Hand clinics
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Heightened awareness of the pathologic conditions resulting in acute vascular trauma will govern the success of management. A thorough examination with appropriate vascular studies followed by meticulous surgical intervention and a carefully monitored postoperative course avoids the associated complications of these challenging injuries.
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The development of microvascular surgical techniques during the last quarter century has advanced the ability of the hand surgeon to reconstruct the traumatically amputated thumb. The use of tissue from the foot has become the mainstay of therapy for this previously exceedingly difficult reconstructive problem. Although numerous minor variations of thumb reconstruction with use of the toes from the foot are available, three main techniques--the complete great toe transfer, wraparound flap, and second toe transfer--provide a predictable outcome. ⋯ This type of transfer does not permit interphalangeal joint motion and may not permit metacarpophalangeal joint motion. Therefore, the requirements of a normal carpometacarpal joint with excellent thenar musculature so that the postoperative thumb can be put through a functional arc of motion are essential. Transferring a portion of the distal phalanx in the wraparound flap permits the intercalary iliac crest graft to have viable bone on both the distal and proximal aspects, thereby reducing postoperative osteopenia of the iliac crest graft itself.(ABSTRACT TRUNCATED AT 400 WORDS)
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The current status of cumulative trauma disorder of the upper limb is examined from the standpoint of its long history, its current controversies, and the philosophic basis of the present laws, which control management of the condition. The future needs that should permit cumulative trauma disorders to be better understood, better managed, and better legislated are also addressed.
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Hand symptoms in musicians reflect a complex, multifactorial etiology. A multidisciplinary approach is required for proper evaluation and treatment. ⋯ Motor control disorders and chronic pain syndromes are associated with poorer results. Early diagnosis appears to improve outcome.
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This paper presents a comprehensive overview of the rehabilitation and management of hand burns. The therapist, as an integral member of the burn team, significantly contributes to the successful outcome of this treatment.