Anal leukoplakia: management using a staged plastic procedure.
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Biomedical subjects
Publications and source records attributed to M D Brennen.
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The clinical applications of the second dorsal metacarpal artery island flap are illustrated by selective case reports from a series of 12 consecutive cases carried out in this Unit. In five cases the flap was transferred as a neurovascular island flap for sensory resurfacing of the thumb. There were no failures and no donor site complications. The anatomy and clinical dissection of the flap are described.
In a prospective study, 114 patients with 138 zone 2 flexor tendon injuries were treated over a three-year period. Early active mobilisation of the injured fingers was commenced within 48 hours of surgery. 98 patients (86%) were reviewed at least six months after operation. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion recovered was graded excellent or good in 77% of digits, fair in 14% and poor in 9%. Dehisence of the repair occurred in 11 digits (9.4%) and in these an immediate re-repair followed by a similar programme of early active mobilisation resulted in an excellent or good outcome in seven digits.
It is suggested that more widespread use of the end to side microvascular suturing technique should be made, especially in arteries. A simple experimental practice model in the rabbit is suggested. Patency rates comparable to end to end anastomosis can be achieved.
Two cases are presented in which a severely damaged hand was reconstructed by the simultaneous transfer of two toes using microvascular techniques. A two year evaluation of the functional result is made in both cases. Conventional reconstructive methods have little place in the reconstruction of these severe disabilities.
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