A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery.

OBJECTIVE: We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery. PATIENTS AND METHODS: A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively. RESULTS: Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05). CONCLUSIONS: Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.

Release of oral submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft--a new technique.

Long standing oral submucous fibrosis is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. This article introduces a new technique of release of submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft. The surgical technique involves a pre-auricular incision extending into the temporal region with dissection carried out in the sub follicular plane to develop the superficial temporal fascia flap to its maximum extent. The masseter muscle origin is released from the zygomatic arch and the temporalis muscle insertion is released from the coronoid process through an external approach. The entire fibrosed mucosa is released intraorally to create a mucomuscular defect thus achieving full mouth opening. The superficial temporal fascia flap is then brought in and sutured to the intraoral defect, which is then covered with a split thickness skin graft. This procedure is performed bilaterally. A total of five patients were treated with this new technique and all of them showed good mouth opening in long term follow up. There was no donor site morbidity. The incision line is well hidden in the hair bearing area. A well vascularised superficial temporal fascia flap brings in good blood supply to the area of affected muscle and mucosa to improve its function.

A microneurovascular study of the great saphenous vein in man and the possible implications for survival of venous flaps.

Cross sections (n = 372) of human long saphenous veins (n = 12) from unsalvageable fresh above knee amputation specimens brought to a trauma centre in a large metropolitan hospital were studied. The veins were harvested longitudinally with an amount of soft tissue equivalent to the diameter of the vein and sectioned at intervals of 5 mm. The sections were stained with haematoxylin and eosin for general study, Van Gieson for better delineation of different coats of the vessel wall and reticulin stain to differentiate between venules and arterioles. The vascular structures within the vein wall and its surrounds were analysed by using analySISpro via a CCD camera attached to a light microscope, with the help of a frame grabber card and image analysis software. Results show that the vein has vasa vasorum within its wall, a capillary network around it, arterioles, venules and the saphenous nerve and its branches with their vascular network a further distance apart. The relevance of the microsurgical anatomy of the saphenous vein and its soft tissue envelope in the survival of venous flaps is discussed.

Early division of pedicled flaps using a simple device: a new technique.

A simple occlusion clamp with screws used to achieve early division of two-staged, distant pedicled flaps is presented. The device is applied to the bridge of a distant flap on the 5th postoperative day and is gradually tightened. It was used on 20 consecutive pedicled flaps in 20 patients: 5 abdominal flaps, 4 superficial external pudendal artery (SEPA) flaps, 9 cross leg flaps, 1 groin flap and 1 medial arm flap. In 17 patients, the flaps were divided successfully between the 9th to the 14th day (Mean: 10 days). The device was removed in 3 patients when ischaemic changes became apparent; their flaps however survived completely and were divided after a longer interval. The principles on which the device works, the technique, feasibility, and advantages of using the device for early flap division are discussed.

Identical unusual subtotal penile amputation in children: a report of four cases.

4 cases are reported in whom an accidental or iatrogenic near complete slow amputation of the penis at the corona glandis was observed at first presentation. A representative case is presented in detail with illustrations showing the surgical repair carried out. The future erectile ability of this reconstructed phallus is speculated upon.

Venous flaps.

One of the earliest postulates concerning the physiological basis of flap survival is attributed to Sushruta, who, in his inimitable style, very succinctly noted in Sanskrit verse the following words: "through continuity survives." Sanskrit being a very telegraphic language, what derives from these words is as follows: Through (the flap's) continuity (with its original location) (it) survives. The principle of continuity has survived through the ages, though continuity has come to imply vascular continuity based on the Harvesian model of circulation. No matter how we classify flaps, i.e., random or axial, the Harvesian model of circulation is the key to the mechanism of survival. Lately, however, a new category of flaps, that is, "venous flaps," have been reported by a number of investigators where the classical Harvesian model is not in evidence, at least apparently. The following effort is directed toward presenting the existing data on this subject for future guidance in research and clinical applications.

The tongue flap in the primary treatment of cleft palate: a report of 19 cases.

The conflict between the need to create an effective levator palati sling on the one hand, and the morbidity of raising oral mucoperiosteal flaps on the other, is highlighted in the treatment of clefts of the bony palate, with a limited review of the existing literature. A method in which an anteriorly based tongue flap is used to cover the raw areas resulting from displacement of the oral mucoperiosteal flaps to reconstruct and maintain the levator palati sling in its proper place is described in the primary treatment of cleft palates in 19 cases. One of these cases is presented in detail with the help of illustrations. Comments are added about the method employed. The future plan of action in regard to this method is mentioned.

Uvulopalatorrhaphy in a case of obstructive sleep apnoea.

A reversible uvulopalatorrhaphy is reported in a case of obstructive sleep apnoea. The patient had an abnormally long uvula but no skeletal abnormality.

Two flag flaps based on the supratrochlear vessels for nasal reconstruction.

A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reconstruction of defects of the lower nose when both lining and cover are needed. Two flag flaps based on the supratrochlear vessels were used in a patient with a full-thickness alar defect and a narrow, short forehead.

A radical approach in the treatment of the deviated nose.

Surgical attempts to straighten a deviated nose do not always produce a satisfactory result, partly due to the surgeon's inability to straighten the anterior part of the nasal septum or to maintain it in a correct position postoperatively. In a radical departure from accepted norms we have, in eight cases, excised the deviated part of the anterior nasal septum and replaced it with a bone graft. The background and the need for this procedure are explained, followed by a case report in some detail. Details of the eight cases are given in a table and representative cases are presented with illustrations and comments regarding the problems encountered with the present method.