11/531. The role of emergency free flaps for hand trauma.Primary closure of a wound with free flap requires minimizing the risk of infection in an effort to cover vital exposed structures. Careful patient selection, radical debridement of the wound, and an experienced microsurgical team are important for the routine application of this technique. Primary reconstruction of all injured structures is an extension of this technique that enables efficient management of severe upper extremity problems in a single setting.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
12/531. Serratus anterior free fascial flap for dorsal hand coverage.Reconstruction of the dorsal surface of hand defects requires thin, pliable, well-vascularized tissue with a gliding surface for the extensor tendon course. Fasciocutaneous or fascial flaps are the two surgical options. Fascial flaps present the advantages of thinness and low donor site morbidity. The authors present 4 cases of serratus anterior free fascial flap (SAFFF) used to cover the dorsum of the hand. The SAFFF with skin graft has many advantages for a fascial flap: long, constant vascular pedicle; very thin, well-vascularized tissue; low donor site morbidity; and the possibility of simultaneous donor and recipient site dissection. Furthermore, it can be associated with other flaps of the subscapular system for complex reconstructions. Of the 4 observations described, 2 used associated flaps, 1 used the SAFFF with a latissimus dorsi flap, and 1 used a scapular bone flap with the SAFFF. One flap was lost due to an electrical lesion to the forearm vessels.- - - - - - - - - - ranking = 1.5keywords = hand (Clic here for more details about this article) |
13/531. Hemophilic pseudotumor of the soft tissue of the hand: a case report.A 25-year-old, right hand dominant man with a history of hemophilia a, presented with an enlarging 2 x 3.5 cm mass on the dorsum of his dominant hand following minor trauma. factor viii activity level was 12 percent of normal. A diagnosis of hemophilic pseudotumor was made and the mass continued to enlarge despite medical management. Surgical intervention was carried out in order to prevent impending skin necrosis or rupture. The patient was treated by surgical excision of the lesion along with factor replacement therapy. The patient's symptoms resolved and he had no recurrence of the tumor.- - - - - - - - - - ranking = 1.5keywords = hand (Clic here for more details about this article) |
14/531. Serratus fascia "sandwich" free-tissue transfer for complex dorsal hand and wrist avulsion injuries.The serratus anterior fascia was used as a free-tissue transfer in four patients for the reconstruction of dorsal hand defects. All patients had multiple open metacarpal fractures with extensor tendon injuries. The fascia was used to "sandwich" the extensor tendons in a bed of areolar gliding tissue to avoid adhesions. The mean follow-up was 2 years. There were no complications and all flaps survived completely. All flaps were grafted with meshed split-thickness skin at the time of transfer with a 100 percent take in all cases. A good functional result was noted in all patients. This free-tissue transfer is recommended for complex injuries to the dorsum of the hand associated with soft-tissue defects.- - - - - - - - - - ranking = 1.5keywords = hand (Clic here for more details about this article) |
15/531. Natural gas inflation injury of the upper extremity: a case report.High-pressure injection injury is well known to hand surgeons. We present a case of low-pressure inflation injury to the upper extremity. Our experience with this injury, its treatment, and the eventual outcome are discussed.- - - - - - - - - - ranking = 0.25keywords = hand (Clic here for more details about this article) |
16/531. Partial transient osteoporosis of the hand.OBJECTIVE: To describe the radiographic and scintigraphic findings of partial transient osteoporosis (PTO) of the hand. To discuss the relationship of PTO and other localized demineralizing diseases. DESIGN AND patients: Three patients with PTO that affected two or three digits of the hand are reported. Two patients were middle-aged women and the third was a young man. All presented with a history of trauma to the hand. All patients experienced localized burning pain, swelling and vasomotor changes including redness of the skin, hyperhidrosis and signs of vasomotor instability of the involved fingers. Plain radiography and bone scanning were used in the diagnosis and follow-up of these cases. RESULTS: All patients had a radial distribution of the osteoporosis that involved adjacent rays. In all patients two rays were involved. The radiographic changes manifested as minimal patchy osteoporosis involving the cortical, cancellous, subarticular and subperiosteal bone with no articular involvement. The increased uptake on scintigraphy coincided with the radial distribution of the osteoporosis. All patients improved on physical therapy and were symptom-free approximately 6 months after the initial injury. These patients were followed up for more than 2 years. CONCLUSION: PTO of the hand is an uncommon disease with typical clinical and radiographic findings. Bone scintigraphy confirms the partial involvement of the hand.- - - - - - - - - - ranking = 2.25keywords = hand (Clic here for more details about this article) |
17/531. keratoacanthoma centrifugum marginatum arising from a scar after skin injury.Among the variants of solitary keratoacanthoma, keratoacanthoma centrifugum marginatum (KCM) is characterized by the lack of a tendency toward spontaneous remission and by continuous centrifugal spread. We describe a case of KCM arising from the scar after an old skin injury. The lesion appeared on the dorsum of the right hand, grew peripherally for 30 months, and became a tumor with a multinodular margin and central atrophy. A biopsy specimen from the edge of the tumor showed features resembling typical solitary keratoacanthoma.- - - - - - - - - - ranking = 0.25keywords = hand (Clic here for more details about this article) |
18/531. The ping-pong ball microphone: facilitating speech for a patient with hand burns and a tracheostomy.patients who have sustained thermal injuries may require tracheostomies as a result of facial burns; these operations may also be required after prolonged intubation for smoke inhalation injury or respiratory failure. For a patient with a temporary tracheostomy, speech may be achieved by occluding the opening of the tracheostomy cannula with the tip of a finger, thereby directing airflow through the vocal cords and allowing phonation to be produced. However, some patients who also have hand burns may not be able to cover the opening of the tube because of the injuries to their fingers and the bulky dressings covering them. A simple tracheal occluder can be made out of a ping-pong ball and a syringe casing. The device presented in this article allows for the restoration of speech in the types of patients described above, and it promotes purposeful movement of their upper extremities.- - - - - - - - - - ranking = 1.25keywords = hand (Clic here for more details about this article) |
19/531. Reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve.Soft-tissue reconstruction of the hand needs to cover the vital structures with flaps. It is usually difficult to maintain function and form with minimal morbidity. Local tissue is preferable but it is also very valuable. Especially in the distal part of the upper extremity, flap coverage is a challenging problem because of limited reconstructive alternatives. On the dorsum of the hand, flaps can be designed based on the paraneural vascular network of the cutaneous sensory nerves. These paraneural vascular networks send branches to the surrounding tissues. The branches to the skin are known as neurocutaneous perforators. The authors used eight reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve. Six flaps were based on the branch to the index finger and two flaps were based on the branch to the thumb. All flaps survived completely, and successful flap coverage was achieved in all patients with minimal morbidity.- - - - - - - - - - ranking = 0.5keywords = hand (Clic here for more details about this article) |
20/531. Free medialis pedis flap as a coverage and flow-through flap in hand and digit reconstruction.BACKGROUND: skin and soft-tissue defects of the hand and digit present a challenge for the hand surgeon especially in meeting the reconstructive needs of thickness, texture, color matching, and sensation. It becomes an even bigger challenge to reconstruct the defect in a devascularized finger with segmental loss of the neurovascular bundle. We use the relatively new flap, the medialis pedis flap, to solve the above conditions and compare it with traditional flaps. methods: From May of 1994 to March of 1997, the free medialis pedis flap was used to reconstruct 19 digit and hand defects; the flap sizes ranging from 1.5 x 3.0 cm to 3.0 x 9.0 cm. Sixteen flaps were used for simple coverage of digit defects, including 12 for single-digit and 4 for multiple-digit reconstruction. The remaining three flaps were used as coverage and a flow-through flap for devascularized fingers. RESULTS: All 19 flaps survived and achieved a good protective sensation. The appearance was very satisfactory, and the donor-site scars were without sensory problems. CONCLUSION: Compared with traditional flaps, the free medialis pedis has the following advantages: it provides good thickness, texture, and color matching for hand and digit resurfacing; it can be used as a flow-through flap and as coverage for a devascularized finger in a one-stage procedure; the size of the feeding vessels of the flap matches those of the digital vessels well; and it consists of glabrous skin rich in nerve endings, so it has good potential for sensory recovery. Because of all of these characteristics, the free medialis flap may become a better consideration for hand surgeons.- - - - - - - - - - ranking = 2.25keywords = hand (Clic here for more details about this article) |
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