Two staged reconstruction of flexor tendons of the fingers using ipsilateral pedicled flexor digitorum superficialis tendon graft

Twenty-three patients with flexor tendon injuries were operated upon for flexor tendon reconstruction using a staged technique of Hunter rode replacement, followed by pedicled flexor digitorum superficialis graft. The indication for this technique was excessive scarring of the tendon bed. There were 16 men and 7 women ranging in age from 16 to 48 years. Four patients had 4 fingers involved, 2 patients had 3 and 6 patients had 2 fingers involved, while the rest 11 patients had one finger involved. The number of involved fingers were 45 fingers. The postoperative follow up period ranged from 1 to 3 years. The measurements of active range of motion of the involved finger were taken in the closed fist position. Twenty seven fingers in this series were rated as excellent, 15 as good, 3 as fair and no finger as poor. Two stage flexor tendon reconstruction using this technique proved to be a safe and effective technique with minimal complications

Results of pollicization in the management of hypoplastic thumb

In this study 27 pollicizations were done in the hands of 27 patients with hypoplastic thumbs. Seventeen with hypoplastic thumb type IV and V, 9 congenital radial club hands with absent thumb and one patient with mirror hand. Sixteen were females and 11 were males with an average age of 12 months [range 8-18]. Different syndromes as VATER, TAR and Holt-Oram were recorded with such condition. The technique used for pollicization was that described by Buck Gramcko and modified by Lister. Patients were followed up for a mean of 12 months [range from 8-24]. All hands were assessed according to parent satisfaction, degree of thumb movements and quality of skin of the first web space. Most parents were satisfied with the appearance and noticed improvement of the function of the operated hand of the child in the daily activities. The degree of abduction and rotation reached by the new thumbs was averagely 40 degrees and 100 degrees respectively. All patients used the pollicized thumb to grasp objects. We have described a scoring system to evaluate the results in such patients. There were no major complications as ischemia and loss of the new thumb. We concluded from this work that surgery for such cases was worthy. It definitely improved the cosmetic appearance and the function of the hand

Supraclavicular decompression for neurogenic thoracic outlet syndrome; an individually tailored approach

The objective of this study was to evaluate the clinical outcome of supraclavicular decompression for thoracic outlet syndrome, and whether first rib resection is needed in all cases. 51 patients underwent 58 procedures, 7 being bilateral. There were 48 females and 3 males. The mean age was 26 years. 88% had lower plexus symptoms, and 5% had a motor deficit. The most sensitive provocative test was the plexus compression test [95%]. Through a supraclavicular approach, the plexus was explored, and the compressing agents resected. Intraoperative dynamic assessment of the plexus was an important part of the procedure. Using the Balci et al, staging system, 90% obtained a good to excellent result at latest follow up. Minimal complications were encountered in this series. In conclusion, the supraclavicular approach affords an excellent exposure of the plexus elements and its compressing agents, and allows dealing with them successfully. The extent of the decompression is individually assessed based upon the patient symptoms, the provocative positioning aggravating his symptoms, the operative findings and the intraoperative dynamic assessment of the plexus including provocative tests, and longitudinal traction of the arm. The final aim should be a plexus free of compression

Primary restoration of thumb opposition with median nerve decompression

In this study, 16 patients [10 females and 6 males with an age ranged from 42 to 65 years with a mean of 56] with long standing carpal tunnel syndrome were operated upon for carpal tunnel release and primary tendon transfer. All patients had complete thenar atrophy and consequent loss of thumb opposition. The right side was involved in 12 patients and the left was in 4. The palmaris longus tendon was used for transfer [Camitz-Littler procedure]. The patients were followed up for 1.2-2 years with a mean of 1.7. All patients reported an immediate postoperative relief from nocturnal pain and numbness. There was a gradual improvement of the sensation and the two-point discrimination. Grip strength reached 85% of the opposite side at the final follow up period. This procedure proved to be simple and effective for the restoration of thumb opposition

Trapeziectomy and ligament reconstruction for osteoarthrosis of the base of the thumb

Eighteen patients [14 females and 4 males with age ranged from 54-61 years with a mean 57 years] with primary osteoarthrosis of the trapezia1 joint were operated upon for trapeziectomy and ligament reconstruction. Indications for surgery were either pain at rest or pain interfering with activities of daily life or occupation, when conservative measures have been unsuccessful. Patients were evaluated preoperatively for the degree of pain, range of abduction, power of pinch and grip. Patients were followed up for 1.2 -2 years with a mean 1.6 years. Sixteen patients enjoyed excellent pain relief and were satisfied with the thumb. Grip strengths improved to a mean of 24 kg compared with preoperative mean of 12.8 kgm. Pinch improved from a mean of 2.6 kgm preoperatively to a mean of 5.2 kgm at the end of the follow up period. Abduction range improved in all patients from a preoperative mean of 2.2 cm to a mean of 5.4 cm at the end of the follow up period. All patients returned to their daily activities with satisfaction and those patients who were not retired at the time of operation returned to their previous jobs