Nail avulsion: indications and methods (surgical nail avulsion).

The nail is a subject of global importance for dermatologists, podiatrists and surgeons. Nail avulsion is a frequently undertaken, yet simple, intriguing procedure. It may either be surgical or chemical, using 40% urea. The former is most often undertaken using the distal approach. Nail avulsion may either be useful for diagnostic purposes like exploration of the nail bed, nail matrix and the nail folds and before contemplating a biopsy on the nail bed or for therapeutic purposes like onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy and retronychia. The procedure is carried out mostly under local anesthesia with or without epinephrine (1:2,00,000 dilution). Besides the above-mentioned indications, the contraindications and complications of nail avulsion are briefly outlined.

Re-enablement of the neurologically impaired hand--2: surgical correction. report of a surgical workshop held at Green Pastures Hospital and Rehabilitation Centre, November 2004, Pokhara, Nepal.

The last half-century has seen tremendous advances in the surgical treatment of neuropathic conditions of the hand. Many of these procedures give clear benefit to patients and have been established by clinical practice and well-formulated assessment. However, much remains to be discovered, especially with respect to which procedures should be used on which hands, and the impact of various procedures on the ability to carry out activities of daily living. Increased communication between the 'West', where funding is available for well designed trials and where reference textbooks are usually published, and the 'East', where the surgery is most commonly performed, will undoubtedly lead to an even better understanding of the treatment of the neuropathic hand.

Reconstructive surgery in upper limbs in leprosy.

Of all the deformities in leprosy, 80% require minor surgery and the rest major surgery. Upper and lower limbs and face are mainly affected by deformities. Either the median or ulnar nerve and rarely the radial nerve are involved in isolation or in combination. Tendon transfer is the only option available in cases of deformities like simian hand, ulnar claw hand, wrist drop and failure to the metacarpals. The only motor function to be restored in median nerve palsy is opponensplasty. For radial nerve palsy standard FCU transfer, FDS transfer and FCR transfer are the reconstructive methods. For ulnar nerve palsy, an intrinsic minus hand function is restored by the motors PL, ECRL, FDS, EIP or EDM extended by four tail fascia lata graft onto lateral or ulnar bands of fingers. When ulnar nerve is part of much more extensive paralysis, reducing the availability of suitable motors, static mathods of conection of claw hand are done.

Surgery for neuritis in leprosy: indications for and results of different types of procedures.

From December 1988 to December 1992, 129 surgical procedures were performed on the peripheral nerves of 64 leprosy patients at the Hospital Cardinal Léger de l'Institut Fame Pereo for leprosy control in Haiti. Sixty-four patients totalizing 129 nerves with sufficient clinical data form the basis of this study. Based on the retrospective analysis of the operated cases, a new classification built on macroscopic findings of the involved nerves is presented. Five grades, according to the presenting aspects of these nerves, are set up as guides for different surgical procedures to be performed on the nerves: external decompression for the lesser grades I and II, intraneural neurolysis, interfascicular neurolysis for the higher grades III and IV, cleaning, and debridement for grade V. The final results are discussed. This new macroscopic grading done at surgery helps to minimize the aggressive procedures performed on nerve trunks, decrease the morbidity of surgical action on the nerve vascular structures, and consequently, preserves all possible sensory and motor functions of a nerve.

Characteristics and operative management of supination external rotation ankle fractures.

Identification and management of the acutely fractured ankle is discussed by the authors. The Lauge Hansen classification system, and in particular, supination-external rotation injuries, is evaluated. Intraoperative technique, perioperative considerations, and generalized management of these pathologic conditions are reviewed, according to the authors' experiences.