Background: The First Dorsal Metacarpal Artery (FDMA) Flap or Foucher’s flap is an island pedicle flap proximally based on the first dorsal metacarpal artery and veins. A branch of radial sensory nerve is incorporated in the flap to make it a sensate flap. Objective: The aim of our study was to evaluate the functional and aesthetic outcomes of the seven FDMA flaps done over a period of four years for reconstruction of the distal thumb soft tissue defects and one defect over proximal phalanx of the index finger. Methods: This prospective study was performed between 2018 and 2022 at the Clinic of Reconstructive and Plastic Surgery. We present a series of six cases of distal thumb soft tissue defects and one patient with defect over the dorsal aspect of the index finger that were reconstructed with the FDMA flap. Results: In six patient donor site was grafted by full-thickness skin graft harvested from the groin and in one case was closed primary. All flaps survived and one case that was closed primary had donor site complication that was related to primary closure of the skin. All the patients had good fine touch and average two-point discrimination of 8.7 mm. Conclusion: FDMA flap is a useful and reliable flap to cover the defects of the dorsal aspect and to a certain extent the volar aspect of the thumb. We showed that can be used to cover the defects over proximal phalanx of the index finger. The flap provides adequate soft tissue coverage and good aesthetic results.

Background: Rhinophyma represents an advanced stage of rosacea, chronic cutaneous inflammatory disorder of the pilosebaceous unit with unknown etiology and primarily affects the central face, predominantly the nose region. Significant psychosocial effects are associated with the disease. The diagnosis is made according to the physical exam and pathohistological findings. Rhinophyma occurs more often in middle aged and older male patients. Objective: The aim of this article was to present the cause of rhinophyma, clinical characteristics, surgical treatment and postoperative results. Case report: We present the case of a 60-year-old male patient with rhinophyma, who was successfully treated surgically at the Clinic of Plastic and Reconstructive Surgery. Conclusion: There is no gold standard treatment for rhinophyma. However, surgical treatments, such as scalpel excision, dermabrasion, cryosurgery, argon laser, carbon dioxide laser, and electrocautery, have been used.

Background: Compression of the ulnar nerve at the level of Guyon’s canal is a very rare compressive neuropathy. Due to the vast range of symptoms that can manifest depending on the degree of ulnar nerve compression, the clinical picture is not consistent. Objective: The aim of the study is to outline the diagnostic techniques and therapeutic options. Case report: We reported a case of ganglion cyst-induced compression of the ulnar nerve in Guyon’s canal. A 45-year-old female patient underwent surgical ulnar nerve release in Guyon’s canal at the Clinic for Plastic and Reconstructive Surgery. Discussion: After a thorough medical history and physical examination, the diagnosis of the syndrome is made, and ultrasound and magnetic resonance imaging (MRI) testing are used to determine the origin of the neuropathy. A ganglion cyst was identified pathohistological one month following the surgical excision of the soft tissue tumor. In order to hasten the patient’s nerve recovery, physical therapy was recommended, and the patient was monitored for the following two years. After two years of treatment, the patient has made a very good recovery of the functionally damaged hand, as determined by a modified Bishop scoring method for evaluating functional ulnar nerve recovery. Conclusion: In virtually all cases, early surgical intervention can lead to an outstanding functional recovery. If the symptoms are more severe and continue or get worse for more than three months, early surgical intervention is the gold standard for treating Guyon’s canal syndrome. If soft tissue formations are compressing the ulnar nerve in Guyon’s canal, MRI is thought to be the gold standard for diagnosis.

INTRODUCTION The ulnar nerve is a mixed motor and sensory nerve, which making nerve repair more difficult and functional recovery less predictable than pure sensory nerves. Recovery of muscle activity and restoration of sensibility are essential for a functional extremity. A nerve graft, if performed in a tensionless manner, has been shown to generally have better results than an end-to-end approximation performed under tension. PATIENTS AND METHODS In study period from 1993 through 2008, evaluation was performed in 48 patients with adequate follow-up. The mean follow-up period was 3.4 years (range, 24 months to 8.3 years). The average patient age was 32.4 years (range, from 6 to 71 years). There were 37 male patients and 11 female patients. RESULTS We analyzed the effect of the age of the patient, level of injury, graft lenght and denervation time on motor and sensory recovery. Values of p < 0.05 were considered significant. Results of motor (chi-square = 8.04, p = 0.154) and sensory recovery (chi-square = 7.53, p = 0.184) were not significantly better in patients younger than 25 years compared to the group of patients older than 25 years. The level of the ulnar nerve injury had an impact on the outcome, with better results both sensory (chi-square = 161., p = 0.000) and motor recovery (chi-square = 238., p = 0.000) in patients with distal lesions. The results were significantly better in the group with graft lenght less than 5 cm compared to those longer than 5 cm for both sensory (chi-square = 72.6, p = 0.000) and motor recovery (chi-square = 196., p = 0.000). The functional results were significantly better for both sensory (chi-square 13.4, p = 0.020) and motor recovery (chi-square = 133., p = 0.000) in the group of patients with denervation time shorther than 6 months. CONCLUSION The graft length, level of injury and denervation time significantly influenced the functional outcome in both motor and sensory recovery. Better results were in the patients in which the autograft length was up to 5 cm, in patients who were operated within six months from the injury and in patients with distal lesions.

UNLABELLED Injuries of hand extensor tendons occur as isolated or combined injury or multiple tendons injuries associated with injuries of other hand structures. Clinical pictures of these injuries depends on the level of occurred injury, and can be expressed in loss of function extension of one or more fingers, wrist and creating contractures. PATIENTS AND METHODS This is five-year retrospective study of 87 patients operated at Clinic for Plastic and reconstructive surgery, Clinical Centre University of Sarajevo. We studied the efficiency of primary surgical treatment in hand extensor tendons injuries in the prevention of hand dysfunction. RESULTS AND DISCUSSION The best recovery results after surgical treatment of hand extensor tendons injury were in zones I, zone II and zone III. But, in zone VII recovery was difficult, and the outcome unpredictable. The most commonly injured zone was zone VI, and in zones of thumb usually violated zone was zone T-III. According to Miller's assessment criteria and recovery functions, after 6 weeks, with excellent finding was 41 (47,1%) and good results 21 (24,0%) of patients, while after 6 months, the excellent results were in 60 (68,9%) and good results in 28,7% of patients, due to well-conducted physical rehabilitation. Only two patient had complications at 6 months after surgery due to very complicated associated injuries of soft tissues and bone structures of the hand. CONCLUSION Results depends in extensivity of injury, anatomic zone, lack of infection, concomitant injuries, skills and operative methods of surgeon.

INTRODUCTION Dupuytren's disease (DD) is a progressive fibroproliferative disorder of the hand causing digital flexion contracture. Treatment goals include removing or releasing the fibrotic cord to allow extension of the affected finger(s) and restoration of hand function. MATERIAL AND METHODS In study period from 2001 through 2008, evaluation was performed in 115 patients. Limited or extensive fasciectomy was performed in all patients. Tubiana classification sheme to rate severity of DD was used. RESULTS There were 106 male patients ( mean age 62.6 years) and 9 female patients (mean age 66.3 years). Before the operation, 38% of all patients were at Tubiana stage I, 32% were at stage II, 22% were at stage III and 8% were at stage IV. Of all patients, 43% were diagnosed with Dupuytren's in only one finger, 39% in two fingers and 18% in three fingers. In 23% of patients DD were diagnosed on both hands. Limited fasciectomy was peformed in 90.4% of patients and extensive fasciectomy in 9.6% of patients. The Tubiana stage achived after surgery was lower in 98% of patients. As a final result after surgery, 66% of patients didn't have contracture, stage I was reported in 28% and stage II in 3% of patients. There were no patients with Tubiana stage III or more after surgery. Postoperative complications were noted in 18% of patients. Wound healing problems were present 12% of patients. Haematoma was reported 5% of patients. Of all patients 22% had diabetes mellitus. CONCLUSION DD is much more common in male than in female patients. Most of the patients are diagnosed at Tubiana stage I and II. Surgical correction has led to an improvement in most patients. Limited fasciectomy is still the gold-standard in DD treatment. Extensive fasciectomy or dermofasciectomy is preformed only in most severe cases.

Introduction: Timely diagnosis is a prerequisite for the successful treatment of malignant skin tumors. Late diagnosis leads a patient into a situation of losing valuable time and chance for cure. Material and methods: A prospective study was conducted from February 2006 until August 2011 which analyzed the reasons that led to establishing the diagnosis of malignant skin tumors in 220 patients. Patients were divided into two groups: Group A (102 patients), patients with diagnosed melanoma, and group B (118 patients) of patients suffering from basocellular (BCC) and planocellular cell (PCC) skin cancer. Parameters for comparison of analysis results were the reasons for coming to examination and reasons for not coming to the examination, because of which skin cancers were not diagnosed in time. Goal: To determine the factors that influences the establishment of late diagnosis and treatment of skin tumors. Results: It was confirmed that the prejudices of patients that tumors of the skin „should not be operated because it is dangerous“ is the main reason for late diagnosis. At the same time it is confirmed that the belief that it is unnecessary to operate congenital changes of the skin is the second most important reason for delayed diagnosis of malignant skin tumors.

Background: Synonymous with carpal tunnel syndrome is the name computer hand which includes a massive use of computers, and is associated with modern lifestyles. In everyday practice, great importance is early detection of carpal tunnel syndrome, and its timely and adequate treatment. The long-term nerve compression generally reduces the chances of successful surgical treatment. Therefore, the priority programs impose improvement of early diagnosis and prevention of disease in general population and occupationally exposed persons, and the detection of risk factors with their timely removal. Objective: The goal of this study was to determine the correlation between the time interval from onset of CTS symptoms to surgery with a recovery time interval. Patients and methods: In a retrospective study, we analyzed 43 patients from which 13 patients were male and 30 female patients who were surgically treated at the Clinic for Plastic and Reconstructive Surgery in the period from January 1st 2000 to January 1st 2008. The criterion by which patients were included in the study was clinically verified diagnosis of median nerve compression in the wrist. All patients included in the study have a history of long-term work at the computer keyboard. Results: The average recovery time after surgery varies depending on the period that has passed since the onset of symptoms to surgery. The study proves the effectiveness of surgery in reducing pain and improving hand function in patients in whom the time interval between onset of symptoms to surgery was less than three months. Conclusion: In everyday practice, the most important is early recognition of CTS, and its timely treatment. Therefore, it is recommended to shorten the time and improve diagnosis of patients with suspected CTS. When it comes to family medicine physicians, it would include additional training and focus attention on early detection of this disease.

Background: Trauma of peripheral nerves are common and it is one consequence of a traumatic extremity injury. Recovery of muscle and tendon activity and restoration of sensibility are essential for a functional extremity. Management of injuries of peripheral nerves are challenge for decision-maker. It is important to make the right decision in the management of peripheral nerve injury. Objective: The aim of this study was to show the importance of algorithm that we use in the treatment of peripheral nerve injury of upper extremities and to explore the factors that influence the decision-making process. Patients and methods: In retrospective study, we analyzed 48 patients who were treated at the Clinic for Plastic and Reconstructive surgery in the period from January 1st 2000 to January 1st 2005, aged from 8 to 57 years (mean 31 years). In the study were included patients with nerve injury of upper extremity. Results: The percentage of patients with neurapraxia who successfully recovered without surgery was 88%. In complete nerve lesion with extensive damaged surrounding tissue or burned tissue, we had adequate results in 71%, while in isolated sharp injury we had adequate results in 20 patients (80%). In all patients with inadequate results, we preformed satisfying re-operation, which mean neurolysis, placement of a nerve graft or tendon transfer. Conclusion: The algorithm that we use and which we have accepted, made possible to get good results that we were satisfied. A sharp laceration, such as a knife wound, has a good prognosis. If a crush component is present, the wound should be free of debris and contamination that may compromise healing. Neurapraxia has a relatively short recovery time, and full function is expected without intervention by 12 weeks after presentation.

BACKGROUND Median and ulnar nerve injuries are common, whether isolated or combined injury of both nerve. A nerve graft, if performed in a tensionless manner, has been shown to generally have better results than an end-to-end approximation performed under tension. OBJECTIVE The aim of this study is to analyze the long-term results of sensory recovery after secondary reconstruction median and ulnar nerve by autograft in patients who were treated on Clinic for Plastic and Reconstructive Surgery in the period from January 1st 1993 to December 31st 2005. We analyzed the influence of the patients age, level of injury, the size of the graft and the period between the injury and operation on the late results. PATIENTS AND METHODS Evaluation was performed in 55 patients with adequate follow-up. The mean follow-up period was 3.9 years. Reconstructions were applied on the median nerve in 31 patients and ulnar nerve in 24 patients. Criteria for inclusion in the study was median and ulnar nerve grafting in the forearm region. Patients were divided by age in two groups, below 25 and over 25 years, by injury level in the distal and proximal forearm injuries, by the length of autograft up to 5 cm and other group with graft length over 5 cm, by the period between injury and operation in group with denervation time up to 6 months and the group with denervation time over 6 months. Rating of sensibility was presented on the Highet Scale as modified by Dellon and more precise rating of sensibility was presented by Moberg's rating scale of sensibility. Calculation of frequencies and percentual values was performed for all included variables. For establishment of differences between the frequencies the /2-test was used (Chi square test) at the level of statistical importance (p < 0.05) with contingency tables. RESULTS We analyzed the results of reconstruction of median and ulnar nerves with respect to factors affecting functionally the result of operation, which are age, injury level, graft length and denervation time. We had 31 patients with median nerve grafting and we achieved sensory recovery S4 in 3 (10%) patients, S3+ in 9 (29%) patients, S3 in 8 (25.5%) patients, 52 in 9 (29%) patients and S2 in 2 (6.5%) patients. We had 24 patients with ulnar nerve grafting and we achieved S4 sensory recovery in 2 (8.5%) patients, S3+ in 6 (25%) patients, 53 in 5 (21%) patients, S2 in 10 (41%) patients and S2 in 1 (4%) patient. There was not significant difference in sensory recovery of median and ulnar nerve (chi-square = 1.00; df = 4; p = 0.909). There was not statistically significant difference by age and level of injury. The results were significantly better in patients with short grafts than in long ones (chi-square = 12.6; df = 4; p = 0.014) and in patients who had undergone surgical repair within 6 months (chi-square = 10; 2 df = 4; p = 0.038). CONCLUSION There was not significant difference in sensory recovery of median and ulnar nerves. The graft length and denervation time significantly influenced the functional outcome in sensory recovery. Mechanism of injury impacted on the results. Two point discrimination testing using a paperclip is a cheap, easily and quickly performed reproducible test of tactile gnosis, and should be included in nerve assessment protocols. We recommended using Moberg's rating scale for further research.