Replantation of fingers is highly complex and technically challenging. Surgeons are serious with their selection criteria as many factors are involved in determining good surgical outcome. Improper storages of amputated parts are usually denied the option for replantation. We report a 42-year-old lady who was assaulted with a machete and presented with total amputation of left thumb. The amputated thumb was stored in a plastic bag directly on ice cubes which eventually melted; thumb immersed in water for two hours. On examination, the amputated thumb was neither macerated nor frozen. Replantation was attempted and was successful. There are limited reports on proper methods of storage of amputated fingers pertaining to daily practical scenario. Yet, it is a strict criterion for surgeons in attempting replantation. Direct contact of amputated fingers on ice and immersion in hypotonic solutions leads to irreversible tissue damage. In our case, two hours of unfavourable storage did not affect surgical outcome. In conclusion, clinical assessment of the amputated part is essential in deciding for replantation. Combination of direct contact with ice and immersion in hypotonic solution for two hours should not be a contraindication for replantation.

Introduction: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes. Materials and methods: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain’s tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire. Results: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain’s tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population. Conclusion: The incidence of de Quervain’s tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.

Introduction: Microsurgery is a subspecialised field which requires high technical skill. Laboratory training offers good opportunity for novice surgeons to learn and repetitively practise their skills prior to hands-on clinical practice. Commonly, the training programme consists of models in a stepwise increase in fidelity: from latex sheet to anaesthetised rat. We introduce microgrids model as a daily warm up procedure in a 5-day basic microsurgery course. The purpose of this study is to evaluate the correlation between microgrids colouring under magnification with microsuturing proficiency among novice surgeons. Materials and Methods:Participants were required to fill in microgrids under magnification everyday during their 5-day training as a starter test. The number of completely filled in microgrids in 20 seconds was recorded. A simulated cut on latex sheet was sutured and the time taken to apply five sutures was recorded. The sutures were evaluated with modified Global Rating Scale (GRS). Data was analysed with SPSS. Results:There was a statistically significant correlation between the number of microgrids coloured and the time taken to apply five sutures (p<0.01). An increase in number of microgrids coloured was significantly associated with the increase in quality of the suturing technique (p< 0.01). During the 5-day basic microsurgery skills training for novice surgeons, microsuturing skill improvement correlated with microgrid colouring. Conclusion:Microgrids colouring reflected microsuturing proficiency. It is an inexpensive, readily available, and simple model of ‘warm up’ for hand dexterity. The microgrids model can function as a starter test for initial training and a quick screening measure to assess microsurgical skill.