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Objective To design technique of local flap transposition to refine the aesthetic appearance of reconstructed fingers by toes transfer.Methods Nine cases with 21 reconstructed finger were included,which involved 6 males and 3 females with an average age of 21.8 years(range,18-34years).A lingual contour flap with a lateral pedicle Was shifted from the inflated distal pulp to the narrow middle part of the"finger"to refine the aesthetic appearance.Overall results were evaluated in terms of the survival of the flap,the appearance improvement and the functional influence of the reconstructed finger.Results All of the flaps survived and healed perfectly.After a mean follow-up of 9.3 months(range,6-12months),the appearance of the reconstructed fingers were impmved apparently.There was little influence on the function of the finger.The results showed that all the patients gained more acceptable fingers.Conclusion From our experience,local flap transposition is a useful method for remolding of reconstructed fingers by toes transfer.
ABSTRACT
Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined.
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Objective To introduce a new optimal operation for the reconstruction of thumb opposition in patients with late median nerve injury. Methods From July 1992 to January 2002, 46 patients of late median nerve injury with loss of thumb abduction were treated surgically by transposition of the flexor pollicis brevis muscle for the reconstruction of thumb opposition. There were 35 males and 11 females aging from 18 to 46 years with the average of 32 years. All of the patients suffered from median nerve injury and nerve repair had been undergone. The interval from injury to the second operation was 2.25 years ranging from 6 months to 4 years. Results All patients were followed up for 4-36 months with an average of 20 months. According to our functional evaluation system designed in 1992, the recovery ratio with favorable function was 100%, no complications and disadvantages were found. Conclusion The new optimal transpositional operation of the flexor pollicis brevis muscle for the reconstruction of thumb opposition is suitable for the patients with late median nerve injury, especially when the ulnar nerve branch to the deep head of the flexor pollicis brevis muscle is uninjured. This method has the following advantages: 1) Minimal operative trauma, only a small incision is required in contrast to the conventional method that need multiple incisions; 2)No other tendon transposition is needed, it does not interfere with other functions of the hand; 3) Postoperatively, it is unnecessary to keep many neighbouring joints in extreme flexion position, except for the thumb in opposition position, movements of all fingers and the wrist are not restrained.
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Objective Twenty- four case of non- traumatic paralysis of radial nerve were reviewed. Methods Between 1985 and 2000, 24 patients with non- traumatic paralysis of radial nerve were referred to this hospital for treatment. There were 18 men and 6 women with a mean age of 38 years (range, 10 to 65 years). Eleven patients had occupations with unduly stress of the forearm. Tendon transfer was performed in 1 patient, operative neurolysis in 18, nerve- grafting in 3, neurorrhaphy in 2. Results Of the 12 patients with the palsy attributed to entrapment of the fibrous edge of muscles, 8 occurred at the supinator, 1 at the tendinous edge of extensor digitorum communis and 3 at multiple sites.The palsy was caused by marked constrictions of the nerves in 5 patients, by benign tumors or tumorous conditions in 4 (by a ganglion in 2, by lipoma in 1 and by haemangioma in 1), by a neurilemmoma on the nerve in 1. The cause was unknown in 1. The patients who accepted neurolysis were followed up from 6 months to 15 years postoperatively. An excellent or good functional result was documented in 14 patients, fair in 3, and poor in 1. The patients who were treated with neurorrhaphy or nerve- grafting were followed- up from 4 months to 6 years, 3 recovered completely, 2 were in the convalescent stage (1 was treated by nerve- grafting and the other by neurorrhaphy). Conclusion The etiology of non- traumatic paralysis of radial nerve was miscellaneous. The results of surgical treatment were satisfactory.
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Objective To study the classification, management and outcome of the injury of hamatometacarpal joint. Methods Retrospective analysis was carried out in 17 patients with injury of hamatometacarpal joint. There were 16 males and 1 female aged 19-51 years old. 3 in left hand and 14 in right hand were injuried. The dominant hands of all were right hand. The injury of hamatometacarpal joint might be classified into 4 major groups based on the condition of the hamate, and subdivided into 2 subtypes based on the isolated dislocation(subluxation) or fracture-dislocation of metacarpal base. Carpometacarpal joint ligment injury without fracture of hamatum and the fourth or fifth metacarpal base dislocation without fracture was defined as typeⅠa. When there was a fracture of the fourth or fifth metacarpal base following typeⅠa was defined as typeⅠb. Avulsion fracture of the back of hamatum and the fourth and/or the fifth metacarpal base dislocation without fracture was defined as type Ⅱa. With the fracture of the fourth or fifth metacarpal base following the typeⅡa was defined as type Ⅱb. Splintered fracture of the back of hamatum with the fourth and/or fifth metacarpal base dislocation without fracture was defined as typeⅢa. With the fracture of metacarpal base following typeⅢa was defined as typeⅢb. The split fracture of coronal side of hamatum with the fourth and/or fifth metacarpal base dislocation and without fracture was defined as type Ⅳa. With fracture of the fourth and/or fifth metacarpal base following type Ⅳa was defined as type Ⅳb. There were 7 typeⅠb, 2 typeⅡa, 1 typeⅡb, 2 typeⅢb, 1 typeⅣa, 4 type Ⅳb in our group. We chose conservative or operative treatment according to the type of injury. Results The follow-up was 4-96 months. The patients had fracture union rate of 100%, and no traumatic osteoarthritis was occurred. There was a statistical significance when the motion of two-side joints was compared post surgery. There was no significant difference between bilateral hand in grip strength. Subjective evaluations of the patients were good or excellent. No complications was occurred. There is no case involved in any complications such as traumatic arthrositis, inflammation, neural injuries and adhesion of tendon. Conclusion The stable injury of hamatometacarpal joint should be ideally treated by closed reduction and immobilization in a well-moulded cast or splint. Satisfactory outcome can be got if keeping under strict surveillance. The unstable or intra-articular fracture should be treated by surgery. The outcome is also satisfactory and the rate of the complication of traumatic arthritis is low in short period follow-up. The outcome of fresh injury is much better than old one.