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Creating a model for fabricating a partial hand glove prosthesis using the realigned casts of the contralateral digits.

A method for creating a model for fabricating a partial hand glove prosthesis is described. The realigned casts of the corresponding digits of the contralateral uninjured hand were used to substitute for the lost digits on a cast of the stump. The technique allows an exact reproduction of the anatomical and fine surface details of the digits. It has the advantage of customisation, allowing a close match in the size, shape and surface characteristics of the prosthesis to that of the remaining digits of the hand.

Adult↗

Transplantation of severed digits to forearm stump for restoration of partial hand function.

Three cases of mutilating injury of the distal end of the forearm, wrist, and palm treated by transplantation of severed digits to the forearm stump are reported. Follow-up examinations made at 1 year and 4 months to 31/2 years postoperatively revealed fair sensory and motor functions. The functional result is better than that obtained after Krukenberg's operation or prosthesis fitting, and is comparable to that of "hand" reconstruction by autotransplantation of toes. Since this procedure can fulfill the basic requirements of hand function by reconstruction, namely, good sensibility; basic motor functions of pinching, grasping, and powerful gripping; and acceptable outward appearance, and can be accomplished in a one-stage operation without sacrificing toes, it should be considered as first choice whenever a suitable case is encountered.

Accidents, Occupational↗

[Treatment of various dyskinesias by intermittent thalamic stimulation].

Abnormal movements or dyskinesias are associated with hyperpathia and hyperalgesia in a number of conditions such as post amputation jumping stumps pseudothalamic syndromes following cerebro vascular accidents and in some cases of demyelinating diseases. Intermittent electrical stimulation of the specific sensory nucleus of the thalamus (I.T.S.) controls at the same time pain and dyskinesias with the same long lasting effect. In some cases where dyskinesias are associated with sensory deafferentation, but not with chronic pain or hyperpathia, the same positive effect of thalamic stimulation on the control of abnormal movements is achieved while in other cases of tremor or dyskinesias without sensory deafferentation such as parkinsonism, intention tremor etc.. the efficacy of I.T.S. is nil. Hence, discriminative sensory deaffrentation is the common link between the cases of tremor or dyskinesias that use to respond to I.T.S. which is up to now the only therapy of proven efficacy in such conditions.

Amputation Stumps↗

A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterial insufficiency.

BACKGROUND: A multicentre randomised controlled trial to determine the effect of a rigid plaster dressing applied at the time of trans-tibial amputation on the number of days to casting for a prosthesis, and the incidence of post-operative stump infection. METHODS: Patients requiring trans-tibial amputation were randomised to one of 2 groups: In Group 1 (intervention) a rigid above-knee plaster dressing was applied at operation and patients were managed according to a standard protocol. Group 2 (control) had the individual surgeons' usual non-rigid dressing regime. Rehabilitation data were extracted from the national physiotherapy database. On completion of the trial a questionnaire was sent to all participants. RESULTS: 14 surgeons in 7 centres enrolled 154 patients, with 96 ultimately cast for a prosthesis. Patients who received a rigid dressing (n = 78) had reduced days to casting (median 36, confidence interval 30-47) when compared with other dressings (n = 76) (median 42, confidence interval 36-45), these differences did not reach statistical significance. There was no significant difference in post-operative infection rates in the two groups. 64% of surgeons, and all physiotherapists and vascular nurses responding to the post-trial questionnaire felt that the rigid dressing was an improvement on their normal regime and wished to continue with the technique. CONCLUSIONS: Despite a median reduction of 6 days in time to casting in patients treated with a rigid post-operative dressing this failed to reach statistical significance. The majority of participants who replied to the post-trial questionnaire expressed a wish to continue using the rigid dressing technique. To confirm that the trends shown in this trial are statistically valid a larger trial is needed.

Amputation, Surgical↗

[Neuroma pain].

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Amputation Stumps↗