The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Jun 1997
Very distal finger amputations: replantation or "reposition-flap" repair?
Management of very distal finger amputations is still controversial. Successful replantation results in an almost normal finger but is not without problems, such as technical difficulty, risk of failure and cost. "Reposition-flap" repair is a simpler procedure: it consists of distal bone and nail bed "graft-reposition" and pulp reconstruction by a flap. ⋯ Replantation has several advantages over reposition-flap repair in terms of less finger shortening, longitudinal nail curvature, absence of PIP flexion contracture and shorter time off work. The results of reposition-flap repair are less satisfactory, but it is nevertheless a useful alternative when replantation is impossible or has failed.
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J Hand Surg Eur Vol · Jun 1997
Carpal tunnel decompression under local anaesthetic and tourniquet control.
A postal survey within the North West Region (UK) revealed that 66% of the consultant orthopaedic surgeons did not use local anaesthesia routinely for carpal tunnel decompression. This prospective study was set up to assess the effectiveness, safety and patient tolerance of performing this procedure using local anaesthesia and upper arm tourniquet control. Eight-six carpal tunnel decompressions were performed on 75 consecutive and unselected patients with confirmed carpal tunnel syndrome over a 6-month period. ⋯ None of the patients reported severe and unbearable discomfort. At review, 3 months postoperatively, all patients with the exception of two reported complete resolution of preoperative symptoms. The use of local anaesthesia and a tourniquet is safe, effective and well-tolerated in carpal tunnel decompressions.
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J Hand Surg Eur Vol · Jun 1997
Treatment of scaphoid nonunions with a vascularized bone graft based on the first dorsal metacarpal artery.
Four patients with chronic nonunion of the scaphoid were treated by a vascularized bone graft based on first dorsal metacarpal artery. The mean duration of the nonunion was 28.5 months (range 12-48 months). There was avascular necrosis in all patients confirmed by magnetic resonance imaging (MRI). ⋯ Two fractures were localized at the waist one in the distal part and one at the proximal pole. Osseous union of the scaphoid was confirmed by X-ray in all patients in an average of 2.1 months. We recommend this technique for the treatment of established scaphoid pseudoarthrosis with avascular necrosis since it is associated with minimal morbidity and predictable good results.
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J Hand Surg Eur Vol · Jun 1997
Nerve xenograft transplantation. Immunosuppression with FK-506 and RS-61443.
An experimental model has been developed to study the potential transplantation of nerve xenografts using the newer immunosuppressive agents RS-61443 and FK-506. Sciatic nerve grafts of 2 cm were transplanted from donor Golden Syrian hamsters into a 0.5 cm gap in the sciatic nerve of recipient Lewis rats. Walking track analysis, somatosensory evoked potentials and histology demonstrated improved regeneration across the nerve xenografts that had been immunosuppressed with RS-61443 and FK-506 compared with non-immunosuppressed controls, but the function never approached that seen in control isografts. Regeneration across nerve xenografts immunosuppressed with FK-506 was better than xenografts immunosuppressed with RS-61443.