Tear of an anomalous lumbrical muscle as a source of pain in the hand.

Symptoms from adhesions between lumbrical and interosseous muscles at the metacarpophalangeal joint have been described. We report a case in which symptoms were secondary to a tear in an anomalous lumbrical muscle of the ring finger.

Microvascular steal phenomenon in lower extremity reconstruction.

Macrovascular bypass procedures and microvascular free tissue transfer have resulted in dramatic improvements in lower limb salvage. Although vascular steal is a well-documented phenomenon in the surgical literature, there is a paucity of information on its potential impact in microvascular surgery, particularly in relation to lower extremity reconstruction in the elderly patient with peripheral vascular disease. We report three cases of lower extremity reconstruction using microvascular free tissue transfer in which the free flap survived but the distal extremity suffered progressive ischemic necrosis. A retrospective analysis of these cases defines the conditions in which microvascular steal phenomenon may adversely influence lower limb salvage.

Upper extremity salvage with free ulnar forearm flap from the amputated part: case report.

Preservation of a functional level of amputation in cases of nonreplantable upper extremity amputation injury can be accomplished utilizing spare-parts technology. A case is presented in which a nonreplantable arm amputated at the mid-humeral level was used for a free ulnar forearm flap to preserve bone level and secure stable coverage.

A barrier technique for pulsed irrigation of cavitary wounds.

A technique for barrier protection during pulsed irrigation of cavitary wounds is presented. The method is discussed within the context of current concerns regarding intraoperative viral transmission.

Magnetic resonance imaging in the evaluation of persistent carpal tunnel syndrome.

Magnetic resonance imaging was used to assess nine median nerves in the wrists of seven patients who had signs and symptoms of persistent compressive median neuropathy despite previous carpal tunnel release. Intraoperative findings were then correlated in eight surgically treated cases with both MRI findings and postoperative results. Magnetic resonance imaging suggested a potential abnormality in each of eight operative cases. These findings correlated very well with both intraoperative observations and postoperative results, which indicated that some abnormality involving either the median nerve or the transverse carpal ligament had been present in all cases. Magnetic resonance imaging proved to be a sensitive and specific tool in the evaluation of persistent postoperative median nerve compression.

Amputation stump salvage using a "banked" free-tissue transfer.

A free radical forearm flap was salvaged from a nonreplantable amputated extremity and banked on the ipsilateral chest wall. Later, the flap was simply rotated to provide coverage of the proximal humeral stump, eliminating the need for a second microvascular procedure.

Temporary ectopic implantation.

Temporary ectopic implantation is a technique designed for extremity salvage in cases of devascularization or amputation of an essentially intact part in conjunction with extensive segmental proximal injury. A case of a traumatic midforearm amputation that survived by ectopic implantation in the abdominal wall, with subsequent replantation eleven weeks later, is presented.

Free temporoparietal flap in burn reconstruction.

A series of 12 patients with deep burns resulting in exposed bones, joints, and tendons, in whom temporoparietal free flaps were used for reconstruction, are presented. Flap loss was 8.3%; good and satisfactory results were achieved in 91.7% of healed defects. Patients with large total body surface area burns are severely compromised, and the use of free flaps requiring prolonged periods of anesthesia and surgery should be a judicious decision. Prior to the availability of free flaps, most of these patients are left with chronic wounds and compromised functional results. Although our experience is limited, we think that in well-selected cases a one-stage reconstruction with free tissue transfer is expeditious, safe, and economical.