ABSTRACT
Recurrent volar displacement of the extensor digitorum communis tendon (EDC) at the metacarpophalangeal joint (MCPJ) more commonly occurs post-trauma or in the rheumatoid hand. This disabling condition of the hand results in painful swelling of the MCPJ, associated with "locking" of the extensor tendon. We report a simple surgical technique used to successfully 'secure' the EDC from recurrent displacement. This was performed for a 59-year-old man who developed the condition in his ring finger, following Vth ray amputation for severe Dupuytren's disease. First, the EDC over the IIIrd and IVth MCPJ are exposed using a longitudinal incision. The junctura tendinum between the EDC tendons was next extended proximally by 2 cm on the radial side of the IVth EDC and then divided to create a distally based junctura slip. Next, a 'lasso' was created by passing the slip beneath the IVth EDC tendon and then securing it onto itself with a 5/0 Ethibond suture (Ethicon Inc.). This reconstruction was then tested in all ranges of MCPJ flexion, successfully preventing volar displacement of the extensor tendon. The 'junctura lasso' provided a satisfactory solution for the patient, who, over the next four years; for the duration of his follow-up, suffered no further displacement of the extensor tendon.
Subject(s)
Metacarpophalangeal Joint/surgery , Tendon Injuries/surgery , Humans , Male , Metacarpophalangeal Joint/physiopathology , Middle Aged , Secondary PreventionSubject(s)
Bites and Stings/surgery , Dogs , Surgery, Plastic/methods , Surgical Wound Infection/prevention & control , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Animals , Bites and Stings/complications , Bites and Stings/epidemiology , Bites, Human/complications , Bites, Human/epidemiology , Bites, Human/surgery , Child , Child, Preschool , Female , Humans , Incidence , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment , Sex Distribution , Surgery, Plastic/adverse effects , Surgical Wound Infection/epidemiology , Time Factors , Wound Healing/physiologySubject(s)
Mammaplasty , Rectus Abdominis/transplantation , Surgical Flaps , Wound Healing/physiology , Adult , Female , Humans , Mammaplasty/instrumentation , Middle Aged , Monitoring, Ambulatory/instrumentation , Pilot Projects , Spectrophotometry/methods , Surgical Flaps/adverse effects , Thrombosis/etiologyABSTRACT
The patient's own palm is used as a template in assessing small patchy burns and is traditionally believed to be 1% of body surface area. This does alter with the patient's age, sex and BMI and there have been suggestions that it can also differ between ethnic groups. We undertook this study to see if there were any differences in the hand surface area between Caucasians, Orientals and Asians. It was done by tracing the hand outline and calculating the surface area. The study showed that there was no significant difference between the three ethnic groups in terms of hand surface area.
Subject(s)
Asian People , Hand/anatomy & histology , Racial Groups , White People , Adolescent , Adult , Anthropometry , Body Mass Index , Body Surface Area , Female , Humans , Male , Middle AgedABSTRACT
In estimating small areas of burns, it is traditionally taught that the patient's palm is 1% of the body surface area. Whether the palm means the palmar surface of the whole hand or palm excluding the fingers, has not been very clear and is a source of confusion to many junior doctors. The ATLS teaching has been in contradiction to the evidence from literature and hence we undertook a study to examine the evidence and practices regarding this issue. It was done through a literature search, telephonic interviews and a review of Web-pages related to burns area estimation. The results highlighted the existing confusion on the topic and the need for educating junior doctors.
