Operative Techniques in Plastic and Reconstructive Surgery最新文献

Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. This technique is appropriate for both acute scaphoid waist and proximal pole fractures, as well as selected nonunions. A headless cannulated compression screw (standard Acutrak) is implanted via a dorsal percutaneous approach using fluoroscopy and arthroscopy to confirm position and reduction. The details of this technique are reviewed. In a consecutive series of 27 fractures treated with arthroscopic assisted dorsal percutaneous fixation, eighteen fractures were treated acutely and 9 were treated more than 1 month after injury. CT scan confirmed 100% union rate at an average of 12 weeks with no complications.

Entrapment of the ulnar nerve that leads to cubital tunnel syndrome is a common and often disabling disease. Current surgical treatment options involve simple decompression, medial epicondylectomy, or a variety of anterior transposition procedures. Such techniques often involve extensive exposure of the ulnar nerve with prolonged periods of immobilization. Because of this, patients may often experience significant postoperative pain, scarring, and joint stiffness. In this paper, we describe a minimally invasive technique for treating cubital tunnel syndrome using endoscopic assistance. This procedure enables complete ulnar nerve decompression through one small incision. Direct visualization of all potential anatomic compression sites for a distance of 20 cm around the medial epicondyle is possible. This endoscopic approach to cubital tunnel release is appealing, especially to those patients with mild to moderate symptoms who may otherwise be reluctant to undergo a more involved conventional surgery. It decreases postoperative pain, reduces scarring, and promotes an earlier return to activity than traditional open techniques allow, due to a decreased immobilization period.

Ganglion cysts are the most common tumor in the wrist. Dorsal carpal ganglion cysts represent 60 to 70% of all ganglion cysts in the hand and wrist. Standard treatment has been limited to observation, rest, immobilization, aspiration with or without injection, and surgical excision. Arthroscopic resection of dorsal carpal ganglion cyst have been done since the late 1980s. It has the advantages of less scarring and stiffness, the ability to inspect the wrist for other pathology and wrist instability. To date, the success of arthroscopic ganglion cyst resection is at least as good (1% recurrence) as current open techniques (0 to 10% recurrence). Risks of the procedure are similar to open techniques. Patient satisfaction with the procedure is high. In the largest reported series, there have been no major complications. This technique, for those who are comfortable with wrist arthroscopy, is effective and safe in treating this common wrist mass. The technique for this procedure is described as well as a brief history of treatment for dorsal carpal ganglion cysts.

Metacarpal shaft fractures are common but consensus on the best mode of treatment has not been established. Open reduction and internal fixation with plates or screws has been performed for severely displaced fractures. Unfortunately, extensor tendon adhesions and/or unsightly scars frequently follow this form of treatment. Percutaneous flexible intramedulary nailing of metacarpal fractures provides an alternative method that minimizes these problems. The technique is simple and provides the ability to lock the nails to control length and rotation. The nails are inserted using a manually operated slotted awl and usually in an anterograde direction to prevent soft tissue irritation around the metacarpo-phalangeal joints. This method utilizes flexible nails (1.5 and 1.0 mm.) and closed fluoroscopically assisted reduction. Rotationally unstable or fractures with a tendency to shorten can be locked proximally using a captured transverse pin which effectively controls length and rotation. Metacarpo-phalangeal flexion block splinting can be used postoperatively and the nails are routinely removed after fracture healing. Experience with this technique has been favorable as it avoids exposure of the fracture, dissection around the extensor mechanism, and scar problems. It has provided excellent functional results and has presented a low complication rate.