Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery最新文献

Early recognition and treatment of volar plate injuries within two weeks is reported to give a good outcome, but there is no published information about the consequences of delayed presentation. We present a series of 14 patients with 16 injuries, who presented more than two weeks after the initial injury. All patients were referred to a specialist hand trauma clinic over a 10 months period and were evaluated prospectively and treated with immediate mobilisation by a specialist hand therapist. Mean time to presentation was 27 days (range 14-79) and mean improvement in range of movement was 25 degrees (range 2-52) with mean residual extension lag 10 degrees (range -4-56). All patients returned to their previous levels of function by the time of discharge. We conclude that it is possible to achieve good outcome without surgical intervention even when the presentation time is four weeks if experienced hand therapists manage the rehabilitation.

We set out this study to verify a hypothesis that orbital floor fractures tend to affect wider areas in patients with unilateral complete cleft palate. Using a striking machine, the inferior orbital rims of eight normal skulls (intact skull group) and eight skulls with parts of the maxillas removed to simulate alveolar and palatal clefts (cleft skull group) were impacted. The fractured areas were compared. Models designed using a computer were produced to simulate the skulls of 12 normal people and 12 patients with left unilateral complete cleft palate, and were classified as the intact model group and the cleft model group, respectively. Computer simulation of applying external forces to the inferior orbital rim of each model was performed. Areas where stresses exceeded the bone-yielding threshold were compared. Actual fractured areas were significantly larger in the cleft skull group than in the intact skull group. Theoretical fracture areas were also significantly greater in the cleft model group than in the intact model group. We conclude that orbital floor fractures develop in wider areas in patients with unilateral complete cleft palates, because of the instability of the maxilla on the cleft side.

In a prospective randomised Scandinavian trial, patients with localised invasive cutaneous melanoma of the trunk or extremities with tumours more than 2 mm thick were randomly assigned to excision with narrow (2 cm) or wide (4 cm) margins after primary surgery. The aims of the present study were to find out if there were any differences in health-related quality of life (QoL) and emotional distress between patients in the two arms over time. Patients were assessed at four time points: before randomisation, and at 3, 9, and 15 months after inclusion, using the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. A study-specific questionnaire was used to assess patient-reported problems related to the scar. A total of 144 patients were included; 70 randomised to narrow excision and 74 to wide excision margins. The response rate was >85% at all assessment points. No differences between the two arms were found for health-related QoL or emotional distress. Emotional functioning, insomnia, anxiety, intrusion, and avoidance improved over time (p

Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis. The male:female ratio was 1:4 and the mean duration of observation 32 months (range 6-52). In three patients the revised implant was a MOJE uncemented carpometacarpal joint prosthesis and in seven patients an Elektra uncemented one. At follow-up grip strength was reduced to less than 90% of the other hand in eight of 10 patients, but the mean Disabilities of the arm, shoulder, and hand (DASH) scores, self-reported pinch-grip-related function, and pain were comparable with our earlier published results with the Elektra carpometacarpal total joint prosthesis.

Our aim was to evaluate the functional outcome of reconstruction of elbow extension in tetraplegia using a new technique for improving the attachment sites of posterior deltoid-to-triceps transfer in conjunction with an active rehabilitation programme. Ten tetraplegic patients (15 arms) had modified deltoid-to-triceps transfer using a tibialis anterior tendon graft. The operation included large overlaps between the tendon attachments, and additional security by anchoring the distal stump of the tendon graft to the olecranon. During the first 3 weeks of immobilisation, isometric contractions were made and during the following 4 weeks the flexion angle of the elbow was increased by 15 degrees a week; weights were also used to reinforce muscle strength. The mean follow up was 10 months (range 5-19). The elbow extension strength after posterior deltoid-to-triceps transfer was measured in horizontal and vertical planes. After rehabilitation the active range of motion and strength of elbow extension had improved substantially. The mean active elbow extension range of motion was 132 degrees (range 120 degrees -145 degrees ) and the elbow could be extended actively in all planes. Elbow extension strength was restored to well above the counteraction of the weight of the arm. Mean (SEM) elbow extension was significantly greater in the horizontal shoulder plane compared with the vertical plane (10.4 (1.0) compared with 6.5 (1.2) Nm, p < 0.001) and strength increased roughly linearly as the degree of flexion of the elbow increased. The most dramatic increase was in the range between 120 degrees and 135 degrees of flexion, regardless of the plane of action of the shoulder. We have shown good functional results and a shorter rehabilitation period using a rigorous suturing technique that allows for active strength and mobility training without additional adverse effects.

An anonymous questionnaire was sent to 118 women who had their breasts reconstructed at the Department of Plastic Surgery, Ullevaal University Hospital, Oslo, from 1992-2001. The questionnaire included 36 questions scored on 6-point scales. Seventy-nine women returned a filled-in questionnaire. Five reconstruction methods had been used, but only implants (n = 32), lateral thoracodorsal flaps (n = 18), and transverse rectus abdominis musculocutaneous (TRAM) flaps (n = 12) had an acceptable number of cases for analysis. A total of 62 patients were included. Most of the cosmetic results differed significantly between the groups. Three-quarters of the patients in the TRAM group were very satisfied with the overall cosmetic results, compared with 11/18 in the lateral thoracodorsal flap group and 11/32 in the implant group. There were general good effects in all groups from the physical, social, and psychological points of view with no significant differences between them. However, achieving symmetry between breasts and the satisfaction about information given to patients about the procedures were two areas that fell short. Fifty (81%) of the 62 women would have recommended the operation to a friend under similar conditions.

We report the successful repair for tracheoinnominate fistula, in which the innominate artery was interposed with a synthetic graft and the pectoralis muscle was used as a seal against infection. We know of 10 other reported cases.

Nowadays direct repair is the treatment of choice for a lacerated flexor pollicis longus (FPL) tendon in any anatomical zone. Up to now repair with the motion-stable Mantero technique has not been published. Over a five years period (2004-2008) 21 complete divisions of FPL tendons in zones 1 and 2 were treated surgically with the Mantero technique. Seventeen patients were evaluated at a mean of 33 (range 14-59) months postoperatively by measuring the range of movement of interphalangeal (IP) and metacarpophalangeal (MP) joints and assessing the results with the Buck-Gramcko score. Fourteen of the patients reported excellent or good results. The mechanical rupture rate was zero. Mantero repair therefore provides a means other than more complex methods to repair FPL tendons and rehabilitation, adding strength while simplifying suture of the FPL.

Omental transposition is often used for reconstruction of soft tissue in the groin. However, the potential for incisional hernia is a relative contraindication. We report the cure of a groin ulcer with omental transposition using a new method of tunnelling to avoid herniation.