Kirschner-wire (K-wire) fixation for 3-6 weeks is an approved method for stabilization of the fingers after the release of flexion contracture deformity. On the other hand, articular surface damage in small joints due to pin fixation is still a topic of debate. Reports claiming permanent joint destruction due to this procedure exist in the literature. To clarify this doubt, a prospective study was carried out in 72 patients with flexion contracture of the hand fingers. After the surgical release of the deformity, immobilization of the interphalangeal (IP) and metacarpophalangeal (MCP) joints was carried out with K-wire fixation for 3 weeks. Clinical evaluation of the patients was accomplished with total active motion (TAM), grip, and pinch force measurements, whereas magnetic resonance (MR) and radionuclide imaging were used as radiodiagnostic tools. Mean follow-up period of the patients was 32 months. Satisfactory results were obtained in terms of functional and esthetic aspects. Evaluation of the data derived from the clinical and radiologic measurements revealed no permanent articular surface damage. K-wire fixation was documented to be an invaluable therapeutic approach not only to prevent recurrence of the contracture deformity but also to stabilize the skin graft effectively. This technique was concluded to provide effective immobilization without permanent articular damage.

Adolescent↗

PubMed2006

Preapplication of lidocaine to split-thickness skin graft donor site to decrease pain during the removal of dressing.

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Bandages↗

PubMed2006

Transfer of innervated split latissimus dorsi free musculocutaneous flap for flexion and extension of the fingers.

A severe form of Volkmann contracture is associated with loss of flexor and extensor compartment muscles. An 11-year-old boy with Volkmann contracture was admitted to our clinics with flexion contracture of the wrist joint and total loss of flexor and extensor muscle functions. Split latissimus dorsi free flap was used for reconstruction. The muscle was split based on the branching of thoracodorsal nerve and artery within the muscle so that each part of the muscle is nourished and innervated by a branch of thoracodorsal nerve and artery. No complication has occurred, and the patient can now grasp objects, although he cannot achieve full range of motion of the fingers. We performed a single muscle transfer for reconstruction of both the extensor and flexor compartments in severe form of Volkmann contracture and omitted the use of a second muscle transfer, thus greatly decreasing the operative time, cost, and morbidity.

Child↗

PubMed2006

Clinical experiences with a new tourniquet device.

Cessation of blood flow to the extremity improves the comfort of the surgeon. So pneumatic tourniquets are commonly used to obtain a bloodless field during upper- and lower-extremity surgery despite the several problems that tourniquet pressure may lead to. In this paper, we present our clinical experiences with a new tourniquet device called S-MART (OHK Medical Devices, Haifa, Israel) and compared the device with the traditional pneumatic tourniquet in terms of efficacy and complications. A total of 30 patients were included in the study. Preoperative systolic blood pressure measurements were obtained, and patients with a systolic blood pressure >190 mm Hg were excluded. S-MART was used in stead of pneumatic tourniquet in half of the patients in group 1. Pneumatic tourniquet was applied to the patients in group 2. The patient groups were compared. No major complications were observed in either group. But it was observed that S-MART was unsuccessful to maintain a bloodless field during the whole operative procedure in some of the cases. In conclusion, application of S-MART is practical, provides bloodless field for a certain time, and does not increase the complication rate related with the pressure applied to underlying tissues, but it is not a suitable tourniquet device for long surgical procedures.

Adult↗

PubMed2006

Vascular anatomy of the lateral pterygoid muscle.

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Hemodynamics↗

PubMed2006

Flexor pollicis brevis adductorplasty: an alternative method in ulnar nerve paralysis.

Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this paper, we discuss the transfer of flexor digitorum brevis muscle to the tendon of adductor pollicis muscle as an alternative method to restore key pinch in ulnar nerve paralysis. The technique was applied to 4 patients with ulnar nerve paralysis. Before clinical application, an anatomic study was carried out in 6 cadaver hands. In cadavers, radial and ulnar arteries were injected with latex and arterial pedicles of flexor pollicis brevis muscle were dissected under 4x magnification. Also, motor branches from the median nerve were shown at the entrance point to the muscle. In surgical practice, the superficial head of the muscle is detached from its insertion and the minor pedicle of the muscle is cut. Muscle is dissected proximally up to two thirds of its length. The dominant pedicle of the muscle originating from superficial palmar arcus is preserved, and the muscle is sutured to the tendon of the adductor pollicis muscle close to its insertion. Patients were evaluated in terms of key pinch strength preoperatively and at the postoperative sixth month using a pinch meter (Chattanooga Group, Inc). Key pinch strengths were recorded and expressed as percentage of the strength of the contralateral uninvolved hand. Mean key pinch strength of our patients was 29.7%. In conclusion, we believe in that flexor pollicis brevis adductorplasty may be an alternative method for restoration of adductor pollicis muscle function in ulnar nerve paralysis.

Adult↗

PubMed2006

Delayed assessment of the nasolacrimal system at naso-orbito-ethmoid fractures and a modified technique of dacryocystorhinostomy.

Nineteen patients between 8 and 65 years of age (mean age 32) who were treated for naso-orbito-ethmoid area traumas and suffering from epiphora were evaluated. The time after the trauma was at least 4 months. The patients were divided into two groups. The first group consisted of 10 (52.7%) patients who have undergone a surgical procedure for the fractures before. The second group has 9 (47.3%) members who have never been surgically treated after trauma. All of the patients were evaluated with dacryocystography. Obstruction was found to be in the bony nasolacrimal canal in 13 (68.4%) patients. The nasolacrimal canal was intact in six (31.6%) of the patients. Dacryocystorhinostomy (DCR) was essential for five (50%) of the patients in the first group and eight (88.8%) of the patients in the second group. No additional surgical intervention was carried out for nasal deformities of the patients resulting from naso-orbito-ethmoid fractures. Palpebral malposition was present in six (32%) patients. Relief in tear flow was supplied in all patients. Our aim is to compare the outcomes of a modified technique of DCR and incidence of nasolacrimal system injury in patients with naso-orbito-ethmoid fractures and epiphora on whom reduction was or was not carried out. In conclusion, early surgical reduction of naso-orbito-ethmoid fractures should be performed to prevent problems and deformities of the nasolacrimal system.

Adolescent↗

PubMed2006

Unusual and giant tumors of head and neck region.

Head and neck tumors can reach to massive dimensions if patients are uneducated and ignorant about the disease. Resection of such giant tumors creates a significant functional and aesthetic loss due to proximity of vital structures in head and neck region. Reconstruction of these complex defects is a demanding procedure and postoperative results are not always excellent in terms of function and aesthetics. We have reviewed a group of patients with giant head and neck tumors treated in our department. Postoperative results were evaluated in terms of function and aesthetic appearance. Postoperative functional results were good in most of the patients and aesthetic results were acceptable. Early diagnosis and excision of the tumors in head and neck region decrease the morbidity of the disease. Treatment should be planned on individual basis. Most of the patients with head and neck tumors are elderly patients with additional medical problems so reconstructive procedures should be selected by taking this in consideration. Complex and long-lasting operations should be reserved for young patients.

Adult↗

PubMed2006

Two extreme conditions of xeroderma pigmentosum.

Two atypical cases of xeroderma pigmentosum are reported. One of these cases with lung metastasis of squamous cell carcinoma in the first decade of life and the other with late onset disease (XP) in fifth decade of life. Lung metastasis of squamous cell carcinoma in first decade of life in patients with xeroderma pigmentosum has never been reported in the literature to our knowledge. Late onset of the disease in fifth decade is also a rare condition. Clinicians should be more alert for the internal organ metastases to improve the survival of the patients and should never forget that xeroderma pigmentosum has got a wide range of clinical presentation.

Carcinoma, Squamous Cell↗

PubMed2006

Giant pleomorphic adenoma of soft palate leading to obstruction of the nasopharyngeal port.

Pleomorphic adenoma is the most common tumor of minor salivary glands, but it is rarely located in the soft palate. It is generally a small mass at the time of diagnosis, but if it is neglected it can rarely become larger, leading to obstructive symptoms such as snoring, hypernasal speech, and dysphagia. Surgical removal of the mass is curative. In this paper, we present a case of an unusually large pleomorphic adenoma of the soft palate leading to snoring and hypernasal speech. The defect that resulted from the excision of the mass is covered with a uvular flap.

Adenoma, Pleomorphic↗