Biomedical subjects
Publications and source records attributed to J P Varian.
Recurrence beneath a Wolfe graft is reported and discussed. While the dermofasciectomy appears able to inhibit myofibroblast proliferation where the graft is in direct contact with the graft bed, it is possible that, in the finger, the narrow strip behind the neurovascular bundle may, very rarely, escape this control and proceed to extension in depth.
We describe a patient who presented with pathological fracture of the fifth metacarpal which on further investigation, was found to be due to Sarcoidosis. There is no previous record of the condition presenting in this way, with a pathological fracture.
The elbow joint is frequently affected by rheumatoid arthritis causing pain and disability which limits the use of the upper limb. Excisional or interpositional arthroplasties of the elbow have failed to provide satisfactory results. The design of a total elbow prosthesis in early 1970's followed the principles and evolution of joint replacement in the lower limb. In this study twenty-two Liverpool elbow prostheses (non-constrained) in nineteen patients were reviewed with an average follow-up of 26.5 months. Postoperatively the arc of flexion-extension improved with no change in pronation-supination range. Pain was significantly improved postoperatively. Rheumatoid patients were very pleased, but patients with secondary osteoarthritis were less satisfied. Two prostheses became loose and three had deep infection and were removed. Five patients had postoperative symptoms of ulnar neuritis and in three the symptoms gradually resolved. Early results of total elbow arthroplasty are promising in carefully selected patients.
A case of osteoclastoma of the first metacarpal is reported. Reconstruction by en bloc excision and autologous bone graft is described. Other therapeutic options are reviewed.
In one hundred patients with Dupuytren's disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42 degrees and the average percentage improvement in proximal interphalangeal joint extension at post-operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.
This study reviews one hundred patients with Dupuytren's disease treated surgically by the Derby Hand Unit between January 1975 and September 1981. One hundred and twenty-eight operations were assessed with a follow-up period from nine months to ninety months, average thirty-eight months. In thirty-five patients the overlying skin was excised and replaced by a full-thickness skin graft (dermofasciectomy). The remaining patients were treated by fasciectomy without skin excision. The overall recurrence rate after surgery was found to be 46.5%. However skin excision and replacement following fasciectomy prevented any appreciable, if not all recurrence of Dupuytren's tissue. The function of the hand was assessed with regard to the improvement in flexion contracture; ability to flex the finger to the distal palmar crease; sensibility of the replaced skin; time to return to work and full activity. It was concluded that skin replacement did not jeopardize hand function.
The experience of the Hand unit at the Derbyshire Royal Infirmary in dealing with this rare condition in twenty one patients has been reviewed and conclusions drawn. It was found that symptomatology varied a little more than is generally described in the textbooks. Recurrence of symptoms is common and this fact is not given its due attention in the literature. Recurrent symptoms can be due either to a recurrence of tumour or to a different tumour in the same site. A more radical resection may achieve more first time cures.
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