Evaluation outcome of replanted digits using the DASH score: review of 38 patients.

The ultimate usefulness of replanted fingers is related to the adequacy of nerve, tendon and bone repair. Thirty-eight patients with successful replantation of the thumb, a single finger or after multiple digital amputations were followed up clinically. The subjective disability after finger replantation was evaluated by means of the DASH score, and the presence of cold intolerance was assessed.

A variant of Cenani-Lenz syndactyly (CLS): review of the literature and attempt of classification.

An oligodactylous variant of Cenani-Lenz syndactyly and its surgical treatment is presented. The deformity is believed to be of autosomal recessive inheritance and caused by a disordered axial and longitudinal differentiation of the upper and lower extremities. The classical form is mainly characterised by a complete syndactyly of the hands.

Self-reinforced bioabsorbable miniplates for skeletal fixation in complex hand injury: three case reports.

We report our preliminary experience with 3 cases in which internal fixation with a self-reinforced poly-l/dl-lactide 70/30 miniplate and 1.5-mm or 2.0-mm screws were used to stabilize an open metacarpal fracture, a metacarpophalangeal arthrodesis in a thumb replantation, and an interposed bone graft for reconstruction of a thumb.

Sonographic evaluation of primary peripheral nerve repair.

Objective: This feasibility study was undertaken to define the potential of sonography for the follow-up evaluation of patients with surgical repair after nerve transection and persistent impairment of nerve function.

Methods: Nineteen patients with primary repair of a transected peripheral nerve because of direct trauma or complex fractures were evaluated with sonography. All patients had persistent clinical symptoms and neurologic signs of impaired nerve function.

Distally based abductor hallucis muscle flap: anatomic basis and clinical application.

Although rarely used, the abductor hallucis muscle has its indications in coverage of small defects at the medial aspect of the hindfoot as a proximally based muscle flap. The authors describe a 69-year-old female patient in whom the abductor hallucis muscle was used as a distally based flap to reconstruct a defect in the forefoot. An anatomic study was undertaken on two cadaveric feet to explore the practicality of the distally based abductor hallucis muscle flap before it was applied clinically.

Treatment of distal radioulnar joint disorders with a modified Sauvé-Kapandji procedure: long-term outcome with special attention to the DASH Questionnaire.

Introduction: An intact distal radioulnar joint (DRUJ) is essential for normal functioning of the upper limb. Osteoarthritis of the DRUJ often leads to ulnar wrist pain, limitation of forearm rotation and reduced grip strength, all of which limit activities of daily living. Once the joint is damaged, salvage procedures are recommended.

Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site.

In this report, the authors describe the application of a muscle-sparing technique to harvest a myocutaneous latissimus dorsi muscle flap, including only a tiny lateral muscle segment but carrying a large skin paddle, with the advantage of leaving intact innervation and function of the remaining latissimus dorsi muscle. According to the experiences and complications associated with the pure thoracodorsal artery perforator harvest at the authors' institution, the necessity of increasing the reliability of the vascular pedicle demands that a small muscle strip be left embedding the perforator vessels attached to the skin paddle. This procedure was applied in eight cases with only one minor complication, which was a distal flap tip necrosis in the largest flap used.

[Technical refinements in planning and surgical therapy of pectus carinatum].

From 1998 to 2002 ten patients underwent surgical correction of pectus carinatum using a new diagnostic preoperative three-dimensional volume rendering mode computed tomography. Particularly the deformed rib cartilages can now also be visualized, which allows exact preoperative planning of the extent of cartilage resection and localization of required sternum osteotomies. This additional information results in a focused surgical approach and hence minimizes scars.

Ultrasonographic appearance of supinator syndrome.

Objective: To describe ultrasonographic findings in 4 patients with supinator syndrome (i.e., deep branch of the radial nerve).

Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy.

Objective: To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy.

Methods: Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer.

[Free microvascular transplantation of parts of the great toe for thumb reconstruction].

Purpose/background: A reconstructed thumb has to fulfil the function of opposition, pinch-grip, stability, sufficient length, sufficient sensibility, and painlessness. Next to pollicisation, these requirements can only be met satisfactory by the microvascular free great toe-to-hand transplantation. The goal of a thumb reconstruction is a compromise between an optimal functional and aesthetic outcome and a minimal morbidity of the donor site.

Receptors for NGF and GDNF are highly expressed in human peripheral nerve neuroma.

Immunhistochemistry of 10 traumatic human peripheral nerve neuromas and 5 normal digital nerves revealed a high immunoreactivity for the nerve growth factor (NGF) receptors p75 and trkA and the glial cell line-derived neurotrophic factor (GDNF) receptor GFRalpha-1. Semiquantitative image analysis showed a significantly increased trkA immunoreactivity in the neuroma group. The presence of the receptors may provide a way to influence therapy of peripheral nerve neuroma by administration of neurotrophins or other substances with binding sites similar to those of a neurotrophic factor.

High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease.

Objective: The value of sonography for the diagnosis of diseases of the peripheral nervous system is only little known. This image presentation is intended to raise the awareness of sonographers and clinicians of the potential of sonography by giving an anatomic-sonographic correlation of lower extremity peripheral nerves and an overview of commonly encountered diseases.

Methods: On 2 lower extremity cadaver specimens, peripheral nerves were imaged in typical locations such as the tarsal tunnel.

Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases.

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications.

The lateral arm flap.

The authors contend that the conventional flap (LAF) and the ELAF should be considered among the best choices of all possible fasciocutaneous flaps for head and neck reconstruction. Easy and quick dissection under tourniquet, design variability, and potential sensory innervation make these flaps superior to other fasciocutaneous flaps. The ELAF provides the same pliable, thin fasciocutaneous tissue and a longer pedicle than the RFF.

Radial nerve palsy associated with humeral shaft fracture: evaluation with US--initial experience.

Purpose: To determine the feasibility of using ultrasonography (US) for evaluation of a radial nerve injury associated with humeral shaft fracture.

Materials And Methods: In a prospective study, 11 consecutive patients with sensorimotor radial deficiency after distal humeral fracture were evaluated with conventional radiography, US, electroneurography, and electromyography. Surgical repair of the fracture and nerve inspection were performed in five patients.

A case of mirror hand deformity with a 17-year postoperative follow up. Case report.

We present a case of a boy with a congenital upper-extremity malformation, including aplasia of the radius, double ulna, aplasia of the thumb, and polydactyly with a 17-year postoperative follow-up. The whole extremity, particularly the upper arm and shoulder girdle were hypoplastic. There was restriction of movement of the elbow and a flexion contracture of the wrist.

Transpositional replantation of digits. Case reports.

Heterotopic or transpositional replantation of digits is technically feasible with results similar to those of conventional replantation procedures. Occasionally in multiple digital amputations not all the digits may be replanted in their correct place as a result of complex injuries proximal to the amputation zone or severe damage to important fingers. In these circumstances the amputated digits that are in the best condition as regards undamaged tissue are used for replantation.

[Iatrogenic lesion of the accessory nerve in cervical lymph node biopsy].

The majority of lesions of the spinal accessory nerve occur as an iatrogenic injury after lymph node biopsy in the posterior cervical triangle (trigonum colli laterale). In most cases the accessory nerve palsy is not recognised immediately after the injury. Therefore surgical repair is often performed too late to regain sufficient function of the paralytic trapezius muscle.

Free flap reconstruction of the foot.

Free flap reconstruction of the foot has been widely performed in the last 20 years, but choice of a free transferred substitute for the soft tissue of the particular defect remains controversial. The authors present a series of 77 free flaps to the foot performed in 68 patients during October 1976 and September 1997. Long-term follow-up ranged from 12 months to 18 years (median, 44.

One-stage reconstruction of defects in the hypopharyngeal region with free flaps.

Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed.

The lateral arm flap: review of 72 cases and technical refinements.

Between 1985 and 1995, 72 free lateral arm flaps (LAFs) were transferred in 68 patients. The main purpose of the reported study was to demonstrate a comprehensive follow-up and essential technical refinements: extension of the flap, shaping of a custom-designed flap, the "emergency" free flap, and sensible nerve coaptation. The effect of nerve coaptation vs.

Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects.

Full-thickness abdominal wall defects continue to be a challenge for the reconstructive surgeon. The most frequently used reconstructive techniques are transfer of a pedicled, local abdominal flap or a distant flap from the thigh region. The purpose of this paper is to present a new approach to full-thickness abdominal wall reconstruction using an innervated free latissimus dorsi musculocutaneous flap.

Reconstruction of a complex hypopharyngeal cervical defect with a single latissimus dorsi free flap.

Large, complex hypopharyngeal defects that include mucosa and cervical skin, and that result from debridement of orocutaneous fistulas secondary to failed repairs of laryngectomy defects, are difficult to treat, especially when previous irradiation has damaged adjacent tissues. We have found that such defects can be repaired sufficiently in one stage using a latissimus dorsi musculocutaneous free flap. The wound is debrided until only healthy tissue remains.