A 53-year old patient amputated his hand with a sheet metal guillotine while working in a workshop. After a preliminary assessment consisting of running diagnostics and wound dressing, he was transported and admitted to the Department of Orthopaedics and Traumatology of the Medical University of Gdańsk. The initial surgery took 8 hours. The microsurgical procedures consisted of anastomosis of the ulnar artery and three superficial veins. The radial artery remained unidentified. Ulnar, median and dorsal branch of the radial nerve neurorrhaphy was performed. Flexor and extensor tendons were sutured according to the standard protocol. Metacarpal osteosynthesis using K-wires, nail matrix perforation and forearm fasciotomy were performed. The patient was equipped with a cast. Antibiotics, fluids, LMWH and hyperbaric oxygen therapy were administered. While hospitalized, the patient experienced necrosis of the first radius and II finger as a result of insufficient arterial flow. Reamputation of the necrotic parts was necessary. As a result of immense tissue shortage, the defect was covered with a superficial inferior epigastric artery tubed flap. After detaching the dermal-tubed flap, the patient was treated in an outpatient clinic. He later returned to the Department several more times due to delayed wound healing. In the course of treatment, as well as reamputation of fingers I and II, a number of redressions were performed.

The authors evaluated regional skin temperatures of the foot following the administration of a variety of local anesthetic nerve blocks with either Xylocaine (lidocaine hydrochloride) or Sensorcaine (bupivacaine hydrochloride). The study was carried out on ten randomized parallel groups of five subjects, each group being tested with one drug and one regional nerve block. The results indicated that both Xylocaine and Sensorcaine, when administered as a posterior tibial block, result in a significantly increased blood flow to the foot. Nerve blockade of the remaining nerves of the foot did not significantly increase the sympatholytic effect obtained by posterior tibial nerve block alone.