Selective replantation with ulnar translocation in multidigital amputations.
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Biomedical subjects
Publications and source records attributed to D Elliot.
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A technique of advancing the soft tissues of the distal palm into the digits for reconstruction of proximal defects of the volar aspect of the digits with V-Y closure of the donor defect is described. Seven indications for using this procedure are illustrated in a series of 55 cases.
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Different internal spring-splint configurations were examined to determine the most effective in preventing adduction contracture after severe injuries disrupting the first web space.
A series of 233 patients with complete divisions of flexor tendons in zones 1 and 2 underwent operation following emergency admission over a period of 3.5 years. These included 203 patients with 317 divided tendons in 224 fingers injuries in zones 1 and 2 and 30 patients with 30 complete divisions of the flexor pollicis longus tendon in zones 1 and 2. All of these patients were mobilized post-operatively in a controlled active motion regimen. 13 (5.8%) fingers and five (16.6%) thumbs suffered tendon rupture during the post-operative period. Patients treated during the last year of the study were followed prospectively for a minimum period of 3 months; ten of the 16 (62.5%) fingers with zone 1 repairs, 50 of the 63 (79.4%) fingers with zone 2 repairs, all three (100%) FPL divisions in zone 1 and three of four (75%) FPL divisions in zone 2 had good and excellent results on assessment by the original Strickland criteria (Strickland and Glogovac, 1980). These results confirm the safety of this regimen as an alternative to other regimens of post-operative flexor tendon repair mobilization in zone 1 and 2 finger injuries. However, in the unmodified form used in this series, this regimen has too high a rupture rate for FPL mobilization.
The Sagas of Icelandic bishops composed in and around the 13th century reveal something of the incidence and treatment of various hand conditions in the medieval period. A selection from the relevant material is translated and discussed.
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The dynamic relationship of the lumbrical muscles to the carpal tunnel was studied in 35 hands in 32 patients and their movement into the tunnel on finger flexion was examined with a view to its use as a diagnostic provocation test in carpal tunnel syndrome.
We report a comparative study of the outcome of flexor tendon repairs mobilized by either a "passive flexion-active extension" or a "controlled active motion" regimen. We show that the controlled active motion regimen conferred significant benefits on the final range of motion and extensor lag. The rupture rate was raised with "controlled active motion" but this was not greater than levels reported by other authors using "passive flexion-active extension" regimens.
This study identifies four miracle cures set in Orkney and Iceland in the 12th and 13th Centuries and recorded in the sagas of the earls of Orkney and the bishops of Iceland, in which the condition of the hand which was healed bears a resemblance to Dupuytren's disease. The possibility that one hand was cured by traumatic rupture of this condition and another treated by palmar fasciotomy is discussed.
The commonly used variant of Moberg's advancement flap for thumb reconstruction requires a skin graft to reconstruct the proximal thumb defect after advancing the flap. A modification has been described previously which allows direct closure of this proximal defect by incorporation of the V to Y principle into the design of the proximal part of the flap. A variant of the V-Y Moberg flap is presented and its advantages discussed.
Use of the small veins of the thenar eminence as an alternative source of vein grafts in distal digital reconstruction is presented.
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Oscillometric automatic blood pressure monitors are now commonly used in theatres and intensive care units. An experimental model has been used to assess the accuracy of these machines when measurements are made from a proximal limb cuff applied over bulky bandages, as is commonly found in burned patients. This study suggests that monitoring arterial blood pressure under these circumstances is sufficiently accurate to make automatic monitoring useful as an adjunct to burns management. This would allow blood pressure measurement where it would otherwise be impossible without invasive techniques.
Buccal mucosal flaps provide a simple and effective method of replacing nasal mucosal lining. This technique has been used in 15 patients requiring reconstruction of full thickness defects of the lateral nasal wall and tip of nose, in combination with a variety of local flaps for skin cover. The buccal mucosal flap is of particular value in reconstructing the common defect of the lower lateral nasal wall and alar rim where more bulky reconstructions often distort the airway.