Superficial acral fibromyxoma of the distal phalanx of the thumb.

Superficial acral fibromyxoma is an uncommon benign tumour which was first described recently (Fetsch et al., 2001, Human Pathology 32: 704-714). It has been reported several times since, suggesting it is more common than initially thought.

Results of treatment of carpal tunnel syndrome with associated hourglass deformity of the median nerve.

Two hundred twenty-seven successive cases of carpal tunnel syndrome confirmed by abnormal electrodiagnostic studies were reviewed. All cases underwent open carpal tunnel release by a single surgeon over a 3-year period. Thirty-two hands (14% of all cases) in 29 patients demonstrated an hourglass deformity at the time of surgery. Electrodiagnostic tests revealed no evidence of any other type of peripheral neuropathy in any patient. Postoperative electrodiagnostic studies were obtained in all cases on completion of therapy. The length of the follow-up period averaged 11 months (range, 3-35 months). The duration of preoperative symptoms ranged from 2 years to more than 10 years. Twenty-eight of the 32 hands (88%) with hourglass deformities demonstrated subjective clinical improvement or complete resolution of symptoms. Chronicity of symptoms and electrophysiologic severity did not correlate with the presence of the hourglass deformity. Presence of hourglass compression of the median nerve in carpal tunnel syndrome is therefore not a negative prognostic indicator.

Permanent nerve injury in the forearm following radial artery harvest: a report of two cases.

Radial artery grafts for coronary artery bypass surgery have recently gained renewed clinical interest. The procedure has been reported to be successful, with a low incidence of morbidity. Although permanent injury to the sensory nerves of the forearm has not been reported, transient or temporary dysesthesia has been known to occur. Recently, 2 patients were referred for long-standing debilitating dysesthesia in their forearms following radial artery harvesting. Electrical studies documented radial sensory nerve injury in both patients, one of whom underwent surgical treatment. Because radial artery grafting for coronary artery bypass surgery may be increasing in popularity, disability from sensory nerve injury may become more frequent. Because of the susceptibility to injury of the sensory nerves in the forearm, and because of the anatomic variations in this region, surgical personnel performing radial artery harvesting should be familiar with the pertinent anatomy so that this complication can be avoided.

Communicating defects of the triangular fibrocartilage complex without disruption of the triangular fibrocartilage: a report of two cases.

Perforations or communicating defects of the triangular fibrocartilage complex have been more commonly identified after Palmer published his classification system (J Hand Surg 1989;14A:594-606). To his variants of class 1B (traumatic) ulnar avulsion with or without distal ulnar fracture, a third category may be added: defects of the ulnar collateral ligament without any associated disruption of the triangular fibrocartilage. The ulnar collateral ligament can be defined as an ulnar capsular structure between the more discrete elements of the triangular fibrocartilage and the ulnar ligaments, with the defect or perforation being distal to the intact triangular fibrocartilage and exiting into the floor of the extensor carpi ulnaris sheath. We present 2 cases that illustrate the diagnosis, the use of both magnetic resonance imaging and arthrography to confirm the diagnosis, the associated dorsal ulnar cutaneous nerve pain distribution, and the open direct and retinacular flap repair.

Use of a rectus abdominis osteomyocutaneous double island flap based on internal mammary vessels.

A very rare condition of osteoma cutis was presented by a patient who required an unusual solution to an unusual problem. Multiple surgical procedures were performed during the treatment of the disease, thereby prohibiting the use of more common regional or distant flaps to achieve successful mandibular reconstruction. Microvascular tissue transfer was also not feasible because of two previously-failed free flaps and an operative field that was densely fibrotic. A pedicled rectus abdominis myocutaneous flap with incorporated vascularized rib graft is described as a last resort approach for simultaneous reconstruction of the mandible and oral soft tissue.

Distal foot coverage with a reverse dorsalis pedis flap.

A reverse dorsalis pedis flap based on the proximal communicating branch of the dorsalis pedis artery was successfully used to close distal forefoot defects in two patients. The skin paddle was oriented transversely across the ankle crease, allowing for direct closure of the flap donor site. Both patients maintained full active ankle motion without bowstringing of the dorsal foot tendons and did not require special footwear. Both flaps maintained sensation to light touch and pinprick. We believe that this flap offers a viable alternative when faced with the challenge of a small soft-tissue defect requiring flap reconstruction in the distal foot.

A simple model for estimating protein solubility in aqueous polymer solutions.

A simple scaling analysis of protein solubility in semi-diluted polymer aqueous solutions was derived based on the recent theoretical development of Abbott et al. on the interactions between protein spheres and entangled polymer coils and the experimental observations of Atha and Ingham on the polymer-induced protein precipitation. Both the hard-sphere nature of the protein and the flexibility of the polymer coils have been taken into account in the model. The experimental data can be fitted by using this model with physically reasonable values of the exponent. This approach may be useful in estimating protein solubilities in water in the presence of polymer from limited and usually costly experimental data.

The surgical applications and implications of cultured human epidermis: a comprehensive review.

Replacement of skin has long been the ultimate task for surgeons facing skin-resurfacing challenges such as thermal burns and chronic ulcerations. Autologous skin grafts have been the "gold standard" for wound closure, but in patients who are massively burned, the availability of normal skin is the limiting factor. In the past 15 years the technique of in vitro cultivation of human epidermis has been developed in an attempt to deal with the problem of extensive skin loss. Although the technique is costly and arduous, grafting patients who are severely burned with cultured epidermal autografts has proved to be a life-saving measure where few alternatives exist. Cultured allografts have promoted rapid healing and pain relief in patients with chronic ulcers. Although longer follow-up is necessary, recent evidence suggests that cultured epidermis provides a wound cover that is just as durable and esthetically acceptable as conventional split-thickness skin grafts. This article reviews the development and applications of epidermal cell culture.