- [Effects of different doses and concentrations of ropivacaine in axillary brachial plexus block]. [Randomized Controlled Trial]
- ZYZhonghua Yi Xue Za Zhi 2008 Apr 15; 88(15):1046-50
- CONCLUSIONS: Sensory and motor never can be blocked perfectly when the dose of ropivacaine is between 1.5 mg/kg and 2.0 mg/kg and the concentration is between 0.30%-0.35%. When the doses of ropivacaine is 1.25 mg/kg and the concentration is 0.20%-0.25% the starting and consummating time are longer and persisting time is shorter. When the doses of ropivacaine is 1.00 mg/kg and the concentration is 0.15%-0.20% the starting and consummating time are longer and only satisfies external debridement and suture without tourniquets.
- [Severe course of a rare non-tuberculous Mycobacteriosis (M. haemophilum) of the hand - case report and strategic comments]. [Case Reports]
- HMHandchir Mikrochir Plast Chir 2008; 40(5):342-7
- CONCLUSIONS: Patients with upper extremity infections caused by atypical Mycobacteria need qualified hand-surgical care. The decision about need and kind of medicamentous treatment is based on germ differentiation and should be made in cooperation with the National Reference Centre for Mycobacteria in Borstel. To shorten the diagnostic gap between first admission and detection of Mycobacteria in hand infections with a non-typical course of disease we suggest a standardised approach.
- Long-term results after vascularised joint transfer for finger joint reconstruction. [Journal Article]
- JPJ Plast Reconstr Aesthet Surg 2008; 61(11):1338-46
- CONCLUSIONS: Whenever possible the 'tissue bank concept' according to CHASE should be applied in finger joint reconstruction using a vascularised joint graft from either an amputated or a redundant digit. Results of vascularised joint transfer have to be compared to those of persisting joint defect, prosthetic joint replacement, arthrodesis, or ultimately amputation of the finger involved. Patients in whom a vascularised joint transfer is anticipated should be informed about the following points: (1) The risk of failure (vascular failure, tendon adhesion, joint stiffness, etc.) is about 10%. (2) The expected active range of motion depends on aetiology, age, donor site and recipient site. Traumatic joint defects show a greater active range of motion than congenital defects. Children have more active joint motion than adults. (3) Because of minor donor site impairment and rapid recovery of normal gait the whole second ray should be amputated after harvesting of a joint graft on the second toe. (4) Hospitalisation takes 1-2 weeks. Immobilisation of the hand (palmar forearm splint) and the foot (lower leg cast) should be applied for 4 to 6 weeks. Intensive physiotherapy is necessary for at least 3 months. Additional splinting is advised for about 6 months. (5) Extensor tendolysis is necessary in a large number of cases but should not be done earlier than 6 months after transplantation.
- [Vascularized joint transfer for finger joint reconstruction]. [Journal Article]
- HMHandchir Mikrochir Plast Chir 2007; 39(4):249-56
- In a retrospective clinical study 16 vascularized joint transfers to the hand with an average follow-up of 8.2 (3 - 15) years were evaluated. The finger joint defect was caused by trauma in 12 patien…
In a retrospective clinical study 16 vascularized joint transfers to the hand with an average follow-up of 8.2 (3 - 15) years were evaluated. The finger joint defect was caused by trauma in 12 patients, tumour in 2 patients and infection and congenital deformity in 1 patient each. There were 14 men and 2 women. The mean age range was 26 (2 - 42) years. In 6 cases a partial vascularized joint transfer was carried out, with the transplant being harvested in two cases from non-replantable finger according to the "tissue bank concept" according to Chase and in the other two cases from the PIP-joint of the second toe. In 10 patients a complete vascularized joint transfer was carried out, with the joint being harvested from the hand in 6 cases and from the 2nd toe in 4 cases. The following criteria were evaluated: active range of motion (neutral-0-method), postoperative arthritis, growth and complications. Active range of motion of the transplanted joint was for partial PIP-joint transfer Ex/Flex 0/20/65 degrees und for partial MP-joint transfer 0/20/30 degrees . After DIP-to-PIP-joint transposition active range of motion was measured Ex/Flex 0/20/60 degrees , after PIP-to-PIP transposition 0/30/60 degrees , PIP-to-MP-transposition 0/20/80 degrees and after MP-to-MP-transposition 0/20/57 degrees . The results after microvascular PIP-joint transfer from the 2nd toe for PIP-joint reconstruction were 0/25/58 degrees for PIP-joint reconstruction and 0/15/70 degrees for MP-joint reconstruction. Arthritic changes could be seen in 3 out of 4 patients with partial vascularized joint transfer. In all complete joint transfers there was no clinical and radiological evidence of arthritis even after 15 years. In the two skeletal immature patients at the time of transfer, normal growth compared to the contralateral donor site could be seen. In 8 out of 14 patients complications occurred. In 4 cases tendolysis of the extensor tendon was necessary. In 4 patients skeletal malalignment (3 x sagittal plane, 1 x rotation) was diagnosed. In one patient flexor pulley reconstruction was necessary in order to correct a bowstring deformity. Indications for vascularized joint transfer at the finger in children is set because of lack of therapy option offering normal growth potential. In adults vascularized joint transfer is indicated in case of contraindication for prosthetic joint replacement or arthrodesis.
- [Is surgery likely to be successful as a treatment for traumatic lesions of the superficial radial nerve?]. [Journal Article]
- NNervenarzt 2006; 77(2):175-6, 179-80
- In the last 10 years 22 patients with lesions of the superficial branch of the radial nerve have been treated surgically in our neurosurgical department. The patients' main complaints were burning pa…
In the last 10 years 22 patients with lesions of the superficial branch of the radial nerve have been treated surgically in our neurosurgical department. The patients' main complaints were burning pain and paraesthesia in the region supplied by the superficial branch of the radial nerve. In most cases the lesion was due to tendolysis performed earlier to treat de Quervain tendovaginitis stenosans. In 8 cases external neurolysis was done with conservation of continuity; in 4 cases the nerve was reconstructed after resection of the neuroma (end-to-end-suture or implantation of a vicryl conduit); and in 10 cases the neuroma was resected and transposition of the proximal nerve end was performed. Nineteen patients were available for evaluation of the postoperative results, after an average follow-up of 51 months. Surprisingly, only 5 reported good subjective improvement of pain after surgery. Seven patients reported an unchanged status postoperatively, and in 1 case the pain was even worse after the surgical intervention. Satisfactory results (complete or partial pain relief in 75% of cases) was found to have been achieved in the subgroup of patients treated by resection of the neuroma of the superficial branch of the radial nerve and transposition of the nerve stump. In conclusion, we recommend caution when surgical interventions are considered for traumatic lesions of the superficial radial nerve, because the prospects of success are limited. In addition, we do not consider nerve reconstruction desirable in these circumstances.
- [Electrophysiological and morphological changes in muscle-flexors of the fingers after injuries of the tendons in children]. [Journal Article]
- OTOrtop Travmatol Protez 1989; (1):24-8
- The investigation of bioelectrical activity of flexors of the fingers in children at different terms after the injury and subsequent restoration of the tendons allowed to determine the dynamics of bi…
The investigation of bioelectrical activity of flexors of the fingers in children at different terms after the injury and subsequent restoration of the tendons allowed to determine the dynamics of bioelectrogenesis of the muscles. Decrease in bioelectrical activity of the muscles was most expressed and stable during the first 6 months after the injury. The morphological studies carried out at that time demonstrated presence of lysis of some muscle fibers. Complete restoration of bioelectrical activity of the muscles was observed after suture of the tendons and autotendoplastn which was performed not later thay 4-6 months after the trauma. The investigation of dynamics of restoration of bioelectrical activity of the muscles allowed to determine the optimal terms for performing tendolysis.
- A staged technique for the repair of the traumatic boutonniere deformity. [Journal Article]
- JHJ Hand Surg Am 1983; 8(2):167-71
- A step-by-step approach to the systematic management of chronic boutonniere deformity due to trauma is presented. If surgical intervention is necessary, the problem should be approached one step at a…
A step-by-step approach to the systematic management of chronic boutonniere deformity due to trauma is presented. If surgical intervention is necessary, the problem should be approached one step at a time. The following stages are described: stage I, tendolysis of the extensor tendon and freeing of the transverse retinacular ligament; stage II, sectioning of the transverse retinacular ligament; stage III, tendon lengthening of the lateral bands over the middle phalanx; and stage IV, repair of the central extensor tendon. After managing 23 patients according to this plan, we have concluded that it is frequently unnecessary to automatically go through all four stages in treating chronic traumatic boutonniere deformity. We found that 17 patients were successfully managed by some combination of stages I, II, and III, and six patients received adequate treatment with stages I, II, and IV.
- Reconstruction of the hand with free microneurovascular toe-to-hand transfer: experience with 54 toe transfers. [Journal Article]
- PRPlast Reconstr Surg 1983; 71(3):372-86
- Over a period of 6 years, 54 toe-to-hand transfers were performed, 24 for thumb and 30 for finger reconstruction. Refinements in evaluation, preparation, and surgical technique are detailed. Forty-ni…
Over a period of 6 years, 54 toe-to-hand transfers were performed, 24 for thumb and 30 for finger reconstruction. Refinements in evaluation, preparation, and surgical technique are detailed. Forty-nine toes (90.7 percent) survived. Exploration was required for circulatory compromise following 13 transfers (34.2 percent), to good effect in 9 (69.2 percent). Secondary surgery was performed in 26 cases, consisting of tendolysis, osteotomy, and deepening of the first web space. Review was undertaken at an average of 1 year and 9 months after transfer. Power grip averaged 28.5 percent of the normal hand and pinch strength 26.6 percent, great toe transfer giving 35.7 percent and second toe transfer to thumb giving 15.6 percent strength compared with normal. Static two-point discrimination of less than 10 mm was present in 37.5 percent of those studied under 2 years after surgery and in 75 percent of those studied more than 2 years later. The choice of procedure for thumb reconstruction is discussed in detail, as are supplementary skin cover, vascular considerations, and the high exploration rate.
- Experience with peritendinous fibrosis of the dorsum of the hand. [Case Reports]
- JHJ Hand Surg Am 1982; 7(4):380-3
- Fifteen patients with a diagnosis of peritendinous fibrosis of the dorsum of the hand (Secretan's disease) were treated between 1958 and 1980. Thirteen patients had excision of a dorsal fibroma with …
Fifteen patients with a diagnosis of peritendinous fibrosis of the dorsum of the hand (Secretan's disease) were treated between 1958 and 1980. Thirteen patients had excision of a dorsal fibroma with extensor tendolysis when necessary. Preoperative findings included a hard dorsal mass and limitation of motion. Postoperative courses were characterized by prolonged periods of rehabilitation and recurrent episodes of swelling. Twelve of 15 patients returned to work 3 to 30 months postoperatively. Permanent disability was substantial. None of these patients had significant wound healing problems, and all had improved range of motion. The question of self-inflicted injury was raised in five cases but could not be demonstrated.
New Search Next
- [Severe blast injury of both hands]. [Case Reports]
- HMHandchir Mikrochir Plast Chir 1982; 14(2):130-3
- A report is presented of a case of an officer, both of whose hands were injured severely by an explosion. On the right side amputation was followed by fitting of a myo-electrical prosthesis. On the l…
A report is presented of a case of an officer, both of whose hands were injured severely by an explosion. On the right side amputation was followed by fitting of a myo-electrical prosthesis. On the left side treatment with an inguinal flap plasty, a two stage tendon graft, transposition of flexor profundus IV-tendon to the thumb, a tendolysis of the second finger, Z-plasty of skin of the thumb in order to ensure a good grip. The functional result was good.