Evaluation of Early Active Controlled Motion in Flexor Tendon Repair

Objectives: The objective was to determine the results of early active controlled motion in the patients rehabilitated by our new protocol.

Methods: 91 fingers in 64 patients with flexor tendon repair in all zones were enrolled in a single group [quasi-experimental] clinical trial. 58 fingers in 43 patients were assessed at least three months postoperatively. Outcomes were defined using the ‘White' criteria for thumbs and the ‘Strickland' criteria for other fingers.

Results: The results for range of motion of fingers were Excellent in 70.7%, good in 13.8%, fair in 6.9% and poor in 8.6%. There were 3 [5.17%] postoperative tendon ruptures.

Discussion: Early active controlled motion with our rehabilitation protocol shows acceptable postoperative results. This rehabilitation protocol is more effective if carried out from the 1st to 4th weeks after surgery, under the supervision of a surgeon or hand therapist. Then, from the 4th to 6th weeks, it should be performed at a hand therapy clinic and from the 6th to 12th weeks at home, supervised by a hand therapist

Comparison of three different methods of dressing for partial thickness skin graft donor site

Split-thickness skin graft is one of the most common operations in plastic surgery. It is always painful and patient discomfort from donor site often is more significant than recipient site. There is not still a standard method for treatment of the donor site. The purpose of this study was to determine the best method of dressing the donor site among three different methods with respect to the rate of healing, pain, secretion, infection and cost. The study includes 60 patients that were randomly divided into three groups. Donor site and thickness of the graft was the same and were dressed with one of the methods including Method A: Paraffin fine mesh gauze, Method B: Nitrofurazone soaked fine mesh gauze and Method C: Dry fine mesh gauze. Each method included an intermediate layer of sterile plastic sheet witch was covered with 10 layers of dry gauze. Comparison with respect to the rate of healing, pain, secretion, infection and cost was done. Thirty seven patients were men and 23 were women. The mean age of the patients was 27.2 years. There was a significant difference between three methods in average time of repair and superiority of dressing with Method B was noted. Pain severity was the least in Method B and difference between the methods was significant. Dressing with Method B had the least secretion and there was a statistically significant difference between three methods. There was no statistically significant difference in cost of the management. This study showed that dressing the donor site with nitrofurazone ointment soaked gauze used as the first layer of dressing and intermediate layer of sterile plastic sheet which was covered with 10 layers of dry gauze was the best method of dressing and had the least complications

[Comparison of the results of single tendon transfer with ternary tendon transfer surgery in patients with radial nerve palsy]

Considering the prevalence of radial nerve palsy and the importance of adequate treatment procedures for this dysfunction, the present study was carried out on patients with radial nerve in 15-Khordad hospital. The study was set to compare the results of single-tendon transfer surgery with those of the common [triple-tendon transfer] surgery. The study adopted a historical cohort method. Patients with definite radial nerve palsy diagnosis were assigned into either the experimental group with single-tendon transfer surgery or the control group with triple-tendon transfer surgery. After similar surgical treatment and at least one-month follow-up, the results of changes in the range of motion in metacarpophalangeal [MP], proximal interphalangeal [PIP] and distal interphalangeal [DIP] joints were compared using Kruskal-Wallis test. The participants consisted of 50 patients who were assigned into a single-tendon transfer [N=33] and a triple-tendon transfer surgery [N=17]. The subjects in either group were similar in terms of the type of disease, simultaneous attendance and socio-economic status [in regard to referring to the same hospital] as well as the initial range of motion in MP, PIP and DIP joints, so that there was no significant statistical difference among them. Following the treatment, the range of motion in the MP joint improved as much as 77.3 +/- 12.1 in triple-tendon subjects and 88 +/- 63 in single-tendon subjects. It improved in the PIP joint as much as 85.9 +/- 13.5 in triple-tendon subjects and 90.5 +/- 40.1 in single-tendon subjects. It also improved in the DIP joint as much as 267 +/- 8 in triple-tendon subjects and 256 +/- 16 in single-tendon subjects [P<0.4]. It seems that the number of tendons transferred to treat radial nerve palsy does not affect the surgical results. Considering the limitations of the present study, it is recommended to conduct further clinical trials on this issue.

running Y-V plasty for treatment of linear and cord-like burn contractures

Linear and cord-like burn scar contractures are commonly treated by severing the scar in a transverse direction and skin grafting or performing Z-plasties. However, skin grafts may result in suboptimal take and contract gradually and the Z-plasty requires undermining flaps in scarred skin which may lead to the distal tip necrosis. In this article the authors present their experience with multiple Y-V plasty technique. From May 2005 to September 2009, 44 linear and narrow cord-like burn contractures in various regions of upper and lower extremities of 32 patients were treated by multiple Y-V plasty technique. The contracted scars were treated successfully in all of the patients. No major post-operative complications or contracture recurrence were observed during the follow up period of 6 to 24 months in this series of patients. By creating a longer length, running Y-V plasty can relax the contracted scar. Considering the advantages and excellent results in the treated patients in this study group, and also other presented series, multiple Y-V plasty can be recommended as a very useful and safe technique for the treatment of linear and cordlike burn contractures

[Comparison of finger tip sensibility following neurovascular Island Flap and V-Y Flap for finger tip reconstruction]

Finger tip injuries are one of the most common types of injury. Destruction of the skin in this area leads to destruction of sensory receptors. As hand function is closely related to sensibility of the finger tips, selecting the best procedure of reconstruction that provides the highest degree of sensation is very important. As V-Y Flap and neurovascular Island flap are more common used, the aim of this study is comparison of these two methods for restoration of finger tip sensation. This is a clinical trial study of 70 patients with traumatic finger tip injury who were randomly divided into two groups. Finger tip injuries reconstructed by V-Y Flap were placed in group A and neurovascular Island flap in group B. Sensation of the reconstructed finger tip was checked in all patients by two point discrimination test 1 year after operation. Each group was included 35 patients. Incidence of necrosis, flexion contracture and discomfort of the patients was similar in the two groups. Sensibility of the fingers was 54.8% in group A, and 93.5% in group B, which is statistically significant. [P= 0.0005]. Restoration of sensibility to the finger tip is significantly more successful by neurovascular Island flap in comparison to V-Y Flap method for finger tip reconstruction

Multiple trigger fingers in a musician: a case report

Trigger finger is a common disease which particularly occurs in middle-aged women. We present a rare case of a male musician with six trigger fingers [five in the left hand and one in the right hand]. Mostly these fingers had been used for playing the guitar.The patient had previously been treated with local steroid injections in his fingers, however no response was seen. Therefore, we performed a surgical procedure. Four weeks after surgery, the patient could play the guitar without discomfort in his hands

[Thenar muscle anatomic variation in carpal tunnel syndrome]

Carpal tunnel syndrome [CTS] is the most common nerve compression neuropathy. It is a multifactorial syndrome and several systemic and local factors such as carpal tunnel anatomy and its variation change the size, shape and volume of this tunnel. In this study, we seek to explain the relation between anatomic variation of thenar muscle and CTS. This descriptive study was conducted on 155 patients with CTS undergoing operation. Care was taken to exclude patients with Rhumatoid Artritis, Hyperthyroidisem, Hypothyroidisom, Diabetic Melitus, acromegaly and previous fracture of distal wrist. During surgery thenar muscle anatomic variations of carpal tunnel have been observed. Of 155 patients, 140 were female [90.3%], and 15 male [9.7%] patients with the mean age of 57.9 years. The anatomic variations have been observed in 35[22.5%] patients. Thenar muscle anatomic variation in CTS is prevalent but further evidence is required