1/28. A reverse ulnar hypothenar flap for finger reconstruction.A reverse-flow island flap from the hypothenar eminence of the hand was applied in 11 patients to treat palmar skin defects, amputation injuries, or flexion contractures of the little finger. There were three female and eight male patients, and their ages at the time of surgery averaged 46 years. A 3 x 1.5 to 5 X 2 cm fasciocutaneous flap from the ulnar aspect of the hypothenar eminence, which was located over the abductor digiti minimi muscle, was designed and transferred in a retrograde fashion to cover the skin and soft-tissue defects of the little finger. The flap was based on the ulnar palmar digital artery of the little finger and in three patients was sensated by the dorsal branch of the ulnar nerve or by branches of the ulnar palmar digital nerve of the little finger. Follow-up periods averaged 42 months. The postoperative course was uneventful for all patients, and all of the flaps survived without complications. The donor site was closed primarily in all cases, and no patient complained of significant donor-site problems. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer, as indicated by 5 mm of moving two-point discrimination. A reverse island flap from the hypothenar eminence is easily elevated, contains durable fasciocutaneous structures, and has a good color and texture match to the finger pulp. This flap is a good alternative for reconstruction of palmar skin and soft-tissue defects of the little finger.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/28. Olmsted syndrome: report of two new cases and literature review.Olmsted syndrome is a rare keratinization disorder; 18 cases have been published so far. It associates a mutilating cogenital palmoplantar keratoderma with periorificial erythematokeratotic lesions. We report herein two new unrelated male children with Olmsted syndrome (OS), one of whom was studied by light and electron microscopy. Our histological, immunohistochemical, and ultrastructural findings suggest that this disease is related to epidermal hyperproliferation. We present herein a review of the twenty cases published so far and discuss the major clinicopathological and genetic features of this disease.- - - - - - - - - - ranking = 0.25keywords = palm (Clic here for more details about this article) |
3/28. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 0.5keywords = palm (Clic here for more details about this article) |
4/28. Is 20 years of immobilization, not sufficient to render metacarpophalangeal joints completely useless?--Correction of a 20-year old post-burn palmar contracture: a case report.This report presents a case of post-burn palmar contracture with flexion contracture of thumb of 20-year duration. The contracture was released and the raw area was covered with split thickness skin graft. Only one 'K' wire in soft tissue was needed to keep all the fingers straight and immobilized, suggestive of intermetacarpal ligamentous contracture. A static night splint was given to maintain the correction. Complete range of movement was achieved in a month with the combination of dynamic splinting and physiotherapy. It was interesting to note that even 20 years of contracted position did not render the metacarpophalangeal joints completely stiff and useless. Probable reasons are discussed.- - - - - - - - - - ranking = 1.25keywords = palm (Clic here for more details about this article) |
5/28. Palmar fascial thickening and contractures of fingers resembling arthritis--a paraneoplastic symptom?A 59-year-old women presented with contractures of the fingers of both hands 11 months before a diagnosis of an ovarian carcinoma with paraaortic lymph node metastases was made. We suggest that the contractures, which were associated with palmar fascial thickening and which clinically resembled arthritis, might have been a paraneoplastic sign.- - - - - - - - - - ranking = 0.25keywords = palm (Clic here for more details about this article) |
6/28. Bilateral palmar contractures as a paraneoplastic syndrome in primary peritoneal carcinoma.Primary peritoneal carcinoma, like ovarian cancer, usually causes non-specific abdominal symptoms, and often presents at a late stage. We report a case of primary peritoneal carcinoma where the development of abdominal symptoms was preceded for 6 months by paraneoplastic palmar contractures. This case demonstrates the importance of recognising palmar contractures as a potential sign of neoplastic disease.- - - - - - - - - - ranking = 1.5keywords = palm (Clic here for more details about this article) |
7/28. Palmar fasciitis and arthritis syndrome associated with metastatic ovarian carcinoma: a report of four cases.Palmar fasciitis and polyarthritis syndrome (PFPAS) is an uncommon paraneoplastic syndrome associated with several malignant neoplasms. We identified 4 patients with PFPAS and ovarian carcinoma. Palmar fasciitis, at times severe, and inflammatory polyarthritis dominated the clinical presentation in all 4 patients. In 3 of our 4 patients the presentation of palmar fasciitis and inflammatory polyarthritis preceded the diagnosis of ovarian carcinoma. Magnetic resonance scanning and biopsy examination of palmar nodules in one patient revealed findings of inflammation and fibrosis. A literature review found 10 other cases of PFPAS associated with ovarian carcinoma. Improvement in palmar fasciitis and inflammatory arthritis often occurs after successful treatment of the ovarian carcinoma. Digital contractures, however, can persist. We recommend a gynecologic examination in any woman presenting with the sudden onset of unexplained hand pain, palmar inflammatory fasciitis, palmar fibromatosis, and digital contractures.- - - - - - - - - - ranking = 1.25keywords = palm (Clic here for more details about this article) |
8/28. Successful correction of severe contracture of the palm using arterialized venous flaps.Severe contracture of the palm causes great difficulty in the performance of the tasks required in daily life. Resurfacing with skin grafts may be sufficient for treating mild and small contractures; but severe and extensive contractures involving the joints, tendons, and neurovascular bundles should be covered with thin flaps. The authors present four cases of successful reconstruction of severe and extensive contractures of the palm using large arterialized venous flaps.- - - - - - - - - - ranking = 1.5keywords = palm (Clic here for more details about this article) |
9/28. Use of dorsal ulnar neurocutaneous island flap in the treatment of chronic postburn palmar contractures.In the present study, the authors evaluated efficiency of the "dorsal ulnar neurocutaneous island flap" in the coverage of palmar defects resulting from radical release of selected chronic postburn contractures. Eight white male hands with palmar contracture were treated with this flap between November 2001 and December 2003. The mean follow-up period was 11.6 months. The flap, which was planned on the ulnar aspect of the forearm and the hand, is transferred to the palmar defect. The subcutaneous pedicle of the flap was skin-grafted to avoid tension. All operations were successful. Distal flap necrosis that healed by secondary intention was observed in one of the eight flaps. Seventy-five degrees was the maximum improvement in metacarpophalangeal (MP) joint extension achieved in the little finger. Grasp function of the hand dramatically improved and the bulk of the flap did not interfere with grasping. No recurrent palmar contracture was observed. The authors concluded that the dorsoulnar neurocutaneous island flap can be used effectively in the treatment of postburn palmar contractures. The safety of the flap can be enhanced by grafting the intervening skin between the pivot point of the flap and the palmar defect.- - - - - - - - - - ranking = 2.5keywords = palm (Clic here for more details about this article) |
10/28. Hand reconstruction using the thin anterolateral thigh flap.BACKGROUND: Perforator flaps have been introduced for various kinds of reconstruction and resurfacing; in particular, the free thin anterolateral thigh flap is becoming one of the most preferred options for reconstruction of soft-tissue defects. methods: Between 1999 and 2002, the authors used this flap as a free flap for nine cases for covering hand defects after burn, crushing injuries, or severe scar contracture release. There were eight men and one woman, the mean age of the patients was 31 years, and the size of the flaps ranged from 7 x 3.5 cm to 15 x 9 cm; thinning was performed in all flaps. RESULTS: All flaps survived completely, and the donor site was closed directly in seven cases; in two cases, the exposed muscle was covered with split-thickness skin graft. CONCLUSIONS: The anterolateral thigh flap was thin enough for defects on the dorsum and/or palm of the hand and for first web reconstruction after scar contracture release. It has many advantages in free flap surgery including a long pedicle with a suitable vessel diameter, and the donor-site morbidity is acceptable. The thin anterolateral thigh flap is a versatile soft-tissue flap that achieves good hand contour with low donor-site morbidity.- - - - - - - - - - ranking = 0.25keywords = palm (Clic here for more details about this article) |
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