1/47. thumb reconstruction in a bilateral upper extremity amputee: an alternative to the Krukenburg procedure.A 23-year-old man sustained traumatic loss of both hands. His left defective forearm underwent lengthening with a 3-cm segment of the ipsilateral radius; this was immediately followed by an ipsilateral second toe microvascular transfer to the stump of the radius to provide pinch. Two years after the procedure the reconstructed hand had recovery of both motion and sensibility.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/47. Treatment of finger avulsion injuries with innervated arterialized venous flaps.Complete degloving injury of the digits not amenable to revascularization may leave poor cosmetic and functional results. We used innervated venous flaps from the dorsum of the foot in two patients with traumatic finger degloving injuries. All the flaps successfully provided coverage over the denuded fingers. Good sensation and nearly full rage of motion of the fingers were obtained. There were no donor-site problems. The advantages of this flap are preservation of a major artery of the donor site, easy elevation without deep dissection, and providing a thin, nonbulky tissue and good sensation. The innervated arterialized venous flap is a useful method that provides functional and cosmetic coverage to the severe avulsion injury of the finger.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/47. Ultrasound study of the motion of the residual femur within a trans-femoral socket during gait.This study analyses the motion of the residual femur within a trans-femoral socket during gait using ultrasound data from two simultaneously transmitting transducers connected to two ultrasound scanners. calibration tests accurately established the orientation of the two transducers mounted on the lateral wall of the socket. Relative positions of the ultrasound image of the femur were measured on video playback. motion of the residual femur, relative to the lateral wall of the socket, at any instant during gait may be estimated, if the relative positions of the two transducers and the motion of the ultrasound image are known. A consistent pattern of femoral motion during 10 gait cycles is displayed graphically. The femoral motion in this paper is expressed as abduction/adduction or flexion/extension relative to the socket. However, without a full gait analysis study, the orientation of the socket relative to the ground or relative to the pelvis cannot be determined. Only one ultrasound scanner may be available for clinical use. Hence data collection may be restricted to only one transducer during gait. In order to simulate the single transducer mode, the ultrasound data recorded during the 10 previous gait cycles, was averaged at any instant of the gait cycle. The angular orientation of the femur was calculated based on the averaged data. Similar patterns of femoral motion were obtained irrespective of the technique adopted.- - - - - - - - - - ranking = 9keywords = motion (Clic here for more details about this article) |
4/47. Ultrasound study of the motion of the residual femur within a trans-femoral socket during daily living activities other than gait.This study analyses the residual femur motion of a single amputee within a transfemoral socket during a series of daily living activities. Two simultaneously transmitting, socket mounted transducers were connected to two ultrasound scanners. Displacement measurements of the ultrasound image of the femur were video recorded and measured on "paused" playback. Abduction/adduction and flexion/extension of the residual femur within the socket at any instant during these activities were estimated, knowing the relative positions of the two transducers and the position of the residual femur on the ultrasound image. Consistent motion patterns of the residual femur within the trans-femoral socket were noted throughout each monitored daily living activity of the single amputee studied. Convery and Murray (2000) reported that during level walking, relative to the socket, the residual femur extends 6 degrees and abducts 9 degrees by mid-stance while flexing 6 degrees and adducting 2 degrees by toe-off. Uphill/downhill, turning to the right and stepping up/down altered this reported pattern of femoral motion by approximately 1 degree. During the standing activity from a seated position the femur initially flexed 4 degrees before moving to 7 degrees extension, while simultaneously adducting 6 degrees. During the sitting activity from a standing position the femur moved from 7 degrees extension and 6 degrees adduction to 3 degrees flexion and 1 degree abduction. The activity of single prosthetic support to double support introduced only minor femoral motion whereas during the activity of prosthetic suspension the femur flexed 8 degrees while simultaneously adducting 9 degrees. Additional studies of more amputees are required to validate the motion patterns presented in this investigation.- - - - - - - - - - ranking = 9keywords = motion (Clic here for more details about this article) |
5/47. Use of a venous flap from an amputated part for salvage of an upper extremity injury.The authors describe a patient in whom a large arterialized venous flap was harvested from a nonreplantable part after partial hand amputation. A 9 x 6-cm segment of dorsal hand skin was transplanted acutely in an artery-vein-vein fashion to cover exposed bone, joints, and reconstructed tendons. The flap provided durable coverage, and at 1 year the patient regained 94% total active motion at the index finger and 99% total active motion at the long finger. Salvage of component parts such as a venous flap and extensor tendons avoided additional procedures for coverage and staged tendon reconstructions.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
6/47. Lengthening of replanted or revascularized lower limbs: is length discrepancy a contraindication for limb salvage?Some replantation cases require substantial bone shortening for primary closure. leg-length discrepancy can be restored by lengthening of the replanted or revascularized extremities. Between 1991 and 2000, four patients with four total and two subtotal below-knee amputations had replantation or revascularization for their severely damaged extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities failed and had to undergo below-knee amputation because of sepsis. No other infection or vascular complications were encountered following the replantations or revascularizations. After bony consolidation, four legs were lengthened; for elimination of length discrepancy in three cases, and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all procedures, a unilateral dynamic axial external fixator was used. The lengthening was performed from the proximal tibial metaphysis, with a subperiosteal osteotomy. Evaluation of injury according to the Mangled Extremity Severity Score (MESS) would encourage the surgeon to avoid salvage surgery with a shortened extremity, because of the required debridement of soft tissue and bone. These authors think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motion and the possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage, even with deliberate shortening that can be restored by lengthening; length discrepancy is not a contraindication for limb salvage.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/47. Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/47. Fingertip replantation using the subdermal pocket procedure.Restoration of finger length and function are the goals of replantation after fingertip amputation. methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. To increase the survival rates for composite grafts, the subcutaneous pocket procedure has been used as a salvage procedure. The subdermal pocket procedure, which is a modification of the subcutaneous pocket procedure, was used for replantation of 17 fingertips in 16 consecutive patients. Eight fingertips experienced guillotine injuries and the other nine fingertips experienced crush injuries. Revascularization of one digital artery without available venous outflow was performed for six fingers, and composite graft techniques were used for the other 11 fingers. The success rate was 16 of 17 cases. The difference in success rates for guillotine versus crush injuries was statistically significant. Comparison of patients with arterial anastomoses and patients without arterial anastomoses also indicated a statistically significant difference. Thirteen fingertips survived completely. One finger, demonstrating complete loss and early termination of the pocketing procedure, was amputated on the eighth postoperative day. Two fingers were partially lost because of severe crushing injuries. One finger demonstrated partial loss of more than one quarter of the fingertip, which required secondary revision, because the patient was a heavy smoker. The pocketing period was 8 /- 1 days (mean /- SD, n = 6) for the fingers revascularized with one digital arterial anastomosis and 13.3 /- 1.9 days (n = 10) for the fingers successfully replanted with composite graft techniques. The mean active range of motion of the interphalangeal joint of the three thumbs was 65 /- 5 degrees, and that of the distal interphalangeal joint of the other 11 fingers was 51 /- 11 degrees. The static two-point discrimination result was 6.4 /- 1.0 mm (n = 14) after an average of 11 /- 5 months of follow-up monitoring. Compared with other methods, the subdermal pocket procedure has the advantages of exact subdermal/subdermal contact, a shorter pocketing period, and more feasible observation. The method can offer an alternative salvage procedure for fingertip amputations with no suitable vessels available for microsurgical replantation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/47. Functional and cosmetic results of fingertip replantation: anastomosing only the digital artery.In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Outcomes were nailbed width and distal-segment length; sensory recovery; and range of motion (ROM) of thumb-interphalangeal (IP) or finger-distal interphalangeal (DIP) joints, and total active motion (TAM) of the replanted finger. Of 15 fingertips replanted after only arterial anastomosis, 13 were successful, and 12 were studied. After a median of 1.3 years, mean nailbed widths and distal-segment lengths were 95.4% and 93.0%, respectively, of the contralateral finger. Average TAM and ROM of the thumb-IP or finger-DIP joints were 92.0% and 83.0% of normal, respectively. Semmes-Weinstein results were blue (3.22 to 3.61) in 4 fingers and purple (3.84 to 4.31) in 8; the mean result from the 2-point discrimination test was 5.9 mm (range, 3 to 11 mm). Thus, amputated fingertips should be aggressively replanted.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
10/47. Free vascularized joint transfer from the nonreplantable digit as a free flap for primary reconstruction of complex hand injury.We report our experience in treating a a patient with an electrical saw injury to the right hand that resulted in incomplete amputation of the ring and small fingers at the metacarpophalangeal (MCP) joint with segmental tissue loss. Ray amputation of the small finger was performed because of extensive tissue loss. The proximal interphalangeal joint of the nonreplantable small finger was transferred as a fillet flap for primary reconstruction of the severely damaged MCP joint of the ring finger after revascularization. Two years after surgery active range of motion of the reconstructed MCP joint was 35 degrees extension to 85 degrees flexion with no instability or pain.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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