Microsurgical toe to thumb transplantation for traumatic thumb loss.

Toe-to-thumb transfer was performed on 13 patients with traumatic thumb loss, using microvascular technique. Of those, 9 patients had industrial injury, 3 patients had a sharp cut injury and the remaining one had animal bite injury. The toes used for the transfer were the great toe(5), and the second toe(8). There were twelve successes, and one partial success. Ten patients have been followed-up for more than 12 months, and they are reviewed in detail. Total active motion after great toe and second toe transfer was 45 degrees and 68 degrees respectively. Static two-point discrimination was 10-15 mm in 10 patients. The donor foot did not suffer functionally. All of the patients returned to gainful employment postoperatively.

Head and neck mycetoma.

Two cases of eumycotic mycetomas in the head and neck region are reported. The first case is the localized mycetoma which involved only the soft tissue of the neck. It was completely excised and the patient needed no further treatment. In the second case, the lesion extensively involved the structures in the parapharyngeal space, submandibular space and carotid sheath. The upper limit is the skull base. The patient was treated by combination of wide excision with radial forearm flap and antifungal agents, however, the prognosis is fair.

The new flap based on the longitudinal fascial branches of the posterior interosseous artery.

An island fasciocutaneous flap, based on the longitudinal fascial anastomotic vessels of septocutaneous branches of the posterior interosseous artery which lies along the forearm fascial septum between the extensor carpi ulnaris and the extensor digiti minimi is easier in harvesting and preserving the posterior interosseous artery.

Peripheral and spinal SEPs in the extraoperative evaluation of non-penetrating brachial plexus injuries.

Peripheral (N9) and cervical (N13) SEPs as recorded at Erb's point and over the fifth cervical spinous process respectively, from the musculocutaneous, median and ulnar nerve stimulation, were examined in 30 cases of unilateral non-penetrating brachial plexus injuries. Among 14 cases (42 nerves examined) who underwent surgical exploration, the SEPs were found to give good prediction of the actual lesions in 9 cases, gave helpful information in 1 and correlated partially in the other 4. In none of the cases did SEPs give totally misleading data. The results indicated that this SEPs testing package was simple, convenient and could be a useful adjunct to the conventional electrodiagnosis in the evaluation of non-penetrating brachial plexus injuries.