Replantation of the hand and fingers

Using microsurgical techniques to replant an amputated hand or digit is one of the most important progress in the field of hand surgery during the last three decades. The result of a replantation depends on: the mechanism and the level of amputation, the length and the type of ischaemia of the amputated segment, the surgical techniques, the postoperative care, the rehabilitation and so on. Although the success of a replantation is first judged on the survival of the replanted segment, it nevertheless should be assessed on the function achieved. Thanks to the 30-year clinical experience, the final functional result of a replantation can now be anticipated at initial examination; thus indications can be better established by patient selection criteria. The replantation of the hand and the digits is henceforth reasonable only if there is a possibility of a useful functional result.     

The role of antibiotics in the management of elective and post-traumatic hand surgery

Stunting syndrome (SS) is a viral enteric disease of turkey poults. The etiologic agent (stunting syndrome agent [SSA]) of this disease has been reported recently. The objective of this study was to develop a method for in vitro propagation of SSA. Primary cells, various continuous cell lines, and embryonated eggs were evaluated. Turkey embryos that were inoculated via the amniotic cavity at 24-25 days of incubation were susceptible to SSA infection. The jejunal maltase activity of SSA-inoculated turkey embryos was significantly (P < or = 0.001) lower than that of control embryos. D-xylose absorption was also altered in SSA-infected turkey embryos. The extent of reduction of D-xylose absorption and maltase activity in the infected embryos was nearly identical to that observed when day-old poults were infected with SSA. The intestines from the infected turkey embryos were pale, thin walled, and distended with fluid. Electron microscopic examination of the intestinal fluid and epithelial cell lysate of infected embryos revealed pleomorphic membraned SSA viral particles. SSA that had been serially passaged in turkey embryos retained its ability to induce SS in day-old poults. All the primary and continuous cells that were evaluated did not support the replication of SSA on the basis of cytopathic effects, electron microscopy, and turkey embryo inoculation. Inoculation of chicken embryos by various routes failed to support SSA. All routes of inoculation, other than the amniotic route at 24-25 days, failed to support SSA in turkey embryos. The results of the this study indicate that the SSA was successfully propagated in turkey embryos that exhibited alterations in embryo intestinal absorption and digestive enzyme activity similar to poults with SS. Successful propagation of SSA in turkey embryos should prove beneficial for future studies including characterization of SSA, prevention and control strategies, and enteric disease modeling.     

The sensory innervation pattern of the fingers

We carried out two separate epidemiological studies on long-term changes, 10 years apart, on the prevalence rate of dementia in the elderly by the same method for the same area in Japan. We also performed a genetic study of patients with dementia of the Alzheimer type (DAT) based on the epidemiological studies. The number of patients with dementia was much larger in 1990 than in 1980. Especially, the number of mildly demented patients was significantly larger in 1990 than in 1980. The 35 patients with DAT did not show any mutations of amyloid-beta protein precursor, presenilin 1 and presenilin 2 genes. The frequency of apolipoprotein E (apo E) sigma4 allele in DAT was significantly higher than that in control subjects (p < 0.005). This study suggests that the frequency of DAT may increase by aging of the population in the future and we confirm the close association between apoE sigma4 allele and DAT in a community-based study in Japan.     

The practical use of axillary brachial plexus block for hand surgery

A retrospective study of 178 patients undergoing axillary brachial plexus block (ABPB) for hand surgery used information gathered by a computer-aided anaesthetic record keeping system. The practical use of local techniques to augment the block meant that only two of the 178 patients required a general anaesthetic, giving a success rate of 98.8%. There were no significant complications.     

The use of endovascular surgery in multi-layer occlusive-stenotic lesions of the arteries in the lower limbs

Application of endovascular interventions conduction in 174 patients with multistory occlusive-stenotic affection of the lower extremities arteries is summarized. Indications for transcutaneous balloon angioplasty, laser and vibromechanical recanalization of the vessel are substantiated, the tactics of roentgensurgical treatment is proposed. Good early result of treatment was noted in 62.7% of patients, fair-in 23.6%. In 48.3% of observed patients good result was retained up to 5-year of follow-up.     

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

INTRODUCTION: Any breast lesion/abnormality detected at mammography must be characterized as (non)-neoplastic before surgery. Fine needle aspiration cytology (FNAC) permits a precise diagnosis in over 70% of cases but exhibits many inadequate, false negatives or questionable findings. This makes surgical biopsy mandatory in many cases. An alternative is offered by fine needle biopsy (FNB: 16-18 G needles) or by large core biopsy (LCB: 14 G needles), which procedures can reduce the number of questionable diagnoses with no major discomfort or side-effects for the patient. MATERIAL AND METHODS: January, 1996, to October, 1997, we performed 422 microhistologic biopsies on breast lesions at the Unità Integrata di Senologia, Azienda Ospedaliera Careggi, Florence, Italy. 383 of these lesions were nonpalpable. FNB was performed in 221 cases and LCB in 201. Most biopsies (65%) were carried out under US guidance and some others (25%) under stereotactic guidance. RESULTS: Microhistologic biopsy allowed accurate lesion characterization in most cases, even though LCB obviously performed much better. Samples were inadequate in 5.88% of cases with FNB and only in 2.98% of cases with LCB. The false negative rate was 1.92% for FNB and 0.99% for LCB. Surgical biopsy was needed for an unquestionable diagnosis only in 9.5% of FNB and 3.9% of LCB cases. CONCLUSIONS: Our results confirm the literature data on how LCB can be considered a valid alternative to surgical biopsy (and, to some extent, to FNAC); in particular, its advantages are: moderate invasiveness, little patient discomfort and high diagnostic accuracy. Moreover, the procedure is short (5-10 minutes) and costs much less than surgical biopsies (1/2 to 1/4).     

Micrographia due to focal cerebral lesions as seen in the dysarthria-clumsy hand syndrome

Five patients with dysarthria-clumsy hand syndrome developed micrographia. Four had lacunar infarctions involving the putamen or the genu of the internal capsule; the fifth patient had a small hemorrhage in the putamen. Micrographia may be a sign of focal cerebral disease, and basal ganglia dysfunction may be involved in the supratentorial dysarthria-clumsy hand syndrome.     

Surgical treatment of congenital metacarpal synostosis of the ring and little fingers

Eighteen cases of traumatic dislocations of the hip in children under 15 years of age presenting between 1985 and 1995 were reviewed. Fifteen of the dislocations were posterior. There were two groups: a younger group dislocating with minimal trauma and an older group whose injuries involved significantly more trauma. All patients were treated by closed reduction, but two required open reduction because of intraarticular fragments preventing a full reduction. On long-term follow-up of the 16 available patients (average length of follow-up, 5 years 10 months; range, 17-132), there were no cases of avascular necrosis or early degenerative change.     

Benign lesions of the hand simulating angiosarcoma: Masson's vegetating intravascular hemangioendothelioma

The authors report a case of intravascular hemangio-epithelioma vegetans of Masson. Usually a tumor of the head and neck. This case was characterized by the presence of two independent tumors on the same hand. On the cases of the 86 cases reported in the world literature, the authors suggest a primary endothelial origin for this benign tumor.     

Use of a silicone prosthesis in two-staged reconstructive surgery of flexor tendons in fingers]

Since the time of introduction in the sixties by Hunter from Philadelphia of temporary prosthesis of tendon which was a silicone rod reinforced with dacron it has come into regular clinical usage enabling reconstruction of large injuries of tendons of flexors of fingers--particularly in the sheath area. In the work the analysis of the remote results after two-staged reconstructive operations of tendons of flexors of fingers is presented. The clinical material includes 68 patients whom in 1982-1993 tendons were reconstructed with the above mentioned method in the Clinic of Injury Surgery of Medical Academy in Wroc?aw. The results of treatment were evaluated according to Buck-Gramcko scale in three groups. In group I (patients with isolated tendons injury) 28% very good, 17% good and 55% satisfactory results were achieved. In group II (patients with tendons and nerves injury) 15% very, good, 30% good, 45% satisfactory and 10% unsatisfactory results were achieved. In group III (patients with tendons, nerves and bones injury) 4% very good, 20% good 30% satisfactory and 46% unsatisfactory results were achieved. Also proportional loss of muscle strength of the operated fingers, degree of return of two-punctual feeling in case of additional injury of finger nerves were evaluated. The analysis of treatment results depending on the number of injured fingers, method of primary dressing and on the time of undertaking the secondary reconstruction was carried out. On the basis of the carried out tests and their analysis the optimal method of treatment of patients qualified for two-staged reconstructions of tendons of flexors of fingers was presented.     

Experimental study on the effects of tension-reduced early mobilization on extensor tendon healing

Numerous clinical and experimental studies have been reported on early postoperative mobilization after flexor tendon repair. However, there have been only a few experimental studies reported on extensor tendon repair. In 1989, Ishiguro reported the usefulness of tension-reduced early mobilization in clinical cases of extensor tendon ruptures. The purpose of this experimental study was to examine the in vivo effect of tension-reduced early mobilization on extensor tendon healing in chicken. An experiment was performed on the extensor tendons of 218 chickens in an attempt to examine the effects of tension-reduced early mobilization on tendon healing and adhesion. The extensor tendon of the fourth toe was cut and the distal stump of the tendon was transferred to the extensor tendon of the third toe. Postoperatively two protocols were employed. In the immobilization group, a cast was applied for three weeks. In the early-mobilization group, immediate active motion of the digits was allowed. A tension-reduced position was maintained by taping the fourth toe to the dorsum of the third. The findings from the early mobilization group and from the immobilization group were as follows: 1. Macroscopically, sutures at the repair site of the early-mobilized tendon were not evident after three weeks because of fibrous connective tissue growth. Despite this abundant connective tissue, tendon gliding was observed to be smooth. Between the suture site and the gliding floor, loose connective tissue, similar to normal paratenon, was observed. Histology confirmed this observation. 2. The tensile strength required to extend the MP joint was significantly lower for the early-mobilization group than for the immobilization group, suggesting minimal adhesion between the sutured tendon and the gliding floor in the early-mobilization group. 3. No significant difference in tensile strength among the various tendon repair techniques employed was observed at the suture site.     

The effect of cancer diagnosis and treatment on hand function

Cancer diagnosis and treatment can have a profound effect upon hand function, presenting a challenge to the occupational therapist. The therapist who specializes in oncology or hand therapy must have knowledge of the medical treatment model in regard to cancer conditions and must be able to set realistic goals that consider the patient's medical prognosis as well as the effect the disease or medical treatment has on the patient's physical and emotional functioning. The challenge to therapists in this area of practice will be to conduct research to verify or validate the effectiveness of the occupational therapy interventions currently provided. As cancer is diagnosed at earlier stages of the disease and survival improves after cancer treatment, hand therapy may improve the functional outcomes of persons with cancer. This judgment of rehabilitation oncology practice will need to be confirmed by research.