Infected palmar pits: a rare presentation of Gorlin's syndrome.

This paper presents a rare hand presentation of Gorlin's Syndrome, also known as Naevoid Basal Cell Carcinoma Syndrome, which has not been reported previously. This condition is an autosomal dominant, multisystem condition whose diagnosis is important to ensure further surveillance and treatment of features of the condition not routinely dealt with by hand surgeons. However, hand surgeons should be aware of this condition and those parts of the syndrome which may present to them.

The management of hand injuries caused by sea urchin spines.

Injuries to the hand by sea urchin spines are not commonly seen in the United Kingdom. There are many varieties of sea urchins (Echinoidea) throughout the world. They have a spherical calcium carbonate exoskeleton covered with spines. Certain varieties may be venomous, in particular the flower urchin (Toxopneustes pileolus) found in the Indo-Pacific oceans. Injury may also be caused by the urchin spines or pedicellaria (delicate seizing organs equipped with jaws). A small number of hand injuries associated with sea urchin spines have been reported in the literature.

A prospective study of the treatment of fractures of the little finger metacarpal shaft with a short hand cast.

This prospective study describes the use of a short hand cast, which leaves the finger metacarpophalangeal and wrist joint free, for angularly displaced little finger metacarpal shaft fractures which require reduction. Twenty-seven patients with a mean age of 25 (range, 16-39) years with little finger or combined ring and little finger displaced metacarpal shaft fractures were prospectively recruited. All were treated by closed fracture reduction and immobilization in the cast. Patients were followed up at 1 week, 4 weeks, and between 6 and 12 months. At each of these follow-up visits posteroanterior and lateral radiographs of the metacarpals were performed to assess angulation of the fracture. The mean initial angulation of the 17 little finger metacarpal fractures with complete follow up was 40 degrees (range, 20-60 degrees ). Their mean final angulation at 6 to 12 months was 8 degrees. The fracture reduction was lost in three patients in whom the final angular deformities were 15 degrees (one patient) and 20 degrees (two patients). Journal of Hand Surgery (British and European volume, 2004)

The diagnostic accuracy of clinical examination in hand lacerations.

INTRODUCTION: Hand injuries account for a significant proportion of emergency department attendance. We investigated the diagnostic accuracy of clinical examination in patients with simple hand lacerations undergoing surgical exploration at our unit. METHODS: One hundred and sixty-five consecutive patients were identified as undergoing exploration of the hand. Case notes of these patients were reviewed. The clinical findings, made by emergency department doctors (ED) and hand surgeons (HS), were compared with the operative findings. RESULTS: A total of 101 patients were included following exclusion criteria. Both ED and HS correctly identified 68.2% of flexor tendon injuries. Overall, the ED diagnosed accurately significantly fewer extensor tendon injuries (ED 65.6% vs HS 75.0%, p<0.001). Similarly, HS diagnosed nerve injuries more accurately than ED (ED 54.5% vs HS 78.8%, p<0.005). DISCUSSION: Clinical examination forms an important part of the patient assessment, provides the surgeon with an idea of which structures are potentially injured, and its value should never be underestimated. Formal exploration, however, should be undertaken since both ED and HS missed about 30% injuries.

Breast reconstruction using deep inferior epigastric perforator flaps in EEC syndrome.

Ectrodactyly, ectodermal dysplasia, cleft lip/palate (EEC) syndrome is a rare condition that may result in failure of breast development. Breast reconstruction in these patients may pose a challenging problem, as they are young and reconstructive options should have minimal long-term complications. The use of deep inferior epigastric perforator (DIEP) flaps in breast reconstruction following breast cancer has been well described with good results. The use of DIEP flaps in breast augmentation, however, is far less common. We present the case of a young patient with EEC syndrome and mammary hypoplasia who underwent DIEP flap reconstruction for breast augmentation. The outcome was satisfactory to both patient and surgeon.