle flap (P = 0.039).ConclusionsPerianal dead spaces accompanying many of the patients with FG provide appropriate conditions for bacterial colonization. Filling these pouches by the gracilis muscle flap prevented the progression of infection and enabled the patients to return to their normal life earlier.

Rubber band syndrome is a condition that usually affects children because of wearing a rubber band on the wrist or the ankle. Depending on the degree of pressure caused by the band, patients may present acutely with ischemia and necrosis of the tissues distal to the bands or chronically with change in shape, oedema, loss of function, sensation and rarely amputation. This condition is very rare in adults and most reports in literature are in patients with cognitive impairment or psychiatric illness. We report 62-year-old lady with a background of a psychiatric illness who presented with an acquired constriction band syndrome affecting multiple digits of both hands. Level of Evidence: Level V (Therapeutic)

However, I have 3 comments about this article:1. For a hand microsurgeon, it is better to avoid injuring the nailbed by using the Kirschner wire. 2. In the no. 13 reference of the article, Chen et al 2 reported a 100% (7/7) survival rate in Tamai I, and the rate of blood transfusion is 29% (2/7, 1 patient with 3-digit amputation) 3. As mentioned in this article, "These reports suggest that as the tissue volume of the amputated part increases, more effective venous drainage is necessary for the replant to survive.... In contrast, as the tissue volume of the amputated part decreases, the survival rate of the replant increases, even under poor venous drainage conditions." 1 The bony shortening and excision of the soft tissue distal to fingerprint core made the subzone III and IV shifting to the subzone of II. So, the title should be "Ishikawa II replantation using artery-only anastomosis with a pulp tissue reduction method." For example, in the case 2, fusion of interphalangeal joint and excision of the distal tissue made the amputation level from IV to near II. The successful rate of replantation without venous anastomosis increased.

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