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1.
J Hand Surg Br ; 24(2): 157-60, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10372768

ABSTRACT

We reviewed 34 patients with 65 zone 2 flexor tendon injuries in 39 digits whose outcome had been prospectively studied in an earlier investigation at a mean of 10.6 years after repair. Grip strength was assessed using a Jamar dynamometer. Outcome of grip strength in relation to normal data indicated an excellent or good outcome in 94% of patients, fair in 3% and poor in 3%. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion was graded as excellent or good in 75% of digits, fair in 15% and poor in 10%. These results compare favourably with those of the original study with 5/39 of digits showing an improvement from good to excellent. Sixteen of the 34 of patients continued to suffer from cold sensitivity.


Subject(s)
Exercise Therapy , Finger Injuries/rehabilitation , Tendon Injuries , Tendon Injuries/rehabilitation , Adolescent , Adult , Aged , Cold Temperature , Female , Finger Injuries/physiopathology , Finger Joint/physiopathology , Hand Strength , Humans , Male , Middle Aged , Range of Motion, Articular , Tendon Injuries/physiopathology , Time Factors , Treatment Outcome
2.
J Hand Surg Br ; 23(5): 669-72, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9821617

ABSTRACT

We describe a V-Y palmar flap that allows both skin advancement and scar lengthening, and which has proved useful in the treatment of Dupuytren's disease.


Subject(s)
Dermatologic Surgical Procedures , Dupuytren Contracture/surgery , Hand/surgery , Surgical Flaps , Adipose Tissue/blood supply , Adipose Tissue/surgery , Cicatrix/prevention & control , Hand/blood supply , Humans , Skin/blood supply , Surgical Flaps/adverse effects , Surgical Flaps/blood supply , Surgical Flaps/pathology , Surgical Wound Infection/etiology
3.
J Hand Surg Br ; 23(3): 308-10, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9665515

ABSTRACT

We present the results of fresh cadaver hand dissections and dye injection studies to help in raising a vascularized bone graft from the index or middle metacarpals based on the second dorsal metacarpal artery. This vascularized bone graft could be used for treating nonunion of the scaphoid and other carpal bones.


Subject(s)
Bone Transplantation , Metacarpus/blood supply , Surgical Flaps/blood supply , Cadaver , Humans
4.
Br J Plast Surg ; 51(7): 564-5, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9924414

ABSTRACT

Vasculopathy as part of the syndrome of neurofibromatosis is well recognised, although rarely identified clinically. A recent report describes a case with rupture of an aneurysm of the superficial femoral artery. We present a case of radial artery aneurysm, a previously unreported complication of neurofibromatosis affecting the upper limb.


Subject(s)
Aneurysm/etiology , Neurofibromatoses/complications , Peripheral Vascular Diseases/etiology , Radial Artery , Aneurysm/diagnostic imaging , Humans , Male , Middle Aged , Peripheral Vascular Diseases/diagnostic imaging , Radial Artery/diagnostic imaging , Radiography
5.
Injury ; 28(9-10): 581-7, 1997.
Article in English | MEDLINE | ID: mdl-9624333

ABSTRACT

Seventeen consecutive patients with Grade IIIB open tibial fractures had definitive treatment of both the fracture and soft tissues performed within 72 h of injury. Free tissue transfer was used for cover in each case. There were no cases of deep infection. Flap survival was 100 per cent. The mean time to fracture healing was 10 months, and mean time to walking unaided was 12 months. The average length of stay in hospital was 82 days. The findings suggest that immediate radical debridement followed by adequate soft tissue cover is a safe and effective method for treating these severe injuries.


Subject(s)
Fractures, Open/surgery , Surgical Flaps , Tibia/surgery , Tibial Fractures/surgery , Adolescent , Adult , Aged , Bone Plates , Female , Follow-Up Studies , Fracture Fixation, Internal/methods , Fractures, Open/diagnostic imaging , Fractures, Open/pathology , Humans , Male , Middle Aged , Radiography , Soft Tissue Injuries/diagnostic imaging , Soft Tissue Injuries/pathology , Soft Tissue Injuries/surgery , Tibia/diagnostic imaging , Tibial Fractures/diagnostic imaging , Tibial Fractures/pathology
6.
J Hand Surg Br ; 21(2): 276-9, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8732419

ABSTRACT

A case of florid reactive periostitis of the thumb is presented. This is a rare pseudosarcomatous lesion which generally has a benign radiographic appearance, but on histology it may be mistaken for a malignant process. The clinical behaviour may simulate a malignant tumour but after local excision there is very little propensity for recurrence. Local resection is the recommended treatment. Surgeons and pathologists should consider the possibility of florid reactive periostitis before making a diagnosis of sarcoma in the hand.


Subject(s)
Periostitis , Thumb , Humans , Male , Middle Aged , Periostitis/diagnostic imaging , Periostitis/pathology , Radiography , Thumb/diagnostic imaging , Thumb/pathology
8.
Br J Plast Surg ; 47(5): 369-71, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8087376

ABSTRACT

A sliding fasciocutaneous flap on the medial side of the lower third of the leg is described. Its application in the management of skin defects in this area is illustrated.


Subject(s)
Skin Transplantation/methods , Surgical Flaps/methods , Tibial Fractures/surgery , Adult , Aged , Fracture Fixation/methods , Humans , Male
9.
J Bone Joint Surg Br ; 75(3): 375-80, 1993 May.
Article in English | MEDLINE | ID: mdl-8496203

ABSTRACT

We treated 37 patients with chronic osteomyelitis of the tibia (25), femur (9), radius (2) and humerus (1) by a two-stage technique, comprising radical debridement of all infected bone and soft tissue with the provision of soft-tissue cover, and delayed autogenous bone grafting when necessary. All patients were reviewed at an average of 49 months (12 to 121). Infection-free bone union was achieved in 34. No patient required amputation. Wide excision of all compromised tissue and the closure of bone within a healthy vascularised soft-tissue envelope are essential if infection is to be eradicated. The combined assessment and management of such patients by an orthopaedic surgeon and a plastic surgeon are advocated.


Subject(s)
Bone Transplantation , Debridement , Osteomyelitis/surgery , Surgical Flaps , Adolescent , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Bone Transplantation/methods , Chemotherapy, Adjuvant , Chronic Disease , Debridement/methods , Female , Follow-Up Studies , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Recurrence , Surgical Flaps/methods
10.
Br J Plast Surg ; 45(8): 571-7, 1992.
Article in English | MEDLINE | ID: mdl-1493528

ABSTRACT

This paper reviews the treatment of 168 open tibial fractures referred to the Northern Ireland Plastic Surgery Service over a 15-year period. Flap reconstruction was carried out in 133 (79%) and split skin graft cover in 22 (13%). There were 18 amputations (11%). There was a high incidence of complications among early post-injury fasciocutaneous flaps and late free flaps. Twenty-five primary free flaps were transferred without complication. The current management of open tibial fractures in this Unit is described.


Subject(s)
Fractures, Open/surgery , Surgery, Plastic/methods , Tibial Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Blood Vessels/injuries , Bone Transplantation/methods , Child , Female , Humans , Leg/blood supply , Male , Middle Aged , Postoperative Complications , Skin Transplantation , Surgical Flaps/methods , Tibial Nerve/injuries
11.
Anat Rec ; 233(4): 643-50, 1992 Aug.
Article in English | MEDLINE | ID: mdl-1626723

ABSTRACT

The rabbit hind limb has been used extensively as an orthopaedic model in the investigation of fracture pathology and healing and the effects of vascular abnormalities. However, a detailed description of the normal arterial supply appears to be absent from the literature. A study of the entire arterial vasculature has been undertaken using a lead oxide injection technique developed for this and other orthopaedic studies. This technique has proved reliable and inexpensive, giving high-quality arteriography, which is easily interpreted. Accurate description of the arterial anatomy is possible without the need for repeated dissection. The rabbit lower limb shows some interesting variations in blood supply, particularly below the knee. The foot has three distinct patterns of blood supply, depending on the presence or absence of the peroneal artery and the degree of dominance of the dorsalis pedis artery. This arrangement has not previously been described and differs from the situation in other mammals. The arteriographic technique and the anatomical description have allowed the interpretation of changes occurring in the vasculature after injury in a fracture model.


Subject(s)
Hindlimb/blood supply , Rabbits/anatomy & histology , Angiography , Animals , Femoral Artery/anatomy & histology , Hindlimb/diagnostic imaging , Iliac Artery/anatomy & histology , Popliteal Artery/anatomy & histology , Tibial Arteries/anatomy & histology
12.
Plast Reconstr Surg ; 89(3): 563-6, 1992 Mar.
Article in English | MEDLINE | ID: mdl-1535848

ABSTRACT

There is good evidence of the benefit of transferring vascularized muscle into wounds that are contaminated or have been infected previously. This benefit particularly applies in cavities around bones and joints. We present two patients in whom the inclusion of a portion of muscle in the lateral arm and radial forearm flaps allowed the effective combination of good-quality skin cover with the properties of vascularized muscle.


Subject(s)
Muscles/transplantation , Surgical Flaps/methods , Adult , Aged , Arm/surgery , Forearm/surgery , Humans , Male , Muscles/blood supply
13.
Injury ; 22(4): 267-70, 1991 Jul.
Article in English | MEDLINE | ID: mdl-1937720

ABSTRACT

A series of 23 type III fractures of the tibia in 20 elderly patients (over 60 years of age) presenting for combined plastic and orthopaedic surgical management over a period of 15 years are reviewed. Overall limb salvage was 53 per cent, with an average inpatient duration not significantly different from that for amputation, suggesting that an age of over 60 years is not necessarily a contraindication to attempts at limb salvage in type III injuries.


Subject(s)
Fractures, Open/surgery , Tibia/surgery , Tibial Fractures/surgery , Aged , Aged, 80 and over , Amputation, Surgical , Female , Fracture Fixation/methods , Fractures, Open/pathology , Humans , Length of Stay , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Tibial Fractures/classification , Tibial Fractures/pathology
15.
Br J Plast Surg ; 43(1): 17-23, 1990 Jan.
Article in English | MEDLINE | ID: mdl-2310895

ABSTRACT

The clinical applications of the second dorsal metacarpal artery island flap are illustrated by selective case reports from a series of 12 consecutive cases carried out in this Unit. In five cases the flap was transferred as a neurovascular island flap for sensory resurfacing of the thumb. There were no failures and no donor site complications. The anatomy and clinical dissection of the flap are described.


Subject(s)
Hand/surgery , Surgical Flaps/methods , Adolescent , Adult , Arteries/anatomy & histology , Female , Hand/anatomy & histology , Hand/blood supply , Hand Injuries/surgery , Humans , Male , Middle Aged , Nerve Tissue/transplantation
16.
J Hand Surg Br ; 14(4): 383-91, 1989 Nov.
Article in English | MEDLINE | ID: mdl-2621396

ABSTRACT

In a prospective study, 114 patients with 138 zone 2 flexor tendon injuries were treated over a three-year period. Early active mobilisation of the injured fingers was commenced within 48 hours of surgery. 98 patients (86%) were reviewed at least six months after operation. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion recovered was graded excellent or good in 77% of digits, fair in 14% and poor in 9%. Dehisence of the repair occurred in 11 digits (9.4%) and in these an immediate re-repair followed by a similar programme of early active mobilisation resulted in an excellent or good outcome in seven digits.


Subject(s)
Early Ambulation , Finger Injuries/rehabilitation , Hand Injuries/rehabilitation , Tendon Injuries/rehabilitation , Adolescent , Adult , Child , Child, Preschool , Female , Finger Injuries/surgery , Hand Injuries/surgery , Humans , Male , Middle Aged , Prospective Studies , Tendon Injuries/surgery
18.
Injury ; 19(4): 287-9, 1988 Jul.
Article in English | MEDLINE | ID: mdl-3229850

ABSTRACT

Three clinical cases are presented to illustrate the usefulness of the radial artery forearm flap in the repair of defects over the elbow joint. Incorporation of a segment of vascularized muscle may be indicated where intra-articular infection is present. The secondary defect in the distal forearm was covered by split skin graft and was free of problems in each case.


Subject(s)
Elbow Joint/surgery , Surgical Flaps , Aged , Aged, 80 and over , Forearm/surgery , Humans , Male , Middle Aged , Elbow Injuries
19.
J Hand Surg Br ; 13(2): 136-45, 1988 May.
Article in English | MEDLINE | ID: mdl-3385287

ABSTRACT

A first dorsal metacarpal artery island flap from the index finger was used in 20 cases for reconstruction of defects in the hand. In six cases it was used as a neurovascular flap for sensory resurfacing of the thumb and in five cases for release of a contracted first web. One flap underwent necrosis and there was a complication in one donor site.


Subject(s)
Hand Injuries/surgery , Surgical Flaps , Thumb/surgery , Adult , Aged , Fingers , Hand Dermatoses/surgery , Humans , Male , Middle Aged , Skin Ulcer/surgery , Thumb/injuries
20.
J Hand Surg Br ; 11(3): 469-70, 1986 Oct.
Article in English | MEDLINE | ID: mdl-3794504

ABSTRACT

Four methods of exsanguination of the upper limb during hand surgery were compared by a randomised blind trial in one hundred patients. Exsanguination by a method of hand-over-hand compression proved ideal in 92% of cases. The advantages of this technique are discussed.


Subject(s)
Arm/blood supply , Hand/surgery , Tourniquets , Hemostasis, Surgical , Humans , Intraoperative Care , Pressure , Random Allocation , Regional Blood Flow
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