Temporoparietal fascial free flap for correction of first web space atrophy.

Fourteen temporoparietal fascial free flaps were used for correction of first web space atrophy from ulnar nerve palsy in 13 patients. Ten sustained ulnar nerve injuries and three suffered from leprosy. The procedures were performed under general anesthesia except one leprosy patient with bilateral ulnar nerve palsy in which local anesthesia and brachial block were employed to harvest bilateral free flaps and recipient site preparations, respectively. The follow-up time varied from 4 to 64 months. The postoperative results were satisfactory and there was no resorption of the free flaps. The consistency of the augmented first web space was soft and compressible like natural feel. The size of the flap was more than enough for augmentation of first web space and donor site morbidity was minimal and accepted by all patients. We conclude that temporoparietal fascial free flap is an ideal autogenous tissue for correction of first web space atrophy.

Immediate postoperative active mobilization versus immobilization following tendon transfer for claw deformity correction in the hand.

PURPOSE: To test the hypothesis that immediate postoperative active mobilization of tendon transfer following claw correction with flexor digitorum superficialis 4-tail pulley insertion will achieve similar outcomes to immobilization in a cast for 3 weeks. METHODS: In a prospective study, 32 hands with complete ulnar nerve paralysis had flexor digitorum superficialis middle finger 4-tail pulley insertions for 4-digit claw deformity correction and mobilization for tendon transfer rehabilitation on the second day after surgery. Surgical technique was modified to increase the strength of transfer slip insertion. Historical records of 32 mobile claw deformities treated prior to the prospective trial in the same institution with a similar procedure and immobilized in a cast for 3 weeks was used for comparison. Outcomes were assessed by (1) the status of tendon transfer attachment to flexor pulley during immediate mobilization to detect tendon transfer insertion pullout; (2) results of the claw correction in open hand position and intrinsic plus position, and range of digit flexion using identical outcome measures (3) morbidity following surgery; and (4) comparing results of immediate mobilization with immobilization. RESULTS: There was no incidence of transfer insertion pullout during immediate postoperative mobilization. There was no clinically relevant difference in results of claw correction of both groups in open hand and intrinsic plus position. Total active motion of digit flexion was considerably better with immediate mobilization at late result. A reduction of morbidity by 21 days and an earlier return to daily living activities were benefits to the patient with immediate postoperative mobilization of tendon transfer for claw correction. CONCLUSIONS: This study supports the hypothesis. Immediate postoperative active mobilization is safe and has similar outcomes of deformity correction compared to immobilization. Immediate mobilization has the added benefits of reduced morbidity and improved total active range of digit flexion compared to immobilization. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

ECRL--a wrist extensor with multiple uses in deformity correction.

Extensor carpi radialis longus muscle has been used in various types of procedures for corrective hand surgery and is a favored muscle for correction of finger clawing due to ulnar nerve palsy in leprosy because its removal leaves an insignificant motor deficit and gives a linear scar at the donor site. It is usually not paralyzed in leprosy. The muscle, being phasic, is easy to re-educate. The excursion of the muscle is similar to lumbrical muscles which it substitutes. Since the muscle is dorsally located, the transfer does not lose tension due to adaptive wrist flexing habit. Its tendon is usually thick enough, can be split into two and used as graft to elongate the muscle-tendon unit or for ligament reconstruction in cases of trapezio-metacarpal joint arthritis.

Bilan de recherches physiopathologiques sur la nevrite lepreuse: 1-role de la temperature, des microtraumatismes par elongation ou subluxation nerveuse et de la striction canalaire / ?

(Role of temperature, microtraumatisms by elongation or subluxation and canalar stricture.)Cold has a slight aggravating effect on leprosy which is observed in some countries as Iran, South Russia, North India and the Andean cordillera. The subluxation of the ulnar nerve has facilitating effect in the development of the neuritic damage in a limited number of patients. The elongation is important for the production of the ulnar neuritis. The canalar stricture is a major factor causing nerve damage in leprosy. It explains the segmentary localization of the principal damages of the leprous nerves in the proximal areas situated above the tunnels. Intraneural hypertension appears first and is responsible for the swelling of the nerve which gets entraped inside the tunnel. A circulus viciosus is, then, created which maintains and aggravates the intraneural hypertension