Extensor pollicis longus rerouting for thumb-in-palm deformity in cerebral palsy: a biomechanical analysis.

Extensor pollicis longus rerouting is a common procedure to improve thumb abduction in thumb-in-palm deformity seen with spastic cerebral palsy. In 1985, Manske redirected the extensor pollicis longus tendon in this procedure through the first extensor compartment. They also proposed an alternative subcutaneous route around the extensor pollicis brevis and abductor pollicis longus tendons proximal to the extensor compartment.

A microcosting study of the surgical correction of upper extremity deformity in children with spastic cerebral palsy.

Objective: Determine healthcare costs of upper-extremity surgical correction in children with spastic cerebral palsy (CP).

Method: This cohort study included 39 children with spastic CP who had surgery for their upper extremity at a Dutch hospital. A retrospective cost analysis was performed including both hospital and rehabilitation costs.

Wound drainage after plastic and reconstructive surgery of the breast.

Background: Wound drains are often used after plastic and reconstructive surgery of the breast, in order to reduce potential complications. It is unclear whether there is any evidence to support this practice and we therefore undertook a systematic review of the best evidence available.

Objectives: To compare the safety and efficacy of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast.

Short-term and Long-term Clinical Results of the Surgical Correction of Thumb-in-Palm Deformity in Patients With Cerebral Palsy.

Background: Thumb-in-palm deformity disturbs a functional grip of the hand in patients with cerebral palsy. Reported recurrence rates after surgical correction are contradicting and earlier studies are limited to short-term follow-up. Therefore, the aim of this retrospective clinical outcome study is to evaluate the success rate of surgical correction of thumb-in-palm deformity around 1 year and at a minimum of 5 years follow-up.

[Hand injuries caused by fireworks and treated by plastic surgeons].

Objective: To make an inventory of the number and nature of hand injuries caused by private firework use in the Netherlands during the New Year celebrations 2013-2014 and that were seen and treated by plastic surgeons.

Design: Descriptive study.

Method: In October 2013 the Netherlands Association of Plastic Surgeons (Nederlandse Vereniging voor Plastische Chirurgie) asked its members to register patients treated for hand injuries caused by fireworks during the New Year celebrations 2013-2014.

Intramuscular connective tissue differences in spastic and control muscle: a mechanical and histological study.

Cerebral palsy (CP) of the spastic type is a neurological disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks. Secondary to the spasticity, muscle adaptation is presumed to contribute to limitations in the passive range of joint motion. However, the mechanisms underlying these limitations are unknown.

Evaluating the Psychopathological Profile of Women Undergoing Reduction Mammaplasty With the Symptom Checklist-90-Revised.

Background: Patients who desire reduction mammaplasty (RM) also may seek relief from social and emotional challenges that accompany their physical condition, including low self-confidence and impaired body image. Reduction mammaplasty is known to improve patients' physical and psychological well-being. It may be speculated that patients who undergo RM are motivated by psychological problems and have psychopathologies.

[Unexpected abdominal trauma from a fireworks explosion].

Background: Fireworks injuries are common and often affect children. Such injuries should be considered high energy trauma in the emergency room and taken care of according to the principles of the Advanced Trauma Life Support (ATLS).

Case Description: A 7-year-old boy was a victim of an explosion when he set off illegal fireworks.

The effect of breast hypertrophy on patient posture.

Background: One of the reasons women with macromastia chose to undergo a breast reduction is to relieve their complaints of back, neck, and shoulder pain. We hypothesized that changes in posture after surgery may be the reason for the pain relief and that patient posture may correlate with symptomatic macromastia and may serve as an objective measure for complaints. The purpose of our study was to evaluate the effect of reduction mammaplasty on the posture of women with macromastia.

Wound drainage after plastic and reconstructive surgery of the breast.

Background: Wound drains are often used after plastic and reconstructive surgery of the breast, in order to reduce potential complications. It is unclear whether there is any evidence to support this practice and we therefore undertook a systematic review of the best evidence available.

Objectives: To compare the safety and efficacy of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast.

The prevalence and risk factors of infantile haemangiomas: a case-control study in the Dutch population.

Haemangiomas are considered to be the most common tumours of infancy. However, despite their frequent occurrence the aetiological determinants of their development remain unknown. Identifying these factors may provide insight on their pathogenesis.

Flexor carpi ulnaris tenotomy alone does not eliminate its contribution to wrist torque.

Background: Flexor carpi ulnaris muscle tenotomy and transfer to the extensor side of the wrist are common procedures used to improve wrist position and dexterity in patients with cerebral palsy. Our aim was to determine whether this muscle still influences wrist torque even after tenotomy of its distal tendon.

Methods: Intra-operatively, we determined in vivo maximal wrist torque in hemiplegic cerebral palsy patients (n=15, mean age 17 years) in three conditions: 1) with the arm and the muscle intact; 2) after tenotomy of the flexor carpi ulnaris just proximal to the pisiform bone, with complete release from its insertion; and 3) after careful dissection of the belly of the muscle from its fascial surroundings up until approximately halfway its length.

A proposal for classification of entities combining vascular malformations and deregulated growth.

Background: Agreement on terminology and nomenclature is fundamental and essential for effective exchange of information between clinicians and researchers. An adequate terminology to describe all patients showing vascular malformations combined with deregulated growth is at present not available.

Objectives: To propose a classification of patients with vascular malformations, not restricted to the face, and growth disturbances based on simple, clinically visible characteristics, on which clinicians and researchers can comment and which should eventually lead to an internationally accepted classification.

Long-term results of lateral band translocation for the correction of swan neck deformity in cerebral palsy.

Purpose: The aim of this study was to evaluate the long-term effect of lateral band translocation for correcting swan neck deformity in patients with cerebral palsy at a minimum follow-up of 5 years.

Methods: Swan neck deformities of 62 fingers were corrected using a modified lateral band translocation. At 1-year and 5-year follow-up, any recurrence of hyperextension was recorded through nonconstrained evaluation.

Development of a test for evaluation of taste perception after tongue reduction.

When performing a tongue reduction a frequently asked question is how operation will influence taste of the patient. Different kinds of taste tests are designed, most of these being non-specific ways to determine taste sensation in which high concentration of taste solutions are used to detect if a person is able to taste. To be able to judge the influence of tongue reduction on taste we wanted to develop a validated test that could be used in early childhood.

[Effect of surgical treatment on patients with cerebral palsy: improvement of manual dexterity but not of perceived competence].

Objective: To examine the relationship between impaired manual dexterity and perceived competence in children with cerebral palsy and the effect of surgical intervention, with the question whether the perceived competence is applicable as an outcome measure for surgical reconstruction of hand function.

Method: The Dutch version of the Michigan Hand Outcomes Questionnaire (MHQ-DLV) for perceived manual dexterity and the Dutch version of the Harter Scales for perceived competence were used in a sample of 25 children and adolescents with hemiplegic cerebral palsy of the spastic type. 10 patients underwent surgical treatment to improve hand function.

Draining after breast reduction: a randomised controlled inter-patient study.

One hundred and seven bilateral breast reductions were prospectively randomised during surgery to receive or not receive wound drains. Fifty-five patients were randomised to have a drain and 52 to not have a drain. There was no statistical difference in the number of complications between the drained and undrained group (P=0.

Assessment of Flexor carpi ulnaris function for tendon transfer surgery.

Active and passive length-force curves of spastic flexor carpi ulnaris (FCU) muscles were intra-operatively measured in 10 patients with cerebral palsy to study the variability in FCU muscle function. Maximum active FCU force was in general situated near the neutral position of the wrist and varied between 40 and 135 N. Passive forces varied between 1 and 8 N at maximum active force.

Myofascial force transmission and tendon transfer for patients suffering from spastic paresis: a review and some new observations.

The current rationale of clinical practice in spastic tendon transfer surgery is based on four assumptions: (1) changes in muscle fiber length (serial number of sarcomeres) determine the available length range and joint excursion, (2) muscle cross-sectional area determines the maximal force output, (3) fiber length and muscle force are invariable functions of muscle length, (4) there is an invariable relation between the elastic force and the active force exerted by the sarcomeres. The validity of these assumptions is discussed. Additionally, some new perspectives in muscle research are discussed and myofascial force transmission is introduced as a co-determinant for the outcome of tendon transfer by presenting some exploratory observations.

Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients.

Background: Combined skin-sparing mastectomy and immediate reconstruction by use of an implant is increasingly accepted as a therapy for patients with breast cancer or a hereditary risk of breast cancer. Because little and contradictory evidence regarding possible risk factors for postoperative complications is available, the authors retrospectively assessed 13 such factors. They also evaluated the oncological safety of the procedure.

Adaptation of the properties of spastic muscle with wrist extension deformity.

To show that human muscle may adapt to tendon transfer, adaptation of flexor carpi ulnaris (FCU) function was studied by measuring active and passive length-force characteristics at initial operation and at reoperation in a case of extension deformity secondary to FCU tendon transfer. At reoperation, FCU was 20 mm shorter; active force decreased approximately 10%, indicating atrophy; and passive force increased, reflecting increased stiffness. FCU fiber length was unchanged.

Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale.

Background: Although scar evaluation tools are necessary for an evidence-based approach to scar management, there is as yet no generally accepted tool. The Patient and Observer Scar Assessment Scale was developed recently and found to be a useful subjective evaluation tool for burn scars. The authors tested the Patient and Observer Scar Assessment Scale on linear scars, the largest category of surgical scars.

Spastic muscle properties are affected by length changes of adjacent structures.

Recent animal experiments have shown that up to 37% of muscle force may be transmitted to adjacent structures rather than reach the insertion of the muscle's tendon, and that the extent of such force transmission depends on the length and relative position of these structures. We tested whether the force-length characteristics of the distally tenotomized human flexor carpi ulnaris muscle (FCU) of nine patients with cerebral palsy varied with the change of relative length of adjacent structures induced by a change of wrist position. In four patients, the FCU exerted up to 40% more active force in a flexed wrist position at short FCU length, whereas the active force was not significantly higher in the other five.

The truly distal lateral arm flap: rationale and risk factors of a microsurgical workhorse in 30 patients.

The forearm part of the extended lateral arm flap may be separately raised on the most distal septocutaneous perforator of the posterior collateral radial artery. This truly distal lateral arm flap shares most of the advantages of the radial forearm flap and is associated with less donor site morbidity. From April 2000 to March 2004, we used 30 such flaps as the fasciocutaneous free flap of choice, mostly for reconstructions in the head and neck region.