Replantation and revascularization of the digits in a community microsurgical practice.

One-hundred and twenty-seven digits in Verdan zones I and II, and 24 thumbs in 106 patients were reviewed from 1979 to 1995. Patients were all followed for a minimum of 5 months to assess early results and complications, and to determine if a short course (minimum 3 days) of dextran 40 anticoagulation adversely affected digit survival. The total survival rate was 88 percent. Digits with only a single artery and vein repaired had a significantly higher rate of failure (p > .05). Index and small fingers also showed a trend toward lower survival. Vein grafts were used in 22 percent of cases. No vascular problems were noted after 5 days. Variables not affecting survival were: presence of a joint fusion, type of fixation, level of injury, number of digits, mechanism of injury, and use of vein grafts. The average hospital stay for the group was 6.5 days (+/-SD 3.3). No complications were seen with dextran use. A total of 51 complications were seen overall and the non-union rate was 10 percent. Community-based replantation and revascularization can be performed with early results equivalent to prior published studies. Complications are to be expected and demand expeditious treatment. Functional recovery of severed digits remains the benchmark for success in these injuries, however, lost digits never work.

Upper extremity disorders: a literature review to determine work-relatedness.

The objective of this review is to establish whether the medical literature validates a causal relationship between upper extremity disorders and work activities. Selected articles were reviewed using a Diagnostic Medical Criteria. Articles meeting this criteria were further reviewed for validity. Only 14 of 52 reviewed articles were felt to encompass medical criteria. However, these articles also contained what appear to be major validity flaws. Very little of the written material dealing with the issue of work-related upper extremity conditions incorporates what are felt to be sound medical diagnostic criteria in the definition and identification of these conditions. None of the reviewed studies have established a causal relationship between distinct medical entities and work activities. Further research using well constructed studies that incorporate reliable epidemiologic and accepted diagnostic criteria is needed. In this manner, the best of the medical and epidemiologic fields can be applied to solving these problems.