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PubMed1995

Leech therapy in digital replantation.

This article presents a protocol for the perioperative care of patients undergoing digital replantation, which is the most common microsurgical procedure performed today. Venous congestion, a common complication of digital replantation, often has been treated through surgical exploration and creation of arteriovenous anastomosis. Leech therapy, however, is experiencing a resurgence among surgeons as an alternative method for treating venous congestion. This article discusses the anatomical, physiological, and clinical indications and methods of leech therapy in digital replantation.

Amputation, Traumatic↗
PubMed2004

Reverse digital artery island flap in the elderly.

The following case report illustrates the successful use of the reverse digital artery island flap in elderly patients. The reverse digital artery island flap is a recognised method of providing good quality soft tissue cover to the amputated fingertip. First described in 1986 by Kojima, Lai and Han have reported their experience of 52 and 120 of these flaps, respectively. The majority of patients in the literature are less than 50 years old, with ages ranging from 3 to 62 years. The flap is based upon reversed flow in the digital artery via a communicating branch from the contralateral artery at a point 5mm proximal to the distal interphalangeal joint crease. In the two cases reported below, we have shown that the indications for this type of homodigital flap reconstruction for fingertip amputations can be safely extended to elderly patients.

Aged↗
PubMed1997

Anatomical factors predisposing to focal dystonia in the musician's hand--principles, theoretical examples, clinical significance.

In this paper, anatomical interconnections between tendons, between tendons and their environment, and anatomical constraints on joint mobility are considered as possible causes of focal dystonia in the hand of the musician. By hypothesis, focal dystonias arise when the constraints on movement resulting from these anatomic limitations impede playing movements with sufficiently low energy expenditure. This hypothesis is modelled for connections between the deep finger flexors. The displacements, forces, stresses, and work per volume in the finger motors in some common piano playing movements are calculated. The results indicate that with mentioned connections, in certain movements the extensor and lumbrical, and in others the lumbrical and interossei are most strained, while the interossei may become the main power source in loaded instrumental movements. Also discussed are compensatory movements. The biomechanical principles of surgical and conservative treatment are summarised.

Cumulative Trauma Disorders↗
PubMed1978

Repair of the established post traumatic boutonnière deformity.

A technique is described for the repair of the chronic, post traumatic, uncomplicated boutonnière deformity which has given consistently good results. The fundamental steps are: Mobilisation and reefing of the lengthened middle slip; Kirschner wire fixation of the proximal joint in full extension and replacement of the mobilised lateral slips with the distal joint flexed approximately 45 degrees.

Finger Injuries↗
PubMed1980

Long term follow up of neurovascular island flaps.

The results of a ten year mean follow up of twenty Neurovascular Island Flaps and two Radial Nerve Innervated Cross Finger Flaps are presented. Sensory acuity sufficient for tactile gnosis was achieved in nineteen cases. In only one case had sensory acuity deteriorated since operation. Use of the flap was hampered in one patient by a pre-existing neuroma. Complete sensory reorientation occurred in five patients. Sensory misreference persisted more commonly on dominant hands. It was our impression that Porter's Letter Test revealed the patients making most use of their neurovascular island flaps. The place of neurovascular island flaps in the management of the mutilated hand is discussed.

Adolescent↗