Medida da força de flexão dos dedos da mão através de órtese dinâmica com dinamômetro

PURPOSE AND METHODS: In order to determine forces acting upon an articular joint during hand rehabilitation, a dynamic splint was built and connected to a dynamometer (capable of measuring forces in the range 0 - 600 gf). Through trigonometric calculation, the authors measured the flexing force in the proximal interphalangeal joint of the middle finger at 30°, 45°, 60°, and 90° of flexion. Measurements were obtained in a population of 40 voluntary adults, 20 females and 20 males, This flexing force was correlated with age, sex, and anthropometric measures. RESULTS: Force in the flexing tendon is maximal at the start of flexion, and decreases as the angle of joint flexion increases. A relationship was observed between finger length and the magnitude of the force exerted on the tendon: the longer the finger, the greater the force exherted upon the tendon. Force is greater at all the measured angles, (except 30°) in males and in individuals of higher stature, and bigger arm span. CONCLUSIONS: The flexing force can be effectively measured at all flexing angles, that it correlates with a number of different anthropometric parameters, and that such data are likely to open the way for future studies.OBJETIVO E MÉTODOS: Em virtude do desconhecimento relativo às forças que atuam em uma articulação durante o processo de reabilitação da mão, foi confeccionada uma órtese dinâmica que, acoplada a um dinamômetro, mediu, através de cálculos trigonométricos, a força (entre 0 a 600gf), flexora na articulação interfalângica proximal do terceiro dedo, a 30º, 45º, 60º e 90º de flexão. Estas medidas foram obtidas, em uma população de 40 adultos voluntários, 20 do sexo feminino e 20 do masculino, e confrontadas com idade, sexo e medidas antropométricas como estatura, envergadura e comprimento do dedo. RESULTADOS: Os resultados do estudo demonstraram que o tendão flexor é submetido à máxima força no início da flexão e que a força no tendão flexor diminui conforme aumenta o grau de amplitude articular. Observou uma relação entre o comprimento do dedo e a magnitude da força exercida no tendão durante a flexão do dedo, sendo que nos dedos mais compridos os tendões são submetidos a forças maiores. Quando comparou a estatura e envergadura com a magnitude da força aplicada no tendão flexor, observou uma relação positiva em todos os graus de flexão estudados, exceto a 30º. O sexo masculino apresentou maior força em todos os graus de amplitude articular. CONCLUSÕES: Conclui que é possível medir a força de flexão transmitida pelos tendões flexores através de uma órtese acoplada a um dinamômetro, que esta força é maior nos indivíduos do sexo masculino, com dedos mais longos, de maior altura e envergadura e que tais dados permitirão o desenvolvimento de futuros trabalhos no campo da reabilitação da mão, auxiliando pacientes portadores de lesões de tendões, retração cicatricial, deformidades e rigidez articular

Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons

OBJECTIVE: The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS: Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair). The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos®). Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS: In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Student's t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS: The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro

Experimental study of histological changes in vascular loops according to the duration of the postoperative period: Application in reconstructive microsurgery

OBJECTIVES: To analyze the histological changes observed in venous grafts subjected to arterial blood flow as a function of the duration of the postoperative period to optimize their use in free flap reconstructions. METHOD: Twenty-five rats (7 females and 18 males) underwent surgery. Surgeries were performed on one animal per week. Five weeks after the first surgery, the same five animals were subjected to an additional surgery to assess the presence or absence of blood flow through the vascular loop, and samples were collected for histological analysis. This cycle was performed five times. RESULTS: Of the rats euthanized four to five weeks after the first surgery, no blood flow was observed through the graft in 80% of the cases. In the group euthanized three weeks after the first surgery, no blood flow was observed in 20% of the cases. In the groups euthanized one to two weeks after the first surgery, blood flow through the vascular loop was observed in all animals. Moreover, intimal proliferation tended to increase with the duration of the postoperative period. Two weeks after surgery, intimal proliferation increased slightly, whereas strong intimal proliferation was observed in all rats evaluated five weeks after surgery. CONCLUSION: Intimal proliferation was the most significant change noted in venous grafts as a function of the duration of the postoperative period and was directly correlated with graft occlusion. In cases in which vascular loops are required during free flap reconstruction, both procedures should preferably be performed during the same surgery

Comparative Study Related to Cardiovascular Safety between Bupivacaine (S75-R25) and Ropivacaine in Brachial Plexus Block

Background and objectives Bupivacaine is a first choice for regional anesthesia considering its effectiveness, long duration and less motor blockade. Bupivacaine (S75-R25) is a mixture of optical isomers containing 75% levobupivacaine (S-) and 25% dextrobupivacaine (R+) created by a Brazilian pharmaceutical company. This investigation compared cardiac safety and efficacy of bupivacaine S75-R25 with vasoconstrictor and ropivacaine for brachial plexus blockade.Methods Patients were randomized to receive brachial plexus anesthesia with either bupivacaine S75-R25 with epinephrine 1:200,000 (bupi) or ropivacaine (ropi), both at 0.50%, in 30 mL solution. We registered a continuous Holter ECG throughout the procedure, as well as the Lovett scale of force in addition to monitoring (heart rate, pulse oximetry and non-invasive blood pressure). The incidence of adverse events was compared with the chi-square or Fisher test.Results We allocated forty-four patients into two groups. They did not show any difference related to age, weight or height, gender, as well as for surgical duration. Supraventricular arrhythmias were not different before or after the plexus blockade, independent of the local anesthetic chosen. Loss of sensitivity was faster for the bupivacaine group (23.1 ± 11.7 min) compared to the ropivacaine one (26.8 ± 11.5 min), though not significant (p = 0.205, Student t). There was a reduction in the cardiac rate, observed during the twenty-four-hour Holter monitoring.Conclusions This study showed similar efficacy between bupivacaine S75-R25 for brachial plexus blockade and ropivacaine, with similar incidences of supraventricular arrhythmias. Keywords: Amides, ropivacaine, Anesthesia, Conduction, Brachial Plexus, Bupivacaine, Electrocardiography, Ambulatory, Stereoisomerism

Estudo comparativo entre bupivacaína (S75-R25) e ropivacaína para avaliar a segurança cardiovascular em bloqueio do plexo braquial

JUSTIFICATIVA E OBJETIVOS: Bupivacaína é o fármaco de escolha para anestesia regional por causa da eficácia, longa duração e do bloqueio motor menos intenso. Bupivacaína (S75-R25) é uma mistura de isômeros ópticos que contém 75% de levobupivacaína (S-) e 25% de dextrobupivacaína (R+) e foi criada por uma companhia farmacêutica brasileira. Este estudo comparou a eficácia e segurança de bupivacaína S75-R25 com vasoconstritor e ropivacaína para o sistema cardiovascular em bloqueio do plexo braquial. MÉTODOS: Pacientes foram randomizados para receber bloqueio do plexo braquial com bupivacaína S75-R25 (Grupo B) com epinefrina 1:200.000 ou ropivacaína (Grupo R), ambos os fármacos a 0,50%, em 30 mL ECG contínuo (Holter) foi registrado durante todo o procedimento, bem como a escala de força de Lovett, além de monitoramento (frequência cardíaca, oximetria de pulso e pressão arterial não invasiva). A incidência de eventos adversos foi comparada com os testes do qui-quadrado ou exato de Fisher. RESULTADOS: Quarenta e quatro pacientes foram estudados. Não houve diferença significativa em relação à idade, peso, altura, gênero e tempo cirúrgico. Não houve diferença entre arritmias supraventriculares antes ou depois do bloqueio do plexo braquial, independentemente do anestésico local escolhido. A perda de sensibilidade foi mais rápida no Grupo B (23,1 ± 11,7 min) em comparação com o Grupo R (26,8 ± 11,5 min), embora não significativa (p = 0,205, teste t de Student). Houve uma redução da frequência cardíaca, observada durante a monitoração contínua de 24 horas (Holter). CONCLUSÃO: Este estudo demonstrou eficácia semelhante entre bupivacaína S75-R25 e ropivacaína para bloqueio do plexo braquial, com incidências semelhantes de arritmias supraventriculares

Measurement of the flexing force of the fingers by a dynamic splint with a dynamometer Medida da força de flexão dos dedos da mão através de órtese dinâmica com dinamômetro

PURPOSE AND METHODS: In order to determine forces acting upon an articular joint during hand rehabilitation, a dynamic splint was built and connected to a dynamometer (capable of measuring forces in the range 0 - 600 gf). Through trigonometric calculation, the authors measured the flexing force in the proximal interphalangeal joint of the middle finger at 30&deg;, 45&deg;, 60&deg;, and 90&deg; of flexion. Measurements were obtained in a population of 40 voluntary adults, 20 females and 20 males, This flexing force was correlated with age, sex, and anthropometric measures. RESULTS: Force in the flexing tendon is maximal at the start of flexion, and decreases as the angle of joint flexion increases. A relationship was observed between finger length and the magnitude of the force exerted on the tendon: the longer the finger, the greater the force exherted upon the tendon. Force is greater at all the measured angles, (except 30&deg;) in males and in individuals of higher stature, and bigger arm span. CONCLUSIONS: The flexing force can be effectively measured at all flexing angles, that it correlates with a number of different anthropometric parameters, and that such data are likely to open the way for future studies.<br>OBJETIVO E MÉTODOS: Em virtude do desconhecimento relativo às forças que atuam em uma articulação durante o processo de reabilitação da mão, foi confeccionada uma órtese dinâmica que, acoplada a um dinamômetro, mediu, através de cálculos trigonométricos, a força (entre 0 a 600gf), flexora na articulação interfalângica proximal do terceiro dedo, a 30º, 45º, 60º e 90º de flexão. Estas medidas foram obtidas, em uma população de 40 adultos voluntários, 20 do sexo feminino e 20 do masculino, e confrontadas com idade, sexo e medidas antropométricas como estatura, envergadura e comprimento do dedo. RESULTADOS: Os resultados do estudo demonstraram que o tendão flexor é submetido à máxima força no início da flexão e que a força no tendão flexor diminui conforme aumenta o grau de amplitude articular. Observou uma relação entre o comprimento do dedo e a magnitude da força exercida no tendão durante a flexão do dedo, sendo que nos dedos mais compridos os tendões são submetidos a forças maiores. Quando comparou a estatura e envergadura com a magnitude da força aplicada no tendão flexor, observou uma relação positiva em todos os graus de flexão estudados, exceto a 30º. O sexo masculino apresentou maior força em todos os graus de amplitude articular. CONCLUSÕES: Conclui que é possível medir a força de flexão transmitida pelos tendões flexores através de uma órtese acoplada a um dinamômetro, que esta força é maior nos indivíduos do sexo masculino, com dedos mais longos, de maior altura e envergadura e que tais dados permitirão o desenvolvimento de futuros trabalhos no campo da reabilitação da mão, auxiliando pacientes portadores de lesões de tendões, retração cicatricial, deformidades e rigidez articular

The Versatile Adani`s Flap for Fingertip Coverage Indications and Case Reports

Heterodigital pedicle flaps have 2 possible patters of vascularization: anterograde flow (Littler) or reverse flow (Adani). The Adani`s flap uses the Y-V pedicle lengthening principle. The flap is raised from the adjacent uninjured finger based on the digital artery. The common digital artery is ligated and a long pedicle is formed from the 2 converging digital arteries to supply a reverse flow flap. Four patients with severe fingertips injuries were submitted to surgical treatment with the Adani`s flap. All flaps integrated and provided skin coverage. The Adani`s flap has a long vascular pedicle that allows a wide arch of transposition. An easier vascular dissection in a site distant from the trauma which evolves a higher diameter digital artery and proximal interphalangeal arterial system promotes a high survival rate and good functional results. Adani`s flap is a reliable technique for severe fingertip injuries