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Biomedical subjects

K Uchinishi

Publications and source records attributed to K Uchinishi.

13 recordsLinked to original sources

Reconstruction of a floating thumb with an excess big toe.

In a three-year-11-month-old girl, an excess big toe was transferred microsurgically to replace a congenital floating thumb. The reconstructed thumb was evaluated nine years after the transfer. It showed almost normal growth, compared with the contralateral side, and the aesthetic result was excellent. However, the patient does not use the reconstructed thumb with much skill. The reasons for this are discussed, and the importance of performing surgery early in life is stressed.

Age Factors↗

Operation for the stiff elbow.

Forty two cases of stiff elbow were treated by operation. Thirty three were subsequent to trauma, seven were due to ectopic ossification after quadriplegia, and two were associated with massive ectopic ossification after long term coma following head injury. Two separate skin incisions, postero-medial or medial and anterior, were used in most cases. In the post-traumatic cases, scarred, thickened posterior oblique fibres of the medial collateral ligament were usually found. Ectopic ossification was frequently situated on the postero-medial aspect of the stiff elbows. Resection of the thickened fibres or the ectopic ossification was the most effective procedure to improve elbow flexion. The average improvement in range of motion was 59 degrees in post-traumatic cases, 72 degrees in ectopic ossification after quadriplegia and 127 degrees in ectopic ossification following coma.

Adolescent↗

Dorsal dislocation of the D.I.P. joint with fracture of the volar base of the distal phalanx.

Between 1978 and 1985, we treated 12 cases of dorsally displaced fracture-dislocation of the I.P. joint of the thumb or of the D.I.P. joint of the finger, with a volar bony fragment. All were treated surgically, active exercise being started three to five weeks later. At the last follow-up, averaging 6.4 years (range 4.3-10 years) after operation, none of the joints was painful but the range of motion was somewhat limited.

Adolescent↗

Extensor tendon involvement in Smith's and Galeazzi's fractures.

Extensor tendon involvement in three Smith's and two Galeazzi's fractures are reported. In two cases of previous Smith's fracture, the extensor indicis proprius tendon had been entrapped and ruptured in one case, and in the other the extensor digitorum communis tendon of the index was pierced by the fragment. Both showed a severe tenodesis effect on the index finger and thumb. In a new case of Smith's fracture, long extensor tendons of the fingers and thumb had been trapped beneath a dorsally displaced third fragment making closed reduction impossible. In the two cases of Galeazzi's fracture; in one the extensor carpi ulnaris tendon was trapped between the dorsally displaced ulnar head and the avulsed styloid process and in the other, the extensor digiti minimi tendon was caught beneath the radial border of the dorsally dislocated ulnar head.

Adolescent↗

An experimental study on the "double crush" hypothesis.

An experimental study investigated the vulnerability of peripheral nerves in the "double crush" situation. Canine sciatic nerves were studied by means of electrophysiologic and histologic examination. Compression was applied by the KEIO compression clamp, with compression force of 15 g (approximately, 27.6 mm Hg). An incomplete conduction block and mild axonal degeneration were induced by a single compression. However, a complete conduction block and severe axonal degeneration could be induced in half of the cases by the double compression. In these cases, the loss of nerve function after a double lesion was greater than the sum of the deficits after each separate lesion. A good therapeutic effect was obtained by removing all compression, but the effect was incomplete when either compression was retained. It is concluded that proximal compression of a nerve could lessen its ability to withstand further compression more distally.

Action Potentials↗

Transfer of latissimus dorsi to replace a paralysed anterior deltoid. A new technique using an inverted pedicled graft.

A new method of replacement for the paralysed anterior deltoid is described. The latissimus dorsi with its neurovascular pedicle is freed and rotated, and then placed over the anterior part of the paralysed muscle. The lever arm of the transposed muscle is as long as that of the deltoid, and the muscle volume is enough to restore the natural contour of the shoulder. We report operations on 10 patients with shoulder palsy, eight caused by brachial plexus injury and two by resection of a neurilemmoma of the plexus. In six cases, active flexion to over 90 degrees was achieved. At least one of the rotator cuff muscles or the long head of biceps should have some active function if good results are to be obtained.

Adolescent↗

Treatment of pseudoarthrosis of the distal phalanx with the palmar midline approach.

Six patients with pseudoarthrosis of the waist of the distal phalanx were operated on with the palmar midline approach. Of these, four patients had sustained injuries of the crush type. The period between the initial injury and this surgery ranged from 2 to 10 months, averaging 4.2 months. With a midline straight incision on the pulp, bone grafting was followed by cross-pinning with Kirschner wires. All six cases obtained bony union within 6 to 11 weeks postoperatively. The operative scar was scarcely detectable and caused no problem.

Adult↗