Elective microsurgery:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1999
|
| Schriftenreihe: | Hand clinics
15,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XI S., S. 541 - 781 Ill. |
Internformat
MARC
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Datensatz im Suchindex
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| adam_text | ELECTIVE MICROSURGERY
CONTENTS
Preface xiii
Fu Chan Wei
Free Flaps for Soft Tissue Coverage in the Hand and Fingers 541
Hung Chi Chen, Mark T. Buchman, and Fu Chan Wei
Free flaps are used for coverage of the hand and fingers when skin graft
and local flaps cannot be employed or would cause undesirable results.
Depending on the shape, size, and location, various free flaps are selected.
Generally, free flaps should be thin and well vascularized. They should
also be sensate for the volar side of the fingers. Special flaps can be
selected for functions other than simple coverage. In the past decade,
the refinement to achieve the best functional and aesthetic results in
reconstruction of the hand and fingers has been remarkable.
Secondary Reconstruction of the Extensor Tendons and
Overlying Soft Tissue Deficiency 555
Susumu Tamai, Hiroshi Yajima, and Yuji Inada
The dorsum of the hand has thin, fragile skin and poor subcutaneous
tissue covering the extensor tendons, with the metacarpal bones and
interosseous muscles lying underneath. The dorsal aspect of the hand is
prone to injury by contusion, abrasion, or shearing force, resulting in
crushing or tendocutaneous defects, with or without metacarpal fractures.
This article discusses reverse flow pedicled radial forearm tendocutaneous
flap transfers that were performed to reconstruct simultaneous skin and
tendon defects in the dorsum of the hand in six patients.
Microsurgical Reconstruction in Abnormalities of Children s
Hands 563
Simon Kay and Caroline McGuiness
Microsurgical reconstruction offers unique opportunities for improving
function and appearance in children s hands affected by congenital anoma¬
lies or following trauma. Strong parallels exist between the surgery for
congenital and post traumatic defects. This article defines some of the
methods used in replacement of skin, the creation of new digits, and the
transfer of muscles.
HAND CLINICS
VOLUME 15 • NUMBER 4 • NOVEMBER 1999 vii
Lengthening in Free Vascularized Fibular Graft 585
Ivor Jiun Lim, Anam Kueh Kour, and Robert Wan Heng Pho
A free vascularized fibular bone transfer was successfully performed in a
1 year old child to reconstruct the loss of the right humeral shaft following
neonatal osteomyelitis. Subsequent growth of the child resulted in gross
arm length discrepancy, with associated functional deficits. Callostatic
distraction lengthening of the vascularized fibular graft was carried out to
compensate for this limb length discrepancy by using an Ilizarov external
fixator. Lengthening of 6 cm over a 3 month period, representing a 75%
increase in the original length of the transplanted fibula, was achieved.
Active bone regeneration, good corticalization and endosteal medullary
cavity formation was observed in the lengthened fibula. The combined
modalities of vascularized bone transfer and Ilizarov callostatic distraction
lengthening offer a solution for reconstruction for large segmental bone
loss associated with growth arrest of the epiphyseal plates in children.
Combined Third and Fourth Toe Transplantation 589
Bien Keem Tan, Fu Chan Wei, Kao Jung Chang, Barbara S. Lutz,
and Samuel Huan Tang Chen
Multiple toe transplantation has been established as an effective technique
for restoring prehensile ability in the metacarpal hand. The combined third
and fourth toe transplant is a new toe transplant that has been developed
for bilateral metacarpal hand reconstruction. Since 1991, the combined
third and fourth toe transplant was added to the armamentarium of toe
transplants for metacarpal hands, although its role in metacarpal hand
reconstruction has not been described previously. This article introduces
the indications for combined third and fourth toe transplant, outlines
relevant vascular anatomy, and discusses technical considerations per¬
taining to toe harvest and transplantation.
Microsurgical Reconstruction of Fingers and Fingertips 597
Guy Foucher and Daniel J. Nagle
Free transfers from the foot have good indications for finger reconstruction
in young, healthy, and well motivated patients. The toes provide a unique
source to reconstruct amputated or partly destroyed fingers. If the range
of motion of the toe joints is quite disappointing from the roll up needed
on the ulnar side of the hand, it can provide strong pinch with good
sensibility on the radial aspect. This article reviews the different types of
transfers, their results, and indications, and provides a description of the
authors basic surgical technique.
Strategies in Multiple Toe Transplantation for Bilateral Type II
Metacarpal Hand Reconstruction 607
Bien Keem Tan, Fu Chan Wei, Barbara S. Lutz, and
Chih Hung Lin
Multiple toe transplantation has been established as an effective means of
restoring prehensile function in the metacarpal hand. The attainable out¬
come, however, must be weighed against potential donor site morbidity.
Restoration of prehensile function in bilateral type II metacarpal hands
can be achieved by reconstructing three opposable digits in the dominant
hand and two opposable digits in the nondominant hand. This article
outlines the strategy for optimizing functional outcome and discusses the
rationale behind toe selection to reduce donor morbidity.
vyj CONTENTS
Vascularized Toe Joint Transplantation 613
Samuel Huan Tang Chen, Fu Chan Wei, and Hung Chi Chen
The vascularized toe joint transfer is an alternative to arthrodesis. For
optimal functional results, the patient must have normal functioning mus¬
cle and associated tendons, effecting joint motion. Although vascularized
toe joint transfer permits long term preservation of joint architecture and
cartilage, the goal of achieving normal range of motion for a reconstructed
digit is still elusive. Reconstruction of the extensor mechanism can be
worthwhile in selected patients because more useful motion can be
achieved even if the result falls short of normal.
Revascularization of the Chronically Ischemic Hand 629
William C. Pederson
Chronic ischemia of the upper extremity can pose challenging problems
for the reconstructive hand surgeon. With a combined macro and micro
vascular approach, many patients can be offered limb salvage rather than
amputation. Direct revascularization probably offers the best approach
when it can be attempted. The indirect approaches do offer improvement
in most patients and are fairly straightforward. Arterialization of the
venous system and free omental transfer should be used with caution by
surgeons with little experience in microsurgery, however.
Nerve Transfers: New Options for Reconstruction Following
Nerve Injury 643
Susan E. Mackinnon and Christine B. Novak
Surgical reconstruction of proximal level nerve repair or long nerve grafts
have provided less than optimal results, presenting the opportunity for
investigation of alternate reconstructive techniques. Good motor function
following an injury to a motor nerve requires a maximal number of motor
axons reaching the motor end plate within a critical time period. Nerve
transfers eliminate the need for a nerve graft by allowing a direct end to
end nerve repair without tension. This article reviews surgical options
using nerve transfers for patients with upper and lower extremity nerve in¬
juries.
Autogenous Venous Nerve Conduits: A Review 667
David T. W. Chiu
Autogenous venous nerve conduit (AVNC) has evolved from an experi¬
mental idea to a clinical reality over the last two decades. The effectiveness
of AVNC for reconstruction of a peripheral nerve with a nerve gap of less
than 3 cm has been established and confirmed. An exciting application of
this technique in the near future is to use the conduit as a vehicle for
moderation and modulation of the cellular and molecular ambience for
nerve regeneration.
Free Vascularized Nerve Transfer in the Upper Extremity 673
G. Ian Taylor
Free vascularized nerve transfer using microsurgical techniques for upper
limb reconstruction should be considered as an alternative to conventional
nonvascularized cable nerve grafts when the recipient bed is heavily
scarred, as occurs in Volkmann s ischemia, when the nerve gap is excep¬
tionally long, or when the free transfer of thick nerves is contemplated.
Possible donor sites for free arteriovenous nerve transplants or arterialized
CONTENTS ix
neurovenous systems are presented and illustrated in four patients with
follow up in excess of 20 years. In each case the rate of axon immigration
across the vascularized nerve bridge and beyond to the hand was in excess
of 1.5 mm per day.
Management of Peripheral Nerve Problems in the Upper and
Lower Extremity Using Quantitative Sensory Testing 697
A. Lee Dellon
Elective microsurgery of the peripheral nervous system concerns nerve
decompression, neurolysis, nerve repair, and forms of nerve reconstruction
with grafts or tubes. Management skills for the peripheral nerve too often
rely on antiquated assessment techniques and depend upon traditional
electrodiagnostic testing. Quantitative sensory testing is an approach to
the evaluation of peripheral nerve function that is available now to all
physicians interested in managing peripheral nerve problems. This article
introduces quantitative sensory testing, with particular regard to the man¬
agement of peripheral nerve problems.
Management of Obstetric Brachial Plexus Palsy 717
Julia K. Terzis and Konstantinos C. Papakonstantinou
Advances in reconstructive microsurgery during the last quarter of the
century have led to an increasing interest in brachial plexus surgery in
infants. The higher potential for nerve regeneration in this patient popula¬
tion as compared to adults with post traumatic brachial plexus injuries,
allowed for more aggressive surgical approaches. Even if the current
thinking is that surgery at an early stage is the best therapeutic modality
for obstetric brachial plexus palsies, there is still some controversy among
reconstructive microsurgeons around the world regarding appropriate can¬
didates, the optimal timing of surgery, and the best reconstruction ap¬
proaches. This article condenses current opinions and presents the authors
approach to this debilitating disease.
Management of Traumatic Brachial Plexus Injuries in Adults 737
David Chwei Chin Chuang
Adult brachial plexus injury (BPI) is a closed injury. It usually involves a
plexus of nerves formed by a number of roots, spinal nerves, trunks, cords,
and numerous terminal branches, in a complicated fashion. Successful
results in the management of adult BPI are based on the knowledge
of anatomic arrangement, pathophysiology considerations, preoperative
evaluation and diagnosis, surgical technique, postoperative management,
rehabilitation and regular patient follow up, surgical treatment of sequelae
deformities, and factors influencing its results. This article deals with
traumatic lesions of the brachial plexus in adults, and focuses on contro¬
versial questions and philosophy of treatment of adult BPI.
Double Muscle Transfer for Upper Extremity Reconstruction
Following Complete Avulsion of the Brachial Plexus 757
Kazuteru Doi, Noriyuki Kuwata, Keiichi Muramatsu,
Yasunori Hottori, and Shinya Kawai
Brachial plexus injuries result in considerable disability. Recent interest in
reconstruction of the upper limb following brachial plexus injuries has
focused on the restoration of prehension following complete avulsion
of the brachial plexus. This article discusses free muscle transfers for
reconstruction of the upper limb to resolve the difficult problems in com
x CONTENTS
plete avulsion of the brachial plexus. The purpose of this article is to
describe the operative technique of the double muscle transfer for upper
extremity reconstruction following complete avulsion of the brachial
plexus and its modification and secondary reconstructions based on the
personal experiences of the authors.
Cumulative Index 1999 769
Subscription Information Inside back cover
CONTENTS Xi
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| spelling | Elective microsurgery Fu-Chan Wei, guest ed. Philadelphia [u.a.] Saunders 1999 XI S., S. 541 - 781 Ill. txt rdacontent n rdamedia nc rdacarrier Hand clinics 15,4 Intervention chirurgicale reconstructive Ledematen gtt Microchirurgie Microchirurgie gtt Plexus brachial Traumatismes de la main - Chirurgie Arm Injuries surgery Arm Wounds and injuries Surgery Microsurgery Surgery, Elective Surgical Procedures, Elective Mikrochirurgie (DE-588)4114590-2 gnd rswk-swf Handverletzung (DE-588)4159060-0 gnd rswk-swf Handkrankheit (DE-588)4023276-1 gnd rswk-swf Handchirurgie (DE-588)4023219-0 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Handkrankheit (DE-588)4023276-1 s Mikrochirurgie (DE-588)4114590-2 s DE-604 Handverletzung (DE-588)4159060-0 s Handchirurgie (DE-588)4023219-0 s Wei, Fu-Chan Sonstige oth Hand clinics 15,4 (DE-604)BV000019309 15,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008838634&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Elective microsurgery Hand clinics Intervention chirurgicale reconstructive Ledematen gtt Microchirurgie Microchirurgie gtt Plexus brachial Traumatismes de la main - Chirurgie Arm Injuries surgery Arm Wounds and injuries Surgery Microsurgery Surgery, Elective Surgical Procedures, Elective Mikrochirurgie (DE-588)4114590-2 gnd Handverletzung (DE-588)4159060-0 gnd Handkrankheit (DE-588)4023276-1 gnd Handchirurgie (DE-588)4023219-0 gnd |
| subject_GND | (DE-588)4114590-2 (DE-588)4159060-0 (DE-588)4023276-1 (DE-588)4023219-0 (DE-588)4143413-4 |
| title | Elective microsurgery |
| title_auth | Elective microsurgery |
| title_exact_search | Elective microsurgery |
| title_full | Elective microsurgery Fu-Chan Wei, guest ed. |
| title_fullStr | Elective microsurgery Fu-Chan Wei, guest ed. |
| title_full_unstemmed | Elective microsurgery Fu-Chan Wei, guest ed. |
| title_short | Elective microsurgery |
| title_sort | elective microsurgery |
| topic | Intervention chirurgicale reconstructive Ledematen gtt Microchirurgie Microchirurgie gtt Plexus brachial Traumatismes de la main - Chirurgie Arm Injuries surgery Arm Wounds and injuries Surgery Microsurgery Surgery, Elective Surgical Procedures, Elective Mikrochirurgie (DE-588)4114590-2 gnd Handverletzung (DE-588)4159060-0 gnd Handkrankheit (DE-588)4023276-1 gnd Handchirurgie (DE-588)4023219-0 gnd |
| topic_facet | Intervention chirurgicale reconstructive Ledematen Microchirurgie Plexus brachial Traumatismes de la main - Chirurgie Arm Injuries surgery Arm Wounds and injuries Surgery Microsurgery Surgery, Elective Surgical Procedures, Elective Mikrochirurgie Handverletzung Handkrankheit Handchirurgie Aufsatzsammlung |
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