Biomedical subjects
Publications and source records attributed to M R Wexler.
We describe the use of two oppositely-based, triangular, cross-arm flaps for primary coverage of a new first web space, created by releasing an abduction contracture of the thumb.
The repair of the caudal end of a severely deviated septum has been a challenge since the beginning of septum surgery. In the time of Freer and Killian, a caudal and dorsal strip was always left. Frequently, the most obvious portion of the septal deformity, the caudal end, was undisturbed and the deformity persisted. Metzenbaum, Fomon and Cottle procedures designed to correct this problem. The procedure described in this presentation utilizes the maxilla-premaxillary approach to the septum. The laporotomy of the rhinoplasty procedure is used to expose the upper lateral cartilages. These cartilages are submucously uncovered and separated from the dorsal margin of the septal cartilage. This provides complete exposure of the line of fracture usually responsible for the extreme deflection of the caudal end of the septal cartilage. A strip of cartilage including the line of fracture is removed. The caudal end is attached to the mucoperichondrium of the right side and now is completely mobile. The caudal end is placed over the maxillary spine and sutured in position by a chromic cat gut suture from the prespine fascia through the caudal edge of the septal cartilage. The upper lateral cartilages are sutured to the dorsal margin of the septum acting as a splint to hold the sections of cartilage straight and immobile until the tissues heal.
A new method is presented for arthrodesis of small joints in the hand. In this method Kirschner wires are inserted dorsoventrally through the phalanges on either side of the joint, and the external ends bent into hooks. Longitudinal compression is achieved by connecting these hooks with rubber bands. This technique gives a solid and painless immobilization in a proper position, and the latter can be corrected easily when necessary. We arthrodesed 46 joints in 39 patients by this method in 1975 and 1976. The fusion time was 4 to 6 weeks, and the method produced a good bony arthrodesis in 42 of the 46 fingers.
We describe a new technique to treat the mallet finger deformity. The method is both simple and efficient, and it does not require follow-up for splint or dressing adjustment. All of our 15 cases regained function without complications.
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A method of reconstructing healed injuries of the nose in the adult and young growing child is presented. The actual surgical technique is relatively simple and may be acquired easily during the period of residency or in many of the excellent postgraduate courses that are presented. Emphasis should be placed on restoration of function and form. A basic understanding of septal anatomy and physiology provides a good foundation in the treatment of this organ. Appreciation of the fundamental inter-relationships of the bone pyramid and the cartilaginous vault and lobule provides the foundation of proper treatment of the external nose. When both elements of the nose require attention, combined septal and rhinoplastic techniques should produce the best result.
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