The Journal of hand surgery
-
The functional results in 25 of 30 patients after successful upper limb revascularization or replantation were evaluated by subjective-patient surveying and objective measurements. Young patients with complete, sharply amputated extremities at the wrist level or those with incomplete injuries and uninjured peripheral nerves had the best functional results. Multiple-level, diffuse crush, or avulsion injuries, even if the injuries were incomplete, and patients with high-level nerve injury had less return of function.
-
Transscaphoid -lunate dislocation is a rare carpal injury resulting in proximal and palmar dislocation of the proximal pole of the scaphoid and lunate as a unit. Treatment in two patients consisted of immediate open reduction and internal fixation. Both patients (at 2 and 4 years' follow-up) are asymptomatic.
-
Since 1970, 151 cases of mallet finger deformities with an average follow-up of 17 months have been treated with a molded polythene splint. Tendon injuries as well as fracture cases are included. This splint has been found to be highly effective, and open reduction of even major fracture fragments without subluxation of the distal phalanx has not been necessary. Although this splint was first described in 1969, detailed results and techniques have not been described previously.
-
Since 1972, the groin flap has been used as an excellent source of skin coverage for the hand. This flap can incorporate the underlying iliac crest to provide both soft tissue and vascularized bone for the reconstruction of complex hand injuries. ⋯ Bony union was rapid and thumb stability was excellent in all patients 3 months after initial reconstruction. The advantages of the osteocutaneous flap include the ability to: (1) supply vascularized bone to what is frequently a poor recipient bed for a bone graft, (2) reconstruct both soft tissue and bony defects simultaneously, and (3) be used in facilities without capability for microvascular surgery.
-
Double tourniquets linked to separate Freon cannisters and two mercury manometers have been effective in maintaining ischemia in over 1,000 consecutive hand surgery operations. The mercury manometers permit constant accurate monitoring of the tourniquet pressure. The cuffs are used alternately. ⋯ This system has permitted sustained ischemia in the upper extremity for up to 3 1/2 hours at a constant tourniquet pressure with no permanent clinically apparent sequellae. There has been no permanent nerve injury, although patients with more than 2 hours of tourniquet time often note hypoesthesia or paresthesia for 1 or 2 days. The alternating double tourniquet linked to a mercury manometer permits up to 3 1/2 hours of continuous ischemia of the upper limb with little risk of nerve damage.