Open Surgical Excision of Dorsal Wrist Ganglia: Puncturing the Dome Reduces Surgery Time.

Background: The following study is retrospective and compared the operative time and complications using two techniques of surgical resection of primary dorsal wrist ganglia in adults. Methods: Surgery was performed by the senior author (M.M.A.) through a transverse skin incision. The dome of the ganglion is dissected in both techniques. In the first technique (group A patients, n = 20 patients), dissection is continued to the base of the ganglion to reach the stalk near the scapho-lunate ligament. The stalk is transected and cauterized near the ligament. This surgical technique has been practiced by the senior author for 25 years. Over the last 5 years, the author has modified the technique (group B patients, n = 20 patients) by puncturing the dome of the ganglion following dome dissection. About two-thirds of the content of the ganglion is removed, and a mosquito is then used to close the puncture site. Dissection of the base of the ganglion to the stalk becomes easier and quicker, and the stalk is transected and cauterized near the scapho-lunate ligament. Results: There was one recurrence in each group. Other complications were not seen in either group. The mean operative time (SD) was 30.75 (SD = 2.98) minutes for group A; and 20.75 (SD = 2.25) minutes for group B. An independent-samples t test was used to compare the operative time of both groups, which showed the difference was statistically significant (P < 0.001). Conclusions: Our study showed that intentionally puncturing the dome of the ganglion makes the dissection of the base quicker, without increasing the risk of complications.

Ulnar Ray Deficiency: A New Classification and a Unique Case Report.

Ulnar ray deficiency is a rare congenital upper limb defect. We report on a unique case with hand-on-flank deformity on the one side and limb truncation on the contralateral side. The standard of care for the hand-on-flank deformity is to do humerus osteotomy to reposition the hand anteriorly. However, the right limb truncation in our patient made the senior author decide not to do the osteotomy. Final assessment showed that the posterior hand position enabled the patient to reach the ano-genital areas, the pocket, and the mouth. It was concluded that in case of hand-on-flank deformity in one limb and limb truncation of the contralateral limb, osteotomies to bring the hand anteriorly are not advised.

Fibromodulin: Structure, Physiological Functions, and an Emphasis on its Potential Clinical Applications in Various Diseases.

Fibromodulin (FMOD) is one of the small leucine-rich proteoglycans. A search of the literature did not reveal any paper that specifically reviews the potential clinical applications of FMOD in the management of human diseases. First, the structure and physiological functions of FMOD were reviewed. Then its potential clinical applications in various diseases including diseases of the skin, tendons, joints, intervertebral discs, blood vessels, teeth, uterus, bone and kidney were reviewed. FMOD is able to switch the adult response to skin wounding to the desired fetal response of scarless healing. Lowered levels of FMOD would be desirable in the management of tendinopathy, uterine fibroids, tumors resistant to radiotherapy, glioblastomas, small-cell lung cancer, and primary liver/lung fibrosis. In contrast, increased levels of FMOD would be desirable in the management of acute tendon injuries, osteoarthritis, rheumatoid arthritis, temporo-mandibular disease, joint laxity, intervertebral disc disease, neo-intimal hyperplasia of vein grafts, teeth caries, periodontal disease, endometrial atrophy, osteoporosis and diabetic nephropathy. Furthermore, FMOD may be used as a prognostic marker of cerebrovascular events in patients undergoing carotid endarterectomy and a marker for prostatic cancer. Finally, the use of FMOD in the treatment of symptomatic endometrial atrophy should be explored in women who are unable to use the standard estrogen management for endometrial atrophy. The review concluded that clinical trials in humans should be initiated to investigate the potential therapeutic effects of FMOD.

Defining the Indications of Pedicled Groin and Abdominal Flaps in Hand Reconstruction in the Current Microsurgery Era.

Three decades ago, pedicled flaps from the groin and abdomen were the workhorses in hand and forearm reconstruction. These pedicled flaps have several disadvantages including patient discomfort, stiffness, the need for flap division, and the inability to elevate the hand after acute trauma. Hence it is not surprising that free flap reconstruction has become the method of choice in coverage of complex hand and forearm defects. Despite this, pedicled flaps may still be indicated in the current era of microsurgery. Based on a review of the literature and the author's experience, the current review defines these indications as follows: complex defects in children aged less than 2 years; coverage of digital stump defects in preparation for toe-to-hand transfer; high-voltage electric burns with the hand surviving on collateral blood supply; salvage of the thumb ray in high-voltage electric burns with concurrent thrombosis of the radial artery; mutilating hand injuries; length preservation of multiple digital amputations in manual workers; and multiple defects within the digits, hand, or forearm. These indications are discussed along with clinical examples.

Expression of nAG and Prod-1 in Terminal Phalanx Amputation Stumps of Adult Mice: An Experimental Model of Bone Regeneration in Higher Vertebrates.

BACKGROUND: nAG and Prod-1 are proteins responsible for the regeneration of completely amputated limbs in salamanders (which are lower vertebrates). The purpose of this study was to introduce an experimental distal phalanx amputation model in mice (which are higher vertebrates) in which nAG and Prod-1 are expressed in the amputation stumps. METHODS: Sixteen mice with amputation of the distal two-thirds of the distal phalanx were used. One hind limb was used and the central three digits were amputated. Injection of nAG and Prod-1 plasmids was performed in the footpad twice weekly in experimental mice (n = 8), and injection of solution only (without the plasmids) was performed twice weekly in control mice (n = 8). RESULTS: nAG and Prod-1 were expressed in experimental stumps only. This expression results in quicker and more mature bone regeneration in experimental animals, and this was shown using histology and immune stains to osteocalcin (an osteoblast marker). Finally, quantitative mRNA showed a 21-fold increase of osteocalcin in experimental stumps compared with control stumps, and this was statistically significant. CONCLUSION: Injection of nAG and Prod-1 into the footpad will result in their expression in the distal amputation stumps, and this will enhance bone regeneration in the model described.

A review of phalangeal neck fractures in children.

Phalangeal neck fractures are uncommon and are almost exclusively seen in children. Most paediatric hand fractures are treated conservatively and an excellent outcome is expected in almost all cases. Paediatric phalangeal neck fractures are different mainly because they are unstable and have a high risk of complications. Even minimally displaced phalangeal neck fractures are known to be unstable following reduction and hence k-wire fixation is required. Furthermore, complications such as persistent deformity, nonunion, and avascular necrosis are commonly seen following management of phalangeal neck fractures; such complications are extremely rare in other paediatric hand fractures. The current paper aims to review the diagnosis, classification, management and complications of these fractures in children. The paper also aims to introduce an extended classification of phalangeal neck fractures and to explain the clinical relevance of the extended classification.