Biomedical subjects
Publications and source records attributed to F Finseth.
Joint arthrodesis is indicated when motion in a joint cannot be restored, and that joint requires stabilization in an optimal functional position. The Harrision Intramedullary peg has been used to advantage for this purpose in hand reconstruction in leprosy in a renal developing area. It is a method to be considered for selected cases requiring joint stabilization to improve total hand function.
Peripheral nerve trauma has been a challenge to surgeons, with significant advances in the surgery of repair occurring in major wars. The standard method of treatment involving wide mobilization and end-to-end suture to close traumatic gaps in peripheral nerves has not produced consistently acceptable results, particularly with large gaps. However, with the recent development of microsurgical techniques and instrumentation, the method of interfascicular nerve grafting has been applied to selected patients with trauma problems of the peripheral nerve, by resecting and autogenous nerve grafting at staggered levels to distribute scar formation, followed by plaster immobilization for 3 weeks. Ten patients are reported, with motor nerve recovery ranging from M2 to M4 and sensory recovery, S2-S4 (See Table I), based on Seddon's classification (11).
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From this brief experience in Ethiopia I believe that plastic and reconstructive surgery can contribute much to the lives of many people in such underdeveloped regions of the world. If one will teach the principles of plastic surgery to the general surgeons and paramedical people who do most of the work in these areas, it can amplify and expand their capabilities. Surgery is, of course, only one link in the long chain of basic health issues, and the ultimate solutions are on a different level. Yet, the magnitude of the problems is a compelling reason to make the effort, to take the time, and to contribute our skills in developing regions of the world. Though we cannot alone conquer the entire problem, we can do our bit.
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Ethiopia, among the world's poorest countries, suffers from a full spectrum of health problems. A plastic surgeon and a public health physician present their experiences in Sidamo province in the Rift Valley.
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Two case histories are presented in which cigarette smoking in the early postoperative period following digital replantation led to vasospasm and thus compromise of the microvascular anastomoses.
The pectoralis major myocutaneous flap is presented in its two basic forms: a muscle flap carrying a skin paddle and the continuous skin-muscle flap technique. The pertinent anatomy of the enveloping fascial planes is reviewed, stressing the increased latitude of safety afforded by elevating the vascular pedicle from the undersurface of the lateral muscle edge. The advantages of a deltopectoral flap outline in approaching the formation of the skin-muscle paddle are introduced. Clinical applications, advantages, and disadvantages are discussed.
Methods of finger reconstruction using a free toe transplantation are described. The thumb, and in some particular cases also the index finger, can be successfully replaced by toes using microsurgical techniques for vascular and nervous anastomosis. Functional results are quite satisfactory and allow the patient to recover complete use of the hand.
Congenital absence or traumatic amputation of the thumb is a major disability profoundly disturbing the function of the hand, as the thumb represents an estimated 50% of total hand function. The methods for thumb reconstruction utilizing the index finger were developed some twenty years ago, and progress has been made in the last several years with emphasis on intrinsic muscle reconstruction as emphasized by Buck-Gramcko. The method, technique and anatomy of index pollicization is discussed, and representative cases presented for congenital absence of the thumb and for traumatic amputation of the thumb.