Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Mar 2018
Case ReportsReconstruction of a Circumferential Upper Extremity Soft Tissue Defect With a Dermal Regeneration Template and Skin Grafting.
Extensive degloving injuries of the upper extremity are rare and pose unique reconstructive challenges. Circumferential loss of soft tissue coverage over the elbow treated by skin grafting is often complicated by elbow contracture and decreased range of motion, requiring secondary contracture release and free-flap reconstruction to restore function. As an alternative approach, we report a good outcome after the use of a dermal regenerative template and subsequent split-thickness skin grafting. ⋯ Six months after skin grafting, the patient had stable soft tissue coverage of the upper extremity. Shoulder motion measured 120-degree abduction and 140-degree forward flexion and elbow range of motion was 15 to 150 degrees. In this case, an excellent clinical outcome was obtained with a dermal regenerative template, aggressive wound care, and a multidisciplinary team approach.
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Tech Hand Up Extrem Surg · Dec 2017
The Blocking Flap for Ulnar Nerve Instability After In Situ Release: Technique and a Grading System of Ulnar Nerve Instability to Guide Treatment.
In situ ulnar nerve release has been gaining popularity as a simple, effective, and low-morbidity procedure for the treatment of cubital tunnel syndrome. One concern with the technique is how to manage the unstable ulnar nerve after release. ⋯ I propose such a grading system, as well as a new technique to stabilize the unstable ulnar nerve. The blocking flap technique consists of raising a rectangular flap off the flexor/pronator fascia and attaching it to the posterior subcutaneous flap so that it blocks the nerve from subluxation/dislocation.
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Tech Hand Up Extrem Surg · Sep 2017
Anatomic Reconstruction of Distal Radioulnar Ligaments With Tendon Graft for Treating Distal Radioulnar Joint Instability: Surgical Technique and Outcome.
Among the various reasons for chronic posttraumatic ulnar-sided wrist pain, instability of the distal radioulnar joint (DRUJ) has recently received major attention and finally achieved fundamental progress in understanding thanks to anatomic and biomechanical studies. This has resulted in more physiological and successful treatment methods compared with the historic options. One and the most dramatic surgical technique consists in the replacement of the main ligamentous stabilizer of the DRUJ, the so-called triangular fibrocartilage, with a tendon graft. ⋯ There was however a loss of forearm rotation of 20 degrees in average (pronation-8 degrees; supination-12 degrees), whereas the range of motion of the wrist and grip strength remained unchanged. We did not find any influence on the result by performing simultaneous ulnar shortening osteotomy, the duration of cast immobilization or the positioning in the cast. There were no postoperative complications, 4 failed cases needed secondary procedures (2× rereconstruction, 2× Sauvé-Kapandji-operation).
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Tech Hand Up Extrem Surg · Dec 2016
The Use of a Simple Dynamic External Fixator for the Treatment of Volar Fracture Subluxation of Proximal Interphalangeal Joints of the Fingers.
Volar fracture dislocation is very uncommon, with few series reported in the literature. Patients with such injuries were treated by modified dynamic external fixators. The mean follow-up was 18 months (range, 6 to 92 mo). ⋯ The total active range of motion (TAM) was excellent (256 degrees). The mean quick disabilities of the arm, shoulder and hand score was 1.2. The advantages of our external fixators are that they are simple, cheap, adjustable, and allow immediate range of motion.