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Our Results in "Spaghetti Wrist" Injuries Associated with Soft Tissue Defects
Alexandru V. Georgescu, MD, PhD; Ileana R. Matei, MD, PhD; Irina Capota, MD, PhD; Octavian Olaru, HT
Plastic Surgery and Reconstructive Microsurgery Clinic, UMF Iuliu Hatieganu, Cluj Napoca, Romania

Introduction
"Spaghetti wrist" defines complex volar wounds involving more than three major structures; it is a very severe lesion and with a significant morbidity. The lesion becomes more severe in association with skin defects. This paper will present the results in 49 patients operated in a 10 years period, in terms of functional recovery and socio-professional reintegration.

Materials and Methods
We analyze the patients operated in a ten years period for pure "spaghetti wrist" lesion, or associating a skin alone or a complex soft tissue defect. The patients were analyzed with regard to the mechanism of injury, type of surgery, functional recovery and socio-professional reinsertion.

Results
In a ten years period, 49 patients (35 men and 14 women), with an average age of 34 were operated for a "spaghetti wrist" lesion. From those, 37 presented a pure "spaghetti wrist" lesion and 12 associated also a soft tissue defect, of more anatomical elements in 7 cases and of skin alone in 5 cases. The mechanism of injury was work related in 35 cases, traffic accidents in 2 cases, home accidents in 10 cases, and suicidal attempt in 2 cases. At least 3 tendons were injured in all the cases. The median nerve was injured in 19 cases, the ulnar nerve in 13 cases, and both of them in 17 cases. The radial artery was lacerated in 11 cases, the ulnar artery in 19 cases, and both of them in 7 cases. A complex soft tissue defect, including skin and tendons/arteries/nerves was registered in 7 cases, and a skin defect alone in 5 cases. All the cases were solved in emergency as an all-in-one procedure. A free flow through simple or composite flap was used in 7 cases, and a propeller perforator flap in 5 cases. The range of motion was very good in 31 patients (8 from those associating defects), good in 12 patients (4 from those associating defects), and fair in 6 patients. The sensory recovery was very good in only 21 patients, good in 19 patients, and only protective in 9 patients (two-point discrimination of 2-5mm in 21 patients, and of more than 6mm for the others).

Conclusions
The outcomes after repair of both simple spaghetti wrist or associated with soft tissue defects are similar if a careful emergency all-in-one procedure is done. The overall functional outcomes after repair are generally good, allowing the socio-professional reintegration of the patients.


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