Biomedical subjects
Publications and source records attributed to S C Sandzén.
Massive open wounds are treated conservatively to preserve all viable tissue. Closed crush injuries may require extensive fasciolysis and debridement to treat compartment syndrome. Meticulous cleansing is the primary treatment for open injuries. Compartment syndrome occurs when intracompartmental pressure impairs capillary function and jeopardizes tissue viability. Rhabdomyolysis associated with crush injuries may lead to renal failure.
Classification of central defect of the hand includes three general categories--Type I (typical), Type II (atypical), and Type III (two, three, and four digit hand). These three types of central defect have one common denominator--central metacarpal deficiency or absence. Otherwise, these three distinct types differ completely in inheritance pattern, characteristic features, bilaterality, and functional management. Functional management of the Type I central defect combines release of the tethered thumb metacarpal from its adduction contracture and simultaneous closure of the cleft using that redundant skin to fabricate a physiologic thumb-index web. Type II reconstructive procedures should be planned to provide as effective a pinch and grasp as possible between the radial and ulnar columns by deepening the central cleft, excising "digital nubbins" and any impinging skeleton, and performing rotational osteotomies of either metacarpal base or both and, occasionally, transfers to provide active digital flexion. Type III reconstructive procedures should release the adducted thumb and fabricate a physiologic thumb-index web along with appropriate releases of syndactyly. In the two-digit hand, rotational osteotomies may increase function.
Contracture of the thumb-index web space negates the ability of the thumb to diverge from the remainder of the hand and consequently to converge toward the fingers in grasp. This is a review of the anatomy of the tetrahedral space and defines the secondary factors leading to web space restriction, including factors related to the mechanism of injury. Treatment is determined by the severity of the condition. The impairment is classified as mild, moderate, or severe, depending on the magnitude of the tissue damage. Specific treatment for joint contractures, bone defects, muscle fibrosis, and inappropriate skin coverage is presented by a format of functional anatomy and surgical technology. Prevention of web space contracture is the key to success.
Growth plate or physeal injuries are classified according to the zones of the physis that are affected and the disruption of bony structure. All physeal injuries should be reduced anatomically, particularly when an articular surface is involved. Inability to restore normal configuration can result in malunion, incongruous articular surfaces and premature cessation of growth plate activity in the region of injury. Innocuous-appearing injuries that do not involve articular surfaces may result in severe abnormalities.
If a dorsal rotational flap is chosen for reconstructive resurfacing of a moderate thumb-index flexion-adduction web contracture release, the design advised in this paper is advocated as the most physiologic use of skin with least torsion on the pedicle base. The key to the procedure is designing the pedicle to cross the axis of motion of the pedicle tip on one side, preferably the thumb, and the pedicle base on the opposite side.
Suspect this common syndrome in young women who are pregnant or on oral contraceptives, in menopausal women, in patients performing unaccustomed repetitive manual activity, in those on hemodialysis and in those with endocrine abnormalities. Diagnosis requires precise neurologic examination and electrodiagnostic studies. Conservative therapy includes nonsteroidal anti-inflammatory agents, night-splint immobilization and local steroid injections. Surgical intervention is required for longstanding cases when conservative treatment fails and when muscular atrophy of median innervated thenar muscles develops.
Two cases of radial artery aneurysm in the anatomical snuff box are described, together with the clinical features which should differentiate this rare lesion from the much more common ganglion in the same location.
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