Principles of limb salvage surgery of the upper extremity.

The goals of limb salvage surgery in the upper extremity are to achieve resection of the tumor and preserve hand function without the risk for local recurrence. Historically, amputation was the treatment of choice for a neoplasm of the hand, wrist, and forearm, but limb-sparing procedures have become feasible largely because of advances in diagnostic imaging, reconstructive microsurgery, and adjuvant radiotherapy and chemotherapy. Because preservation of hand function, even modest levels thereof, is clearly superior to amputation from a functional standpoint, the authors review the principles of limb salvage in this article.

Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longitudinal assessment in patients older than age 70.

Purpose: Advanced stages of nerve compression are likely to result in irreversible intraneural changes including intrinsic fibrosis and axon loss, and advanced age is expected to compromise nerve regeneration and recovery. Although satisfactory outcomes have been reported we hypothesized that carpal tunnel release in an elderly population with advanced carpal tunnel disease might not significantly improve symptom severity, functional status, or grip strength compared with before surgery. Our purpose was to evaluate these 3 parameters both before and after surgery to assess the efficacy of surgical intervention.