Intra-tendinous gout in a repaired flexor digitorum profundus.

A patient presented with decreased flexion and triggering following a zone IIc flexor digitorum profundus repair 7 years previously. Chalky-white deposits, confirmed histologically as gout, were present at the repair site.

Microvascular soft tissue reconstruction of the digits.

INTRODUCTION: Composite tissue loss to digits following trauma may require flap coverage. Local reconstruction techniques are popular but can result in a functional limitation at the donor site. Small free flaps though complex, may provide a superior alternative. METHOD: We retrospectively reviewed the case-notes of all patients who had a small free flap to a digit following trauma. The time period was 4 years (2000-2004). Sixteen patients with 18 digital free flaps were identified. These comprised of 10 venous flow-through flaps, one lateral arm flap, one great toe to thumb pulp transfer, three first web space flaps from the foot, one medial plantar flap and two free posterior interosseous flaps. All 16 patients were invited for clinical review at an out-patients clinic. Ten patients (11 flaps) attended follow-up. Standardised assessment of outcome in terms of scar quality at both the recipient and donor sites, sensibility, range of motion and function of the hand was completed. RESULTS: Overall the average follow-up period was 14 months, with 16 out of 18 flaps surviving. Of the patients that attended for clinical review, the majority recovered excellent function of the hand (quick-DASH--av. 5.7) with satisfactory aesthetics, minimal pain or limitations in range of motion. The flaps were all soft and durable. Ten flaps recovered protective but not discriminative sensation (only one flap was innervated). The three patients whose donor site was the first-web space of the foot developed significant hypertrophic scarring. CONCLUSION: Small free flaps provide an acceptable method of reconstructing digital defects. Venous flow-through flaps provided the best overall results in this series. The donor site for first-web space flaps is probably unacceptable.

Revision amputation achieving maximum function and minimizing problems.

Revision amputation is one of the most commonly performed operations in hand surgery. Despite being considered, a relatively straightforward procedure, it demands the full skills of the operating surgeon. Appropriate management is dependent upon a comprehensive understanding of hand anatomy and function, the ability to communicate clearly with the patient, and a repertoire of technical skills that allows the surgeon to select the most appropriate line of management.

Double V-Y advancement flaps in the reconstruction of skin defects of the anterior lower limb.

A double V-Y advancement flap based upon a vertical subcutaneous pedicle was assessed for reconstruction of moderate sized defects of the anterior lower leg. The technique is described and the results of a retrospective analysis of thirteen cases are given. The procedure has proven to be a reliable alternative means of providing skin cover in this area.

Neonatal primary hyperparathyroidism--a case report and review of the literature.

Primary Hyperparathyroidism in the neonate is exceptionally rare and is almost invariably fatal unless a prompt diagnosis is made and urgent surgical intervention instituted. The first case was reported in 1947 by Prat et al (30) and since then 35 cases have been published. The true number is probably greater due to the diagnosis being missed both clinically and at autopsy and it has been suggested as a possible contributor to a small number of cases of the Sudden Infant Death Syndrome (17). The authors report on a case presenting in a female neonate, review the world literature and discuss the clinical manifestations, investigators findings and the management options available.