Syndactyly correction: an aesthetic reconstruction

Various flaps have been used with and without skin grafts to separate digits with syndactyly. Dorsal flap techniques with and without grafts result in dorsal and thus more visible scars. Some of the recent techniques which use no grafts are only applicable for some simple syndactylies. The technique described in this paper uses a combination of techniques which have been described previously. A shaped palmar flap is used to create the web space; narrow V-flaps and full-thickness skin grafts are used to resurface the lateral defects on the fingers and reciprocal pulp flaps are used to create aesthetically pleasing nail folds. This technique allows the full thickness grafts to be hidden on the radial and ulnar sides of the fingers and palm. It increases the span of the hand in conditions where there is shortage of palmar skin. A retrospective review has been undertaken of 102 patients in whom 221 webs were reconstructed through 176 surgical procedures. There were 54 cases of simple syndactylies (53%) and the rest were complex. Complications were encountered in 11 operations (6%) and web creep was noted in 12 web spaces (5%). Re-operation for web creep has been carried out in seven web spaces (3%).

Patient satisfaction following abdominoplasty: an NHS experience

Abdominoplasty is one of the few cosmetic procedures performed in the UK on the National Health Service (NHS). In the current climate of tight resource rationing many primary care trusts (PCTs) are refusing to fund such operations, resulting in a number being carried out in the independent sector. There are very few studies in the literature on patient satisfaction following abdominoplasty, with none from the UK. Our study aimed to look at the patient satisfaction rate following abdominoplasty in the NHS and study further the areas of dissatisfaction. A questionnaire survey was sent to 153 patients who underwent the procedure over a 5-year period. Replies were received from 118 (78%) patients, revealing a 77% satisfaction rate amongst responders. Further analysis of the dissatisfied patients revealed particular dissatisfaction with dog-ears, residual abdominal overhang and issues relating to the scar. The dissatisfied group was exclusively female from across the age spectrum, although analysis showed an increase in dissatisfaction with time, with the highest levels seen at 4-6 years post-abdominoplasty. This study has identified a number of areas of patient dissatisfaction, even in carefully selected patients.

Ulnar nerve compression in Guyon's canal in the presence of a tortuous ulnar artery

A case of ulnar nerve compression in Guyon's canal occurring in the presence of a tortuous ulnar artery in the canal is presented and the pathology and classification of ulnar nerve compression in Guyon's canal discussed.

A spontaneous compartment syndrome in a patient with diabetes

A compartment syndrome is an orthopaedic emergency which can result from a variety of causes, the most common being trauma. Rarely, it can develop spontaneously and several aetiologies for spontaneous compartment syndrome have been described. We describe a patient with diabetes who developed a spontaneous compartment syndrome. The diagnosis was delayed because of the atypical presentation.

Effect of optic size on posterior capsule opacification: 5.5 mm versus 6.0 mm AcrySof intraocular lenses

PURPOSE

To determine the effect of intraocular lens (IOL) optic diameter on posterior capsule opacification (PCO) using digital retroillumination images.

SETTING

Eye Department, St. Thomas' Hospital, London, United Kingdom.

METHODS

In this prospective study, 60 patients with senile cataract had routine phacoemulsification by a single surgeon and received standardized medication. The patients were divided into 2 equal groups. The first group received a 5.5 mm 3-piece AcrySof IOL (MA30BM, Alcon) inserted in the bag. The second group received a 6.0 mm 3-piece AcrySof IOL (MA60BM, Alcon). Retroillumination images were obtained 1, 30, 90, 180, and 360 days postoperatively. The percentage area of PCO was calculated objectively by dedicated software at 90, 180, and 360 days. At 1 day, the degree of capsulorhexis-IOL contact was determined by inspecting the images.

RESULTS

Throughout the follow-up, there was less PCO in the 6.0 mm optic group than in the 5.5 mm optic group, and the difference reached significance 1 year postoperatively (P =.0017). At 1 year, the median percentage of PCO was 1.5% (95% confidence interval [CI] 1.4-5.3) in the 6.0 mm group and 6.9% (95% CI 5.8-18.0) in the 5.5 mm group.

CONCLUSIONS

A larger IOL optic diameter was associated with less PCO.

A control systems approach for the simulation of renal dynamic software phantoms for nuclear medicine

For renal dynamic studies, the COST B2 hybrid phantom is an example of an artificially created software phantom. Although this phantom is useful, it is not possible to implement the phantom in a self-consistent fashion to produce, for example, a collection of tracer in the bladder which is related to the flow from the kidneys. In this study control systems are used to provide a self-consistent model. A feed-forward control system was designed for the transport of DTPA in the human body using SIMULINK. The system is based on a three-compartment model described by a set of differential equations with flow rates which may be set by the operator. The differential uptake in the kidneys may also be specified, while the flow of tracer through the renal parenchyma and collecting system of each kidney is determined using two-parameter retention functions. Curves corresponding to normal or pathological conditions may be simulated for plasma, parenchyma, collecting system and bladder by appropriate selection of parameters. The system is user-friendly and can be used to simulate almost all conditions seen in patient studies. The next stage of using this information to design dynamic image simulations is in progress.