[Free multi-tissue microvascular transplants in the treatment of pseudarthrosis].
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Biomedical subjects
Publications and source records attributed to K A Solonen.
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Nine patients received a toe-to-finger transfer after accidental amputation and one after a congenital defect. One led to secondary amputation due to arterial thrombosis. Seven of the 9 patients would have the operation again if needed. Five transplants were great toe-to-thumb transfers which the authors feel superior to second toe to thumb transplantations. The method seems to be useful in reconstructive hand surgery.
A series of 28 neurovascular island flaps are presented together with a series of three radial innervated pedicled flaps. The former method gave superior results compared to the latter. The mean follow-up period was 4.3 years. All the flaps survived and 21 of the neurovascular flaps were classified good to excellent, 4 cases gave fair results and in three cases the result was classified poor. Only one of the neural pedicled radial innervated flaps could be classified as fair whereas both of the others gave poor results. The neurovascular island flap method is regarded a valuable alternative to a tree vascularized composite tissue graft.
Three patients with brachial birth palsy were operated on within 3 months after delivery. Reconstruction of the part of the torn brachial plexus was accomplished width free nerve grafts. At follow-up after an average interval of 2 years, 4 months, the deltoid, biceps, and external rotators of the upper arm were improved to a degree that could not possibly have been achieved without surgery.
A review of the operative treatment of avulsion or rupture of the distal biceps brachii tendon is presented. Five cases are described. One patient had bilateral avulsion. All were operated on using the technique described by Thomsen or Boyd & Anderson.
Two cases of posterior dislocation (PD) and four cases of posterior fracture-dislocation (PFD) of the shoulder are reported. There was one bilateral PD and two bilateral PFD. One PD was treated with closed reduction but in three cases of PFD operative reduction was necessary. All measures were applied in the late phase within 1 to 10 months after the injury with good primary results. However, because of posttraumatic arthrosis, the final result was poor. The average follow-up period was 4 years. The diagnosis of posterior dislocation is often missed. An axillary X-ray is essential.
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This paper reports tendon transfers carried out to restore the pinch grip in thirty-four patients with irreparable traumatic ulnar palsy. The advantages and disadvantages of the procedure are discussed. Performed for proper indications the results show improved function in most patients.
The condition of the anterior portion of the prolapsed lumbar disc and the possible peroperative lesion of this structure was studied by peroperative discography. In 3 of 25 patients leakage of contrast medium anterior to the vertebral column occurred after evacuation of the nucleus pulposus. This finding may be taken as an intimation of structural weakness and vulnerability of the anterior part of the annulus fibrosus of the posteriorly herniated disc.
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