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At least 487 records · Page 27Linked to original sources
PubMed1998

[What's new in cosmetic surgery of the hand? Technical notes].

The author analyses the aesthetic aspects of the hand in three circumstances: trauma, rheumatism, and ageing. He describes the unsightly appearance of certain grafts and flaps and certain amputation stumps and malunions following trauma and emphasizes the cosmetic indication for finger transfer to an adjacent finger in four-finger hands. The main indications for rheumatic digital deformities concern distal deformities: DIP arthrodesis or arthroplasty depending on the finger. In the context of ageing of the hand, related to excess skin and prominent veins, the author proposes a one-stage operation via a palmar incision.

Aged↗
PubMed2004

Dressings and topical agents for surgical wounds healing by secondary intention.

BACKGROUND: Many different wound dressings and topical applications are used to cover surgical wounds healing by secondary intention. It is not known whether these dressings heal wounds at different rates. OBJECTIVES: To assess the effectiveness of dressings and topical agents on surgical wounds healing by secondary intention SEARCH STRATEGY: We sought relevant trials from the Cochrane Central Register of Controlled Trials, Cochrane Wounds Group Specialised Trials Register, MEDLINE, EMBASE, and CINAHL databases in March 2002. SELECTION CRITERIA: All randomised controlled trials (RCTs) evaluating the effectiveness of dressings and topical agents for surgical wounds healing by secondary intention. DATA COLLECTION AND ANALYSIS: Eligibility for inclusion was confirmed by two reviewers who independently judged the methodological quality of the trials according to the Dutch Cochrane Centre list of factors relating to internal and external validity. Two reviewers summarised data from eligible studies using a data extraction sheet, any disagreements were referred to a third reviewer. MAIN RESULTS: Fourteen reports of 13 RCTs on dressings or topical agents for postoperative wounds healing by secondary intention were identified. WOUND HEALING: Whilst a single small trial of aloe vera supplementation vs gauze suggests delayed healing with aloe vera, the results of this trial are un interpretable since there was a large differential loss to follow up. A plaster cast applied to an amputation stump accelerated wound healing compared with elastic compression, WMD -25.60 days, 95% CI -49.08 to -2.12 days (1 trial). There were no statistically significant differences in healing for other dressing comparisons (e.g. gauze, foam, alginate; 11 trials). PAIN: Gauze was associated with significantly more pain for patients than other dressings (4 trials). PATIENT SATISFACTION: Patients treated with gauze were less satisfied compared with those receiving alternative dressings (3 trials). COSTS: Gauze is inexpensive but its use is associated with the use of significantly more nursing time than foam (2 trials). LENGTH OF HOSPITAL STAY: Four trials showed no difference in length of hospital stay. One trial found shorter hospital stay in people after amputation when plaster casts were applied compared with elastic compression (WMD -30.10 days; 95% CI -49.82 to -10.38). REVIEWERS' CONCLUSIONS: We found only small, poor quality trials; the evidence is therefore insufficient to determine whether the choice of dressing or topical agent affects the healing of surgical wounds healing by secondary intention. Foam is best studied as an alternative for gauze and appears to be preferable as to pain reduction, patient satisfaction and nursing time.

Bandages↗
PubMed2006

Cosmetic reconstruction of distal finger absence with partial second toe transfer.

The authors successfully performed a series of 32 distal finger reconstructions using partial second toe-to-finger transfers solely for aesthetic indications. The resulting hand function shows an average static 2-point discrimination of 8 mm. Total active range of motion was 205 degrees. Key-pinch strength and grip strength averaged 65 and 90% of the normal contralateral side, respectively. Patient satisfaction, as reflected by the average subjective satisfaction scores for aesthetic appearance and function (SSSAF) of the reconstructed distal finger, was high at 82 and 78, respectively. The SSSAF for the donor site averaged 88 for function and 75-80 for aesthetic appearance, which is statistically significant (p<0.05). The authors modified the technique of distal finger reconstruction using second toe transfers in three ways. One is to skeletonize the neurovascular bundle of the harvested toe and pass it through a subcutaneous tunnel between the distal finger incision and the web space incision to avoid lengthy and unsightly scars on the reconstructed finger. Another is to defat the skin flaps developed at the amputated stump and to use a zigzag incision on the toe flap to create a smoother skin junction between the stump and the transferred toe. The third refinement is to perform the arterial microanastomosis at the level of the web space to take advantage of the larger diameter of the vessels in this area. Cosmetic reconstruction of the distal finger with a partial second toe-to-hand transfer provides a high degree of patient satisfaction, both aesthetically and functionally.

Adolescent↗
PubMed1993

A new design of the cross-finger flap: the C-ring flap.

A new cross-finger flap, the C-ring flap, is described for repair of degloved amputation stumps and dorsal and volar defects of the fingers. The C-ring flap is an axial pattern cross-finger flap based on one digital vascular bundle either distally or proximally. We used this flap in 12 cases with different types of finger defects. The results were satisfactory. We conclude that the C-ring cross-finger flap had distinct advantages over standard cross-finger flaps. These advantages are discussed.

Adolescent↗
PubMed1989

Pre- and postischemic transcutaneous oxygen tension measurements and the determination of amputation level in ischemic limbs.

The value of transcutaneous pO2 (TCpO2) measurements in determining amputation levels was studied in patients with atherosclerotic lower limb ischemia. A postischemic TCpO2 response did not predict healing of the amputation stump better than measurements at rest. No minimal resting or postischemic TCpO2 was found below which healing could not occur. However high TCpO2 values probably are indicative of a good healing potential. In patients with poor skin viability, assessed clinically, the method may be of value; in some cases TCpO2 values compatible with healing may be found. Attention should be paid to the TCpO2 sensor as its characteristics may influence the measurements in patients with critical ischemia causing underestimation of tissue pO2.

Aged↗
PubMed2000

Skin blood flow level and stump healing in ischemic amputations.

Skin blood flow was measured with xenon 133-histamine mixture in 20 lower extremities of 18 patients before performing amputations. The amputation levels were chosen according to clinical criteria; 13 below-knee, 3 distal femoral, 1 midfemoral, 2 transmetatarsal, and 1 Syme's amputations were performed. Fourteen stumps had normal healing, 2 had delayed healing, and 3 had necrosis. All of the stumps with normal healing had a skin blood flow >1.76 ml/100 g tissue/minute. Bleeding from the skin also was a good predictor of healing. Skin blood flow measurement may be helpful for level selection in ischemic amputations.

Adult↗
PubMed1997

Prevention of painful neuromas by epineural ligatures, flaps and grafts.

Neuroma formation at the proximal end of a divided nerve is a common problem in peripheral nerve surgery. Forty-eight nerve endings in 23 patients with traumatic or post-elective surgery amputation stumps were capped with either an epineural ligature, epineural flaps or an epineural graft. Each technique was used on 16 nerve endings. After at least 6 months follow-up, pain at the nerve endings was assessed by tapping the treatment sites and asking the patients to score their pain on a visual analogue scale (VAS) from 0 to 10. The mean VAS scores were 5.18 for epineural ligatures, 4.25 for epineural flaps and 2.06 for epineural grafts. Epineural grafts were significantly more effective in preventing neuroma pain (ANOVA: F = 11.4, P < 0.05).

Adolescent↗
PubMed1988

The fillet foot for endweight-bearing cover of below knee amputations.

Four patients with five severely traumatized lower legs but preserved feet were treated with fillet flaps from the foot to cover an elective, below knee amputation stump. The posterior tibial neurovascular bundle nourished and innervated this flap. While the posterior tibial artery and vein may be cut and re-anastomosed to prevent kinking and occlusion, the posterior tibial nerve should always be kept in continuity to maintain the quality of sensation to this flap. Four flaps survived and one necrosed secondary to venous insufficiency. Due to its innervation and the unique qualities of heel skin, the flap is very durable and has endweight-bearing capabilities. This has permitted the fitting of an endweight-bearing, total contact, fully extended, below knee prosthesis that appears to offer significant improvement in ease of use and normality of gait pattern over standard patellar tendon-bearing prostheses.

Adult↗
PubMed2000

Evaluation of the psychophysical detection threshold level for vibrotactile and pressure stimulation of prosthetic limbs using bone anchorage or soft tissue support.

In the present study the psychophysical detection threshold levels mechanical stimulation of 32 prosthetic limbs were determined. Prosthetic limbs were anchored to the bone by means of an implant (n=17) or supported by a socket enclosing the amputation stump (n=15). Detection threshold levels were assessed for pressure and vibratory stimulation of the prosthesis and the limb at the contralateral side (control). Following vibratory stimulation, thresholds were increased on an average 20% for socket prostheses. but approached those of the control for bone-anchored prostheses. For pressure stimulation, thresholds were increased up to 60% for socket prostheses and 40% for bone-anchored prostheses compared to the control. While bone-anchored prostheses yielded significantly lower threshold levels than socket prostheses, there was no significant difference between both treatments regarding pressure stimulation. Results were applicable to both upper and lower limb amputees. It could be concluded that detection thresholds for pressure and especially vibratory stimulation of prosthetic limbs were generally higher than for control limbs. The outcome was related to the prosthetic limb design with bone-anchored prostheses yielding better perception than socket prostheses.

Adult↗
PubMedDate not supplied

[Study of static transcutaneous oximetry before amputation in patients with arteritis].

Transcutaneous oximetry has been used to define the level of amputation in arteritic patients, with discrepant results. We have studied preoperative statix oximetry in 33 arteritic patients at the Leriche-Fontaine Stage IV, who underwent 36 amputations (thighs = 6, Legs+Symes = 14, transmetatarsal = 7, toes = 9). Oximetry included the measurement, at the level of amputation, of the transcutaneous partial oxygen pressure (tc pO2), of the tissue oxygenation ratio (TOR), preferably with a precordial electrode, of the tc pO2 gain after oxygen inhalation and of the gain ratio with the reference electrode. Two patients died postoperatively, the amputation stump did not heal in another 8 patients. The tc pO2 value was 36.6 +/- 16.2 mm Hg in the healed group and 21.1 +/- 19.9 mm Hg in the non healed group. The TOR respectively was 71.2 +/- 32.7% and 38.6 +/- 29.9% in these two groups. These differences were statistically significant. The difference between the two groups in the measurements made after the oxygenation test was not statistically significant. With a tc pO2 threshold at 26 mm Hg, the sensitivity was 73% and the specificity 75%, the positive predictive value 90%, the negative predictive value 46% and the value of the test 73.5%. The thresholds calculated to be 56% for TOR, 11 mm Hg for the gain and 32% for the gain ratio, did not improve the performances of oximetry. In our study, the tc pO2 was the parameter that best allowed predicting healing was obtained with smaller values than the threshold. Other elements such as the general condition and diabetes have played a role in the prognosis.

Aged↗
PubMedDate not supplied

Achilles tendon lengthening, the panacea for plantar forefoot ulceration?

BACKGROUND: Recent reports on Achilles tendon lengthening (ATL) have documented rapid healing of chronic plantar neuropathic forefoot ulcers. METHODS: Sixty-eight patients with 75 ulcerated neuropathic feet (63 patients with diabetes with 69 ulcerated feet) underwent ATL and were retrospectively studied for chronic plantar ulceration in the forefoot and reduced dorsiflexion range of motion at the ankle. Median duration of ulcers was 48 months (range 11-84 months) in 16 forefoot amputation stumps and 11 months (range 3-84 months) for the rest of the patients. RESULTS: Healing of the ulcers was obtained in 68/75 feet (91%). At a median follow-up of 12 months (3-26 months), 4 had never healed, 5/10 recurrent ulcers and 6/11 transfer ulcers (localized to the heel) had not healed, that is, a healing rate of 60/75 (80%). Acute transfer ulcers to the heel occurred in 47% of patients with complete anaesthesia of the heel pad. Late heel ulceration occurred in 14% of those with extreme ankle dorsiflexion (>15 degrees). Failure to heal or ulcer recurrence occurred more frequently at dorsiflexion <10 degrees (33%). Rupture of the Achilles tendon occurred in 7 feet (10%). Charcot event was experienced in 3 (4%). CONCLUSION: Lengthening of the Achilles tendon is effective in healing plantar neuropathic ulceration. Patients with complete anaesthesia of the heel pad should not undergo this procedure and extreme dorsiflexion should be avoided because of the risk of heel ulceration. Moreover, the procedure should be performed only in a multidisciplinary setting for immediate dealing with complications and for surveillance and treatment of future ulceration.

Achilles Tendon↗
PubMed1981

Electrical injury involving the immature skeleton.

Two patients are presented with significant problems of skeletal development and function consequent to electrical impulse propagation through the immature skeleton. Amputation stump revision in the first case allowed an opportunity to assess specific histologic and morphologic changes. Electrical damage completely destroyed portions of trabecular bone in the metaphyses and epiphyseal ossification centers. There were morphologic irregularities in the physis of the distal femur, while in the proximal tibia complete cessation of growth occurred through presumed electrical ablation of the physis. There was virtually no endosteal or periosteal callus, no intertrabecular inflammatory response, and no new bone formation well over a year following the original injury. The knee joint exhibited severe fibrous ankylosis. In the second case localized arrest of the posterolateral portion of the proximal tibial physis caused a valgus/recurvatum deformation, and probably slowed down distal growth sufficiently in the stump end to prevent irregular terminal overgrowth of the tibia, although it did occur in the fibula.

Bone Development↗
PubMed1993

The sartorius myocutaneous island flap.

The vascular supply to the distal part of sartorius m. was studied in 37 limbs by dissection under magnification and after black ink and latex injections. The muscle or myocutaneous island flap pedicled on the saphenous artery (SA) is supplied by a retrograde circulation through anastomoses of the SA with the perforating branches of the posterior tibial artery and the medial inferior genicular artery. Three different vascular patterns were defined. Retrograde injection also showed good perfusion of the SA. The flap is useful for covering around the knee, the proximal and middle thirds of the lower leg, and the end of the amputation stump. Raising of the flap has not resulted in any functional or cosmetic defect. Eighteen operations have so far been performed, six using the muscle island flap and twelve using the myocutaneous island flap, and all survived completely.

Humans↗
PubMed2002

[The use of fillet flaps in upper extremity and shoulder reconstruction].

Extensive soft tissue defects of the upper extremities were reconstructed with major fillet flaps in nine patients over a 5-year period at two institutions. Etiologies included trauma and tumor resection. Defect locations were the shoulder ( n=3), combined defects of the shoulder plus neck, arm or chest wall ( n=4) as well as one upper arm and one forearm defect. Seven of nine flaps required microsurgical free tissue transfer. Fillet flaps harvested from amputated parts represent the "spare part" concept, providing coverage of defects without additional donor site morbidity. Unlike the classic "spare part" fillet flap concept, the partial or complete conversion of an anatomically intact arm was performed for the coverage of large defects, especially for tumor reconstruction, in this series. Fillets flaps facilitate reconstruction in difficult and complex cases. Major fillet flaps represent a valuable option for reconstruction in the upper extremities with either pedicled or free tissue transfers involving extensive tissue defects.

Adult↗
PubMed2005

Posthemipelvectomy hernia.

We report the case of a white male who underwent a classic hemipelvectomy due to a femur fibrosarcoma with inguinal metastases, which 33 years later, developed into a posthemipelvectomy hernia in the amputation stump that impaired the use of his Canadian prosthesis. The hernia was repaired with a polypropylene mesh in a subaponeurotic position. A seroma was drained in the postoperative and it was only 2 months after the operation that he could use his prosthesis with any difficulty. A year after the operation, the hernia had not recurred. Only seven similar cases have been published, and there are only four cases with details of their correction, two with a mesh as was our case, and the rest with a primary suture of the aponeurotic borders. A brief review of the bibliography is given on this subject.

Femoral Neoplasms↗
PubMed1994

Extended palmar advancement flap with V-Y closure for finger injuries.

The technique of using volar advancement flaps with V-Y closure to the fingers is described. It is possible to perform volar flap advancements up to 15 mm and use V-Y closures in the distal palm, avoiding a skin graft. This method is based on knowledge of the vascular anatomy of the finger dorsum, to avoid devitalising dorsal skin. This method was applied to 14 fingers of 13 patients including finger amputations, claw nail deformities, and skin defects of the middle phalanx. Favourable results were observed.

Adolescent↗