Botulinum toxin as an adjunct for severe Dupuytren's contracture treated with collagenase injections.

Even with Dupuytren's proximal interphalangeal joint (PIPJ) contractures successfully released, volar flexor muscle memory can contribute to persistent contracture. We report using botulinum toxin (BoNTA) to the flexor digitorum superficialis muscle (FDS) to reduce flexor tone during recovery. .

Needle Aponeurotomy for Stage IV Dupuytren Contracture: A Wide-Awake First Step Approach in 204 Consecutive Rays.

Summary: Severe forms of Dupuytren disease are difficult to treat. Surgical fasciectomy is often the first choice, despite its high complication rate. At times, amputation is recommended.

Treatment Options for Dupuytren's Disease: Tips and Tricks.

Unlabelled: Dupuytren's disease (DD) is a common fibroproliferative condition of the hand.

Methods: Management of DD includes observation, non-operative management, and operative management. Operative treatments include percutaneous needle fasciotomy (PNF), open fasciotomy (OF), Clostridium collagenase histolyticum (CCH) injections, limited fasciectomy (LF) and dermofasciectomy (DF).

Collagenase Tenotomy for Dupuytren Boutonniere.

Summary: Treatment of boutonniere Dupuytren disease is rare and is resistant to treatment because of altered tendon dynamics. The authors used a small dose of collagenase clostridium histolyticum for an enzymatic tenotomy of the distal interphalangeal joint and showed that hyperextension at the distal interphalangeal joint improved significantly. Fifteen patients with boutonniere Dupuytren disease with severe proximal interphalangeal joint contractures averaging -69 degrees of extension were included in the study.

Evidence-Based Medicine: Options for Dupuytren's Contracture: Incise, Excise, and Dissolve.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren's disease. 2.

Axillary Web Syndrome: Current Understanding and New Directions for Treatment.

Background: Axillary web syndrome (AWS) is a poorly understood but common cause of significant morbidity after axillary lymph node dissection for breast cancer. It is characterized by painful scar tissue formation and contracture extending from the axilla down the medial arm which limits shoulder and arm mobility. We sought to gain a better understanding of its pathophysiology and available treatments.

The 19th Century Origins of Facial Cosmetic Surgery and John H. Woodbury.

John H. Woodbury was an incredibly entrepreneurial, self-trained dermatologist who, between 1870 and 1909, built an empire of cosmetic surgery institutes in 6 states, with 25 physician/surgeon employees and an advertising budget of $150,000/year (1892 data). Under his management, his surgeons, and perhaps Woodbury himself, performed multiple facial cosmetic surgeries, including early versions of browlifts, frown excisions, lower facelifts, mid-face lifts, rhinoplasties, double-chin reductions, and dimple creation.

Minimally invasive options in Dupuytren's contracture: aponeurotomy, enzymes, stretching, and fat grafting.

Learning Objectives: After studying this article, the participant should be able to: (1) Perform needle aponeurotomy, fat grafting, Digit Widget insertion, and collagenase injection for Dupuytren's cords. (2) Describe how cords can be stretched without surgery. (3) Explain to patients the risks and benefits of these new alternatives of treatments.

Nerve and arterial supply to the hand in Vesalius's De Humani Corporis Fabrica.

Belgian anatomist Andreas Vesalius, in his groundbreaking medical atlas De Humani Corporis Fabrica, 1543, committed to paper two anatomical errors relating to the vascular and nervous system of the hand. In the diagrams, he depicts a highly irregular symmetrical sensory innervation of the median and ulnar nerves. He also fails to mention or illustrate the deep or superficial palmar arches.

Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions.

Purpose: To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results.

Methods: This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English.

Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature.

Objective: Excisional surgery is the mainstay of treatment of Dupuytren's disease. Although outcomes are generally good, complications are common. The objective of this study was to evaluate intraoperative and postoperative complications associated with fasciectomy for Dupuytren's disease.

Finger injection with high-dose (1:1,000) epinephrine: Does it cause finger necrosis and should it be treated?

Objectives: Accidental finger injections with high-dose (1:1,000) epinephrine is a new and increasing phenomenon. The purpose of this study is to document the incidence of finger necrosis and the treatment for this type of injury. The necessity or type of treatment required for this type of injury has not been established.

A critical look at the evidence for and against elective epinephrine use in the finger.

Background: Medical texts continue to perpetuate the belief that epinephrine should not be injected in fingers. Little attention has been paid to analyze the evidence that created this belief to see whether it is valid. The significance is that elective epinephrine finger injection has been shown to remove the need for a tourniquet, and therefore delete sedation and general anesthesia for much of hand surgery.

Extended crescent mastopexy with augmentation.

Problems with periareola or circumareolar mastopexy procedures include areola spreading, hypertrophic scar, and recurrence of the ptosis largely because of tension on the closure. To minimize this tension associated with a conventional crescent mastopexy procedure, the authors modified the operation by excising parenchyma with the crescent of skin as well as two small triangles of parenchyma on either side of the areola. Implant augmentation was performed at the same time.

A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase.

Purpose: To examine prospectively the incidence of digital infarction and phentolamine rescue in a large series of patients in whom local anesthesia with adrenaline was injected electively into the hand and fingers. There continues to be a commonly held belief that epinephrine injection is contraindicated in the finger despite a lack of valid evidence to support this concept in the literature.

Methods: From 2002 to 2004 there were 9 hand surgeons in 6 cities who prospectively recorded each consecutive case of elective hand and finger epinephrine injection.