Biomechanical assessment of a novel tendon junction.

The Pulvertaft weave has been the standard tendon junction technique used both in tendon transfers and tendon grafts. A limitation of this repair is the sequential failure of stabilizing sutures, rather than the tendon. A novel loop weave is described and compared with the Pulvertaft weave in biomechanical performance. Ovine deep flexor and extensor tendons were used to simulate Pulvertaft or loop weaves (n = 11) for tensile testing. The Pulvertaft weaves failed at the stabilizing sutures, whereas the loop weaves repairs failed by longitudinal splitting of the motor tendon. The loop weave demonstrated significantly higher mean initial failure and ultimate strengths. Tensile loads required to elongate the loop weave by 4, 6, and 8 mm were significantly higher, while more displacement was associated with the Pulvertaft repair under the application of 50, 75, and 100 N tensile loads. This study demonstrates favourable biomechanical characteristics of the new loop weave technique.

The symptomatic carpal boss. Is simple excision enough?

We reviewed 48 patients with symptomatic carpal boss seen during the 10 year period 1985-1994. Thirty-one patients had undergone either local excision of the boss or arthrodesis of the affected carpometacarpal joint. The mean follow-up was 3 years and nine cases have been revised. Twenty-four patients remained symptomatic and considered that surgery had failed to relieve their symptoms. These findings are in sharp contrast to previous reports that suggest simple excision of the carpal boss gives uniformly good results.

Long-term results following digital flexor tenosynovectomy in rheumatoid arthritis.

A retrospective review of flexor tenosynovectomy for rheumatoid flexor tenosynovitis in the palm and digit was performed. Fifteen patients (61 fingers) were reviewed for at least 1 year (average, 4 years) after surgery. An average of 2.2 cm improvement in active flexion (pulp to distal palmar crease) was observed. A significant difference in preoperative and postoperative results was found. Sixty-seven percent of digits were classified as having excellent or good results, 21% fair results, and 12% poor results. The clinical recurrence rate was 31% and the reoperation rate was 15%. Only minimal complications from the extended surgical approach were observed. Debulking the fibro-osseous canal by excising a slip of flexor digitorum superficialis was associated with a reduction in the recurrence and reoperation rates.

A simple means of access for harvesting the lesser saphenous vein.

Enhanced patient expectations combined with improvements in vascular technique have increased the number of lower limb arterial bypass operations performed. The natural consequence is a parallel increase in the number of re-operations for failed or failing bypasses where the optimal conduit--the ipsilateral long saphenous vein has already been used. Indeed, there are many occasions where the long saphenous vein cannot be utilised at the primary operation, either because of the demands of coronary artery bypass surgery, or because of the presence of phlebitic vein segments. As autologous vein is generally preferred to prosthetic material for distal (tibial) bypasses, the vein must be harvested from other sites. Frequently there is insufficient or inadequate arm vein from a single source. Also, there is a natural reluctance to use the contralateral long saphenous vein, even if it is still available, because of the potential need for an arterial bypass on that side. The short saphenous vein is a valuable alternative. We describe a simplified approach (compared to the more conventional posterior approach) to harvest this vein which can then be used either in isolation or in combination with a superficial femoral endarterectomy or as part of a composite vein graft.