1/16. 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 = 1keywords = palm (Clic here for more details about this article) |
2/16. 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 = 2.5keywords = palm (Clic here for more details about this article) |
3/16. rupture of flexor tendons after arthrodesis of the basal joint of the thumb.We report a case of rupture of the flexor tendons to the index finger after arthrodesis of the basal joint of the thumb. The tendons ruptured as a result of the Kirschner wires having penetrated in the carpal tunnel. This unusual complication was treated by tendon graft of the palmaris longus tendon.- - - - - - - - - - ranking = 0.5keywords = palm (Clic here for more details about this article) |
4/16. Repair of avulsion injury of the whole hand with single-stage transfer of five combined tissues: case report.The authors present a 32-year-old man with an entire left hand avulsion injury. This was repaired in one stage with five free-tissue transfers, a combination of a left hallux wrap-around flap for thumb reconstruction, bilateral second toes for middle and ring finger reconstruction, and bilateral femoral anterolateral flaps for coverage of the injured hand at the palmar and dorsal aspects. All the transfers survived uneventfully. Due to enlargement of the flaps and narrowness of the first web space, three further surgical procedures were subsequently carried out. Over a 2-year follow-up, a satisfactory appearance of the reconstructed hand and functional restoration were obtained.- - - - - - - - - - ranking = 0.5keywords = palm (Clic here for more details about this article) |
5/16. Severe palmo-plantar hyperkeratosis in Koebner epidermolysis bullosa simplex.A 22-year-old Japanese woman with Koebner epidermolysis bullosa simplex presented with severe palmo-plantar hyperkeratosis. skin biopsy specimens from the palm revealed hyperkeratosis and acanthosis with blistering in the basal cell layer. An electron microscopic study showed cytolysis of basal cells and clumping of tonofilaments forming thick bundles and perinuclear electron-dense bodies. Hand contractures were released and covered with full thickness autografts or split thickness autografts. The donor site was successfully treated with cultured epidermal autografts.- - - - - - - - - - ranking = 3keywords = palm (Clic here for more details about this article) |
6/16. Total palmar resurfacing with scapular free flap in a 26-year contracted hand.The scapular free flap offers a large-sized and well-vascularized coverage for variable defects. It is not regarded, however, as a favorite tool for palmar resurfacing because of its bulky and rigid nature. A 28-year-old man had sustained a contact dermal injury at the age of 2 years that resulted in a severely deformed hand. The total palmar defect was resurfaced by surgical intervention with a scapular free flap. After secondary procedures, the final result was promising. The present report focuses on the secondary procedures, which make a more functional and aesthetically pleasing hand after coverage with the scapular flap. Also, our result suggests that even finger joints contracted for 26 years can recover motion if they have not been directly damaged.- - - - - - - - - - ranking = 3keywords = palm (Clic here for more details about this article) |
7/16. Hand splint for rheumatoid arthritis patients during gait training after joint replacement in lower extremity.Rheumatoid arthritis patients have multiple joint problems, often making it difficult to use gait aids after a joint replacement in the leg. To address this problem, we designed a hand splint with a hook on the palmar side for use with parallel bars. patients put these splints on both hands and they can walk holding the bars with the hooks. Best suited for using this splint are rheumatoid arthritis patients who are unable to hold parallel bars without marked pain in the hands or fingers, contracture of the wrist joint, or dislocation of finger joints. Several patients have tried this splint, which worked safely and satisfactorily during exercise.- - - - - - - - - - ranking = 0.5keywords = palm (Clic here for more details about this article) |
8/16. Surgical correction of the hand in epidermolysis bullosa dystrophica.epidermolysis bullosa dystrophica (polydysplastic type) is a rare congenital skin anomaly which, in the hands, because they are exposed to repeated trauma, results in a severe "mitten"-like deformity. Functional benefit was obtained in three patients by separation of the digits and application of split-thickness grafts. Wolfe grafts or "split-off" (epidermis) grafts. arthrodesis of the interphalangeal joints and filleting of the little finger to provide a flap which could be turned in to the palm, resulted in an improvement in hand function.- - - - - - - - - - ranking = 0.5keywords = palm (Clic here for more details about this article) |
9/16. The false cortical thumb.Two cases of thumb-in-palm deformity are presented that are postulated to be complications of repeated radial artery puncture and cannulation with secondary damage to the thumb extensor tendon sheath and its extensor pollicis brevis and abductor pollicis longus tendons. Nonfixed adduction-flexion posturing of the thumb is to be differentiated from "the cortical thumbs" often associated with adduction, flexion contracture of upper motor neuron injury, and other disorders with thumb-in-palm deformities. The risks of complication of radial artery puncture are multiple. An added risk is the potential for impaired extensor tendon function as a complication of a radial puncture.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
10/16. The psycho-flexed hand.Five mentally disturbed patients had flexion contractures of the middle, ring, and little fingers of one or both hands. All gave a history of psychiatric illness manifested by depression. Since no organic etiology for the contractures was found, the authors name this condition the "psycho-flexed hand." Four of the five patients were middle-aged women who suffered long-term depression, hypochondriasis, and/or schizophrenia. The patients' severely contracted fingers often macerated the palm. Manipulation under anesthesia and splinting only temporarily relieved the contractures. Multiple complications occurred following splinting and hand therapy, as well as surgery. Therefore, caution is urged when attempting surgical correction before resolving the mental illness.- - - - - - - - - - ranking = 0.5keywords = palm (Clic here for more details about this article) |
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