Six patients sustained extensive hand and upper limb trauma, including median nerve and/or thenar muscle loss. Initial treatment consisted of various median nerve and/or soft tissue reconstructions. Because of extensive palmar scarring and lack of useful opposition (Kapandji stage 3), a 2-stage opposition transfer was performed. In stage 1, a silicone rod was placed along the path of the intended tendon transfer. In stage 2, the rod was removed and the donor tendon was passed through the pseudosheath to the point of insertion at the thumb. All patients were monitored for a minimum of 1 year and all achieved significant functional improvement, documented by Kapandji stage 6 opposition in 1 patient and by at least stage 7 or 8 opposition in the other 5 patients.

Adult↗

PubMed1997

Replantation and revascularization of the digits in a community microsurgical practice.

One-hundred and twenty-seven digits in Verdan zones I and II, and 24 thumbs in 106 patients were reviewed from 1979 to 1995. Patients were all followed for a minimum of 5 months to assess early results and complications, and to determine if a short course (minimum 3 days) of dextran 40 anticoagulation adversely affected digit survival. The total survival rate was 88 percent. Digits with only a single artery and vein repaired had a significantly higher rate of failure (p > .05). Index and small fingers also showed a trend toward lower survival. Vein grafts were used in 22 percent of cases. No vascular problems were noted after 5 days. Variables not affecting survival were: presence of a joint fusion, type of fixation, level of injury, number of digits, mechanism of injury, and use of vein grafts. The average hospital stay for the group was 6.5 days (+/-SD 3.3). No complications were seen with dextran use. A total of 51 complications were seen overall and the non-union rate was 10 percent. Community-based replantation and revascularization can be performed with early results equivalent to prior published studies. Complications are to be expected and demand expeditious treatment. Functional recovery of severed digits remains the benchmark for success in these injuries, however, lost digits never work.

Adolescent↗

PubMed1994

A large, pigmented nail bed lesion in a child.

An unusual case of an extremely large junctional nevus of the nail bed with histological atypia in a 6-year-old Japanese child is described. The evaluation and management of subungual pigmented lesions is reviewed.

Child↗

PubMed1980

Attitudes toward weight gain in pregnancy.

Recently, there has been increased interest in the influence of maternal prenatal nutrition on the course and outcome of pregnancy. Evidence has accumulated that a woman's weight before pregnancy and the weight gained during pregnancy directly affect infant birth weight, incidence of neonatal mortality, and growth and development of the infant during the first year of life. Although recent recommendations for weight gain in pregnancy have been liberalized, a survey of 195 pregnant women who had prenatal visits in both clinic and private offices showed deficiencies in their understanding of the subject. Some 37 percent of women believed they should gain 20 pounds (9 kg) or less during pregnancy. Eight percent admitted to dieting before at least one antenatal visit and 54 percent thought their doctor would not be concerned about too little weight gained during pregnancy. This suggests that many women and some doctors are still ignorant of current concepts of proper nutrition during pregnancy. Apparently, increased lay and professional educational efforts are needed.

Attitude to Health↗

PubMed1978