[Artificially operated prostheses].
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Biomedical subjects
Publications and source records attributed to G Neff.
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101 cases of syndactyly in 34 male and 14 female infants who were aged three months to seven years at the time of their initial surgery were reviewed one to 9.5 years thereafter. The web space was formed by a palmar and a dorsal flap; in 50% of all commissures the result was found satisfactory in the follow-up series. Straight incision - performed in two thirds of our cases - caused scar contractures and deformities of several fingers. In contrary, zig-zag or wavy incisions showed good results. Using almost exclusively full thickness skin grafts from the arm, the donor site looked poor because of non-cosmetic scares and keloids. After surgery two thirds of all patients used a special splint for finger abduction for an average of about one year; neither an amelioration of insufficient primary surgery was achieved nor reappearance of syndactylism could be avoided by this device. The mobility of joints was partially decreased regardless of the pre-operative condition. Combined functions in grasping, however, were not restricted to a considerable degree. There was no difference between cutaneous and osseous syndactylism with respect to the abduction ability. Even slight impairment of wound healing caused reappearance of syndactylism; reseparation of fingers was necessary 32 times during a ten year period of follow-up. Scar contractures - especially after necrosis of skin grafts and deep infections - required early correction, while slowly developing secondary webs had to be separated some years later. Disturbance of wound healing must, therefore, be treated adequately, or better should be avoided by precise surgery and careful management of postoperative dressing.
Pertinent accident statistics show that, opposed to the need for safety which ought to be expected, there is an insufficiently practiced safety consciousness. The objective probability of getting into danger rises with the increasing readiness to take risks. Advertising tries to influence the potential customer quantitatively and qualitatively in such a way that he believes that his secret desires will be fulfilled by the acquisition and use of certain products. The mechanism of character transference through paralogical conclusions required for this shows parallels to the logic schizophrenia. Both sponsors and ad-men can contribute decisively to safety in skiing if they dispense with the use of certain attributes in their advertisements.
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A 23 year old male with a mirror right hand, duplicated ulna and aplasia of the radius is presented. A large deformity of the distal and anterior surface of the humerus was also noted. Based on clinical documentation and X-rays it was felt that this unusual bony formation probably represented a minimal rudiment of the radius and that the bone deformity at the distal end of the humerus did not represent a supracondylar humeral spur which is occasionally seen in humerus without any concommittent congenital deformities, as is nearly always seen in mammals.
The task of the occupational therapist following surgical procedures on deformed hands is discussed. In the child with congenital malformations, we must not only be concerned with treatment of the deformity but we must be concerned about the psychic problems which can develop following prolonged hospitalization or overprotection. One must be keenly observant to detect these problems early. Preoperative testing utilizing a standardized gripping test is carried out by the occupational therapist. The necessity for this is demonstrated by the example of the radial clubhand. In this way complications such as correction of clubhand in the face of a stiff elbow or pollicisation in the presence of inadequate clubhand correction can thus be avoided. After operation training in the new functions is begun as early as possible; preferably with individual supervision. Daily repetative and progressive exercises should result in maximum utilization of gripping ability provided by the operative procedure. The treatment program also includes the adaptation of clothing, the production of appliances and splints, in co-operation with the orthopedic technician, as well as specially designed functional exercises. All these factors are as important as the operative procedure itself in contributing to maximum benifit. All essential findings and their variations must be written down. Also the photographic documentation of the functions is the job of the occupational therapist. Sufficient time should be allowed prior to discharge to inform the parents about the newly acquired functions and the use of the applicances. The maintenance and further development of the newly acquired functions is insured through the continued ambulatory supervision by the doctor and the occupational therapist. The occupational therapist thus has a significant job as a member of the team in a special unit for children with congenital malformations.
A review of 48 patients in whom 101 syndactyly separations were performed between 1963 and 1972 is reported with the peaks of frequency of the inital operation (being in early infancy, and just before entering school). Different surgical techniques were used for restoration of the web space, with the two-flap-technique of ZELLER most often used. About 60% of the fingers were separated by longitudinal incisions with the remaining 40% with zig-zag incisions. Of the skin grafts, about two-thirds showed excellent cosmetic appearance with the remaining third showing evidence of hyperpigmentation. Digital abduction was measured and approximated the spread seen in normal children.
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