Percutaneous Mesh Expansion: A Regenerative Wound Closure Alternative.

Background: Puncture wounds in the 1-mm range usually heal without scars. Stacking rows of these punctures offers a scarless method to generate tissue by mesh expansion. The authors developed a percutaneous mesh expansion procedure and present their experience for its wound closure application.

Current Clinical Applications of Fat Grafting.

Learning Objectives: After reading this article, the participant should be able to: 1. Understand the theory and principles behind successful avascular fat transfer; 2. Apply these principles into techniques that yield safe and successful fat grafting operations; 3.

Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting.

Background: Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients.

Materials And Methods: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA.

Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren's Contracture: A Prospective, Randomized, Controlled Trial.

Background: As an alternative to needle aponeurotomy release and limited fasciectomy treatment of Dupuytren's contracture, the authors introduced an extensive percutaneous aponeurotomy and lipofilling (PALF) procedure. In their previous study, the authors reported that contractures significantly improved and most patients returned to normal use of the hand within 2 to 4 weeks. To establish the safety and efficacy of PALF, the authors compared it to the standard limited fasciectomy in a single-blind, multicenter, prospective, randomized, controlled trial.

Percutaneous Aponeurotomy and Lipofilling (PALF): A Regenerative Approach to Dupuytren Contracture.

Dupuytren disease is a progressive fibroproliferative disorder, which leads to flexion contractures of the digits. A minimally invasive technique consisting of an extensive percutaneous aponeurotomy of the cord with a needle combined with lipofilling is presented. The selective cutting of the cords under continuous tension disintegrates the cords while sparing the looser neurovascular bundles.

Ulnar nerve component to innervation of thumb carpometacarpal joint.

Purpose: Thumb carpometacarpal (CMC) joint arthritis is one of the most common problems addressed by hand surgeons. The gold standard of treatment for thumb CMC joint arthritis is trapeziectomy, ligament reconstruction and tendon interposition. Denervation of the thumb CMC joint is not currently used to treat arthritis in this joint due to the failure of the procedure to yield significant symptomatic relief.

Extensive percutaneous aponeurotomy and lipografting: a new treatment for Dupuytren disease.

Background: Surgical resection of Dupuytren contracture is fraught with morbidity and prolonged recovery. This article introduces a novel minimally invasive alternative for Dupuytren disease and its outcome.

Methods: The procedure consists of an extensive percutaneous aponeurotomy that completely disintegrates the cord and separates it from the dermis.

The glabrous palmar flap: the new free or reversed pedicled palmar fasciocutaneous flap for volar hand reconstruction.

We devised a new flap using the palmar cutaneous branch of the superficial radial artery proximally and anastomosed with a cutaneous perforator of the superficial palmar arch distally. We named our flap "the volar glabrous palmar flap." The flap was used both as a free flap and as a reverse-flow island flap.

Management of elbow ankylosis in a head injured patient with floating elbow injury.

The development of heterotopic ossification around the elbow has been linked to trauma (particularly fractures or dislocations), closed head injury, spinal cord injury, burns of the extremity, genetic traits, adult respiratory distress syndrome, and orthotopic liver transplant. Pain and lack of motion are the most common complaints during the progression of ectopic bone about the joint. Opposite to common credence, fracture healing is not accelerated in patients with traumatic brain injury.

Arthroscopic indications and technique for artelon interposition arthroplasty of the thumb trapeziometacarpal joint.

Advanced basal joint arthritis that has failed conservative treatment has traditionally been treated with some type of procedure that encompasses complete trapezial excision. An arthroscopic technique entailing only minimal trapezial debridement coupled with insertion of a synthetic interposition material is described. This provides the implicit benefits of a minimally invasive procedure, with less pain and faster recovery, along with the great advantage of trapezium preservation.

Treatment of early basal joint arthritis using a combined arthroscopic debridement and metacarpal osteotomy.

Osteoarthritis of the thumb basal joint is a common and disabling condition, and early stages of which are often seen in middle-aged women. Arthroscopic assessment of the first carpometacarpal joint allows easy identification and classification of joint pathology with minimal morbidity. This allows the condition to be managed either arthroscopically or converted to an open procedure as indicated.

Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears.

This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage tears by using ultrasonic suture welding technique, thus avoiding the need for traditional suture knots. This technique eliminates the potential causes of ulnar-sided wrist discomfort especially during the postoperative period. Twenty-three patients (9 women and 14 men; mean age, 35 years; range, 18-52 years) were operated during a 1-year period in 2001 for Palmer grade 1B triangular fibrocartilage complex tear and followed up for 17 months.

Arthroscopy of the trapeziometacarpal and metacarpophalangeal joints.

Indications for small joint arthroscopy in the hand remain poorly understood. This is due to a paucity of articles discussing these techniques in the literature, as well as inadequate hands-on training in the pearls and pitfalls regarding this application within the routine "scope" of hand surgery. Despite the fact that small joint arthroscopes have been available for more than a decade, hand surgeons have been slow to adopt this technique for the treatment of both traumatic and degenerative conditions involving the thumb and the digital metacarpophalangeal joints.

[Arthroscopy of the trapeziometacarpal and metacarpophalangeal joints].

Indications for small joint arthroscopy in the hand remain poorly understood. This is due to a paucity of papers discussing this technique in the literature, as well as inadequate hands on training in the pearls and pitfalls regarding this application within the commonly used "scope" of arthroscopy. Despite the fact that small joint arthroscopes have been available for over a decade, hand surgeons have been slow to adopt this technique within their treatment armamentarium for the treatment of both traumatic and degenerative conditions involving the thumb and the digital metacarpophalangeal joints.

[Arthroscopy of the Trapeziometacarpal and Metacarpophalangeal Joints.].

Indications for small joint arthroscopy in the hand remain poorly understood. This is due to a paucity of papers discussing this technique in the literature, as well as inadequate hands on training in the pearls and pitfalls regarding this application within the commonly used "scope" of arthroscopy. Despite the fact that small joint arthroscopes have been available for over a decade, hand surgeons have been slow to adopt this technique within their treatment armamentarium for the treatment of both traumatic and degenerative conditions involving the thumb and the digital metacarpophalangeal joints.

Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis.

Purpose: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women. Many different surgical techniques have been proposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Joint replacement has been an effective treatment of this condition.

Arthroscopic repair of peripheral triangular fibrocartilage complex tears with suture welding: a technical report.

This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage complex tears that replaces traditional suture knots with ultrasonic welding of sutures. This will help eliminate potential causes of ulnar-sided wrist discomfort during the postoperative period.

The treatment of unstable metacarpal and phalangeal shaft fractures with flexible nonlocking and locking intramedullary nails.

Metacarpal and phalangeal shaft fracture fixation can be achieved by closed IM nailing. This technique provides sufficient stability to commence early unsupported joint motion and minimize soft-tissue irritation and scar formation. Stability is enhanced by proximal nail locking; a measure that extends the indications to spiral and comminuted fractures.

Sports-related injuries of the elbow.

Sports-related injuries about the elbow occur commonly and are often managed by a wide variety of health care providers. It is particularly important that a surgeon well versed in arthroscopy, reconstructive trauma, and peripheral nerve techniques evaluates potentially complex injuries. It is equally imperative that the preoperative care regimen and postoperative management be conducted by an experienced therapist who understands elbow biomechanics and function.

Trapeziometacarpal arthroscopy: a classification and treatment algorithm.

Arthroscopic assessment of the CMC joint allows direct visualization of all components of the joint, including synovium, articular surfaces, ligaments, and the joint capsule. It also allows for the extent of joint pathology to be evaluated and staged with intraoperative management decisions made based on this information. The author recommends this arthroscopic staging to ensure better judgment of this condition in order to provide the most adequate treatment option to patients who have this disabling condition.