V-Y advancement of the entire volar soft tissue of the thumb in distal reconstruction

The commonly used variant of Moberg's advancement flap for thumb reconstruction requires a skin graft to reconstruct the proximal thumb defect after advancing the flap. A modification has been described previously which allows direct closure of this proximal defect by incorporation of the V to Y principle into the design of the proximal part of the flap. A variant of the V-Y Moberg flap is presented and its advantages discussed.

The use of the veins of the thenar eminence in digital revascularization and replantation

Use of the small veins of the thenar eminence as an alternative source of vein grafts in distal digital reconstruction is presented.

Reconstruction of the axilla with a posterior arm fasciocutaneous flap

We present our experience with the use of the posterior arm fasciocutaneous flap in the reconstruction of 22 axillae in 17 patients. These patients all suffered from long-standing, severe hidradenitis suppurativa and this flap was used to reconstruct the axilla after surgical excision of the whole hair-bearing area of the axilla and the underlying axillary disease. In most cases, excision included all of the axillary contents up to the axillary vessels but excluded the apex of the axilla. Nineteen axillae were reconstructed with a pedicled flap. Three axillae were reconstructed more recently with an island flap. All reconstructions were achieved without flap complications.

Buccal mucosal flaps in nasal reconstruction

Buccal mucosal flaps provide a simple and effective method of replacing nasal mucosal lining. This technique has been used in 15 patients requiring reconstruction of full thickness defects of the lateral nasal wall and tip of nose, in combination with a variety of local flaps for skin cover. The buccal mucosal flap is of particular value in reconstructing the common defect of the lower lateral nasal wall and alar rim where more bulky reconstructions often distort the airway.

Reducing morbidity in the radial forearm flap donor site

The radial forearm flap, although widely used, has been criticized for the poor quality of its donor site. To investigate the causes of morbidity, 100 radial artery free-flap donor sites have been reviewed. Sixty-seven patients required skin grafting (group 1), and the remaining 33 patients were closed directly (group 2). Seventeen patients in the series had compound osteocutaneous flaps (group 3). Wound healing proved to be a significant problem in groups 1 and 3, and fracture of the radius occurred in 4 of the 17 patients in group 3 and was the most significant cause of morbidity. The radial artery was reconstructed in 12 patients, but only 6 of the arteries (50 percent) were patent at the time of review. Subjective assessment on a scale of 0 to 10 demonstrated a relatively pain-free donor site with low pain scores (2.5 of 10). The cosmetic result was acceptable in men (1.5 of 10) but was less so in women (4 of 10). Angulated fracture of the radius produced an unacceptable cosmetic result (7 of 10). In light of this experience, we no longer reconstruct the radial artery as a matter of routine. The donor defect is closed directly wherever possible using an ulnar artery-based transposition flap when required. A "boat shaped" osteotomy is used in preference to right-angled bone cuts when harvesting a segment of radius to avoid the complications and sequelae of fracture. These changes in surgical technique have improved the acceptability and minimized the problems associated with this donor site.

The use of automatic blood pressure monitors in the burned patient

Oscillometric automatic blood pressure monitors are now commonly used in theatres and intensive care units. An experimental model has been used to assess the accuracy of these machines when measurements are made from a proximal limb cuff applied over bulky bandages, as is commonly found in burned patients. This study suggests that monitoring arterial blood pressure under these circumstances is sufficiently accurate to make automatic monitoring useful as an adjunct to burns management. This would allow blood pressure measurement where it would otherwise be impossible without invasive techniques.

A controlled dose-ranging study of remoxipride and haloperidol in schizophrenia--a Canadian multicentre trial

The efficacy and side-effect profile for three dose ranges of remoxipride were compared with haloperidol in 242 schizophrenic inpatients in 13 centres. All patients were in a productive phase of schizophrenia according to DSM-III criteria. Relative efficacy of low dose (30-90 mg daily) vs middle dose (120-240 mg daily) vs high dose (300-600 mg daily) was compared with the standard dose of haloperidol (15-45 mg daily), as were the side effects. It was concluded that the therapeutic efficacy of remoxipride was comparable to that of haloperidol for acute episodes of schizophrenia; that the low dose range was significantly less effective than the higher ranges; that there was a clear advantage of remoxipride over haloperidol with respect to incidence and severity of extrapyramidal symptoms. The general safety profile of remoxipride as assessed from clinical chemistry, haematology, and cardiovascular variables suggests that remoxipride in the dose ranges studied can be used safely for the treatment of schizophrenic patients.

The stretched scar: the benefit of prolonged dermal support

A study of skin suture following elliptical excision of tattoos from the upper limb shows that when the dermis is supported by a subcuticular non-absorbable suture for 6 months there is (a) a highly significant and numerically considerable (37.5%) reduction of scar stretching over that following conventional interrupted skin suture and (b) a significant reduction of scar width (15.7%) when compared with the same material used as a subcuticular suture for 3 weeks. Subcuticular polyglycolic acid achieved no reduction in scar width at one year when compared with conventional interrupted sutures.

Functional deficit following loss of continuity of the long extensors of the fingers: a method of assessment

A method for assessing hand function following loss of the long finger extensors in Zones 6 and 7 (Verdan, 1968) is described. It relies on a number of mechanical and functional tests combined with a detailed questionnaire.

Ulnar fasciocutaneous flap of the wrist

An ulnar fasciocutaneous flap has been developed to provide skin cover of the donor defect after elevating radial forearm flaps and used for that purpose in 55 patients. A case is reported in which the same type of flap was used to cover a traumatic skin defect on the front of the wrist.

Direct closure of the radial forearm flap donor defect

A method of direct closure of the donor defect of the radial forearm flap is described. This avoids the complication of delayed wound healing which remains a problem after split skin graft reconstruction.

Functional Deficit Following Loss of Continuity of the Long Extensors of the Fingers: A Method of Assessment

A method for assessing hand function following loss of the long finger extensors in Zones 6 and 7 (Verdan, 1968) is described. It relies on a number of mechanical and functional tests combined with a detailed questionnaire.

Ulnar Fasciocutaneous Flap of the Wrist

An ulnar fasciocutaneous flap has been developed to provide skin cover of the donor defect after elevating radial forearm flaps and used for that purpose in 55 patients. A case is reported in which the same type of flap was used to cover a traumatic skin defect on the front of the wrist.

The expanded latissimus dorsi flap

The safety of tissue expansion of the latissimus dorsi musculocutaneous flap is confirmed and the advantage of expansion of this flap before transfer illustrated.

Long term hand function without long finger extensors: a clinical study

This study examines the premise that, following severe injuries to the dorsum of the hand, reconstruction of the long extensor tendons of the fingers may not be necessary for many patients. The long-term hand function of nine patients who sustained such injuries and had operations to provide skin cover only, has been comprehensively assessed using objective tests and a detailed questionnaire. It is concluded that provision of skin cover followed by intensive early mobilisation may be an adequate management of these injuries.

Long Term Hand Function without Long Finger Extensors: A Clinical Study

This study examines the premise that, following severe injuries to the dorsum of the hand, reconstruction of the long extensor tendons of the fingers may not be necessary for many patients. The long-term hand function of nine patients who sustained such injuries and had operations to provide skin cover only, has been comprehensively assessed using objective tests and a detailed questionnaire. It is concluded that provision of skin cover followed by intensive early mobilisation may be an adequate management of these injuries.

Ptosis with blepharophimosis and epicanthus inversus

The rare syndrome which includes ptosis, blepharophimosis and epicanthus inversus is recorded in one family through five generations. The genetic significance of the syndrome is emphasised and the literature on the surgical management of the condition reviewed.

The excursions of the long extensor tendons of the hand

In a cadaveric study in seven hands, the mathematical relationship between extensor tendon excursion and joint motion (wrist, m.p., p.i.p. and d.i.p.) has been investigated. This has been found to be linear at all joints, allowing the mean tendon excursions corresponding to ten degrees of joint motion to be calculated for each of the above joints for all five rays of the hand. A table of these excursion values is presented as a reference for calculation of clinical problems.

Free toe pulp transfer to restore traumatic digital pulp loss

Nine toe pulp flaps based on the first dorsal metatarsal artery for reconstruction of thumb and index pulp loss are reviewed. The method is capable of giving excellent results, and particular indications are noted.