Regional anesthesia for hand surgery.
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Biomedical subjects
Publications and source records attributed to M Rousso.
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A simple method for achieving satisfactory regional anaesthesia for a wide range of hand surgery is presented. It entails separate attention to the two aims of regional anaesthesia, namely analgesia of the tourniquet and of the operative site. This study of 149 patients indicated that (a) subcutaneous ring anaesthesia produced excellent tourniquet analgesia, both in the forearm as well as the upper arm; (b) a tourniquet applied to the forearm provided excellent regional ischaemia in 98% of our cases, contrary to what has been previously accepted. The advantages of this method are its safety and simplicity even for the relatively untrained surgeon. It also obviates the need for brachial plexus blocks, intravenous regional or general anaesthesia with all their drawbacks.
A 6-year-old girl with an avulsion injury of the dorsum of both feet had multiple fractures of the ankles and the tarsal and metatarsal joints. She was treated by wet dressings followed by simultaneous coverage of both feet with bilateral cross-thigh flaps.
The exceptional case in the distal radius of an 18-month-old girl demonstrates the natural history and characteristic features of solitary bone cyst at an early age. There were recurrent pathological fractures and even recurrence of the cyst, but spontaneous complete healing occurred after a period of 7 years. Splinting of the fractures, curettage and bone graft were performed per primum. Aspiration of the cyst and collapse of the cyst walls were secondary procedures. The recommended treatment is biopsy and prolonged immobilization until spontaneous healing of the cyst is complete.
Reimplantation was attempted in 24 of 30 amputated fingers in 16 patients; 17 attempts were successful. The indications for surgery, the operative technique postoperative complications and results are discussed. It should be stressed that revival of the amputated digits does not necessarily mean functional success, and a careful evaluation of the results is needed. Organization of the reimplantation service is very important for achieving better results in this branch of surgery.
The use of basic trigonometrical principles enables the translation of theoretical pre-operative estimations for the correction of bony deformities in long bones into accurate wedge resections at surgery without the need for templates or the use of goniometer in a restricted operative field. The method described has been shown both to be accurate and simple, obviating the need for extra instrumentation and undue manipulation during surgery.
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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.
An unusual association between macrodactyly of the thumb and a severe abnormality of the thenar eminence is presented. A reduction of the soft tissues and opponens transplant gave a satisfactory cosmetic and functional result.
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