A history of hand surgery in Finland.
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Finland↗
Biomedical subjects
S K Vilkki
Publications and source records attributed to S K Vilkki.
Microvascular temporomandibular joint and mandibular ramus reconstruction in hemifacial microsomia.
Microvascular temporomandibular joint (TMJ) and mandibular ramus reconstruction was performed in a 4-year-old hemifacial microsomia patient with multiple craniofacial and extracranial anomalies (Goldenhar syndrome). Her major craniofacial anomalies included bilateral cleft lip and palate, left macrostomia, left microtia, and complete absence of the left vertical mandibular ramus and TMJ. Most of her other anomalies had been corrected surgically before TMJ and vertical mandibular ramus reconstruction, which was accomplished with a metatarsophalangeal (MTP) joint transplantation. The MTP joint was placed in hyperextended position in the skull base inserting the proximal phalanx under the remnants of the zygomatic arch and replacing the vertical mandibular ramus with the metatarsal bone. Straight mouth opening, correction of the midline, and normalized lateral movements of the mandible were accomplished. The graft includes two epiphyseal plates, which should maintain growth of the transplant. During the follow-up period (16 months) the achieved results have been maintained without adverse effects. The present technique appears to be a promising alternative in the treatment of children with Pruzansky type 3 hemifacial microsomia.
Abnormalities, Multiple↗
Thumb reconstruction in a bilateral upper extremity amputee.
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Amputees↗
Distraction and microvascular epiphysis transfer for radial club hand.
This paper presents a different technique of treatment for Bayne type IV radial club hand using a microvascular joint transfer in order to reconstruct the absent half of the wrist joint, aiming for better movement and stability at the wrist joint with preservation of longitudinal growth. The method uses preoperative soft tissue distraction to obtain proper alignment of the hand on the ulna before the second metatarsophalangeal joint with the whole metatarsal bone is transplanted. The treatment takes about 4 months and the optimum period for surgery is during the second year of life. Pollicization is added later in the normal manner. The new technique has been used in 12 cases by the author since 1987 and the results of the first nine cases are reported with a mean follow-up of 6 years. This technique appears to be promising but is demanding because of the microvascular joint transplantation at an early age.
Adolescent↗
Advances in microsurgical reconstruction of the congenitally adactylous hand.
A series of 18 microsurgical toe transfers for congenitally adactylous hands was done from 1983 to 1994. The functional results achieved depended on the approach and technical features applied to hand reconstruction in congenital amputations. Function was improved significantly by using 3-jointed second toes, including the metatarsophalangeal joint, and by performing meticulous intrinsic repair. The use of donor arteries changed during the 11-year study period toward the goal of perfect revascularization with a minimized ischemic time. Abundant nerve supply was found to be important for achieving near normal growth of the transferred digit. The results showed improvement in the use of the defective extremities. The ability to pinch was restored successfully in 14 of 17 congenitally defective extremities. Growth measurements were obtained from 11 transfers at followup, which ranged from 1.5 to 6 years (mean, 4 years). Linear growth was observed at the phalangeal epiphyses, whereas the metatarsal head epiphyses showed clear disturbances in at least 2 patients.
Child↗
Experimental models for microsurgical joint reconstruction in the upper extremity.
Microsurgical joint transplantation offers a new approach in the reconstruction of different joints. Experimental trials of the new innovations in the field of joint reconstruction are, however, necessary before they can become clinically useful. The purpose of this study was to investigate the possibility of using an autogenic second metatarsophalangeal joint transplant in the replacement of an acromioclavicular joint with the aid of skeletal and cadaver models. The factors influencing the stability, mobility and durability of the joint in the new task are discussed. Also, the features of operative techniques necessary in this kind of procedure are outlined with reference to microsurgical reconstruction possibilities. The major conclusion is that microsurgical joint transplantation can possibly be used in irreparable acromioclavicular joint situations and that the second metatarsophalangeal joint seems to be a versatile donor joint for different joint reconstruction problems of the upper extremity.
Acromioclavicular Joint↗
Reconstructive microsurgery--a review.
We present some important current applications of reconstructive microsurgery. This field is expanding rapidly and the techniques are finding application in many branches of surgery. There is a pressing need for educational programs and training in microsurgery, as well as for continued research. Many of the procedures reviewed here have already been shown to substantially reduce costs, shorten hospitalization, and lessen patient disability; and as a result, several conventional procedures have been out-dated. We have stressed the concept that this is team surgery. To cover the needs of replantation and emergency free flaps around the clock, several microsurgeons must work together in established centers, and the team must possess expertise from all the involved surgical specialities. This may imply revision of many organizational aspects of patient care. Replantation centers would provide the necessary educational bases and give an impetus to the development of microsurgery.
Bone Transplantation↗
Replantation of a leg in an adult with 6-years' follow-up.
After traumatic amputation of the distal half of the leg, a replantation was carried out using microsurgical technique in a 24-year-old lumber mill worker. He returned to his job after 1 year, and 6 years after the accident he had good function and satisfactory sensibility in the sole of his foot. The case shows that even a lower limb replantation may give useful results under favourable conditions.
Adult↗
[Free toe transfer to the forearm stump following wrist amputation--a current alternative to the Krukenberg operation].
A new and simplified technique for reconstruction of the gripping ability after total loss of the hand is introduced. Previous techniques have not gained popularity because of the rather complicated procedures trying to extend the stump with two additional toes. Poor skin in the distal end of the stump has been a limiting factor and technically transplantation of two separate toes has been a difficult procedure. The stability in such a grip may be compromised. In the author's modification only one toe is used with an island flap from the big toe. The opposing post in this grip is the stable resection plane of the radius, covered partly by dorsal sensible skin and partly by the first web space skin with the island flap from the big toe. The stability is good because of the width of the post. The mobility of the new "thumb" may be excellent if the balance between the different muscle transfers is optimal and the rehabilitation is done in an adequate way from the beginning. This is a preliminary report of the technique and the preliminary results in three similarly operated patients are very promising. The technique is introduced especially as a modern alternative to the Krukenberg-plasty and may have its greatest value among blind patients with long forearm stumps.
Adult↗
Postoperative skin temperature dynamics and the nature of vascular complications after replantation.
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Adolescent↗
Replantation surgery in Tampere University Central Hospital 1977-1981. A general survey.
During the period June 1977-May 1981 a total of 94 replantations or revascularisations were performed in 73 patients with an amputation injury. The overall success-rate was 90.4%. The functional result has been satisfactory in the majority of cases. However, the needs of replantation surgery will not be covered without further efforts to improve the service and provide more accurate information for both the public and the medical personnel throughout the country.
Adolescent↗
Microvascular sleeve anastomosis in clinical replantation.
A clinical use of the sleeve anastomosis is presented in a series of 12 replantation patients. Altogether, 11 completely amputated and 3 incompletely severed parts were reconstructed. A sleeve anastomosis for the arteries alone was used in 9 replants with a success rate of 100%. In 5 replants the sleeve anastomosis was combined with a conventional anastomosis. In the latter series one failure occurred because of the avulsion injury. In this small series the sleeve anastomosis was considered reliable for arterial repair in microvascular surgery.
Angiography↗
Traumatic amputations and the need for a replantation service in Finland.
The authors review a series of 290 upper extremity amputee patients injured between 1974-79 from a 400,000 population area of one central hospital. Among these amputation injuries were 55 cases which were considered "serious", i.e. effecting seriously the function of the hand. Calculations were extrapolated to obtain reliable numbers for the need of a replantation service in Finland within a population of 5 million. According to the available data 90-160 patients annually would need a replantation service for their amputation injuries inthe country. Some conclusions were also drawn about the results obtained with or without replantation surgery among the "seriously injured" group. The results obtained with the replantation service were clearly superior to the results achieved without replantation.
Adolescent↗
[Thumb replantation: results of avulsion injuries and other traumatic amputations--a comparison].
In Tampere Central Hospital, Finland, 30 thumb replantations or revascularisations were carried out between March 1977 and March 1980. 22 were complete amputations and 8 were incomplete severances. Half of this material was due to avulsion injury and the other half consisted of local crush or sharp cut injuries. Ten cases in each group were considered equal and functional comparison was possible. Some technical points in replanting avulsed thumbs are presented. In particular the reconstruction of the flexor pollicis longus tendon and muscle is described. The avulsed flexor tendon was rerouted and refixed to its own torn muscle remnants in 11 of 12 cases with totally avulsed tendon. The results show that by abundant use of free veingrafts (in 80% of cases) the survival rate with avulsion injury can be almost as high as with local crush or more sharp injuries. Three thumbs were lost--two in the avulsion group--giving an overall primary survival of 90%, avulsion 87%, local crush 93%. Functional results show after 9 to 36 months follow-up time (mean 21 months +/- 8) that sensory recovery is superior after local crush compared with replantations after avulsion injury. Otherwise the differences are small and a useful end result can be obtained in most avulsion cases. 80% of the patients returned to their original work within the first six months (four months mean). Avulsion injury of the thumb, which is rather common among people working with fast rotating axles, seems to be an important indication for replantation surgery although more painstaking work is needed to obtain a favourable end result.
Amputation, Traumatic↗