1/151. Surgical management of hands in children with recessive dystrophic epidermolysis bullosa: use of allogeneic composite cultured skin grafts.Recessive dystrophic epidermolysis bullosa (RDEB) is characterised by progressive childhood hand syndactyly and flexion contractures, which can be managed surgically but require split thickness autografts to facilitate satisfactory postoperative healing. We report on the partial substitution, for autografts, of improved composite cultured skin (CCS) allografts. The structure and preparation of these CCSs is outlined and their application in the course of 16 operations performed on 7 RDEB children with syndactyly and flexor contractures of fingers is described. Hand contractures were released and web spaces were covered with local flaps and split thickness autografts, while adjacent sides of the digits and other areas, as well as donor sites were generally grafted with CCS. Morphologic and functional results with CCS were judged to be good to excellent, the average time to recurrence was increased approximately 2-fold and smaller autografts needed to be used. In addition, healed CCS-treated donor sites could provide superior donor sites for further surgery.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
2/151. Extensor tendon dislocation in cerebral palsy.An 18-year-old man with cerebral palsy presented with a flexion deformity of the middle finger particularly at the metacarpophalangeal joint and ulnar dislocation of the extensor tendon. Releasing the tight ulnar sagittal band and imbricating the attenuated radial sagittal band allowed centralization of the extensor tendon. For complete correction of other deformities intrinsic release and extrinsic flexor muscle lengthening were done. Extensor tendon instability in this case was due to the combined forces of the extrinsic and intrinsic muscles on the retinacular system of the extensor mechanism.- - - - - - - - - - ranking = 1.364214740249keywords = deformity (Clic here for more details about this article) |
3/151. Restoring hand function in patients with severe polyneuropathy: the role of electromyography before tendon transfer surgery.electromyography (EMG) was evaluated as a supplement to clinical examination and biomechanical considerations to optimize forearm donor muscle selection before tendon transfers to 4 functionless hands in 3 patients with slowly progressive polyneuropathies. Two patients had unusually severe charcot-marie-tooth disease; the third patient had idiopathic mononeuropathy multiplex. Standard EMG parameters were used to devise an intuitive muscle grading system, including most importantly interference patterns and motor control, plus motor unit morphology and stability. Given our objective of restoring survivable function despite ongoing polyneuropathy, we found that EMG reveals prognostically important differences among partially denervated candidate muscles that cannot be detected by experienced clinical examiners. Opposition transfer was performed on one hand of each patient. After 39-, 39-, and 51-month follow-up durations, restored opposition was graded as good in these 3 hands. We conclude that EMG provides meaningful guidance in selecting optimal forearm muscles for tendon transfers to hands in the setting of slowly progressive polyneuropathies.- - - - - - - - - - ranking = 1.6keywords = hand (Clic here for more details about this article) |
4/151. Extra-abdominal desmoid tumor of the hand: a case report and review of the literature.Extra-abdominal desmoid tumor of the hand is rare and only 10 cases have been described in the literature. We present a 14-year-old boy with a recurrent extra-abdominal desmoid tumor in the dorsal site of the right hand. MR image demonstrated the tumor in the third dorsal interosseous muscle, and adhered to the radial side of the forth metacarpal bone. The lesion revealed iso-signal intensity on T1-weighted images and high intensity on T2. We performed a marginal excision. Histological examination of the tumor showed proliferation of the fibroblastic cells with abundant collagen bundles. He developed local recurrence for the third time. The size of the third recurrent tumor has not been changed for 2 years and 3 months. Therefore, we have not performed any additional surgery. Since extensive resection markedly diminishes the function of the hand, we consider that a marginal surgical margin is acceptable for the quality of daily life of patients with a desmoid tumor of the hand.- - - - - - - - - - ranking = 1.6keywords = hand (Clic here for more details about this article) |
5/151. Extensor digiti minimi tendon "rerouting" transfer in permanent abduction of the little finger.Permanent abduction of the little finger is a bothersome deformity which usually occurs in the context of sequelae of ulnar nerve palsy (Wartenberg's sign), but also in rheumatoid arthritis. The authors report an original technique for correction of this deformity. The extensor digiti minimi tendon is sectioned at its distal insertion and transferred in the wrist through the extensor retinaculum. The "rerouted" tendon is finally resutured distally on the radial aspect of the interosseous muscle. Side-to-side suture of the transferred tendon to the extensor digitorum tendon of the little finger further reinforces the solidity of the procedure. The distal insertion of the extensor digiti minimi tendon is consequently radialized. Its new direction eliminates the abduction component, and the tendon then behaves as an active adductor of the little finger. Five cases (2 cases of ulnar nerve palsy, 3 cases of rheumatoid arthritis) are reported with a mean follow-up of 19 months. All patients have complete active adduction of the little finger in extension, with a persistent capacity for abduction. The other correction techniques published in the literature are discussed.- - - - - - - - - - ranking = 2.728429480498keywords = deformity (Clic here for more details about this article) |
6/151. Isolated finger flexion: a novel form of focal neuromyotonia.Two almost identical elderly women are described who presented with gradually progressive painless involuntary flexion of the ring and middle fingers over 12 months, leading eventually to contractures. The flexion deformity persisted during sleep and was the sole neurological abnormality. Both patients had advanced chronic obstructive pulmonary disease and were on long term salbutamol and oxygen. Neurophysiological studies indicated that this was due to neuromyotonia mainly involving flexor digitorum superficialis muscles without evidence of underlying peripheral neuropathy, proximal conduction block, or generalised neuromyotonia. Voltage gated potassium channel antibodies were negative. The clinical and neurophysiological picture remained static over a 2 year follow up period. It is suggested that this is a novel form of acquired focal neuromyotonia and speculate both on its cause and distribution.- - - - - - - - - - ranking = 1.364214740249keywords = deformity (Clic here for more details about this article) |
7/151. Surgical management of tophaceous gout in the hand.A patient who suffered from severe deforming arthritis secondary to chronic tophaceous gout with multilobular, solid, tender, enlarged subcutaneous nodules and draining tophi in both hands was evaluated and treated by second ray amputation of the most deformed second finger to provide a more functional result.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
8/151. Development rate of mutilans fingers in patients with rheumatic disease.OBJECTIVE: To describe arthritis mutilans (AM) deformity during the progression of rheumatic disease. methods: The development of mutilans-like hand deformities in 2 patients with juvenile chronic arthritis (JCA) and in 2 patients with adult onset rheumatoid arthritis (RA) are presented. The hands of these patients were evaluated at least at two time points during the course of disease using two different scoring methods based on differently summed Larsen grades of the hand joints. RESULTS: Two patients (one with JCA and one with RA) showed AM changes after a disease period of less than 10 years and 2 not until after 30 years. The patients with adult onset disease were young at the onset of joint disease. Early wrist fusions were performed on both patients showing a slow development rate. CONCLUSIONS: The development rate of AM is very variable, even in patients with the same diagnoses. wrist fusion prevents shortening of the carpus and may decrease the development rate of AM.- - - - - - - - - - ranking = 1.964214740249keywords = deformity, hand (Clic here for more details about this article) |
9/151. tuberous sclerosis with macrodactyly.tuberous sclerosis with macrodactyly is a very uncommon presentation. We report a 15-year-old girl with a thick, loose hyperpigmented area on the dorsum of the left hand with macrodactyly. A skin biopsy specimen from the dorsum of the left hand revealed dense collagenization in the dermis. Radiographs showed marked irregular thickening of the cortex of the metacarpals and phalanges of the left index and middle fingers.- - - - - - - - - - ranking = 0.4keywords = hand (Clic here for more details about this article) |
10/151. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 5.128429480498keywords = deformity, hand (Clic here for more details about this article) |
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