The Journal of hand surgery
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Case Reports Clinical Trial
Chronic peripheral nerve pain treated with direct electrical nerve stimulation.
Chronic somatic peripheral nerve pain was treated prospectively in 24 nonrandomized patients by a program of direct electrical nerve stimulation. Patients qualified for the program if anesthetic (lidocaine) nerve block of the involved cutaneous zone of the peripheral nerve relieved symptoms and transcutaneous electrical nerve stimulation transiently improved and did not exacerbate somatic pain. Results were judged according to a pain score. ⋯ Most patients had some relief of pain, which increased their quality of life and eliminated the need for narcotic analgesia. Direct electrical nerve stimulation should be considered for somatic peripheral nerve pain that has not been ameliorated with other methods. It will reduce, although not necessarily eliminate, pain and pain behavior in most patients.
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Case Reports Clinical Trial
The use of island and free flaps in crush avulsion and degloving hand injuries.
Reconstructive options for early microsurgical tissue and island flap transfer are discussed in 23 patients with extensive avulsion and degloving injuries of the hands and fingers. The patients were divided into three groups (1) degloving thumb injuries; (2) crush avulsions with or without degloving of the palm and fingers; (3) complete degloving injuries of the hand and distal forearm. ⋯ The advantages and indications for the use of distally based radial forearm flap for degloving thumb injuries and pedicled ulnar forearm flap for avulsion of the distal part of the hand are discussed. The use of free transfer of greater omentum in the cases of extensive degloving of the hand is shown.
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Comparative Study
Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression.
To evaluate the effect of critical anatomic structures on the ulnar nerve after cubital tunnel decompression, we determined the intraneural ulnar nerve pressure in 50 fresh cadavers after the following surgical procedures: simple decompression, medial epicondylectomy, subcutaneous transposition, and submuscular transposition by the Learmonth and by the musculofascial lengthening technique. Intraneural pressure was measured in 0 degrees, 30 degrees, 60 degrees, and 90 degrees elbow flexion at locations that were proximal, within, and distal to the cubital tunnel. ⋯ While both the simple decompression and the medial epicondylectomy had significantly lower intraneural pressures than the Learmonth or the subcutaneous transposition, each of these four techniques resulted in elevated intraneural pressures. The musculofascial lengthening technique for submuscular transposition was the only surgical strategy that reduced intraneural ulnar pressure at each site of measurement and for all degrees of elbow flexion, this reduction of pressure being significant in comparison with the other surgical techniques.