Background: Paracetamol is widely used for acute pain management in orthopedic trauma; however, interindividual variability in analgesic response remains insufficiently understood. Cytochrome P450 2E1 (CYP2E1), a key enzyme involved in paracetamol metabolism and the formation of the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI), may contribute to this variability. This study aimed to investigate the relationship between CYP2E1 gene polymorphisms and the analgesic efficacy of paracetamol in patients with lower extremity fractures. Methods: A total of 127 patients with lower extremity fractures and 100 healthy controls were included. All patients received 1000 mg of intravenous paracetamol. Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline and at 30, 60, and 120 min after administration. Genotyping of CYP2E1 polymorphisms (*1A, *5B, *6, and *7B) was performed using PCR-RFLP. Differences in the VAS scores and analgesic response were analyzed according to genotype. Results: Paracetamol administration resulted in a significant reduction in pain scores at all time points (p < 0.001). Patients carrying the CYP2E15B variant exhibited significantly higher VAS scores and a weaker early analgesic response compared to non-carriers (p ≤ 0.001). Similarly, CYP2E11A carriers demonstrated higher pain scores across all time points (p < 0.05), although the magnitude of effect was less pronounced. No significant differences were observed for the CYP2E16 variant. Due to low frequency, CYP2E17B could not be reliably analyzed. Conclusions: Paracetamol is an effective analgesic in patients with lower extremity fractures; however, CYP2E1 polymorphisms may modulate individual pain perception and early analgesic response. In particular, the *5B and, to a lesser extent, *1A variants are associated with higher pain scores. These findings support the potential role of pharmacogenetic approaches in personalized pain management.

Background and Objectives: Complex wounds in the hand and distal lower extremities pose challenges in reconstructive surgery, often involving critical structures like tendons. Tendon injuries, prevalent in such wounds, necessitate optimal repair methods for functional recovery. This study investigates the impact of vascularised and nonvascularised adipofascial tissue on tendon repair, focusing on early healing stages, mobilisation, and scintigraphic evaluation of flap vascularity. Materials and Methods: Wistar Albino rats were divided into groups undergoing primary tendon repair, vascularised adipofascial flap application, or nonvascularised flap application. Scintigraphic evaluation and histopathological assessment were performed to analyse healing processes. Results: Pedicle-free flaps support healing in tendon injuries without negatively affecting medium-term outcomes. Vascularised flaps exhibit faster healing. The scintigraphic analysis showed that the static measurements of the late phase were statistically significantly higher in the group with the non-vascularised adipofascial flap (p = 0.038). The mean perfusion reserve was higher in the vascularised pedicled adipofascial flap group than the non-vascularised adipofascial flap group. Scintigraphic analysis highlights the viability of pedicle-free flaps. Conclusions: Pedicle-free adipofascial flaps support the healing of the tendon without complicating the results, while vascularised flaps show accelerated healing. These findings provide valuable insights into optimising tendon repair strategies using adipofascial flaps, with implications for enhancing functional recovery in complex wounds.