The Journal of hand surgery
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Comparative Study
Cadaveric modeling of the pronator teres rerouting tendon transfer.
The purpose of this study is to report the biomechanics of the supination effect of the pronator teres rerouting procedure and to determine the optimum insertion point for the transfer using a cadaveric model. Pronator teres rerouting procedures were performed on 5 fresh-frozen above-elbow cadaver specimens mounted in a forearm rotation mounting frame. The pronator teres was detached from its native insertion and tested at 6 insertions on the radius. ⋯ The results of this study show that placement of the pronator teres through the interosseous membrane, around the radius, with reinsertion onto the volar surface produced the greatest amount of forearm supination. Rerouting of the pronator teres tendon produces supination through a windlass effect when the tendon is rerouted through an interosseous window and reinserted onto its original insertion or onto the volar surface of the radius. Placement of the insertion 1 cm proximal on the radius did not affect the amount of forearm supination compared with 6 original insertion sites.
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We retrospectively reviewed the cases of 14 fingertips reconstructed with a combination of local or regional flaps and nail bed grafts, some of which were placed wholly or partially over a de-epithelialized flap. Most of the fingertips sustained a crushing injury and were reconstructed at the time of the injury. Soft tissue coverage was provided by palmar V-Y flaps in 6 cases, thenar flaps in 4, lateral V-Y flaps in 2, a Moberg flap in 1, and a cross-finger flap in 1. ⋯ There was 1 partial graft loss and 1 partial flap loss. The remaining cases had completely successful grafts and good soft tissue healing. Subsequent nail growth and adherence were good in all but the 1 digit requiring secondary composite grafting.
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The tensor fascia lata pedicled flap was successfully used to salvage 3 severely injured upper extremities in 2 patients. Both patients had undergone 3 prior free tissue transfers without complete closure of their wounds. All 3 tensor fascia lata flaps (2 myocutaneous, 1 myofascial) survived entirely. We believe this flap offers a distinct advantage compared with the groin flap when pedicled flap coverage of the upper extremity is required.
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Journal clubs are a time-honored method of teaching literature appraisal skills in many residency programs. A questionnaire was completed by 57 hand surgery fellowship directors and 91 hand fellows to define the role of the journal club in hand fellowship training. We sought to identify definitive characteristics of hand surgery journal clubs and assess their strengths and weaknesses. ⋯ Increased faculty participation was the most frequently suggested improvement. The great majority of those surveyed felt that their journal club was successful and was an important part of the fellowship training. We conclude that journal clubs have a high perceived value by participants, and recommend the journal club to all hand surgery communities, with or without fellowship involvement.
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Histology of the transverse carpal ligament and flexor tenosynovium was investigated in 166 wrists from 130 patients with idiopathic carpal tunnel syndrome. Nine wrists from 9 controls were used for comparison. ⋯ The majority of these changes were mild in degree and the pathophysiology did not appear to be meaningful. We conclude that in idiopathic carpal tunnel syndrome, the ligament and tenosynovium often show normal histology and there are no typical or consistent changes with which idiopathic carpal tunnel syndrome can be associated.