Functional sensibility of the hand after nerve repair.
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Hand↗
Biomedical subjects
J Holmberg
Publications and source records attributed to J Holmberg.
Post-traumatic neuralgia in the upper extremity treated with extraneural scar excision and flap cover.
19 patients with neuralgia in the upper limb after surgical or non-surgical trauma to peripheral nerves were treated by excision of the extraneural scar and surrounding hypersensitive skin and application of free or pedicle flaps. The subcutaneous fat of the flaps was wrapped around the affected nerves. After a mean follow-up time of 5.8 years the patients were sent a questionnaire. Only one patient considered herself cured, six were almost cured and seven improved. Two patients were unchanged and three worse. The results after three to four months appeared stable.
Arm Injuries↗
Observed lung markings in normal chest roentgenograms.
The digital chest posterior-anterior roentgenograms of 42 healthy individuals were ranked twice (interval of at least 5 days) in the order of increasing lung parenchymal markings. The evaluations were made by three radiologists, two residents, a medical student and a radiographer. All observers regardless of their radiological experience showed good intraobserver correlations between their two subsequent rankings (p < 0.05-0.001). The interobserver agreement on rankings was generally poor, even if the radiologists were considered. Radiologic training seemed to eliminate the influence of false leading factors (the object's respiration and body constitution). "The golden standard of evaluation" (= the added-up rankings by the radiologists) did not correlate either with the patient's ages (19-54 years) or smoking habits (0-45 pack-years, mean 4.2).
Adult↗
Interpreting laser Doppler recordings from free flaps.
Although the transfer of free flaps is nowadays accomplished with an increasing degree of safety, thrombosis of the microvascular anastomoses is still a problem. In order to avoid delay in re-operating, various methods for objective blood flow monitoring have been tried, among them Laser Doppler Flowmetry (LDF). When one reviews the literature, it is apparent that opinions differ about whether or not LDF is a reliable technique for this purpose. To focus on the need to interpret continuous recordings, this paper reports our findings in six latissimus dorsi free flaps chosen from our series of LDF monitoring procedures. One uneventful flap, no. 1, had an immediate postoperative LDF value of 4.5 perfusion units (PU). LDF values improved during the recovery period and the graphic recording showed fluctuations due to normal physiological variations of the blood flow in the flap. Another uneventful flap, no. 4, showed the same pattern, though at an appreciably lower level, 2 PU, on average. Flap no. 2 had an acceptably high value of 3.5 PU despite suffering a venous thrombosis. However, the LDF recording showed no fluctuations and the value declined gradually. Another flap, no. 3, showed fluctuations and blood flow was normal although the value decreased to 2.5 PU. In flap no. 5, any value between 2 and 3.5 PU could be obtained merely by adjusting the position of the probe in the holder. In no. 6, the LDF value suddenly dropped, accompanied by a decrease in the total amount of backscattered light, indicating venous obstruction which was confirmed at re-operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Humans↗
Pain drawing as an investigative tool in hand surgery.
Fifty consecutive patients referred to the departments of hand surgery in Malmö and Lund were asked to chart their pain on a diagram of the body before their first visit to the clinic. Three patients never answered the questionnaire and were excluded. The drawings were evaluated separately by a senior hand surgeon without access to the case records. In 19 of 47 cases (40%) the evaluation of the pain drawings agreed with the clinical diagnosis. In another 17% (8 of 47), in which the pain drawings had indicated a condition not related to hand surgery, clinical examination failed to establish a diagnosis. The evaluation of the drawings had a false negative rate of 4% (2 of 47). In the remaining 18 cases pain drawings did not give enough information for diagnosis because of the variety of symptoms. Pain drawing seems to be valuable in the evaluation of patients with chronic pain in the upper extremity.
Adult↗
HTLV-I among U.S. Marines stationed in a hyperendemic area: evidence for female-to-male sexual transmission.
Among 5,255 active duty United States Marines on permanent tour in Okinawa, Japan, screened for human T-cell leukemia/lymphoma virus type I (HTLV-I) seropositivity, 3 (0.06%) were confirmed by Western blot analysis to have core and envelope reactivity. All three seropositive individuals have a history of prolonged sexual contact with Okinawan women, and two of the three individuals are married to seropositive Okinawan wives. Two gave a prior history of gonorrhea, while all three were negative for syphilis (MHA-TP) and hepatitis B. No other risk factors associated with HTLV-I seropositivity in the United States were identified. A banked sample from one individual, obtained 8 months after initial sexual relations with his HTLV-I-seropositive Okinawan spouse and 20 months before being retested in the survey, showed a pattern suggesting seroconversion. Although based on small numbers, these data suggest that female-to-male transmission of HTLV-I occurs in the absence of other cofactors, e.g., ulcerative genital lesions.
Adult↗
Reoperation in high ulnar neuropathy.
Twenty-two reoperations were done on 16 arms in 14 patients who had previously been unsuccessfully treated by neurolysis for cubital tunnel syndrome. For the first reoperation subcutaneous transposition was chosen for 10 arms, and submuscular transposition for six. The symptoms were cured or improved in seven arms, eight were unchanged and one was made worse. In six arms in which first neurolysis and then subcutaneous transposition had been unsuccessful, submuscular transposition was carried out. Five patients were improved or cured, and the symptoms were unchanged in one. Reoperation after ulnar neurolysis therefore gave satisfactory results in about half the cases. Submuscular transposition carried out as a second reoperation may be useful in cases in which subcutaneous transposition had not been successful.
Adolescent↗
Reconstruction with a free vascularized fibular graft for malignant bone tumor.
Seven patients with a bone tumor were operated on with local excision and a free vascularized fibular graft. Four of the patients received both chemotherapy and radiotherapy. The blood flow in the grafts was evaluated by scintigraphy within 1 week after the operation. The median follow-up time was 4 (1-5) years. All but one graft-host junction healed primarily. There were 5 graft fractures in 3 patients. Four of the fractures occurred in 2 patients who received preoperative and postoperative chemotherapy and radiotherapy. Three of these fractures healed without surgery. Resorption of the grafts was never seen, whereas hypertrophy was observed in 6 patients. None of the patients had any permanent morbidity at the donor site. One patient had tumor recurrence and died after 2 years. Our findings indicate that a vascularized bone graft is also a useful alternative for reconstruction of large bone defects in patients receiving both chemotherapy and radiotherapy.
Adolescent↗
Flap coverage for post-traumatic nerve pain in the arm.
14 patients with painful neuroma, skin hyperesthesia or neuralgic rest pain were followed up (mean 20 months) after excision of skin and scar, neurolysis and coverage with pedicled or free flaps. Painful neuroma had improved in 3 of 7 patients. Skin hyperesthesia had been eliminated in 8 of 11 patients, and had improved in 3. Neuralgic rest pain had been eliminated in 5 of 6 patients, and was partially relieved in one. It is concluded that painful neuroma in continuity is not relieved by flap coverage, whereas skin hyperesthesia and neuralgic rest pain are appropriate for this type of treatment.
Adolescent↗
Thumb replantation or not?
Over a three-year period 14 consecutive cases of amputated thumbs, 10 complete and 4 incomplete, were replanted/revascularized. Eight thumbs (57%) survived. These cases were compared with a control group, in which replantation had failed or had not been attempted. The control group was chosen to be as similar as possible with respect to thumb amputation level, type of trauma, age, occupation and sex. Costs for hospital care, duration of sick leave and disability rate were calculated. Hand function was estimated as the ROM of the thumb, power of pinch and grip, two-point discrimination and ability to perform a standardized hand function test (Sollerman). It was concluded that replantation yields better functional and social results than alternative treatment of thumb amputation at similar costs.
Accidents, Occupational↗
The free scapular flap. An alternative to conventional flaps on the upper extremity.
The free scapular flap was used as an alternative to a conventional pedicle flap in resurfacing scarred areas and padding major nerve trunks on the upper extremities in a series of 8 patients. The free flap proved to be rather reliable (one failure), convenient to the patients and cheaper for the Health Service than a conventional flap.
Adult↗
Detecting arterial and venous obstruction in flaps.
Island skin flaps based on the latissimus dorsi muscle were raised in domestic pigs. Flap circulation, maintained only by the vascular pedicle, was monitored by laser Doppler flowmetry, laser photometry, and transcutaneously measured carbon dioxide tension. Both arterial and venous occlusion were accompanied by very low laser Doppler flow values. In laser photometry, the backscattered intensity of light remained unchanged or was slightly increased during arterial occlusion. In response to venous occlusion, however, the light intensity decreased markedly. Transcutaneous carbon dioxide tension increased in both venous and arterial occlusion. When venous outflow pressure was raised incrementally, both the laser Doppler flow value and the total backscattered light intensity fell proportionately. Laser Doppler flowmetry might thus be useful clinically to detect decreased blood flow in transferred flaps, and laser photometry may determine if the decreased flow is related to the arterial or venous side.
Animals↗
Detecting changes of arterial and venous blood flow in flaps.
Island skin flaps based on the latissimus dorsi muscle were raised in domestic pigs. Simultaneous recordings of laser Doppler flowmetric and laser photometric values were made on the skin in the middle of the flap. Occlusion of either the artery or the vein of the pedicle was accompanied by very low laser Doppler flow values. In laser photometry the total intensity of backscattered light remained unchanged or was sightly increased during arterial occlusion. In response to venous occlusion, however, it decreased markedly. As venous outflow pressure was increased step by step, both the laser Doppler flow value and the laser photometry value fell proportionally; thus, the greater the increase in pressure the lower were the steady state levels of both variables. Stepwise reductions of arterial inflow pressure were followed by proportional decreases in both mean blood volume flow, recorded using electromagnetic flowmetry, and in laser Doppler flowmetric values. However, laser photometric values varied only minimally. Laser Doppler flowmetry thus might be a useful clinical aid in detecting decreased blood flow in transferred flaps, and laser photometry may determine whether the decreased flow is due to arterial or venous causes.
Animals↗
Denervation of the wrist.
In a series of 48 painfully restricted wrists denervation was used during a 6-year period on wide indications as a surgical alternative. The observation time averaged 2.4 years. Pain relief occurred in 56% of the patients. Considering the simplicity of the method and the lack of serious complications, it is concluded that denervation of the wrist is worth trying as a palliative measure prior to more extensive surgery.
Denervation↗
Laser Doppler flowmetry and transcutaneously measured carbon dioxide tension for observing changes of skin blood flow in fingers.
Laser Doppler flowmetry (LDF) and transcutaneous carbon dioxide tension measurements (PtcCO2) were performed on fingers of healthy volunteers subjected to a sequence of hydrostatic and thermal stimuli. LDF response using an unheated probe agreed well with measurements made with Xenon133 clearance and strain gauge plethysmography in a previous work. The PtcCO2 results, however, were found not in any way to reflect changes in skin blood flow.
Adult↗
On the relation between transcutaneous oxygen tension and skin blood flow.
Transcutaneous oxygen tension (pTcO2) varies with pAO2, circulatory parameters, skin metabolism and oxygen diffusion. The necessity to heat the skin beneath the electrode to allow transcutaneous oxygen diffusion limits the use of pTcO2 in the study of skin blood flow. The oxygen measured probably emanates from the capillaries of the superficial dermis. A large number of arteriovenous shunts in the skin may modify the pTcO2 response. The heat-dilated vessels beneath the electrode behave passively in most circumstances. Differences in local blood temperature with secondary shifts in the release of oxygen from oxyhemoglobin may affect pTcO2 at high and low flow rates respectively. pTcO2 may vary with the perfusion pressure and possibly also with the resistance of the blood vessels outside the area heated by the electrode, but only at low flow rates.
Blood Pressure↗
[Microvascular surgery for replantation and recirculation in acute hand injuries].
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Finger Injuries↗
Restoration of the digital tendon sheath. A new concept of tendon grafting.
The repair of flexor tendons which have been divided within the digital sheath remains an unsolved problem. Adhesions occur at would sites and points of tendon trauma. It is well known that an intact digital canal prevents formation of adhesions. Previous studies in chickens have shown that autologous tendon sheath tissue can successfully be transplanted from one digit to another with preserved vitality and that by this technique the continuity of an injured tendon sheath can be restored. The present series represent a clinical application of this new concept. 40 patients with flexor tendon injuries within the critical zone in the finger were treated by the use of a two-stage tendon grafting procedure. In the first stage operation the continuity of the tendon sheath was restored by transplantation of autologous synovial tissue. In the second procedure 3 months later a conventional tendon grafting was performed. Using the criteria of Boyes & Stark (1971) successful results were obtained in 88%. It can be concluded that the present method of tendon grafting provides a favourable recipient bed and improved gliding conditions.
Adolescent↗