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Biomedical subjects

R C Wray

Publications and source records attributed to R C Wray.

At least 55 records · Page 3Linked to original sources
PubMed1980

Treatment of partial tendon lacerations.

We treated twenty six patients with thirty four partial tendon lacerations by not suturing the tendons and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 per cent of the cross sectional area. The mean and median cross-sectional area lacerated was 60 per cent. Twenty three of these patients obtained excellent function, one patient obtained good to excellent function and one patient obtained fair function. One patient was lost to follow-up. No tendon ruptured but one patient did develop trigger finger which spontaneously resolved. Partial flexor tendon lacerations should not be repaired and early active motion should be used if bevelling of the laceration is not present. Bevelled partial tendon lacerations of less than twenty five per cent of the cross sectional area can be either excised or repaired with a simple interrupted suture. If greater than twenty five per cent of the cross-sectional area is lacerated and bevelled, the laceration should be repaired with a few simple sutures. Regardless of the treatment of the tendon early active motion is necessary.

Adolescent↗
PubMed1980

Experimental comparison of technics of tendon repair.

We compared tendon gliding and tensile strengths after 70 modified Bunnell, Kessler, Kleinert, or Tsuge flexor tendon repairs in chickens. We evaluated gliding by three different measurements: angular motion, longitudinal tendon movement with the toe intact, and with the repair isolated. The tendon dimensions and the rupture strengths were measured. We found equal rupture rates and tensile strengths after all repairs and equal gliding after the modified Bunnell, Kessler and Kleinert repairs. Angular motion was better after the Tsuge repair than after the modified Bunnell repair, but longitudinal tendon movement with the toe intact or with the repair isolated was the same. From our observations we believe that a hand surgeon could use either the Bunnell, Kessler, Kleinert, or Tsuge technic of flexor tendon repair and expect equal results.

Animals↗
PubMed1980

Operative mobilization of stiff metacarpophalangeal joints: dorsal versus volar approach.

The effectiveness and merits of the dorsal and volar approaches for release of structures contributing to metacarpophalangeal joint stiffness were studied in 61 joints in 23 patients. Seventy-six percent of the joints in the volar group gained greater than 50 degrees passive motion compared to 29% in the dorsal group. Forty-four percent of the joints in the volar group gained greater than 50 degrees active motion compared to 16% in the dorsal group. Discussion of surgical technique and postoperative management reveals that the advantages of the volar approach are most evident during postoperative management, while the main advantage of the dorsal approach is better operative exposure.

Finger Joint↗
PubMed1980

The results of nerve grafting in the wrist and hand.

To evaluate the usefulness of nerve grafting we studied 38 patients having 11 median, 7 ulnar, and 33 digital nerve grafts. Group funicular (interfascicular) grafting using magnification was performed in all patients. We followed 12 patients with 8 median and 5 ulnar nerve grafts for at least one year and 18 patients with 27 digital nerve grafts for at least six months. Medical Research Council criteria were used for evaluation of nerve function. Results in our patients and in previously reported patients having nerve grafting or repair were compared. Sensory function following ulnar nerve grafting was significantly better than that following nerve repair. Sensory function following median and digital nerve grafting was as good as that following nerve repair. Motor function following ulnar nerve grafting was as good as that following nerve repair. Previously reported patients having median nerve repairs or grafts had significantly better motor function than our patients.

Adolescent↗
PubMed1980

Speech prosthesis versus pharyngeal flap: a randomized evaluation of the management of velopharyngeal incompetency.

Thirty-nine children with moderate-to-severe velopharyngeal incompetency were randomly assigned to either prosthetic or surgical palatal management. A classification for evaluating velopharyngeal incompetency was designed. The prosthetic speech appliance, when obtained and tolerated, corrected velopharyngeal incompetency as effectively as did pharyngeal flap surgery. However, the noncompliance and failure rate for prosthetic management was 35 percent. The surgical failure rate was 9 percent. Furthermore, 33 percent of patients who received prosthetic management have subsequently undergone pharyngeal flap surgery. The equivalency of these types of palatal management lead one to question the combination of the noncompliance and failure rate for prostheses, the incidence of secondary surgical conversions, and the persistent sense of deformity with prosthetic management.

Adolescent↗
PubMed1979

The effects of suturing technique and vessel size on patency after microarterial repair.

According to most of the literature, sutures for microarterial repair must include the intima to prevent an "intimal flap" and occlusion of the anastomosis. Some authors have said that vessel diameter affects patency rate. This study was designed to evaluate these two statements. The femoral arteries (about 1.0 mm in diameter), the epigastric arteries (about 0.5 mm), and the central ear arteries (about 0.5 mm) of rabbits were studied. Alternate arteries were repaired using conventional suturing techniques or sutures which included the adventitia and media but excluded the intima. The patency rate in the 1 mm or 0.5 mm vessels was not affected by inclusion or exclusion of the intima from the microarterial repair. The patency rate for conventionally repaired arteries 1 mm in diameter was significantly higher than that for 0.5 mm arteries.

Abdominal Muscles↗
PubMed1979

Factors influencing final range of motion in the fingers after fractures of the hand.

We evaluated 123 patients in which we treated 150 fractured fingers primarily. Sixty-seven percent of these fractured fingers required open reduction with internal fixation; the remainder had closed reduction with internal or external fixation, or immediate arthrodeses. Active and passive range-of-motion (ROM) exercises were usually begun within 3 days after injury. The active and passive ROM of all joints of each finger in the involved hand were measured at regular intervals until no further change in ROM occurred. An associated crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significantly more frequent decrease in the final ROM of the unfractured fingers of the same hand. An associated joint injury, more than one fracture per finger, a crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significant decrease in the ROM of the fractured fingers. After treatment of a simple fracture, the ROM in both the fractured and the unfractured fingers was essentially normal.

Adolescent↗
PubMed1978

The results of non-operative management of stiff joints in the hand.

We selected 500 patients randomly from a total of 1300 patients seen in our Hand Rehabilitation Center between 1971 and 1975; 212 of the 500 presented with a chief complaint of stiff hand joints. Of the 212 patients treated non-operatively, 173 responded sufficiently to this treatment alone. Of the 789 stiff joints, 686 responded sufficiently to this treatment alone. The results of this regime of non-operative treatment of stiff joints provide excellent functional improvement in most patients, with a large saving of money through the reduction in disability payments required.

Exercise Therapy↗
PubMed1978

Experimental study of the optimal time for tenolysis.

We have attempted to define the optimal time for tenolysis by evaluating the blood supply, the rupture rate, and the tensile strength of tenolysed and control tendons. In 128 chickens tenolysis was performed 1, 3, 6, 12, 16, and 24 weeks after primary tendon repair. Tenolysis at 1 and 3 weeks resulted in devascularization, weak tendons, and high rupture rates. Tenolysis at 6 weeks after the primary repair had mixed effects on the blood supply but weakened the tendon. Tenolysis at 12 weeks after the tendon repair did not weaken the tendon and resulted in an increased blood supply. Tenolysis at 16 and 24 weeks did not weaken the tendon, but had varied effects on the blood supply. We recommend an interval of 12 weeks between primary tendon repair and tenolysis.

Animals↗
PubMed1978

The surgical management of stiff joints in the hand.

Significant and lasting improvement in stiff MP and PIP joints can be achieved by operative management. Operative intervention should be considered only after persistence of stiffness after a vigorous program of nonoperative therapy. In our series of 135 such stiff finger joints, capsulotomy increased the range of motion in MP joints by more than 30 degrees in 68 percent of the patients, more than 50 degrees in 57 percent, and more than 70 degrees in 32 percent. The increased range of motion for the PIP joints was more than 30 degrees in 63 percent of the patients, more than 50 degrees in 41 percent, and more than 70 degrees in 25 percent.

Exercise Therapy↗
PubMed1977

The effects of steroid instillations and hematomas on the pseudosheaths around miniature breast implants in rats.

In a controlled study in rats, neither the instillation of steroids nor the presence of hematoma alone had a significant effect on pseudosheath thickness or on the intra-prosthetic pressure of mammary implants. The presence of hematoma plus steroid instillation did, however, cause an increased intra-prosthetic pressure, but these did not cause a change in the thickness of the pseudosheath.

Animals↗
PubMed1977

Scar carcinoma: prognosis and treatment.

A 30-year experience with 31 cases of squamous cell carcinoma arising in scars is reviewed. Mean age of the patients was 58 years. Average time from injury to diagnosis was 23 years. The male to female ratio was 4:1. Tumors were well differentiated in 23 cases and poorly differentiated in eight cases. Three-year survival rate was 94% for patients with well-differentiated lesions, but only 38% for those with poorly differentiated ones which were more likely to metastasize. Implications of these findings are discussed in relation to therapy.

Adult↗
PubMed1977

Median nerve compression and trigger finger in the mucopolysaccharidoses and related diseases.

Patients with Hurler's syndrome (MPS-1H), I-cell disease (ML-II) and pseudo-Hurler's syndrome (ML-III) had median nerve compression and triggering of the fingers which limited finger extension. To our knowledge, this combination has not been reported previously in patients with mucopolysaccharidoses and related disorders. In all of our 3 cases the median nerve was compressed by thickened flexor tenosynovium. Synovectomy and resection of the volar carpal ligament improved the hand function in all, including the mentally retarded patient with Hurler's syndrome. Release of the fibroosseous tunnel in two patients was followed by an increased range of motion (but not full extension). A fourth patient, without a mucopolysaccharide storage disorder, also had the combination of trigger finger and carpal tunnel syndrome.

Carpal Tunnel Syndrome↗