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PubMed1992

The random fasciocutaneous flap for upper extremity coverage.

Rapid and appropriate healing of any upper extremity wound is essential for preservation of normal hand function. If vascularized tissue must be used, local cutaneous flaps nourished by the multiple perforators to the fasciocutaneous plexus avoid the complexity of microsurgical tissue transfers or prolonged immobilization required for distant pedicled flaps. For small or moderate-sized defects, assuming that adequate adjacent deep fascia has remained intact, these simple, rapidly elevated, so-called random fasciocutaneous flaps deserve initial consideration, as demonstrated in all 11 cases in this reported series.

Adult↗

PubMed2004

Pigmented skin lesions of the upper extremity.

This article discusses pigmented lesions of the upper extremities, including nevi, melanoma, and Merkel cell carcinoma. The diagnosis and work-up is emphasized, with attention also given to the techniques of sentinel node biopsy. An overview of the latest treatment strategies is provided.

Arm↗

PubMed1987

Digital subtraction venography of the upper extremity.

Seventy four digital subtraction venograms of the upper extremity and mediastinum were performed in 69 patients. The indications included idiopathic arm and shoulder swelling, difficulties with a central venous catheter, chronic venous access device, or dialysis fistula, superior vena cava syndrome, or pre-operative anatomical mapping. Clinically useful information was obtained in all studies. The digital subtraction technique allows the simple and rapid performance of venography, especially in patients with limited venous access.

Adult↗

PubMed1983

Total joint replacement in the upper extremity.

Prosthetic replacement of the joints of the upper extremity relieves pain, mitigates deformity, and improves function. As newer designs of prostheses are tested, we expand our knowledge of the biomechanics of each joint. Newer materials are rapidly changing the variety of implants on the market and improving prosthetic function. The problem of fixation of the noncemented prostheses to viable bone tissue remains one of the major unanswered questions for orthopedic surgeons today. Extensive research around the world is underway; different means of providing the environment that allows biologic ingrowth with fixation of a prosthesis are being investigated, thus avoiding the use of methyl methacrylate and its inherent problems.

Arm↗

PubMed1983

Dynamic radionuclide imaging as a means of evaluating vascular perfusion of the upper extremity: a preliminary report.

Vascular competence in the upper extremities of 44 patients was evaluated by three-phase bone scans consisting of rapid sequence dynamic radionuclide imaging (DRI), an immediate postinjection "blood pool" image, and a 3- to 4-hour delayed image. Findings were correlated with definitive anatomy determined by arteriography, operative findings, or both, in 50 extremities. DRI provided the correct diagnosis in all but four extremities (92%). Limited resolution precluded precise anatomic definition of aneurysms in three limbs and of digital artery occlusion, with adequate collateral circulation in the fourth limb. The greatest value of DRI was its provision of quantitative information about relative blood flow and preferential perfusion in every instance. We believe DRI to be a useful adjunct to preoperative and postoperative assessment of arterial perfusion.

Adult↗

PubMed1983

The management of acute thermal injuries to the upper extremity.

In summary, although thermal injuries of the upper extremity can produce permanent functional compromise, intelligent management of burns of the hands and fingers can produce fully functional and cosmetically acceptable hands. When the dorsal aspects of the hands alone are injured by thermal insult, the immediate excision of the burned tissue and replacement by split-thickness skin grafts will produce functional and esthetically satisfying results. Should immediate excision and grafting be contraindicated because of massive burns of the body, management by application of topical antibacterial agents and dressings is possible. With this treatment, carefully supervised exercises are mandatory. Revisions of hypertrophic and contracted scars can be done at a later date. The stiff and painful hand is not the direct consequence of thermally destroyed skin, but is due instead to the metabolic and biologic complications of unhealed burn wounds. It follows, therefore, that the burn illness should preferably be terminated by prompt excision of the eschar and wound closure by the application of split-thickness skin grafts.

Adult↗

PubMed2003

Use of "spare parts" in mutilated upper extremity injuries.

Management and treatment of complex mutilated upper extremity injuries often can be challenging and at times seemingly formidable. A reconstructive surgeon's ability to mobilize, transpose, and transfer tissues has allowed not only closure of complex wounds but also restoration of function and form. Use of "spare parts" from an otherwise unsalvageable limb represents the ultimate form of reconstruction that probes the creative mind and challenges the reconstructive knowledge of the surgeon. In this article, the authors review and discuss the use of various "spare parts" in the treatment of mutilating hand injuries.

Amputation, Traumatic↗

PubMed1990

External fixation of high-energy upper extremity injuries.

Forty patients with high-energy upper extremity injuries involving the humerus and forearm bones were treated by primarye external fixation. Concomitant soft tissue or neurovascular injuries were rated by the Gustilo classification, and this rating correlated well with the final results: three fractures were Gustilo type I, two fractures were type II, and 35 were type III (IIIA, nine fractures; IIIB, eight; and IIIC, 18). Immediate external fixation, open wound treatment, delayed bone grafting, and late internal fixation led to good to excellent results in 73%. Complications were either minor (related to the external fixation and included pin loosening, 20%) or significant (osteomyelitis, 3%).

Adolescent↗

PubMed1976

External stabilization of a replanted upper extremity: case report.

A case replantation of the upper extremity is presented using external fixation as the method to achieve bony stability. Although internal fixation may remain the method of choice for stabilization of a replanted limb, external fixation can also provide bony stability where more conventional methods are not applicable.

Adult↗

PubMed1985

Epithelioid sarcoma of the upper extremity.

Three cases of epithelioid sarcoma of the upper extremity are presented. Information regarding 112 previously published cases is reviewed. It is concluded that epithelioid sarcoma must be included in the differential diagnosis of soft-tissue tumors of the extremities. Moreover, the diagnosis of epithelioid sarcoma demands prompt and aggressive surgical intervention. Irradiation therapy and chemotherapy have not been proven to be of value in the management of epithelioid sarcoma.

Adolescent↗

PubMed2000

Repair of peripheral nerve defects in the upper extremity.

Repair of peripheral nerve defects in the upper extremity using end-to-end coaptation is accomplished by one of four techniques: in situ mobilization, rerouting and transposition, joint positioning, and bone shortening. A key concern is the amount of tension generated when nerves are elongated to overcome a gap defect. The evidence indicates that elongation should be limited to 8% to 10% of the original length to avoid neural ischemia. It should be noted, however, that when repairs are delayed, the vascularity of nerves is increased. As a result, compared with acute injuries, chronic injuries will tolerate the same degree of elongation with less neural ischemia despite increased stiffness. The mesoneural attachments along each end of the nerve may be safely stripped to a distance of 8 to 12 cm when mobilizing the nerve. Larger nerves tolerate greater lengths of mobilization than smaller nerves. The maximum amount of mobilization that does not produce ischemia can be expressed as a ratio of the diameter of the nerve to the length mobilized and its value is 1:45. The amount of nerve mobilization required for a secondary repair may be reduced by the initial application of tension to unrepaired nerves, thereby reducing the amount of retraction. As the interval to repair increases, nerve retraction results in up to a six-fold increase in the gap defect that must be overcome. Finally recommendations exist for the repair of peripheral nerve segmental defects in the acute setting.

Algorithms↗

PubMed2000

Management of acute burn injuries of the upper extremity in the pediatric population.

Burns of the upper extremity occur frequently in children. Because of differences in development and anatomy, patterns of burn injury are different in children compared to adults. Immediate goals after these injuries are to prevent compartment syndromes and minimize progressive damage. The second decision is whether the burn requires conservative care or grafting. If the injury heals within 2 weeks, then scarring is minimized. If the wound has not healed in that time period, then grafting should be considered. Grafting techniques that optimize function and cosmetic appearance are outlined.

Arm Injuries↗

PubMed1976

Arthrogryposis of the upper extremity.

Patients with arthrogryposis multiplex congenita of the upper extremities can be helped a great deal by comparatively minor procedures. At the outset it is important to decide which patients can be helped and which patients cannot owing to the severity of disease or the social situation. It is also important, of course, to decide which patients do not require surgical or other methods of treatment. Once these decisions are made, one can safely begin in most patients with nonoperative measures, which consist of serial corrective cast applications starting at birth with changes every two to five days initially and then less often as the deformity is corrected. In patients who do not respond to this treatment, surgical intervention is necessary. We feel that surgery will be necessary in a great many of these patients. Surgery most often consists of soft tissue releases about the elbow, principally posterior capsulotomy, and triceps lengthening with or without tendon transfers to gain active motion. In the shoulder, surgery is rarely indicated, and when it is, this will be an osteotomy. In the wrist and hand, bone operations are almost always indicated because soft tissue procedures usually fail. These patients have two advantages in spite of their severe problems: They have normal sensation and they are usually of average or above average intelligence. Any improvement in the position of their extremities and any decrease in deformity will improve their functioning significantly.

Adolescent↗

PubMed1992

[Prospective analysis of infections of the upper extremity].

In a prospective investigation infections of the upper extremity are examined with respect to incidence, bacterial pathogens, operative or conservative treatment, and duration of disability for work. A total of 255 patients (pts) (170 men, 85 women; mean age 37 years, range 16-85) were entered into the study. In a 12-month period 163 (64%) were treated as outpatients, the condition of 92 pts (36%) required hospitalisation. Conservative and operative treatment was performed in 82 (32%) and 173 (68%) pts, respectively. Conservative treatment included fixation by cast as well as antibiotics (penicillinase resistant penicillin), usually given by the oral route for a mean of 4 days. Surgical procedures consisted of excision and debridement. Intraoperatively intravenous antibiotics were instituted for a mean of 3 days, followed by oral application for another 4 days. In 135 of 173 pts who underwent surgery, sufficient material for bacterial culture was obtained. There was a polymicrobial infection in 50% of pts. Most common isolated pathogens were Staphylococcus aureus, beta-hemolytical streptococci group A, and indigenous skin flora in 34%, 21%, and 11%, respectively. Among the 255 pts there were 26 HIV-positive iv drug abusers, who suffered from abscesses at injection sites. The infections in these immunocompromised HIV-positive pts did not reveal differences with respect to number and species of isolated pathogens as compared to immunocompetent pts. Resistant bacteria were not found. Response to treatment was satisfactory usually within a few days in all but 12 pts (4.7%) in which the failure could be attributed to inadequate primary debridement.

Adolescent↗

PubMed1991

[Embolic occlusion of arteries of the upper extremity].

Ninety-nine patients underwent embolectomy of upper extremity arteries; in 12% of the cases reoperation and in 4% amputation was necessary. Thrombosis is the cause of reocclusion of the brachial artery, based on endothelial lesions of the axillary passing into the brachial artery. At autopsy studies these andothelial lesions were verified by histological and electron-microscopical examinations in a high percentage. Therefore embolectomies should be performed very carefully by means of thin fogarty catheters. Postoperative anticoagulant therapy seems to improve the survival rate.

Adult↗

PubMed1987

Peripheral nerve tumors in the upper extremity.

Peripheral nerve tumors involving the hand and upper extremity are rare. The types of tumors are few and they can usually be suspected on clinical grounds. The hand surgeon should have a knowledge of the diagnostic possibilities and the treatment options.

Forearm↗

PubMed1988

Management of the upper extremity in traumatic tetraplegia.

The management of the upper extremity in traumatic tetraplegia is complex and extremely important for the rehabilitation of the patient. The evolution of present management is reviewed. The evaluation and classification of the tetraplegic patient is discussed with general recommendations for treatment.

Arm↗

PubMed1995

Osteoid osteoma of the upper extremity.

Osteoid osteomas, relatively rare lesions in the upper extremity, can be a persistent source of hand or wrist pain. Patients under age 40 who have otherwise unexplained pain should be evaluated. Relief of pain with oral nonsteroidal anti-inflammatory drugs should suggest the possibility of osteoid osteoma. Examination may demonstrate localized swelling or joint effusion. Radiographs should be examined for sclerosis in the region of pain. If radiographs are nondiagnostic, a bone scan should be obtained. If the nidus cannot be clearly visualized by radiography and bone scan, a CT scan should be obtained. If the location of the nidus makes excision difficult without removal of a large block of bone, localization with a CT-guided needle or by radioisotope labeling will help to assure removal of the nidus.

Arm↗