Biomedical subjects
Publications and source records attributed to B N Bailey.
Three cases of forearm muscle hernia are described. Their aetiology differed but, in all three, symptoms were sufficiently severe to interfere with the patient's work. Surgical repair of the myocoeles, by closure of the fascial defects using lata onlay grafts or an interweave of palmaris longus tendon, produced complete resolution of symptoms and enabled the patients to return to full employment.
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A case of ulnar nerve compression at the wrist caused by a reversed palmaris longus muscle is reported. We are not aware of any previous reports of ulnar nerve compression due to this particular muscle anomaly.
Many descriptions of infective cutaneous gangrene have been published under a variety of names. The classification adopted by Ledingham and Tehrani is illustrated by 4 cases seen in the Stoke Mandeville Hospital. Although the incidence is high in Eastern countries, infective cutaneous gangrene is uncommon in the Western hemisphere owing to a difference in geographic pathology. Early and delayed management is described, stressing that early diagnosis and aggressive treatment is required, ideally by a team consisting of a microbiologist and plastic and general surgeons. There is a substantial risk associated with the failure to diagnose and treat this condition. Mortality rates and prognosis are reviewed.
Silastic sheet interposition arthroplasty was performed in 20 patients with persistently painful but stable wrists. Synovial recurrence with progression of symptoms was seen in one patient. Quantitative analysis of pain demonstrated an 87% improvement in their perception of pain in the remaining 19 patients, with an average follow-up of 8.5 years. The postoperative range of motion was 58 degrees Total Active range of Motion (TAM) (range 27 degrees - 97 degrees). Nine patients showed later ulnar translocation of the carpus, and 10 patients had continuing carpal collapse. There was no relation between these changes and the degree of pain relief at the radio-carpal joint. Those patients operated on within 18 months of the onset of symptoms showed a significantly greater post-operative range of motion (68 degrees) compared to those whose symptoms had persisted from 2 to 4 years (48 degrees).
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Clinical experience has shown that a very large part of a free muscle, musculocutaneous or even osseo-musculocutaneous flap which loses its axial blood supply at ten days may survive. Vascularisation of muscle-containing flaps from the base is progressive and when a free-flap appears avascular on surface inspection careful tangential excision of the dead tissue will usually reveal surviving tissue in the deeper layers that will accept a split-skin graft or even another flap. Four illustrative cases are presented and discussed in detail.
We have used free latissimus dorsi muscle flaps in nine patients to cover a variety of defects. The muscle has been covered with unexpanded meshed split-skin. The method is a reliable means of providing skin cover with a minimal donor site morbidity and less flap bulk than in conventional myocutaneous flaps. Our one "failure" was not related to the fact that the muscle was taken without its overlying skin, it was due to avulsion of the vascular anastomosis.
The value of the latissimus dorsi flap in its various modalities is illustrated. The practical aspects of planning, raising, transferring and monitoring the flap are discussed.
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