ABSTRACT
This study assess the use of muscle flaps to cover exposed knee prostheses and emphasises the need for early plastic surgery consultation. In five of the six patients studied the wound was successfully covered and the knee prosthesis salvaged with a reasonable functional outcome.
Subject(s)
Knee Prosthesis/adverse effects , Plastic Surgery Procedures/methods , Surgical Wound Dehiscence/surgery , Adult , Aged , Aged, 80 and over , Animals , Female , Follow-Up Studies , Humans , Male , Rats , Surgical Flaps , Surgical Wound Dehiscence/etiology , Treatment Outcome , Wound Healing/physiologyABSTRACT
Over a 6-month period 147 consecutive deep hand lacerations referred to a plastic surgery department were explored in 136 adult patients. At operation 121 complete tendon divisions, and 72 nerve injuries were found. Accident and emergency (A&E) officers diagnosed only 64% of tendon divisions compared with 84% for the admitting hand surgeons. Nerve injuries were more accurately diagnosed, 87% by A&E officers compared with 94% by hand surgeons. These findings support the view that significant palmar hand lacerations should be referred for a hand surgery opinion.
Subject(s)
Hand Injuries/surgery , Wounds, Penetrating/surgery , Adolescent , Adult , Female , Hand Injuries/complications , Humans , Male , Middle Aged , Retrospective Studies , Tendon Injuries/etiology , Tendon Injuries/surgery , Wounds, Penetrating/complicationsABSTRACT
The evaluation and comparison of results of pollicisation for different pre-operative conditions is difficult as no standard method exists. An assessment is proposed, based upon tip pinch, opposition, pulp pinch, grasp, mobility, sensitivity and cosmetic appearance which gives a numerical score.
Subject(s)
Thumb/physiology , Humans , Movement , Thumb/surgeryABSTRACT
Between 1977 and 1988, 30 pollicisations were performed on 22 children with hypoplasia or aplasia of the thumb. A review was undertaken to grade the results. 73% were graded good or excellent, 17% fair and ten % poor. 36% required secondary surgery to achieve a satisfactory result. Better results were obtained in Blauth III or IV deformities, with poorer outcomes in Blauth V or patients with associated radial hypoplasia. Good functional and cosmetic results were found in patients operated upon at an early age. The presence of previously unreported bony spikes was a significant cause of poor mobility and was amenable to secondary surgery.
Subject(s)
Thumb/surgery , Adolescent , Child , Child, Preschool , Humans , Infant , Movement , Radiography , Reoperation , Retrospective Studies , Thumb/abnormalities , Thumb/diagnostic imaging , Thumb/physiopathologyABSTRACT
A retrospective review of 51 patients with isolated flexor pollicis longus tendon repairs has been undertaken to determine the value of post-operative splintage. Evaluation by the Buck-Gramcko criteria confirms the benefit of controlled dynamic mobilisation. Overall, 44% of patients treated by immobilisation post-operatively achieved good or excellent results compared with 60% treated by dynamic traction. For repairs in zone 2, the results of mobilisation were significantly better, 62% achieving good or excellent results compared to 33% treated by fixed splintage.
Subject(s)
Hand/surgery , Splints , Tendons/surgery , Thumb/surgery , Hand Injuries/rehabilitation , Hand Injuries/surgery , Humans , Retrospective Studies , Tendon Injuries/rehabilitation , Tendon Injuries/surgery , Thumb/injuriesABSTRACT
The evolution and uses of free tissue transfer since 1976 are documented. Two hundred free flaps have been performed with an overall success rate of 91%. The factors which may influence survival are the type of flap used, the recipient region and the timing of surgery following trauma. Twenty-five percent of cases required re-exploration postoperatively, of which 78% were successfully salvaged. Venous thrombosis was the commonest problem and appears better tolerated than arterial occlusion. Eighty-two percent of venous thromboses were salvaged compared with only 50% of arterial failures.
Subject(s)
Surgical Flaps , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Graft Occlusion, Vascular/etiology , Humans , Middle Aged , Postoperative Care , ReoperationABSTRACT
A technique is described using the radial forearm free flap for pharyngostome closure. The flap may be used in combination with local flaps for external cover only or may be raised as a double paddle for external and internal lining.
Subject(s)
Pharyngostomy , Surgical Flaps , Aged , Humans , Male , Methods , Middle AgedABSTRACT
A review was undertaken of 100 patients with 218 surgically-treated syndactylies operated upon over a ten year period. The pre-operative factors which influenced the result of surgical treatment were the complexity of the syndactyly and the presence of other congenital abnormalities in the hand. The operative factor which most influenced outcome was the type of skin-graft used. 42 patients required at least one secondary operation to obtain an acceptable result, comprising 22% who developed web creep and 26% a significant flexion contracture; five patients developed both a contracture and web creep. In contrast, the type of flap used to reconstruct the web floor had little influence on the result.
Subject(s)
Fingers/surgery , Syndactyly/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Surgical FlapsABSTRACT
The serratus anterior muscle and rib composite flap has been well described for oral and mandibular reconstruction. The flap may also be used in combination with the latissimus dorsi flap based on the common thoracodorsal vascular pedicle, a blood supply which has hitherto been proven to be reliable. This case demonstrates a totally independent arterial supply to the serratus anterior and latissimus dorsi muscles.
Subject(s)
Blood Vessels/abnormalities , Facial Asymmetry/surgery , Muscles/blood supply , Surgical Flaps , Child , Female , Humans , Regional Blood Flow , RibsABSTRACT
Axillary nerve blocks are now frequently used for emergency and elective upper limb surgery. The method gives reliable anaesthesia with few complications. A case is described in which a patient developed Herpes Zoster following an Axillary Nerve Block, a hitherto unreported complication.
