Results of treatment of extensive volar wrist lacerations: the spaghetti wrist.

A series of 38 volar wrist lacerations is reviewed with regard to epidemiologic aspects and results. In general, return of tendon function was quite good, and return of nerve function in this series was also satisfying. We attribute the generally good results to immediate repair of all structures, microscopic repair of significant arterial injuries, microscopic grouped fascicular nerve repair, early mobilization (dynamic splinting and intensive occupational therapy), and a generally youthful group of patients.

Crescent mastopexy and augmentation.

We have defined a group of patients with a lesser degree of moderate breast ptosis whose ptosis correction is not adequately improved by augmentation alone but requires some elevation of the nipple-areola complex. We have selected the crescent excision mastopexy to provide this additional needed lift. Experience with 26 patients employing this technique has helped to define the indications and limitations for this approach.

[Incidence and significance of epiphyseal and para-epiphyseal injuries in replantations in the area of the upper extremity in children].

A series of 15 cases of replantation in children is reviewed with special attention to the frequency and the implications of epiphyseal lesions. Definite conclusions, however, will only be possible after these patients reach maturity.

[Vein interposition as a pathway for peripheral nerve regeneration].

In experiments on rabbits the use of a vein graft for bridging defects of peripheral nerves was examined. A 10-20 mm long segment of sciatic nerve was removed bilaterally. On one side the gap was bridged with an autologous nerve graft, on the other one an autologous vein graft was used.

Structure of capsules around silicone implants in hand surgery.

Histological examination was made of twenty-three capsules around silicone implants used in hand surgery. The structure of the capsules was found to be similar to that seen in animal experiments, though they tended to be thicker. A further difference was the frequent occurrence of histiocytes accumulating near the inner margin of the capsule; these would quite frequently form a pseudoepithelium.

Basic technical considerations in reattachment surgery.

Replantation surgery offers a rewarding challenge for one to apply basic biologic and functional concepts to deal with an infinite variety of amputation problems. Although there is an obvious requirement for technical skill, there is no place for stereotype procedures. Often the exact plan of treatment cannot be determined until debridement is completed, so by taking on the responsibility to manage these problems one must have not only fine technical skills but also a thorough knowledge and comprehensive experience in hand surgery, Upper limb amputations are complex and difficult compound hand injuries involving not only the vascular system but the bone, tendon, nerve, muscle, and skin as well.

Present indications and contraindications for replantation as reflected by long-term functional results.

It is evident that the independent experiences of these hand surgery units in three completely different parts of the world are remarkable similar. For the most part, one can readily account for the differences reported on the basis of interpretations of such vague terms of evaluation as "good" or "poor" and on case selection, which is often dictated by local cultural considerations. For example, a hand with some useful prehension placed on an extremely shortened arm may be most welcome to a Chinese patient, whereas a hand attached to the humerus may be looked upon as grotesque in the Western cultures an so be psychologically devastating.

[Microsurgery: indications and organization].

Microsurgery is an important, but purely technical advancement. It would be a serious error for medicine and patient care to accept the concept of a "microsurgeon" rather than recognizing the necessity for surgical specialists working in many anatomical regions to learn microsurgery techniques as related to comprehensive care of their area. In hand surgery it is already clear that the duration of procedures and the exhaustion associated especially with reattachment surgery demands care by a team rather than by a single individual.

[The problem of contracture of small hand muscles after mid-hand replantation].

A longterm follow-up of a mid-palm re-attachment in which intrinsic tightness developed is presented. The initial bone shortening in this case was 7 mm. Because in 5 subsequent cases of mid-palm re-attachment with an initial bone shortening of 12-15 mm problems of intrinsic tightness did not occur, it is concluded that in re-attachment at this level the initial bone shortening should be at least 12 mm.

[Immobilization of the injured hand].

The so-called "functional position" of the hand for immobilization of an injured hand or finger may in many cases lead to stiffness of the finger joints by shrinkage of the joint capsule and -ligaments. This process can be minimized by immobilization of the small finger joints in a position where the most important ligament structures are under maximum tension. Basically this is the intrinsic-plus-position for the long fingers and palmar abduction and extension of the thumb.