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Biomedical subjects

J E Kutz

Publications and source records attributed to J E Kutz.

At least 19 recordsLinked to original sources
PubMed1998

Avulsion injuries of the thumb: survival factors and functional results of replantation.

Twenty-seven cases of replantation for avulsion injuries of the thumb from 1979 to 1987 were analyzed retrospectively. Inclusion criteria required all thumbs to have tendinous attachments (either the extensor pollicis longus or the flexor pollicis longus) to the amputated part. Thirteen replants survived for an overall survival rate of 48%. Avulsions at or proximal to the metacarpophalangeal joint had a survival rate of 83% compared with a 38% survival rate distal to the metacarpophalangeal joint. This difference was not statistically significant. Of the 13 patients with surviving replanted thumbs, 11 (85%) achieved protective sensation only and 2 attained a two-point discrimination <10 mm. Of the 13 replanted thumbs that survived, 7 were treated with primary arthrodesis, 4 at the level of the interphalangeal joint and 3 at the metacarpophalangeal joint. The other 6 thumbs were treated with primary or secondary tendon transfers. In a literature review of thumb avulsion injuries, survival rates range from 26% to 100%. In this study, tendon transfers and primary arthrodesis were useful adjuncts in the management of thumb avulsions, and the majority of patients with successfully replanted thumbs attained protective sensation only. Larger studies are needed to better define statistically significant relationships affecting replantation survival.

Adolescent↗
PubMed1993

Flexor tendon injuries of the hand.

Flexor tendon injuries can be problematic injuries from the time of occurrence until the patient returns to full and complete recovery. There are many misadventures that can occur along the way. The emergency physician must be keenly aware of the anatomy involved, and a careful history and physical examination must be performed. The diagnosis may be obvious or subtle, and the emergency physician must methodically search for the unsuspected injury. An appropriate referral should be initiated soon after an injury is determined. The hand surgeon has many considerations and obstacles in flexor tendon repairs, but good to excellent results can be expected in up to 80% of patients if the emergency physician and the hand surgeon work together to ensure an optimal patient outcome.

Emergencies↗
PubMed1993

Extensor tendon injuries of the hand.

Extensor tendon injuries are often initially evaluated and diagnosed in the Emergency Department. These injuries may be painfully obvious or frightfully subtle, but if the emergency physician has a firm understanding of the anatomy involved and he or she embarks on a careful and complete history and physical examination, the diagnosis should be made. There are various considerations in the ultimate treatment and outcome for the patient, and the patient's best interests are served when the emergency physician provides the initial appropriate treatment and proper disposition.

Emergencies↗
PubMed1993

Vascular compression about the shoulder.

Arterial and venous compression about the shoulder girdle are rare clinical entities. Potential complications can be disastrous for the patient. A heightened awareness of the problem and careful physical examination may lead to earlier diagnosis. Controversy still exists as to the optimal treatment once diagnosis is confirmed. Evolution of noninvasive diagnostic techniques may be of considerable benefit in the future.

Compartment Syndromes↗
PubMed1990

Improvement in motor function after brachial plexus surgery.

Motor functional recovery of 52 patients with brachial plexus surgery followed up for more than 2 years was evaluated. Fifty-eight surgical procedures were done, including autologous nerve grafting (38 cases), neurolysis (14 cases), and neurotization (6 cases). Overall results, evaluated according to the 0 to 5 formula of the Medical Research Council, were as follows: good, 58%; fair, 15%; and poor, 27%. Good results were evident in 58% of patients with nerve grafts and in 64% of those with neurolysis. In patients with neurotization, no good recovery and only one fair recovery were seen. Patients with open injuries showed good recovery, whereas the group with closed injury showed good recovery in only 48%. Patients with closed injuries caused by traffic accidents showed a worse recovery than those caused by other means. Patients with closed injuries and nerve grafting done within 3 months of injury or neurolysis within 6 months showed better recovery.

Adolescent↗
PubMed1987

Venous flaps in digital revascularization and replantation.

This is a report on 15 patients who underwent replantation/revascularization of a single digit with a substantial dorsal soft tissue defect. The dorsal defect was covered with a venous flap, a free flap that has only venous inflow and outflow. Postoperatively, the venous flaps were warm, pink, and appeared to exhibit a blanch and refill phenomenon, clinically resembling capillary filling. The flaps from the dorsal aspect of an uninjured digit had a survival rate of 100 percent, with no partial necrosis, while the flaps from a forearm or dorsal foot donor site failed. The advantages of using venous free flaps are twofold. Not only does this technique provide for venous drainage, but it also provides flap coverage and avoids complications, such as vessel occlusion or hematoma formation, associated with skin grafting over a venous anastomosis, with subsequent loss of the skin graft.

Adult↗
PubMed1986

The role of the epiphyseal and metaphyseal circulations on longitudinal growth in the dog: an experimental study.

An experimental model using the immature canine proximal fibular epiphysis was developed to isolate and investigate the effects of the epiphyseal and metaphyseal circulations on longitudinal growth. Experimental constructs studied the epiphyseal circulation, the epiphyseal and metaphyseal circulations, a devascularized growth plate, and a control group. Twenty-four limbs were studied by serial x-ray films and microangiographic and histologic analyses at time of death, 24 weeks after surgery. The data from this preliminary study show that both metaphyseal and epiphyseal circulations are necessary for predictable longitudinal growth.

Animals↗
PubMed1985

Chronic exertional compartment syndrome of the forearm: a case report.

A 40-year-old man sustained a circumferential crush injury to his right forearm. Four months after injury, he experienced the onset of numbness and tingling in the distribution of the median nerve after exercise. Elevated compartment pressures of the palmar forearm and slowing of median nerve conduction after exercise suggested chronic exertional compartment syndrome. A flexor fasciotomy led to complete relief of symptoms, which allowed the patient unrestricted activity.

Adult↗
PubMed1984

Primary microsurgical repair of ring avulsion amputation injuries.

Patients with ring avulsion injuries of the fourth and fifth digits often demand attempts at reconstruction rather than completion of the amputation. In the past, this has led to reconstruction involving a staged series of operations with results that were often less than desirable. Seven patients with ring avulsion amputation injuries that were reconstructed by use of microsurgical reanastomoses are reported. All were classified as either Carroll type IV or Urbaniak type III. Six patients (85%) had a successful replantation leading to a useful finger. The operating time averaged 5.5 hours. On average, 1.9 arteries (range 1 to 2) and 3.3 veins (range 2 to 5) were repaired for each digit. Average hospital stay was 6.7 days (range 4 to 15). Average range of motion was 0(2)/84(2) for metacarpophalangeal joint and 15(2)/90(2) for proximal interphalangeal joint (PIP) with distal interphalangeal joint ankylosis at between 0(2) and 15(2) of flexion. Sensibility was protective in all cases and good in three. If the PIP joint was damaged, completion of amputation was the treatment of choice. If the amputation is distal to the PIP with a functional superficialis tendon, primary microsurgical repair is the treatment of choice in complex ring avulsion injuries.

Adult↗
PubMed1983

Upper extremity replantation.

The most important determinants of the functional ability of an amputated part are proper patient selection and the recognition of vascular compromise. Ideally, a well-performed anastomosis should need no pharmacologic assistance, but the ideal is often the exception. The authors present an empirical approach to use of anticoagulation medication.

Amputation, Traumatic↗
PubMed1982

Vascularized autogenous whole joint transfer in the hand--a clinical study.

Nine vascularized autogenous whole joint transfers were employed in the reconstruction of traumatized joints of six male patients ages 6 to 38 years. The proximal interphalangeal joint was involved in four patients, the thumb metacarpophalangeal (MP) joint in two, and the small finger MP joint in one. In five patients, the donor joint came from the foot, and in one patient an MP joint was transferred from a digit that had sustained a more distal amputation. The mean follow-up was 24 months (range 13 to 38). Bony union as well as full radiographic preservation of the articular space has occurred in each case. Four joints were transferred with an open epiphysis and three demonstrated longitudinal growth and an intact epiphyseal plate. The mean range of active motion was 22 degrees/55 degrees. We believe the early results demonstrate the feasibility of this method of joint reconstruction in the young patient.

Adolescent↗
PubMed1981

Interfascicular nerve repair.

The technique of nerve repair that results in the greatest percentage of regeneration of axons into their original end organs will result in the greatest functional return and the best result. Of prime importance is the motor-to-motor and sensory-to-sensory axonal orientation. Anatomic and physiologic data, as well as technical expertise, must be utilized for precise nerve approximation. To this end, fascicular repair under high-power magnification is an attempt to achieve the best alignment and coaptation of the neural elements.

Axons↗