Microvascular free flaps for reconstruction

The development of microvascular free flaps has significantly affected our reconstructive principles. In many situations, it has become the procedure of choice. Thus, defects caused by trauma, tumour resection, infection and irradiation or related to congenital anomalies can be adequately covered by microvascular free flaps. Free flaps have also evolved from skin to tissues such as muscle, bone, toes, and other composite flaps, and the factors affecting their choice include patient's needs, defect characteristics, donor site morbidity, and surgeon's experience. Recent advances in surgical techniques, thrombolytic drugs for flap salvage, prefabrication technique, synergistic use of tissue expander and osteogenesis by callus distraction will contribute to the future development of microvascular free flap.published_or_final_versio

Mycobacterium marinum infection of the hand and wrist

PURPOSE: To review records of 166 patients who underwent treatment for Mycobacterium marinum tenosynovitis of the hand and wrist to identify factors associated with functional outcome. METHODS: Records of 97 men and 69 women aged 13 to 85 (mean, 50) years who underwent treatment for suspected M marinum tenosynovitis of the hand and wrist were retrospectively reviewed. All underwent open biopsy; synovectomy was performed when florid synovitis was present. Rifampicin and ethambutol were usually prescribed. Clarithromycin, minocycline and/or levofloxacin were used as adjuvants if there was drug intolerance, allergy, or relapse. The duration of antibiotic treatment depended on the clinical recovery. Patients were followed up for one year after completion of drug treatment. Functional outcome was considered excellent for those with >195 masculine total active motion (TAM) and >75% return of motion, good for those with 130 masculine to 195 masculine TAM and 50 to 75% return of motion, fair for those with 65 masculine to 129 masculine TAM and 25 to 49% return of motion, and poor for those with2 months after injury (27% [21/79] vs. 9% [7/77], p=0.004, Pearson Chi squared test), and have undergone synovectomy (23% [28/124]) vs. 0% [0/32], p=0.001, Fisher's exact test). Worse functional outcome correlated with late presentation (r=0.218) and the greater number of debridement procedures (r=0.453). CONCLUSION: Delayed antibiotic treatment of M marinum infections and steroid injections were associated with unsatisfactory outcome. Clinicians must have a high index of suspicion for this condition and avoid inappropriate management such as intralesional steroid injections. Public awareness to this condition should be raised.published_or_final_versio

Occupational repetitive strain injuries in Hong Kong

OBJECTIVE: To review currently available evidence on the epidemiology and management of occupational repetitive strain injuries with particular reference to Hong Kong. DATA SOURCES AND STUDY SELECTION: Medline, PubMed and Cochrane Library searches of local and internationally published English journals from 1990 to 2007 regarding repetitive strain injuries. DATA EXTRACTION: All articles involving occupational repetitive strain injuries in Hong Kong were included in this review. DATA SYNTHESIS: There were 16 articles contributing data on the impact of repetitive strain injuries both in Hong Kong and around the world. There were seven articles dealing with the problem of computer station set-ups and methods for improving the workstation environments. CONCLUSION: Currently there were significant data on the impact of repetitive strain injuries in Hong Kong. The data took the form of compensation claims, days away from work, and cost of medical consultations. Other articles described proper workplace adjustments to help prevent repetitive strain injuries. However, there were no figures in the current literature showing the impact of these adjustments in reducing the incidence of repetitive strain injuries. More research could help to delineate the relationship between different types of interventions and occupational repetitive strain injuries.published_or_final_versio

Lateral tibial condyle reconstruction by pedicled vascularized fibular head graft: Long-term result

The technique of pedicled vascularized fibular graft for lateral tibial condyle reconstruction after en bloc resection of aggressive giant cell tumours was described by SP Chow et al. Early follow-up of two patients was presented in 1986. We present the 25 years follow-up of one patient with a literature review of alternative present day treatment options. The patient maintained community ambulant status despite developing late stage osteoarthritis. Although this procedure is performed rarely, it remains an alternative to the more sophisticated treatment options making it a useful method in centres with limited facilities and expertise. © 2011 The Author(s).published_or_final_versio

Dynamic treatment for proximal phalangeal fracture of the hand

PURPOSE: To assess a protected mobilisation programme (dynamic treatment) for proximal phalangeal fracture of the hand, irrespective of the geometry. METHODS: Clinical and radiological results of 32 consecutive patients with proximal phalangeal fracture of the hand treated from January 2001 to February 2007 were evaluated. Our supervised rehabilitation programme was strictly followed to gain full range of movement of the proximal interphalangeal joint and to prevent the development of an extension lag contracture. Patients were followed up for a mean period of 15 (range, 13-16) months. Results were evaluated using the Belsky classification. RESULTS: The results were excellent in 72% of the patients, good in 22%, and poor in 6%. Some patients defaulted follow-up, which made long-term assessment difficult. The poor results may have been related to patient non-compliance or default from rehabilitation. Many good results upgraded to excellent following further rehabilitation. CONCLUSION: Skeletal stability, not rigidity, is necessary for functional movements of the hand. Proximal phalangeal fractures can be effectively treated by closed methods, using the stabilising effect of soft tissues (zancolli complex-metacarpophalangeal retention apparatus) and external devices (metacarpophalangeal block splint), thus enabling bone healing and movement recovery at the same time.published_or_final_versio

Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures

The authors reviewed 31 distal tibial fractures (16 involving the tibial plafond) treated with Ilizarov external fixation. The study population was composed of 19 males and 12 females, with an average age of 54. The fractures were classified according to the AO classification: A1 (3), A2 (6), A3 (6), C1 (2), C2 (8), C3 (6). There were six open injuries. In 14 pilon cases, open reduction of the intra-articular fragments and bone grafting via a limited incision was performed. Clinical follow-up averaged 28 months (range 18-42). All but one fracture united with an average healing time of 13.9 weeks. Nearly all patients with AO type A fracture had excellent or good functional scores. The 14 cases of AO C2 and C3 group had five (38%) good results, five (38%) fair results and three (24%) poor results. This method yielded results comparable with previous studies using open reduction and internal fixation. Twenty-nine percent of the patients had pin track infection, which remained the most important complication of this method. © 2003 Elsevier Ltd. All rights reserved.postprin

Does timing of surgery matter in fragility hip fractures?

The effect of delay of surgery on the geriatric hip fractures has been a subject of interest in the past two decades. While the elderly patients will not tolerate long periods of immobilization, it is still unclear how soon these surgeries need to be performed. A review of existing literature was performed to examine the effect of timing of surgery on the different outcome parameters of these patients. Although there is conflicting evidence that early surgery would improve mortality, there is widespread evidence in the literature that other outcomes including morbidity, the incidence of pressure sores, and the length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. We concluded that it is beneficial to the elderly patients to receive surgical treatment as an urgent procedure as soon as the body meets the basic anesthetic requirements. © 2010 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Overprotection and the psychological states of cerebral palsy patients and their caretakers in Hong Kong: A preliminary report

Objective: To examine the relation between perceived overprotection and the psychological states of cerebral palsy patients and their primary caretakers in Hong Kong. Design: Cross-sectional survey, in which data of 14 pairs of cerebral palsy patients and their caretakers were analysed. Setting: Duchess of Kent Children's Hospital, Hong Kong. Participants: Cerebral palsy patients and their primary caretakers in Hong Kong. Main outcome measures: Perceived overprotection and psychological states. Results: Nearly two thirds of the 14 patients (mean age of 15 years) and 86% of the 14 primary caretakers (mean age of 47 years) perceived various levels of overprotection. For both patients and caretakers, perceived overprotection was positively associated with anxiety and unhappiness. The patients' and caretakers' psychological states and perception of overprotection were not related to the actual motor ability of the patients. Perceived overprotection of the patients was not related to that of the caretakers. Conclusion: Caretakers should be mindful that a well-meaning move may have undesirable consequences. More support and child-rearing education should be considered for caretakers.published_or_final_versio

Dupuytren's disease in bosnia and herzegovina. An epidemiological study

BACKGROUND: It is generally held that Dupuytren's disease is more common in northern than in southern Europe, but there are very few studies from southern European countries. METHODS: We examined the hands of 1207 men and women over the age of 50 years in Bosnia and Herzegovina. RESULTS: The prevalence of Dupuytren's disease was highly age-dependent, ranging from 17% for men between 50–59 years to 60% in the oldest men. The prevalence among women was lower. The great majority only had palmar changes without contracture of the digit. The prevalence was significantly lower among Bosnian Muslim men than among Bosnian Croat and Serbian men and significantly increased among diabetics. No association could be detected between Dupuytren's disease and smoking, alcohol consumption or living in rural or urban areas. CONCLUSION: We conclude that, contrary to previous opinion, Dupuytren's disease is common in Bosnia and Herzegovina