Abductor pollicis longus deviation graft operation: modified for stabilizing CMC and MCP joints of 'intrinsic minus' thumb.

The original procedure abductor pollicis longus deviation graft operation by Beine (1996) was introduced to correct retroposition of the thumb and to balance the instability at the carpometacarpal (CMC) joint in cases of ulnar-cum-low median palsy in leprosy, so that bone-using procedures can be avoided to some extent. It provides an antagonistic force to the action of the abductor pollicis longus (abd. pol. long.) by giving this muscle a second insertion, with the result that the action of the abd. pol. long. now stabilises to a considerable extent the CMC joint in its mid-rotational position by a partial replacement of the action of the opponens pollicis (opp. pol.) and abductor pollicis brevis (abd. pol. brev.). Experience over five years with the original procedure showed us that it can make an ulnar deviation more visible at the MCP joint of the thumb. The modification of the procedure corrects this as well, as the results in 12 hands of 11 patients have shown. Interestingly, of the 11 patients who underwent operation, one was not a leprosy patient, but referred to us for partial triple palsy of the left hand and arm without sensory loss. It is shown that the indication of this procedure is wider than mentioned earlier.

Modification of the "wrap around" tendon anastomosis of fascia lata graft with a slim double tendon of palmaris longus.

A modification of Brand's "wrap around" technique of anastomosis is described, which allows joining a double tendon or split tendon of palmaris longus to fascia lata graft, when one of the slim tendons would not allow performance of the Brand tendon anastomosis. Four such cases have been done successfully.

Prevention of post-operative "sublimis minus" deformity by modified surgical procedure at the donor finger.

"Sublimis minus" deformity occurs quite often as a post-operative deformity in the donor finger after transfer of the flexor superficialis tendon e.g., for paralytic claw finger correction. Our experience with a new procedure to avoid this outcome is described here. Long term results in 35 cases are very encouraging and the new procedure promises to be useful to prevent sublimis minus deformity. It also opens out a wider range of discretion given to hand surgeons to use the sublimis tendon more freely for transfers.

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

A modification of the surgical correction of the thumb--a long term follow up.

A modification of the commonest surgical procedure to restore Abduction-Rotation using the flexor superficialis transfer with Y-insertion is described. The modification consists of doing a triple insertion at the thumb instead of Y-insertion. After introducing the triple insertion the procedure shows 80-90% or more good results, whereas 50% or more failures are reported in the existing literature, when a Y-insertion only is used which cannot safely prevent 'Z' deformity. 60 cases were followed up.

Partial flexor carpi radialis many-tailed transfer for correction of claw fingers.

The method described shows, that correction of claw fingers is possible using a portion of the flexor carpi radialis as motor. Usually, this method is indicated, whenever it is desired to do a Palmaris Longus many-tailed transfer in the absence of palmaris longus (e.g. for correction of hyper-mobile claw fingers).

Modified suture technique for six-tailed fascia lata graft to slim palmaris longus tendon. A preliminary case report.

A modified suture technique is described, which allows to join a very slim tendon palmaris longus (below 3 mm wide) with a many-tailed fascia lata graft (15 mm wide). This technique is useful in case of ulnar palsy in children, where palmaris longus many-tailed graft is desired as lumbrical replacement and where Brand's anastomosis is considered too difficult. One successful case is also shown.

Extensor pollicis brevis deviation graft operation in case of Z-deformity of the thumb in ulnar palsy--a preliminary case report.

This new procedure is described as an analogous operation to Extensor Diversion Graft Operation for correction of claw fingers (Srinivasan H.) (5). The procedure is found useful to stabilise the metacarpophalangeal joint of the thumb preventing or correcting Z-deformity and weakness of the pinch showing many advantages compared to other procedures. A single case is shown as a preliminary report.