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Hand surgery, upper limb surgery, microsurgery

Ravikiran Naalla, Moumita De, Rakesh Dawar, Shashank Chauhan, Maneesh Singhal
Purpose: Microvascular reconstruction is the standard of care for salvage of soft tissue defects in complex upper extremity due to their distinct advantages over the pedicled flaps. However, in the era of microsurgery, pedicled flaps have an acceptable significant role for reconstruction of complex soft tissue defects. The authors aim to demonstrate the versatility of pedicled thoracoumbilical flap (TUF) in selected clinical scenarios. Patients and Methods: Retrospective analysis of patients who underwent TUF for upper limb posttraumatic reconstruction was performed between January 2016 and October 2017...
April 2018: Journal of Hand and Microsurgery
Kavit Amin, Anita T Mohan
This reconstructive microsurgery course will run yearly and was borne and popularized from its infant meeting the year before, primarily focused on perforator flaps. It is a 2-day course updating residents/registrars to attending physicians/consultants about the most topical advancements in microvascular reconstructive surgery. The course is held at the New York University Langone Hospital in the United States.The timetable is primarily lecture based with the advantage of live-surgical procedures by world-renowned faculty...
January 2017: Annals of Plastic Surgery
Anderson S M Leung, Margaret W M Fok, Boris K K Fung
Venous thromboembolism in hand surgery is rare. There is no report in the literature on postoperative mortality from venous thromboembolism following microsurgery in upper limbs. We report the case of a 56-year-old Chinese man who died from pulmonary embolism as a result of bilateral lower-limb deep vein thrombosis following prolonged surgery under general anaesthesia after replantation of a finger. This case raises awareness of the need for precautions against venous thromboembolism following prolonged microsurgery and identification of high-risk patients...
June 2015: Hong Kong Medical Journal
Davide Ciclamini, Pierluigi Tos, Ernesta Magistroni, Bernardino Panero, Paolo Titolo, Ilaria Da Rold, Bruno Battiston
The aim of this retrospective study was to analyse the results of 20 thumb replantations with special and exhaustive attention on functional outcomes. Twenty patients with traumatic thumb amputation were enrolled in the study. Range of motion, grip strength, sensory recovery, and subjective perception of overall hand function recovery were measured. The average age at the time of surgery was 35 years (range, 13-73 years). The mean follow-up was 3.25 years (range, 1.9-10.25 years). The long-term results of thumb replantation confirmed satisfactory outcomes in terms of general upper limb function, handgrip and pinch strength, and social and work reintegration...
April 2013: Injury
S Marinescu, I P Florescu, C Giuglea, I Lascăr
INTRODUCTION: The development of microsurgery allowed huge advancements in the reconstructive surgery of the upper limb. The use of free digital transfer started a true revolution for the reconstruction of the mutilated, functionally compromised hand, with multiple amputations. Slowly, surgeons started using free tissue transfers in other reconstructive procedures of the hand, forearm and arm. This way they avoided amputating a limb and they realized quality reconstructions in a single surgical step in cases in which classical methods did not apply...
January 2012: Chirurgia
A Hold, L Kamolz, M Frey
BACKGROUND: Due to the improvement of surgery and intensive care more and more patients survive even severe burn injuries. Therefore we have to pay attention not only to survival alone but also to the achievement of a good quality of life. Thereby, one of the most important aspects is sufficient tissue coverage. After appropriate debridement functionally important structures may be exposed. Therefore, these areas require more than split skin coverage. These cases necessitate flap coverage for preservation of function or, respectively, limb salvage...
December 2009: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
M Dididze
Traumatic injury of major nerve roots of extremities paralyzes the limb and causes high degree of disability. The aim of the study was to evaluate outcomes of surgical treatment of upper and lower limb nerve root avulsion using various microsurgical techniques to reconstruct the function of the extremity. 31 contralateral nerve transfer surgeries were performed on 17 patients with upper and lower extremities nerve root avulsion. Neurological and EMG examinations were carried out. To assess the return of function in the patient's hand Medical Research Council grading systems were used; to evaluate the return of function in the patient's leg we developed special microsurgical techniques...
September 2008: Georgian Medical News
Elisabeth Zetlitz, Eva Weiler-Mithoff, Tom Turner
Idiopathic neonatal limb ischemia remains a rare occurrence. It is a devastating process that leads to complete or partial loss of affected limb or severe deformity. The main treatments over the years have been conservative and nonsurgical, such thrombolysis. Surgical treatment has traditionally been delayed until a line of demarcation is clear, at which time amputation of the limb proceeds. We present a case of idiopathic upper limb ischemia in a newborn, where it was clear that nonsurgical management would result in limb necrosis...
September 2008: American Journal of Perinatology
Matthias Rab, Karl-Josef Prommersberger
OBJECTIVE: Coverage of defects on the upper limb with the distally pedicled, fasciocutaneous posterior interosseous artery flap. INDICATIONS: Defects with exposed tendon and/or bony tissue on the palmar and dorsal side of the wrist, the hand upon the proximal interphalangeal joint level and the whole thumb. Coverage of defects on the palmar side of wrist and palm of the hand with exposed median and/or ulnar nerve. Enlargement of the 1st interdigital web space in cases of thumb adduction contracture...
June 2008: Operative Orthopädie und Traumatologie
Claude Kenesi, Emmanuel Masmejean
For decades hand trauma surgery was a small branch of general surgeons' practice. Only after the second world war did some orthopaedic or plastic surgeons with specific training in microsurgery start to sub-specialize in hand surgery. In the past 50 years, National Hand Societies have been created all over the world Hand trauma represents a significant proportion of emergency room attendance, and 20-25 % of traumatic emergencies. Most hand trauma patients are manual workers, who are sometimes injured at work...
2004: Bulletin de L'Académie Nationale de Médecine
Michael E Leit, Matthew M Tomaino
The goals of limb salvage surgery in the upper extremity are to achieve resection of the tumor and preserve hand function without the risk for local recurrence. Historically, amputation was the treatment of choice for a neoplasm of the hand, wrist, and forearm, but limb-sparing procedures have become feasible largely because of advances in diagnostic imaging, reconstructive microsurgery, and adjuvant radiotherapy and chemotherapy. Because preservation of hand function, even modest levels thereof, is clearly superior to amputation from a functional standpoint, the authors review the principles of limb salvage in this article...
May 2004: Hand Clinics
F Moutet, J P Haloua
Training of the hand surgeon HAND SURGEON A CONCEPT: The hand surgeon is supposed to be in charge of all the hand lesions regarding, skeleton, muscles, tendons, nerves and vessels. He has to be able to insure reparation and coverage of all of them. So he is involved in all the structures, which insure integrity and function of the hand. PURPOSE AND WAYS OF TRAINING: To obtain the asked ability, the hand surgeon training has to be global and sustained by two underlying surgical specialities: orthopedic surgery and plastic and reconstructive surgery...
October 2003: Chirurgie de la Main
S Houzé de l'Aulnoit, M Schoofs, P Leps, G Auvray
The failure of macro-implantation of the upper limb must not be considered as the end of a therapeutic method, but instead as a step in the functional rehabilitation of the upper limb. From a group of 24 patients that have been operated with a macro-implantation of the upper limb, we have seen 11 patients for who the reimplantation had failed. We have studied the surgical procedure of those failures, the mid-term evolution (prosthesis and operations), and a long-term evolution with the functional future of those patients...
April 2001: Annales de Chirurgie Plastique et Esthétique
F Tomei, J P Aubert, J L Benaim, R Legré, G Magalon
INTRODUCTION: Wounds involving the peripheral nerves cause serious damage in the upper limb. The prognosis for recovery remains uncertain despite microsurgery. It is commonly accepted that the results are far better in children than in adults. We sought to confirm this idea on the basis of objective recovery criteria, discriminating between peripheral axonal regeneration and the child's own capacity to adapt. In other words, do nerves regenerate better in children? MATERIALS AND METHODS: The clinical results of 25 nerve sutures of the wrist, in children under 15, were analysed with a minimum follow-up of 12 months...
February 2000: Chirurgie de la Main
M R Colonna, U M Giovannini, A M Longoni, G E Pajardi
Restorative tendon transfer in upper limb palsy should be regarded as an important tool in hand surgery. An adequate planning and patient selection must be required, as well as several techniques can be used. Particularly, associated articular lesions must be detected and cured in the same time. Wrist extension palsies should be treated surgically with PT or LS transfer, whereas flexion palsies can be corrected with opportune balance in movements. Finger palsies can be treated with Zancolli's methods, including MP plasties and "lazos"...
July 1998: Annali Italiani di Chirurgia
M Völlinger, B D Partecke
BACKGROUND: The posterior interosseous nerve syndrome is a rare compression neuropathy of the upper limb, which must be differentiated from tennis elbow. The aim of our study is to show etiology, symptoms, and diagnostic methods, and to illustrate the common operative techniques. PATIENTS AND METHODS: We examined retrospectively all patients of the Department for Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftlichen Unfallkrankenhaus Hamburg, who underwent operative treatment because of posterior interosseous nerve syndrome between 1984 and 1992...
March 1998: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
H C Chen
Hopfner performed the first successful experimental limb replantation in 1903, and Malt performed the first successful clinical replantation for an above-elbow amputation in 1962. Since then the range of applications for reconstructive microsurgery has expanded rapidly, and it is now widely used for repair of nerves, vessels and lymphatics. In 1972 the first successful case of free flap transfer was performed. Many new applications followed including: (1) coverage of extensive wound defects with exposure of bones, joints, tendons and major vessels which can not be covered with local tissue; (2) vascularized bone transfer for bone defects; (3) vascularized joint transfer for hand joints and the temporomandibular joints; (4) functioning muscle transfer to replace the muscles of the upper limbs and face; (5) toe transfer for missing fingers and thumbs; (6) reconstruction following tumor ablation; (7) reconstruction of congenital anomalies; (8) reconstruction of chest, pharynx and cervical esophagus; (9) transfer of gliding tissue, fascia and sensory flaps for certain injuries...
September 1997: Changgeng Yi Xue za Zhi
H E Kleinert, M A Pickford
Since its recognition as a subspeciality soon after World War I, hand surgery has evolved into a highly specialized and sophisticated field of medicine. Enormous advances have been made in the diagnosis and treatment of disorders of the upper limb; primary tenorrhaphy and the application of microsurgical techniques for revascularization, replantation, and free tissue transfer are among the most important innovations. This article reviews the history of flexor tendon surgery and reconstructive microsurgery up to the present time, and makes some predictions for the future direction of these, and other, areas of hand surgery...
September 1997: Journal of Emergency Medicine
S Kay, M Coady
A review of the role of microvascular autotransplantation in reconstructive surgery of the paediatric upper limb is presented. Such techniques bring versatility to reconstruction of the upper limb that has previously not been available. In particular they offer the opportunity for transplantation of skin flaps in one stage, and the transplantation of vascularised joints and growth centres. Most importantly however, they offer the opportunity to reconstruct digits by transplantation of homologues from the foot...
July 1995: Annals of the Academy of Medicine, Singapore
J Fissette, T Lahaye, D Boucq
Reconstructive procedure of the upper and the lower limbs by free flaps are presented. The most frequently used donor sites are analysed in order to make a choice according to their characteristics and their reliability. Attention is drawn to the fact that these new procedures bringing cutaneous, muscular, osseous or composite tissues are especially interesting in reconstruction of the distal half of the limbs but will not systematically replace the classical reconstructive surgery procedures. The donor sites are summarized in a recapitulatory table...
May 1982: Acta Chirurgica Belgica
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