Surgical treatment of noma.

In the acute stage of noma the role of surgery is a minor one: wound care and, very occasionally, treatment of haemorrhage. However in patients who survive noma, and develop a mutilated and disabled face (trismus, leakage of saliva, impaired speech), reconstructive surgery may improve their fate significantly. Because of economic and educational reasons reconstructive surgery in noma patients should be performed preferably in their own country. Treatment consists of excision of all scar tissue, correction of the trismus and closure of the tissue defects with local, pedicled or free flaps. Because of the large variety of tissue defects and the many surgical options, systematization and subsequently standardization of the reconstructive surgical approach to patients with the sequelae of noma is needed.

Stressful life events and psychological dysfunction in Complex Regional Pain Syndrome type I.

OBJECTIVE: To determine to what extent stressful life events and psychological dysfunction play a role in the pathogenesis of Complex Regional Pain Syndrome type I (CRPS). DESIGN: A comparative study between a CRPS group and a control group. Stressful life events and psychological dysfunction evaluation was performed with a life event rating list and the Symptom Checklist-90 (SCL-90). SETTING: A university hospital. SUBJECTS: The CRPS group consisted of 24 patients with a history of upper extremity CRPS of less than 3 months. The control group consisted of 42 hand pathology patients waiting for elective hand surgery within the next 24 hours. MAIN OUTCOME MEASURES: Stressful life event rating was measured using the Social Readjustment Rating Scale. Psychological dysfunction was measured using the SCL-90. RESULTS: Stressful life events were experienced by 19 patients (79.2%) in the CRPS group and by 9 patients (21.4%) in the control group. This difference was significant. Testing of psychological dysfunction (SCL-90) in CRPS patients and the control group demonstrated some significant differences: male patients were more anxious than male controls; female patients were statistically more depressed, had feelings of inadequacy, and were emotionally less stable than female controls. In multivariate analysis, no significant differences were found across gender, age, or gender x group interactions. Of the SCL-90 dimensions, only insomnia correlated with the experienced stressful life events. CONCLUSION: Stressful life events are more common in the CRPS group, which indicates that there may be a multiconditional model of CRPS. The experience of stressful life events besides trauma or surgery are risk factors, not causes, in such a model.

Coupling the venous anastomosis: safe and simple.

Various anastomotic coupling systems have been developed aiming to facilitate microvascular anastomoses. Of these only the 3M Precise Microvascular Anastomotic System (MAS) has recently gained increasing popularity. However, clinical studies on the use of the MAS are sparse. We report our clinical experience with the MAS in a two-centre study between 1991 and 1996. Of the 96 MAS coupling rings used, 50 were accessible for final analysis, and a 100% patency rate was obtained. The main indication is venous end-to-end anastomosis in vessels of minimal discrepancy. In selected cases in head and neck surgery even end-to-side venous anastomoses appear to be feasible. Although it is not universally applicable for microvascular anastomoses, we conclude that, if appropriate, the MAS coupling device leads to a reliable venous anastomosis in a greatly reduced operating time of less than 4 minutes.

[A bilateral hand replantation]. / Een dubbelzijdige handreplantatie.

We describe a patient whose both hands were amputated at the level of the wrist in an accident with a farm machine. Both hand were replanted. In spite of an extremely severe injury and consequently a bad prognostic situation an acceptable functional result was obtained. This patient is capable of performing his daily activities reasonably well. He can also ride a bicycle and drive his car.

[Functional treatment of Colles fractures and the relation of anatomic recovery and function]. / Functionele behandeling van Colles-fracturen en het verband tussen anatomisch herstel en functie.

Functional treatment of Colles fractures is a recently developed approach to fracture injury. It aims to bring about faster recovery and a better functional end result by permitting early motion and function by means of a functional brace. Early motion and function, however, might jeopardize the anatomical result. Whether an inferior anatomical result jeopardizes the functional end result is not clear, as the relationship between anatomy and function has not been established. In a prospective clinical study it was concluded that in displaced Colles fractures functional treatment with a below-the-elbow functional brace offers little advantage over conventional plaster of Paris immobilisation. Minimally displaced Colles fractures (volar angle greater than or equal to 0 degrees) should be treated with a bandage after one week of plaster immobilisation. The relationship between the anatomical and functional end result is weak and probably depends on initial displacement and complications. To improve the functional result after a Colles fracture, prevention and better treatment of complications seem to be more important than improvement of the method of fracture treatment of the anatomical end result.