Free vascularized temporal parietal flap in hand surgery.

Free vascularized temporo-parietal fascia (TPF) flap is a flap of thin, pliable and vascularized tissue which can cover an area measuring up to 12 cm x 14 cm. The flap is harvested based on temporal vessels, which provide a smooth, gliding surface for tendon function and eliminates the need for secondary procedures usually required by the pedicled or bulky free vascularized myocutaneous flaps. The donor pedicle is long and consistent with an average diameter of 3 mm in adults. This flap is versatile. In 12 resurfacings for traumatic wounds of hand and wrist, no flaps were lost. Donor site morbidity, except for a transient sideburn hair loss in one case, was not encountered. We recommend this flap as a viable one-stage procedure for coverage of complex hand wounds.

Enzymes of B-ring-deoxy flavonoid biosynthesis in elicited cell cultures of "old man" cactus (Cephalocereus senilis).

Elicited cell cultures of the cactus Cephalocereus senilis produce a group of flavonoids with unsubstituted B-rings, including an aurone which represents a new class of phytoalexin. Preliminary enzymological studies indicated that the chalcone synthase (CHS) and chalcone isomerase (CHI) from cultures of C. senilis were active with cinnamoyl-CoA and 2',4',6'-trihydroxychalcone, respectively, probable intermediates for synthesis of flavonoids with unsubstituted B-rings. We now demonstrate that the cultures contain two isoforms of CHI, both of which are induced by elicitor treatment and are active with both 2',4,4',6'-tetrahydroxy- and 2',4',6'-trihydroxychalcone. (Hydroxy)-cinnamate:CoA ligase in the cactus cultures was active with cinnamic, 4-coumaric, caffeic, ferulic, and 4-methoxycinnamic acids, but not sinapic acid. A single form of CoA ligase, as resolved by chromatofocusing analysis, was active against both cinnamate and 4-coumarate. Cinnamic acid 4-hydroxylase (CA4H) activity was induced by elicitor treatment. Thus, elicited cultures contain the necessary enzymatic activities for synthesis of B-ring-hydroxy and -deoxy flavonoids. Synthesis of only the deoxy class in response to elicitation may result from some form of metabolic compartmentation through which the CA4H reaction is bypassed, leading to formation of cinnamoyl CoA which may then be incorporated into B-ring deoxy flavonoids via nondiscriminating CHS and CHI activities.

The effect of intercarpal joint motion on wrist motion: are there key joints? An in vitro study.

The contribution of each intercarpal joint individually and as a member of a regional group to total wrist motion was analyzed in 10 fresh, frozen cadaver specimens. Each intercarpal joint had an effect on the total wrist motion, but the contribution of each to the different planes of motion was not equal. The scaphoid-capitate joint had a governing effect on the motion of a region comprised of scaphoid-trapezium, scaphoid-trapezoid, and scaphoid-capitate. The lunate-capitate joint had a governing effect on the motion of a region comprised of the lunate-triquetrum, lunate-capitate, triquetrum-hamate, and hamate-capitate complex. Elimination of motion in either of the key governing joints affected total wrist motion the same as elimination of motion in all the joints in that region. Intercarpal fusion for treatment of ligament injury of the proximal intercarpal row may be limited to the scaphoid-capitate or lunate-capitate joint. There is no need to attempt fusion in all joints of either of the two regions.

Ethylene is not involved in the blue light-induced growth inhibition of red light-grown peas.

Although the growth of intact plants is inhibited by irradiation with blue light, the growth rate of isolated stem segments is largely unaffected by blue light. We hypothesized that this loss of responsiveness was a result of ethylene production as part of the wounding response. However, we found no interaction between ethylene- and blue light-induced growth inhibition in dark- or red light-grown seedlings of pea (Pisum sativum L.). Inhibition of growth begins in dark-grown seedlings exposed to blue light within 3 min of the onset of blue light, as was known for red light-grown seedlings. By contrast, ethylene-induced inhibition of growth occurs only after a lag of 20 to 30 min or more (dark-grown seedlings) or 60 min (red light-grown seedlings). Also, the inhibition response of red light-grown seedlings is the same whether ethylene is present from the onset of continuous blue-light treatment or not. Finally the spatial distribution of inhibition following blue light was different from that following ethylene treatment.

Segmental motion of the proximal carpal row: their global effect on the wrist motion.

The contribution of the scapho-lunate and luno-triquetral joints to global wrist motion was studied in 11 fresh-frozen cadaver specimens. The carpus were labeled with metallic markers and the joints were selectively transfixed with wires. The wrist was allowed to follow its natural radial and ulnar deviation during flexion and extension, extension and flexion during radial and ulnar deviation, respectively. The data was collected by means of radiography, goniometric measurement, and computer analysis. The proximal carpal row (the intercalated segment) although anatomically represented as a row, presented through its two intersegmental joints, a definite segmental behavior. Each intersegmental joint of the proximal carpal row influenced global wrist motion in all directions but to a different degree for each plane of motion. The segmental joints within the intercalated segment collectively govern 40% of the wrist flexion, 33% of extension, and 10% of ulnar deviation. The scaphoid through its scapho-lunate link exerts a governing effect on total intersegmental proximal carpal row contribution to the global wrist motion.

Median innervated hypothenar muscle: anomalous branch of median nerve in the carpal tunnel.

A hypothenar motor branch of the median nerve in the carpal tunnel was observed and its motor function was documented by direct intraoperative nerve stimulation in two patients having carpal tunnel releases. The hypothenar branch left the median nerve at the midcarpal tunnel area. It crossed the tunnel superficial to the flexor tendons and penetrated the transverse carpal ligament ulnarly to innervate the abductor digiti quinti. Such branching of the median nerve at this level has not been reported previously. Good visualization of the carpal tunnel and careful dissection of its content even in the so called safe zone ulnar to long axis of palmaris longus tendon is recommended.

Piso-triquetral pain syndrome after carpal tunnel release.

Hypothenar pain was a major complaint in 1.1% of patients 6 months after operation in 500 consecutive carpal tunnel releases. Pain, discomfort, and loss of grip strength was noticed mostly during activities requiring full hand grip or activities associated with use of the heel of the hand, such as pushing up from a chair, or pushing open a door with the flat palm. The pain originated from the piso-triquetral joint, possibly a result of intercarpal alignment change after carpal tunnel release. Pisiform excision was curative, with complete relief of symptoms and return of strength and dexterity. Awareness of this syndrome and systemic evaluation of the piso-triquetral joint preoperatively and postoperatively, as presented here, are essential in the management of this condition.