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Biomedical subjects

G D Lister

Publications and source records attributed to G D Lister.

At least 19 recordsLinked to original sources
PubMed1992

Venous anatomy of the thumb and thenar area.

The venous anatomy of the thumb and the thenar area, including the first web space, was studied after injection of a polymerizing plastic resin into the vascular tree of six fresh human cadaveric specimens. As in the previously described parts of the hand and fingers, certain anatomical features were consistently present in all examined specimens. The topography of the vessels is different from that of veins in other parts of the hand, and we conclude that this reflects differences in mechanical demands upon the soft tissues in various parts of the hand and the digits.

Hand↗
PubMed1992

Treatment of skin and soft-tissue loss of the thumb.

Many options exist to provide soft-tissue cover of the thumb. The choice of cover should be dictated by the defect itself: the location, size, and requirements for sensibility and durability. Within these boundaries, the choice of cover should be in accordance with the goals of any extremity reconstruction, permitting primary wound healing and early active use.

Humans↗
PubMed1992

Early free-flap coverage of electrical and thermal burns.

Because of the clinical concept of progressive tissue necrosis, the concept of immediate excision and coverage of high-tension electrical burns and deep thermal burns has been a controversial subject. Recent clinical and laboratory research has cast doubt on this concept. We present a series of five patients who suffered severe extremity electrical and thermal injuries in whom early excisions were performed with immediate free-flap reconstruction. Special importance is given to radical debridement of all questionably nonviable tissues, excepting intact tendons, nerves, and bone. In these tissues, anatomic continuity is more important than apparent viability. No infections or wound-healing complications were seen as a result of this protocol. Of eight digital nerves that did not function at the initial examination, five subsequently recovered two-point discrimination of less than 10 mm.

Adult↗
PubMed1992

Radial nerve compression.

Symptomatic radial nerve compression is relatively uncommon. A relatively high incidence of compressive neuropathy involves other major nerves in the same extremity. Because sensory complaints are minor, radial nerve compression may successfully masquerade as tendonitis or tendon rupture. The most common site of radial nerve compression is in the forearm, at the arcade of Frohse. Spontaneous onset of dense paralysis is often due to space-occupying lesions in the forearm. Trauma-related compression in the forearm is most often due to radial head dislocation and either humeral fracture or local external pressure in the upper arm. Compression resulting in weakness that does not improve with several months of splinting, anti-inflammatory medication, and activity changes should be treated surgically to reduce the extent of permanent deficit. After decompression, early active motion is instituted to encourage nerve gliding. Results after decompression are not as favorable as those for carpal or cubital tunnel release. The worst results of decompression are seen in patients who have work-related injuries, chronic pain, and poor localization of symptoms on physical examination.

Diagnosis, Differential↗
PubMed1991

Toe transfer for congenital hand defects.

Toe-to-hand transfer is a well-established reconstructive option for certain congenital hand anomalies. It is the only technique which can add growth potential to the immature skeleton. Toe transfer is best suited for constriction ring amputations, which have relatively normal proximal anatomy. Transfers should be performed early in life to avoid lack of cortical integration of the new part. Anatomic variations of both hand and foot are often encountered, which influence both operative approach and functional prognosis. Indications, techniques, and complications are reviewed.

Fingers↗
PubMed1991

Preferential use of the posterior approach to blood vessels of the lower leg in microvascular surgery.

A posterior approach to the vessels of the lower leg, with particular emphasis on the posterior tibial artery, is presented as the method of choice for microvascular free-tissue transfer to the region. This approach offers wide exposure, better definition of the zone of injury, appropriate selection of the recipient vessel and of the site of anastomosis, and enough room for microsurgical work. Exposing the large posterior tibial artery down to the distal third of the lower leg facilitates the use of end-to-side anastomosis and makes the transfer of large muscle flaps to that region more predictable, in part by obviating the need for long vein grafts. This exposure leaves no functional and few aesthetic deficits.

Arteries↗
PubMed1991

Arterial T and Y grafts.

Presented is the use of an autogenous arterial T graft for the salvage of a thrombosed arterial end-to-side anastomosis. The T-graft concept also offers the possibility of replacing a segment of artery in patients with arterial vessel wall defects, stenosis, obliteration, or disease during free latissimus dorsi or scapular flap transfer. The arterial T graft is harvested from the axilla and consists of segments of the subscapular, circumflex scapular, and thoracodorsal arteries. The large diameter of these vessels offers a good match with the arteries of the lower leg and forearm. The arterial Y graft consists of the same arteries and is used as an interpositional graft to revascularize two distal vessels from one proximal vessel.

Anastomosis, Surgical↗
PubMed1991

Deep venous anatomy of the human palm.

The anatomy of the deep veins of the human palm was studied in a series of dissections on 12 fresh cadaver specimens after injection of a polymerizing plastic compound into the vascular tree. Using measures of function rather than position in the hand as criteria for the classification of the vessels, six venous types were identified and characterized: arborized, arches, deep axial, web space, perforating, and synovial.

Cadaver↗
PubMed1991

Surgical alternatives in Dupuytren's contracture.

The treatment of Dupuytren's contracture is still controversial. The use of subcutaneous fasciotomy is useful in the medically unstable patient in whom long-term results may be a moot point. Limited fasciectomy is preferred over radical excision as a simpler operation and because of fewer complications. Wound closure is still a major point of contention. A prospective, randomized study of open wounds versus skin grafts versus closed procedures is needed to give more information regarding the long-term results. Currently, at our institution, we perform limited fasciectomy and leave the palm open. Early and aggressive mobilization is thought to be the key to good results.

Dupuytren Contracture↗
PubMed1990

A role delineation study of hand surgery.

In 1986, The American Association for Hand Surgery and the American Society for Surgery of the Hand jointly sponsored a Role Delineation Study of Hand Surgery. The purpose of this study was to define the knowledge and skills necessary for competent hand surgery practice and to determine the responsibilities and activities of hand surgeons. Eight hundred thirty-eight hand surgeons returned a self-report questionnaire. This questionnaire was designed to collect information relative to the demographic characteristics of the respondents, the importance of 38 surgical procedures, and 60 categories of knowledge related to hand surgery, and to elicit respondents opinions regarding certification in hand surgery. This study is a first attempt to define the domain of hand surgery. The data collected in this study provide the basis for designing residency fellowship and continuing education programs and may also be used to study manpower needs, regional variations in practice patterns, and to identify the educational needs of the profession of hand surgery.

Education, Medical↗
PubMed1990

Injection-corrosion-lavage. Techniques for study and description of vascular anatomy in the hand.

The venous anatomy of the human hand has not been accurately described. Two main reasons for this deficiency in our knowledge are apparent: technical difficulties involved with dissection and imaging of the vessels, and the seemingly limitless number of topographic patterns in this field. This paper introduces firstly, a method for injection and corrosion of hand specimens, and secondly, a routine for describing the venous anatomy, primarily based on their function, and only secondarily on their position or topography.

Hand↗
PubMed1990

The palmar digital venous anatomy.

Fresh human cadaveric hands were injected with a liquid plastic polymer and dissected under the operating microscope. On the palmar aspect of the digits, four different venous patterns could be identified, characterized by their tributaries and branching pattern, and by the presence, position and direction of valves. Arborized veins drain a limited volume of tissue by a number of very slender vessels that come together to form a common trunk. Venous arches are found both superficial and deep, palmar and lateral; they neither branch nor have valves, except at both ends. Deep axial veins accompany the digital arteries as comitant veins. They drain to both the metacarpal comitant veins and the web space veins. Superficial axial veins run principally in the subdermal layer of the finger; they drain either directly to dorsal veins or to the natatory vein on the ligament of the same name.

Hand↗
PubMed1990

Superficial venous anatomy of the human palm.

In a study of the venous anatomy of the palm, a high degree of consistency has been found in the organization of the superficial vessels, which lie between the palmar fascia and the dermis. Although in the superficial palm, as previously reported for the fingers, there are large individual variations in the detailed topography, the basic functional venous anatomy remains highly consistent. The present paper demonstrates the findings from dissections of 12 human cadaver hands after injection of a polymerizing plastic solution into the vascular tree. The basic types of superficial venous structures found in the superficial palm are presented, and their functional importance for the drainage of blood from the palm is discussed.

Hand↗
PubMed1990

Syndactyly.

Congenital syndactyly is associated with a wide spectrum of local anomalies that strongly influence the ultimate outcome of treatment. Surgical options, indications, timing, and prognosis are all determined by the preoperative degree of deformity. The surgeon must apply knowledge of anatomic variations and adhere to fundamental principles of technique, which are reviewed in detail.

Fingers↗
PubMed1989

Detection of submaximal effort by use of the rapid exchange grip.

To assist in distinguishing patients with truly decreased hand grip strength from those deliberately not gripping the dynamometer at maximal capacity, a rapid exchange grip strength test was devised and tested under four conditions. Part I, 100 normal subjects undergoing static grip testing and the rapid exchange grip test. Part II, 45 patients chosen at random from physical therapy with various hand injuries tested using only the static grip test. Part III, a blind control study on 15 normal subjects instructed to fake an injury to either the right or left hand. This group was given both the static and rapid exchange grip test. Part IV, a retrospective evaluation of 45 patients seen in a private hand practice who had both the static and rapid exchange grip test. After the dynamometer had been set to the position at which the patient had previously achieved maximal grip strength, the patient was instructed to rapidly alternate hands while gripping the dynamometer. Uninjured subjects had consistently lower rapid exchange grip test scores than previous scores at the same setting (negative rapid exchange grip). Average rapid exchange grip test scores were higher than previous scores (positive rapid exchange grip) when subjects were instructed to fake an injury with one hand. We conclude that if maximal performance has not been achieved on the static test, the rapid exchange grip shows a significant increase in grip strength on the affected side. More patients claiming worker's compensation had positive rapid exchange grips and the average score was higher than that of patients not claiming worker's compensation.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1989

Immediate silastic arthroplasty for non-salvageable intraarticular phalangeal fractures.

Fourteen patients with open non-salvageable intraarticular fractures of the proximal interphalangeal joint or metacarpophalangeal joint, underwent immediate silastic arthroplasty using Swanson H.P. hinged implants. The patients' ages ranged from 14 to 49 years, with an average of 29 years. Time from surgery to final examination ranged from 4 months to 6 years, with an average of 26 months. The active range of motion obtained at the metacarpophalangeal joint arthroplasties ranged from 45 to 80 degrees, with an average of 60 degrees. The active range of motion obtained at the proximal interphalangeal joint arthroplasties ranged from 0 to 70 degrees, with an average of 29 degrees. Better results were generally obtained at the metacarpophalangeal level, and in those arthroplasties performed in non-amputated digits. There were no post-operative infections and all but one joint were stable.

Adolescent↗
PubMed1988

The lateral arm free flap in releasing severe contracture of the first web space.

To permanently release severe contracture of the first web space, suitable additional skin must be provided. Local skin is often insufficient and is unable to fill the depths of the space. Pedicle flaps are bulky, require a second operation for division, and frequently demand further procedures for revision. A precisely tailored lateral arm free flap allows unparalleled correction to be achieved with one surgical intervention. The operation can be performed under regional anaesthesia with morbidity restricted to one extremity.

Adult↗