The Authors report a case about a scaphoid remowing’s wrong operation performed in anohter hospital on a woman who was affected by rizoarthrosis. The authors visited the woman in the clinical outpatients six months after the wrong operation. In the Centre of Hand Surgery and Microsurgery of Modena the Authors performed an operation of an arthrodesis of TM associated with a arthrodesis capitate-lunate-hamate on that woman. The Authors report the good clinical outcome and X-ray’s results.
The anatomical integrity of the epi- and para-nevrium is the most relevant factor for the correct gliding of the median nerve, and when they are surrounded by scar tissue, the result is a chronic neuropathy. This recurrent compressive neuropathy represents a very challenging clinical and surgical problem. Neurolysis can not always improve the recovery of nerve function, and the soft tissue coverage is necessary to prevent recurrent scar and to achieve a useful mobilization of the median nerve. The autogenous vein graft wrapping technique has shown great promise for the treatment of chronic compressive neuropathy after other procedures have failed. The author present their experience using the Basilic vein grafting as a valid alternative to the Saphenous one. All our patients presented symptoms in the median nerve distribution, including pain, swelling and numbness, and grip strength reduction. Four of these patients presented a CRPS and have been evaluated before treatment in a multidisciplinary dedicated equipe to plan the surgical procedure. The vein graft wrapping represents a simple technique without problem in donor area. In the authors’ casuistry it presented also as a very useful technique in the treatment of median neuropathy in CRPS.
A new island fasciocutaneous flap raised on the inner surface of the upper arm has been used for reconstruction of soft tissue of the elbow as described by Maruyama in 1987. The medial arm represent a very useful potential donor site for flap because of its excellent colour, fine texture and ideal thickness. The flap sa described by Maruyama achieves a good coverage of the defects of the elbow region and results extremely suitable for contracture and ulcers treatment at the elbow region as we can see after burns or other various trauma and lesion. The blood supply to this flap comes from the fasciocutaneous perforators of the ulnar recurrent vessels. In our experience this flap is relatively quick and simple, involving only one stage procedure that adequately corrects the skin defect around the elbow region.
The Authors report their experience in the treatment of scaphoid non-union recurring to the vascularised bone graft technique as described by Zeidemberg. The patients have been treated between the 1999 and 2004. The authors report 22 cases (21 males and 1 female) with an average age of 31 years (from 17 to 42). 10 cases the involved wrist was the right one and in the other 12 cases was the left one. 18 patients presented an avascular necrosis of the proximal fragment of the scaphoid, recognised by the MNR. Two patients have been previously treated by the traditional bone graft technique as described by Matti-Russe, using a cannulated screw for the stabilization of the graft. 16 patients have been controlled at the follow-up (mean 23 months, from 3 to 65). The authors, looking at the good results obtained at the follow-up, feel that this technique might be a very useful one in the treatment of the established scaphoid non-union, mainly in presence of an avascular necrosis of the proximal third of the scaphoid. This technique might also be useful in the treatment of the failure of the classic bone graft technique.
The authors report their results of “extension-block Kirschner wire fixation” for the treatment of mallet finger fracture. This technique should be considered in presence of a large bone fragment involving more than the 30% of the articular surface, with or without palmar subluxation of the distal phalanx. A modification of the extension-block technique is described reducing the fragment to 0° extension of the distal interphalangeal joint. The results confirmed the better outcomes of this modification, minimizing the postoperative extension lag at the distal interphalangeal joint. The Wehbe and Schneider method was used to classify the mallet finger fractures and the results were graded according to Crawford’s criteria (66,6% excellent and 33,4% good). The extension-block K wire technique, when properly applied, is a very helpful procedure avoiding the risks and complications of the open surgery and achieving a good indirect anatomical reduction of the fracture.
Composite tissue defects in absence of general contra-indications are now routinely dealt by composite free tissue transfers which now stand as routine procedures. When dealing with amputations of the thumb several reconstructive procedures are now available and should be tailored on individual basis. Microvascular surgical techniques are especially gratifying when the appropriate indications are followed: young age, absence of systemic diseases no alcohol or smoke abuse. A custom – made thumb can be reconstructed assembling in a single composite tissue graft different tissues harvested from various parts of the body. An outcome study as been performed on 72 patients where the wrap-around technique, the second and great toe transfer have been carried out. Overall assessment included, as a preliminary analysis, the of vassessement behaviour of each single transferred tissue: the nail complex, the pulp and the bone. Donor – site problems at the foot were assessed by gait analysis. Vascular complications were recorded in 5% of the patients, and 89% of the patients had excellent outcomes.
In 15 patients who underwent open exploration of the brachial plexus, the somatosensory evoked potentials and nerve action potentials recorded at the time of operation were useful as guides to the most appropriate surgical procedure, and also in predicting the outcome in certain lesions. In three patients the apparent normality of the upper trunk of the plexus was concealing a more proximal lesion which was irrecoverable. The presence of a somatosensory evoked potential showed functional continuity in three patients in whom the C7 root was clinically involved and who recovered after operation. In five patients proximal stumps of ruptured C5 roots showed functional central continuity; this indicated their suitability for grafting. These patients recovered except one who suffered from co-existing disease. The electrophysiological studies also confirmed the clinical diagnosis of avulsion of the C8 and T1 roots and therefore prevented unnecessary dissection.
