Successful prolonged local infusion of urokinase for the hypothenar hammer syndrome.

Ulnar artery thrombosis secondary to trauma, also known as the hypothenar hammer syndrome, has been most commonly been treated by surgical techniques. Applying concepts of local lysis of thrombotic occlusion used in cardiac and peripheral vascular intervention, we describe a method of correction of the hypothenar hammer syndrome by prolonged urokinase infusion.

The hand in Charcot-Marie-Tooth disease.

The upper extremity was evaluated in 68 symptomatic individuals previously diagnosed as having Charcot-Marie-Tooth disease. Consistent patterns of motor and sensory involvement were found noted as well as a predictable progression of neuromuscular deficits. Improved understanding of the clinical behaviour of this disorder is necessary to develop better treatment strategies.

Quantification of error in measurement of radial inclination angle and radial-carpal distance.

Posteroanterior wrist radiographs of eight patients were evaluated by eight orthopedists. Radial inclination angle and radial-carpal distance were measured by use of a standardized technique. The standard deviation for radial inclination angle was 2 degrees. The standard deviation for radial-carpal distance was 1 mm. The measured rotational variation of radial inclination and radial-carpal distance is 1 degree and 1 mm, respectively, through a 10-degree arc of supination and pronation.

Doppler mapping in hypothenar syndrome: an alternative to angiography.

Four patients with hypothenar hammer syndrome were evaluated preoperatively with Doppler mapping and angiography. Both tests documented ulnar artery occlusion. In one patient, the proximal extent of thrombosis could not be identified by angiography. In all cases Doppler mapping accurately documented the extent of occlusion as confirmed by surgical exploration. Doppler mapping is a noninvasive alternative to angiography in the evaluation of hypothenar hammer syndrome.

The effect of dacarbazine on wound healing.

The effects of dacarbazine on wound healing were studied in an animal model. Sixty rats were divided into four groups. Each animal received a standard dorsal midline wound on day 0. Group 1 was injected with normal saline and acted as control; group 2 received 4 mg/kg of dacarbazine daily on days -3, -2, -1 (preoperative); group 3 received dacarbazine on days +1, +2, +3 (perioperatively); and group 4 received dacarbazine on days +5, +6, +7 (postoperatively). Wound bursting strength (WBS) was measured on days +7, +14, and +21. There was a significant decrease in WBS in experimental animals in groups 3 and 4 (perioperative and postoperative administration) compared to control animals, but no significant effect of preoperative dacarbazine on WBS in experimental animals (group 2). It is suggested that these effects are mediated through the late inflammatory phase of wound healing.

Composite tissue transfer in burn patients.

The advent of microsurgery has presented many advantages to the reconstructive surgeon in the treatment of burns and their resultant deformities. The skilled microsurgeon has a vast armamentarium from which to choose. The best method of reconstruction requires a thorough knowledge of flap alternatives and careful patient individualization. Five clinical cases are presented.

The effect of perioperative adriamycin on skin-graft take and adherence in the rat.

This two-part study was undertaken to evaluate the effect of perioperative Adriamycin on skin-graft take and adherence in an animal model. Thirty-four male Fisher rats were divided into control and experimental groups. The controls received intravenous saline, and the experimental animals received Adriamycin 6 mg/kg (LD 10) 24 hours preoperatively. Each animal was then grafted with an autogenous split-thickness skin graft on a contiguous dermal and fascial bed. Skin-graft take was judged and measured at 7 and 14 days postoperatively. The average skin-graft take for controls was 6.1 cm2 on both the dermal and fascial beds. This was significantly better than the average skin-graft take sustained by the experimental groups of 4.3 and 3.5 cm2 on the dermal and fascial beds, respectively (p less than 0.01). Another 30 animals were divided into three control and three experimental groups. They were treated with saline and Adriamycin as before, and they underwent a similar surgical procedure. Skin-graft adherence, which was measured at 12, 24, and 48 hours postoperatively, was significantly less in the experimental groups compared with the control groups at all times measured. These data suggest that a single supratherapeutic dose of Adriamycin given preoperatively decreases skin graft take in the experimental model studied and that this decrease may be the result of a concomitant decrease in graft adherence.

Chemotherapy and wound healing.

This paper provides a review of common chemotherapeutic agents and the experimental evidence supporting their effects on wound healing. Correlation with clinical studies is used to establish relevance, and therapeutic guidelines are developed.

Meshed skin grafts versus sheet skin grafts on a contaminated bed.

An experimental model was designed to test the premise that meshed skin grafts survive better than sheet grafts on contaminated wounds. In this rat model, meshing of grafts significantly improved graft take, and expansion of the mesh led to an even greater improvement. The results of this study indicate a need for further investigation of this technique in the management of contaminated wounds.

External fixation for pedicle-flap immobilization: a new method providing limited motion.

The external fixater has proven to be an effective method of providing immobilization in pedicle-flap surgery. In certain instances, when the pedicle will permit some degree of mobility, limited-motion fixation eliminates the common disadvantages of rigid fixation. On this basis, we recommend the use of a ball-joint adapter in conjunction with the external fixater for certain types of pedicle-flap immobilization.

Innervated cross-leg tensor fascia lata fasciocutaneous flap for foot reconstruction.

A traumatic, extended first ray amputation in a child was treated with an innervated cross-leg tensor fascia lata fasciocutaneous flap. The flap provided thin composite tissue coverage, immobilization in a position of relative comfort, and sensory innervation to the weight-bearing surface. Consideration of this flap is recommended when dealing with large defects of the foot.

The effects of Surgicel on bone formation.

The subperiosteal implantation of Surgicel has been advocated for the stimulation of bone formation by some authors. A clinical trial in five patients demonstrated no radiographic evidence of bone formation after 12 months. An experimental model was designed in the rabbit. This study also demonstrated no radiographic or histologic evidence of bone formation with the use of subperiosteal Surgicel. The further use of Surgicel for the stimulation of bone formation is not recommended.