Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Sep 2009
The glabrous palmar flap: the new free or reversed pedicled palmar fasciocutaneous flap for volar hand reconstruction.
We devised a new flap using the palmar cutaneous branch of the superficial radial artery proximally and anastomosed with a cutaneous perforator of the superficial palmar arch distally. We named our flap "the volar glabrous palmar flap." The flap was used both as a free flap and as a reverse-flow island flap. Thirty-six patients with volar hand defects (24 digits, 7 palms, and 5 first web space) were reconstructed with this flap. ⋯ Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer for pulp defects. At the same time, we studied 6 cadaver hands to understand the vascular anatomy of the thenar area of the hand. We also revised several published anatomic papers to obtain a refined and scrutinized understanding of the palmar anatomy.
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Tech Hand Up Extrem Surg · Sep 2009
V-M plasty and double Z-plasty: two versatile flaps for treatment of postburn syndactyly.
The release of postburn contractures in the hand is one of the most commonly performed procedures in burn injuries. Various local flaps have been described for release of severe postburn contractures. As the largest burn center covering north and northwest of Iran, we always needed acceptable reliable methods to reconstruct postburn syndactyly and make it as a standard treatment. ⋯ Three cases of necrosis of tip of Z-plasties and 2 cases of necrosis of tip of V-M plasties occurred which were under 3 mm and resolved gradually. Double Z-plasty in first web and V-M plasty in second to fourth webs are considered good choices for release and reconstruction of postburn syndactyly. They are straightforward in technique and can be carried out with little complications.
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Tech Hand Up Extrem Surg · Sep 2009
Endoscopically assisted ulnar neurolysis for cubital tunnel syndrome.
Controversy remains regarding the surgical treatment of cubital tunnel syndrome. Similar outcomes with ulnar nerve transposition, both subcutaneous and submuscular, and simple decompression have recently been reported. ⋯ Four patients who developed ulnar nerve subluxation intraoperatively who were treated with medial epicondylectomy failed to experience relief of symptoms and were successfully treated with anterior submuscular transposition. Patients with more profound motor weakness and/or electrodiagnostic studies had less complete relief of symptoms.
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Tech Hand Up Extrem Surg · Sep 2009
Mini-invasive surgery for chronic exertional compartment syndrome of the forearm: a new technique.
Chronic exertional compartment syndrome is now easily identified among the athletic population. It remains common in motorcyclists. The only treatment is the fasciotomy of the compartments and the gold standard procedure is still the open-invasive surgery. ⋯ The mini-invasive technique for fasciotomy seems to be as efficient as the open technique procedure, which is still the gold standard. But the length of surgery, recovery time, and scar sequelae are much better. Mini-invasive surgery is simple, efficient, and the results are reproducible.
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Tech Hand Up Extrem Surg · Jun 2009
ReviewManagement of comminuted olecranon fractures with precut K-wires and tension band wiring.
Various methods are used to treat comminuted fractures of the olecranon. The preferred method of management of fractures of the olecranon is tension band wiring over K-wires. Often, it becomes difficult to fix small articular fragments with the 2 K-wires used for tension band wiring. Since 2005, we have used the missing K-wire technique to fix the small articular fragments.