1/10. Free temporoparietal fascial flap for coverage of a large palmar forearm wound after hand replantation.A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/10. Applying "cell surgery" to nerve repair: a preliminary report on the first ten human cases.We have applied a new technique of nerve repair, based on the principles of "cell surgery", to ten nerve lesions of the upper limb. Eight lesions were recent, five to 36 hours; they were divisions of the ulnar nerve (1), median nerve (2), sensory radial nerve (1), palmar and digital nerves (4). One lesion was 15 days old (median nerve). One eight-month-old loss of 4.5 cm. of the median nerve was grafted. In nine out of the ten cases, the short-term results were encouraging. Poor local conditions (fibrosis of the nerve bed) or poor general health (chronic alcoholism) had no adverse influence on the results. In the remaining case, the protocol was not followed in its entirety: it was not possible to crystallise properly the nerve, and trimming was done with scissors in the conventional way instead of smoothly trimming the solidified tips. The functional result in this case is a failure. These preliminary results seem to indicate that correctly applying the technique in its entirety may be more important than local conditions. We think that this technique can be applied to the majority of nerve lesions. The appropriate equipment is absolutely necessary in order to apply the method.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
3/10. Sensate palm of hand free flap for forearm length preservation in nonreplantable forearm amputation: long-term follow-up.In traumatic proximal forearm amputation where replantation is not possible, "spare parts" from the amputated segment can be used to maintain adequate length for successful use of a below-elbow prosthesis. Two patients with long-term follow-up are presented in whom forearm length was preserved with the use of a sensate palmar skin free flap.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
4/10. forearm muscle herniae and their treatment.Three cases of forearm muscle hernia are described. Their aetiology differed but, in all three, symptoms were sufficiently severe to interfere with the patient's work. Surgical repair of the myocoeles, by closure of the fascial defects using lata onlay grafts or an interweave of palmaris longus tendon, produced complete resolution of symptoms and enabled the patients to return to full employment.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
5/10. Double level amputation: should it be replanted?Multiple level amputation has been described as a contraindication to replantation. This is a case report of a patient with a double level amputation through the palm and forearm that was successfully replanted. Because of the need for multiple stages of reconstructive surgery, it was not clear until the end result that the replantation was worthwhile. The patient developed an acute respiratory distress syndrome that was probably caused by the reperfusion phenomenon. The stages of reconstruction are described in detail, as are the problems encountered. The final result included a reasonably functional hand that was far superior to the prosthetic alternative.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
6/10. Chronic exertional compartment syndrome of the forearm: a case report.A 40-year-old man sustained a circumferential crush injury to his right forearm. Four months after injury, he experienced the onset of numbness and tingling in the distribution of the median nerve after exercise. Elevated compartment pressures of the palmar forearm and slowing of median nerve conduction after exercise suggested chronic exertional compartment syndrome. A flexor fasciotomy led to complete relief of symptoms, which allowed the patient unrestricted activity.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
7/10. transplantation of severed digits to forearm stump for restoration of partial hand function.Three cases of mutilating injury of the distal end of the forearm, wrist, and palm treated by transplantation of severed digits to the forearm stump are reported. Follow-up examinations made at 1 year and 4 months to 31/2 years postoperatively revealed fair sensory and motor functions. The functional result is better than that obtained after Krukenberg's operation or prosthesis fitting, and is comparable to that of "hand" reconstruction by autotransplantation of toes. Since this procedure can fulfill the basic requirements of hand function by reconstruction, namely, good sensibility; basic motor functions of pinching, grasping, and powerful gripping; and acceptable outward appearance, and can be accomplished in a one-stage operation without sacrificing toes, it should be considered as first choice whenever a suitable case is encountered.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
8/10. Lower limb salvage using an extended free radial forearm flap.A case is reported of an unusual double injury, in which a lower limb salvage procedure employed a free radial forearm flap from an amputated upper limb. The use of amputated parts for salvage procedures is well documented but none has previously involved a free forearm flap. This clinical case shows that the entire forearm and hand skin can be adequately perfused on the radial artery along with the superficial palmar arch.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
9/10. Palm of hand free flap for forearm length preservation in nonreplantable forearm amputation: a case report.In traumatic forearm amputation, if replantation is not indicated or possible, then adequate forearm length preservation is desirable to allow use of a below-elbow prosthesis. A case is presented in which forearm replantation was not done, but forearm length was preserved by use of a palmar skin free microvascular flap.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
10/10. Resurfacing a circumferentially degloved hand by using a full-thickness skin graft harvested from an avulsed skin flap.Twelve patients with circumferentially degloved hands were treated with full-thickness skin grafts harvested from defatted avulsed flaps. All injuries were industrial accidents caused by various roller machines, not crush injuries. Of these 12 patients, 9 patients were degloved from the wrist level and 3 patients were degloved from the forearm. There were 11 distally based skin flaps and one flap was completely detached. Four patients were avulsed distally to the mid palm, with volar neurovascular bundles damaged at the "fenestrae" of the palm, which resulted in devascularization of the involved fingers. Among them, distal fingers were successfully revascularized by microsurgical techniques in 3 patients. The full-thickness skin grafts were prepared from the attached, avulsed skin flap to avoid junctional hypertrophic scarring. The graft was then secured to its anatomic position with multiple skin staples to improve skin graft take. Initial take of the graft averaged 93% (range, 85%-100%). Compared with conventional methods, this approach provides a higher rate of skin take and better cosmetic and functional results.- - - - - - - - - - ranking = 0.4keywords = palm (Clic here for more details about this article) |
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