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Biomedical subjects

J Henk Coert

Publications and source records attributed to J Henk Coert.

17 recordsLinked to original sources
PubMed2006

Results of partial fasciectomy for Dupuytren disease in 261 consecutive patients.

Many different surgical techniques are still being used for Dupuytren disease. The outcome of 558 consecutive operations with 1 technique was reviewed. Distinct subgroups were made to detect risk factors for a poor outcome and complications. The mean follow-up time was 7.3 years. Younger patients (first surgery before 45 years) were operated significantly more than older patients (after 45 years). Results of contracted proximal interphalangeal (PIP) joints were significantly worse than other joints. The overall complication rate was 26%. Nerve lesions occurred in 7.7%. Young age proved to be a prognostic factor for the total number of operations. The contracted PIP joints will lead to more complications and poorer result. The risk at nerve lesion, necrosis, and infection are higher for recurrent surgery. These findings can be used in advising patients.

Adult↗
PubMed2005

Closure of the donor site of the free radial forearm flap: a comparison of full-thickness graft and split-thickness skin graft.

INTRODUCTION: Donor-site complications of free radial forearm flaps (FRFF) after closure with a split-thickness skin graft (STSG) have been reported repeatedly. Different types of closure of the donor site have been advocated to reduce donor-site complications. In our practice, a V-Y closure with a local full-thickness skin graft (FTG) is performed generally. PURPOSE: A retrospective follow-up study was performed comparing subjective and objective outcomes of FTG versus STSG closure. FRFF donor site closure in 34 head and neck cancer patients (15 STSG, 19 FTG) was studied. RESULTS: Both methods of closure showed good function, sensibility, and esthetic outcome. No statistical differences between the 2 methods could be shown. CONCLUSION: V-Y local donor site closure is a good technique which prevents an additional donor site scar and discomfort when performing an STSG closure.

Carcinoma, Squamous Cell↗
PubMed2004

Documentation of posttraumatic nerve compression in patients with normal electrodiagnostic studies.

BACKGROUND: Electrodiagnostic evaluation may suggest the absence of posttraumatic nerve compression in the presence of patient symptoms. Computer-assisted neurosensory testing documents peripheral nerve sensory impairment. In the setting of trauma, where there are often legal implications, documentation of peripheral nerve compression is important. This is highlighted in the diabetic, who may have neuropathy. METHODS: A prospective study tracked trauma-related peripheral nerve problems in patients with "normal" electrodiagnostic studies, and for whom surgical care or legal outcome was determined by documentation of abnormalities by testing with the Pressure-Specified Sensory Device. Eight patients were identified, four of whom had diabetes. RESULTS: In all eight patients, neurosensory testing documented peripheral nerve problems, which was critical in obtaining approval from workers' compensation insurance carrier for decompression of the nerve and facilitating legal settlement. CONCLUSION: Neurosensory testing with the Pressure-Specified Sensory Device identifies peripheral nerve compression related to trauma, facilitating management of the patient, even in the presence of diabetic neuropathy.

Diabetic Neuropathies↗
PubMed2004

Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.

BACKGROUND: In the absence of a randomized, prospective study comparing different surgical approaches for decompression of the ulnar nerve at the elbow, the choice of an approach relies on the individual surgeon's training and experience. The present report describes the results of a prospective, long-term evaluation of the musculofascial lengthening technique in a large series of patients. In these patients, the degree of ulnar nerve compression was staged with use of a numerical grading system that included measures of both motor and sensory function. METHODS: From 1985 through 1991, 121 consecutive patients (161 ex-tremities) in whom the ulnar nerve was entrapped at the elbow were treated with surgical decompression with use of a musculofascial lengthening technique. In addition to the patient history and physical examination, measurements of sensory and motor function were obtained prospectively to permit staging of the severity of the compression by means of a grading scale. The preoperative and postoperative scores on this scale were evaluated. The mean duration of follow-up after surgery was 45.6 months. RESULTS: On the basis of traditional criteria, 105 limbs (65%) had an excellent result; thirty-seven (23%), a good result; six (4%), afair result; twelve (7.5%), a failure; and one (0.5%), a recurrence. There was significant improvement in ulnar nerve function in terms of both the sensory (p < 0.001) and motor (p < 0.001) components of the grading scale. Comparisons of clinical subgroups revealed significant improvement in patients with diabetes, those with a Workers' Compensation claim, and those who had a severe degree of compression rather than a mild degree of compression. CONCLUSIONS: Surgical decompression of ulnar nerve entrapment at the elbow by means of a musculofascial lengthening technique was associated with an 88% rate of good to excellent results. The results of the present study demonstrate the feasibility of performing a statistical analysis of surgical results by using a numerical grading system to stage the degree of nerve compression. This method may be used to study different surgical techniques for the treatment of this common nerve compression syndrome.

Contraindications↗
PubMed2003

Neuropathy related to Crohn's disease treated by peripheral nerve decompression.

Neurological complications of Crohn's ileitis have been reported, and the aetiology ascribed to vitamin deficiencies and iatrogenic treatment. In this report we describe a patient who developed multiple areas of nerve compression in lower and upper extremities. After failure of conservative treatment, she was successfully treated surgically. As far as we know this has not been reported before.

Adult↗
PubMed2003

Short-term and long-term results of speech improvement after surgery for velopharyngeal insufficiency with pharyngeal flaps in patients younger and older than 6 years old: 10-year experience.

Velopharyngeal insufficiency (VPI) is a well-known cause for hypernasality. To overcome this problem, the authors use a static surgical technique: a cranially or caudally based flap. In 93 patients, the results of this technique on speech (hypernasality, nasal air escape, articulation) and velopharyngeal function were evaluated over a period of at least 1 year. In 53 patients, pharyngoplasty flaps were based caudally. In 40 patients, pharyngoplasty flaps were based cranially. The patients were age 2.5 to 24.5 years, with a mean of 5.5 years (SD: 4 years and 2 months). Improvement was found in almost all patients. The patients who underwent surgery when they were younger than age 6 significantly improved better then the patients who were treated when they were older than age 6. There were no differences in outcome between cranially based and caudally based flaps. There were also no differences between patients with plain VPI and patients with VPI (e.g., Pierre Robin sequence and Shprintzen).

Child↗
PubMed2003

Documenting neuropathy of the lateral femoral cutaneous nerve using the Pressure-Specified Sensory Testing device.

Entrapment of the lateral femoral cutaneous nerve has been difficult to document. The variability of the anatomic location of this nerve makes it difficult to measure with traditional electrodiagnostic studies. At the same time, anatomic variability increases the likelihood for this nerve to become entrapped within the inguinal ligament. The current study reports the ability to document the presence of this nerve entrapment in 24 patients, compared with 10 asymptomatic control subjects, by using nonpainful and noninvasive computer-assisted neurosensory testing with the Pressure-Specified Sensory Device.

Adult↗
PubMed2003

Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.

BACKGROUND: In the absence of a randomized, prospective study comparing different surgical approaches for decompression of the ulnar nerve at the elbow, the choice of an approach relies on the individual surgeon's training and experience. The present report describes the results of a prospective, long-term evaluation of the musculofascial lengthening technique in a large series of patients. In these patients, the degree of ulnar nerve compression was staged with use of a numerical grading system that included measures of both motor and sensory function. METHODS: From 1985 through 1991, 121 consecutive patients (161 extremities) in whom the ulnar nerve was entrapped at the elbow were treated with surgical decompression with use of a musculofascial lengthening technique. In addition to the patient history and physical examination, measurements of sensory and motor function were obtained prospectively to permit staging of the severity of the compression by means of a grading scale. The preoperative and postoperative scores on this scale were evaluated. The mean duration of follow-up after surgery was 45.6 months. RESULTS: On the basis of traditional criteria, 105 limbs (65%) had an excellent result; thirty-seven (23%), a good result; six (4%), a fair result; twelve (7.5%), a failure; and one (0.5%), a recurrence. There was significant improvement in ulnar nerve function in terms of both the sensory (p < 0.001) and motor (p < 0.001) components of the grading scale. Comparisons of clinical subgroups revealed significant improvement in patients with diabetes, those with a Workers' Compensation claim, and those who had a severe degree of compression rather than a mild degree of compression. CONCLUSION: Surgical decompression of ulnar nerve entrapment at the elbow by means of a musculofascial lengthening technique was associated with an 88% rate of good to excellent results. The results of the present study demonstrate the feasibility of performing a statistical analysis of surgical results by using a numerical grading system to stage the degree of nerve compression. This method may be used to study different surgical techniques for the treatment of this common nerve compression syndrome.

Adolescent↗