A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren's disease.

Before surgery for Dupuytren's contracture, 54 patients with a proximal interphalangeal (PIP) joint flexion contractures of at least 30° were randomized to receive either a 3-month splinting protocol together with hand therapy under the direct supervision of hand therapists, or the same hand therapy alone. Extension deficit of the PIP joint (primary outcome measure), global perceived effect, pain intensity, comfort and complications were assessed at baseline and 1 year after surgery. In an intention-to-treat analysis, the group assigned to splint-plus-hand therapy had a mean reduction of 21° in flexion contracture after 1 year, compared with 29° in the group receiving hand therapy alone (p = 0.1). There was no difference between the groups regarding other parameters. After operative release of a Dupuytren's contracture, a postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures.

Surgical management of hypothenar and thenar hammer syndromes: a retrospective study of 31 instances in 28 patients.

This retrospective study assessed the results of treatment of 29 cases of hypothenar hammer syndrome and two cases of thenar hammer syndrome. Three hands were symptom free, 15 were improved, 11 were unchanged and two were worse at a mean follow-up of 43 (range 4-60) months. Follow-up colour-coded Duplex sonography of revascularizations (n=27) revealed 13 patent, five occluded and one partially thrombosed grafts, seven grafts with aneurysmal dilatations and one coiled graft. Colour-coded Duplex sonography results after venous interposition graft combined with endoscopic thoracic sympathectomy were no better than venous interposition graft alone. All three arterial interposition grafts and two end-to-end-reconstructions were patent. The Duplex outcomes of the revascularizations did not correspond well with the clinical outcomes. Endoscopic thoracic sympathectomy was associated with a high rate of inconvenient side effects.

[Fifty years of plastic surgery in the Netherlands. I. Seemingly minor accidents: major hand injuries]. / Vijftig jaar plastische chirurgie in Nederland. I. Ogenschijnlijk kleine ongevallen: grote handletsels.

In patients with hand injury, careful clinical examination is necessary, even in cases of seemingly trivial lesions such as small puncture wounds. Four patients, two women aged 18 and 51 years and two men aged 16 and 28 years, presented with a small volar cut caused by a glass fragment (three patients) and a saw. They suffered from loss of motor function, loss of sensibility or loss of circulation in one finger. They were treated by plastic surgery. Lesions of tendons and peripheral nerves can be diagnosed by relatively simple tests. It is important to recognize them at an early stage because adequate treatment may result in recovery of the sensibility and the motor function. Even a 'dead' finger may be salvaged.

[Fifty years of plastic surgery in the Netherlands. VII. Hand surgery]. / Vijftig jaar plastische chirurgie in Nederland. VII. Handchirurgie.

The first and second world wars were responsible for a turbulent development of surgery of the hand. The sixties and seventies were marked by the emergence of microsurgery, growing of the knowledge of functional anatomy and use of vascularized skin flaps and joint prostheses. These days hand surgery is mainly concentrated in 'hand centres', with co-operation of a plastic surgeon, physical and occupational therapists and rehabilitation specialists. In the future much can be expected from the genetic and metabolic manipulation of congenital malformations and acquired deformities.

The distally based sural artery flap.

The sural artery flap is a distally based fasciocutaneous flap. It is based on a reverse flow through anastomoses between the peroneal artery and the communicating vascular network of the medial sural nerve. In the difficult area of defects in the lower leg and the ankle and heel region, it has a wide variety of indications, even in vascularly compromised patients. It has the largest arc of rotation of all flaps that have been described in this region. The most important advantage is that it does not compromise a major artery. Furthermore, it is simple to dissect and has a low donor morbidity. A series of 15 patients is described in which we covered defects in the lower leg, malleolar, and heel regions. Seven patients were vascularly compromised seriously. Twelve flaps survived completely, two survived partially, and one flap failed.

Quantitative pH imaging in cells using confocal fluorescence lifetime imaging microscopy.

The pH-sensitive probe carboxy SNAFL-1 can be used for imaging using ratiometric and fluorescence lifetime techniques. The former method suffers from the drawback that quantitative pH imaging in cells requires a time-consuming and cumbersome calibration procedure. In contrast, straightforward calibrations in buffer suffice for fluorescence lifetime imaging. This is illustrated here by a comparative study of the two techniques under different controlled conditions. The effect of probe concentration, protein concentration, and hydrophobicity, the contents of damaged cells and living cells on the emission ratio, and the fluorescence lifetime of carboxy SNAFL-1 were studied. The results clearly demonstrate that the fluorescence lifetime imaging technique is more convenient than the ratiometric method for pH determination.

Confocal fluorescence lifetime imaging of free calcium in single cells.

Ca(2+) concentrations in biological cells are widely studied with fluorescent probes. The probes have a high selectivity for free calcium and exhibit marked changes in their photophysical properties upon binding. The differences in the fluorescent lifetime of the probes can now be used as a contrast mechanism for imaging purposes. This technique can be further exploited for the quantitative determination of ion concentrations within the cells. We describe the use of a fast fluorescence lifetime imaging method in combination with a standard confocal laser scanning microscope for the determination of Ca(2+) concentrations in single rat cardiac myocytes using the intensity probe Calcium Green.

Fowler's tenotomy for mallet deformity.

35 patients with established mallet finger deformities were treated with Fowler's tenotomy of the central extensor tendon. The mean lack of extension before operation was 45 degrees. 26 patients regained full extension, eight patients had a residual deformity of 10-20 degrees and one patient of 30 degrees.

Intraneural lipofibroma of the median nerve.

A case of an intraneural lipofibroma of the median nerve is described. The patient was first seen with an enlarging mass on the flexor side of the wrist and in the palm. After interfascicular dissection of the tumor there was a permanent loss in sensibility and motor function. In most cases decompression of the nerve will suffice; resection by means of interfascicular dissection is rarely justified.

Bilateral congenital hypoplasia of the carpal scaphoid bone.

A case of bilateral congenital scaphoid hypoplasia, with wasting of the thenar muscles and absence of certain muscles of the forearm is presented. The patient had additional congenital disorders of the vertebrae, skull and elbow.

The result of breast reconstruction after mastectomy for breast cancer in 109 patients.

One hundred and eleven breast reconstructions after a mastectomy for carcinoma in 109 patients are reported. Depending on the quality of muscle and skin coverage, reconstructions were performed either with a latissimus dorsi musculocutaneous flap or a subpectoral prosthesis (including expander prosthesis). The follow-up involved 90 patients. The purely aesthetic results as well as the very positive result of reconstruction with regard to appearance in clothing, participation in sports, and self-esteem were of great importance to the patients. The difference in ptosis, the most obvious shortcoming in our reconstructions, is discussed. Attention is given to the importance of flap planning and the restoration of the anterior axillary fold in the latissimus dorsi flap reconstructions. The disappointing results of tissue expansion and the shortcomings of the nipple-areola reconstructions are discussed.

Tissue expansion in reconstructive surgery.

A surplus of skin for closure of a defect can be obtained by gradual filling of a subcutaneous balloon. In this way reconstruction of extensive skin defects with neighbouring skin is possible. Two patients with skin defects of the head are illustrative for this expansion technique. The technique, indications and histology are discussed.