Digit Replantation The First 50 Years.

Since the first successful digit replantation by Japanese surgeons Komatsu and Tamai, the past half century has seen the field of digit replantation in the USA experience exponential growth followed by a steady decline in volume of cases and percentage of successful viable digits. The initial enthusiasm and technical progress of digital replantation has been tempered by mediocre functional outcomes, rising healthcare costs, and limited healthcare resources. The history and approach to digit replantation is reviewed and highlights the likely push toward the development of regional replant centers staffed by highly skilled teams to improve the functional outcomes following these complex procedures. More than 50 years have passed since the first successful digit replantation by Komatsu and Tamai who replanted a sharply amputated thumb in a 28-year-old male at the metacarpal-phalangeal joint level in a 4.5 hour procedure. Two arteries and 2 veins were anastomosed using 8-0 monofilament nylon and 7-0 braided silk suture. The patient remained in the hospital for 40 days and did not return to work for 4 months. News of this triumph of microvascular skill was heralded throughout the world as the first successful replantation of a completely amputated digit. Over the past half century, the field of digit replantation in the USA experienced exponential growth followed by a steady decline in volume of cases and percentage of successful viable digits. The initial enthusiasm and technical progress of digital replantation has been tempered by mediocre functional outcomes, rising healthcare costs, and limited healthcare resources. In the next 50 years, it is possible that the majority of digit replantation procedures in the USA may be performed in tertiary centers or regional replant centers by highly skilled teams.

Microsurgical management of acute traumatic injuries of the hand and fingers.

Traumatic injuries of the hand and fingers may be devastating and can result in irreversible functional and psychological problems in individuals who sustain them. They occur in all age groups, ranging from the elderly to young children. The management of these injuries can be challenging and onerous. As a result, it is imperative that the surgeon be both knowledgeable and meticulous in order to afford the best possible outcomes. This review focuses on the anatomy, initial evaluation, and acute management of these injuries. A variety of treatment algorithms are discussed as well, including primary closure, grafting, commonly utilized flaps, and replantation.

[Otto Hilgenfeldt (1900 to 1983)--an unusual approach for finger reconstruction]. / Otto Hilgenfeldt (1900 bis 1983)--Ein ungewöhnliches Verfahren zum Fingerersatz.

Reconstructive surgery of detached extremities, especially fingers, has a long historical tradition. The first clinically correctly documented cases go back to the 19th century. During the first and second world wars numerous reports appeared about the surgical care of war victims. Pioneering innovative surgical methods were developed by especially motivated surgeons for the reconstruction of these disfiguring war injuries in Europe. Because of these particular circumstances and the prevailing revolutionary spirit, many innovations in surgery were developed. The report of Otto Hilgenfeldt (1950) described his unusual approach in reconstructing a finger by using the great toe.

No man's land revisited: the primary flexor tendon repair controversy.

New surgical procedures, novel concepts, and/or the presentation of very good results with an apparently discredited technique meet varying degrees of resistance among the establishment of any profession. In hand surgery this phenomenon was exemplified in a striking fashion with the presentation of a controversial report entitled, "Primary repair of flexor tendons in no man's land" by Kleinert, Kutz, Ashbell, and Martinez of Louisville, KY, at the 1967 American Society for Surgery of the Hand (ASSH) annual meeting. The discussant, Joseph Boyes, expressed such skepticism that a special ASSH committee was appointed to go to Louisville and review the results to determine if they were as good as claimed. They were, and today primary flexor tendon repair is the procedure of choice for most flexor tendon lacerations.

Historical perspective of finger joint motion: the hand-me-downs of our predecessors. The Richard J. Smith Memorial Lecture.

Understanding the mechanics of human dexterity requires an appreciation of the kinetic chains that comprise the hand and the intricate interplay of muscles and ligaments that control its movements. Some of the salient contributions to this field are described from a personal point of view in the hope that this perspective will stimulate further understanding of this unique human tool.

Composite graft replacement of digital tips. 1. Before 1850 and after 1950.

The successes of composite grafting of fingertips in the early years of plastic surgery have been repeated in the few studies of this treatment which have been reported during the last 50 years. The early and recent history of this subject are reviewed in the light of the increasingly pessimistic view of composite graft replacement of fingertips taken by recent reviewers.

[Robert Schumann. From music to orthopedics]. / Robert Schumann. De la musique à l'orthopédie.

The psychiatric personality of Robert Schumann has notably concerned doctors. On the contrary his right hand orthopedic impairment seems to have been neglected. Relying on some well established facts and the fingering study of certain musical works, the authors put forward a plausible diagnosis and consider a treatment which would have allowed a functional rehabilitation of the great musician and nine-fingers-handed pianist.

Carpenter's nails, phonograph needles, piano wires, and safety pins: the history of operative fixation of metacarpal and phalangeal fractures.

This century has witnessed advances in basic sciences that have led to and resulted from advances in operative fixation of fractures. In addition to the sweeping changes in medicine and surgery, the development of corrosion-resistant alloys underpins all current concepts of fracture surgery. Most of the techniques were originally borrowed from work on large bones and most of the materials came from workshops or sewing boxes. Today, as improved understanding of bone healing and appropriate application of mechanical principles to skeletal injuries have become indispensable for appreciating the relative value of these techniques, operative fixation of hand fractures has emerged as a science in its own right.