Biomedical subjects
Publications and source records attributed to H E Kleinert.
Twenty patients with symptoms present for an average of 21.1 months and who in most cases had been treated by several conservative techniques for chronic tennis elbow were diagnosed as having radial tunnel syndrome, as originally described by Roles and Maudsley. Release of the tunnel was followed by eventual relief in 19 instances (95%).
Free vascularized fibular grafts were employed in five patients with segmental bone defects following trauma or resection of tumors of the upper extremity with excellent results in three patients and satisfactory results in two. No donor site morbidity was experienced. A comparison with rib and iliac crest grafts indicates that the fibula is more suitable for reconstruction of long bone defects. The advantages of this technique are stability without sacrificing viability and a shorter immobilization period with more rapid incorporation and hypertrophy of the graft. The disadvantages are prolonged operating time, difficulty in assessing patency of anastamoses in the immediate postoperative period, and sacrifice of a major vessel in the lower extremity.
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The association between polyarteritis and peripheral neuropathy may be overlooked in the clinical assessment of nerve lesions in the extremity. Nerve palsy may be the initial presenting complaint in polyarteritis nodosa. A case is presented which demonstrates the pathological process. A method for early recognition and treatment is suggested.
Forty-six patients with ulnar artery thrombosis were evaluated. A comparison of the results was made between those patients who were treated by sympathectomy and those in whom we attempted to reestablish the blood flow. A reverse vein graft was often used in the latter group. Based on the results of this study, we believe the preferred method of treatment for ulnar artery thrombosis is an attempt at the reestablishment of blood flow.
We present 7 cases of digital artery thrombosis with ischemic symptoms. Six were treated successfully by application of the Leriche principle of resection of a segment of the thrombosed artery. One was treated successfully by resection of a thrombosed segment and replacement with a small vein graft. The symptomatic relief has been conplete in 4 of the 6 patients who had resections, and in the patient who had the single vein graft. The other two patients (with resection only) have had improvement.
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This paper reviews experience with thirty-six trapezial replacements over a period of six years. The indications for replacement are given, the group of patients analysed and the technique outlined, with particular attention given to tendinous reinforcement of the capsular repair. The results with regard to pain, dislocation and other complications are recorded. The causes of dislocation and its prevention are discussed.
The problems of extensive scarring involving the median and ulnar nerves at the wrist are discussed. Possible methods of separating the dermal cicatrix from the nerves are skin flaps or muscle flaps. A case is presented in which an abductor digiti minimi muscle flap was used. The reasons for this choice are discussed and the technique described.
Defining replantation as the restoration of a completely amputated part as opposed to simply restoring circulation to an incompletely severed part, the results of replantation of 86 completely amputated parts in 71 patients performed from January, 1970, to December, 1975, were studied. Twenty-eight, or 32.5 percent, were the result of sharp severances of the part; localized crushing accounted for 56, or 65.1 percent. Two were classified as degloving injuries. Twelve amputations were transmetacarpal, six were at the metacarpophalangeal joints, 14 through the proximal phalanx, 15 at the proximal interphalangeal joint, 21 in the middle phalanx, 13 at the distal interphalangeal joint, and five through the distal phalanx. The technique consisted of bone shortening and fixation and repair of all tendons and nerves if possible. Veins are repaired first, at least two for each artery, and heparinized saline and lidocaine are used locally. Irrigation of the vessels is not done, but an intravenous bolus of 3,000 U. of heparin is given when the anastomoses are completed. Aspirin and low molecular weight dextran are given for 3 to 7 days. For the more distal replantation, heparin may be used. Antibiotics are given. In the total series of 86 completely amputated hand units, 52 were unsuccessful, primarly due to vascular thrombosis and usually on the venous side. In the year 1975 a success rate of 69.2 percent was achieved, whereas in the last 50 replantations, done between Jan. 1, 1976, and Oct. 15, 1976, the success rate was 90 percent. Results improved with more experience in the technique and with more careful selection of patients.
A study was made of the results of immediate repair and controlled mobilization in 156 severed flexor tendons in 68 patients occuring over an 18-month period. Eight patients with 16 tendon injuries could not be followed. Results were obtained from examinations done 6 weeks to 18 months (mean, 5.3 months) after repair. Thirty-one of the 60 patients were less than 20 years old, and 44 of the 60 were less than 30 years old. Seventy-nine (56%) of the injuries occurred in the area known as "no man's land"; 28 patients with repair of tendons in this area were rated by our standards as "excellent" or "good"--75% of patients as compared to 84.4% for the results of repair in other areas. In one fourth of the cases of severance of both tendons, because of local conditions in the wound, the superficialis was excised, but in all others it was repaired.
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We present a patient who had a desmoplastic fibroma at the base of the metacarpal of his long finger. The operation to remove the lesion and to reconstruct the metacarpal is described. The history of the experiences with this lesion is reviewed.