[Complex evaluation of hand function]. / Die komplexe Bewertung der Handfunktion.

The authors offer a method of assessment of hand function which renders numerical data, in which all functions of the hand are represented with appropriate emphasis. The result of the examination is expressed as a percentage of perfect function. The method, which seems on first reading somewhat complicated, can be simplified very much with a computer aided work-up of data. The method is suggested first of all for the assessment of the results of healing in severe complex hand injuries. It is also suitable for the expression of hand function in all cases (for example, judgement of the decrease of working capacity and decisions on insurance claims, etc.).

[Double flap reconstruction of extended facial defects]. / Kiterjedt facialis defektusok kettós lebenyes rekonstrukciója.

The authors report the reconstruction of large facial defects remaining after resection of two advanced facial cancer cases. In both cases double flap closures were carried out. In the first case the internal flap was created from the remaining part of the oral mucosa membrane, while in the second a forearm fascio-cutan free flap was used. For external closure in both cases platysma based transpositional flaps were used, prepared from the neck. On the basis of excellent aesthetic results and safe applicability the authors recommend the more frequent use of this method.

[Laryngopharyngectomy and free jejunal graft reconstruction in the treatment of hypopharyngeal tumors]. / Laryngopharyngectomia és szabad jejunum transzplantátummal végzett pótlás hypopharynx tumor kezelésében.

The authors performed a total laryngopharyngectomy due to a hypopharyngeal neoplasm. The continuity of the alimentary tract was restored by the insertion of a vascularized free jejunal graft, using microsurgical technique. On the occasion of this case the authors give a survey of the therapeutical methods used in the therapy of hypopharyngeal tumors, of the indications of the free jejunal transplant and of the technical issues and complications of this procedure.

[Possibilities of finger substitution]. / Ujjpótlások lehetöségei a kézen.

Authors deal, in connection with their clinical cases, with the replacement of the fingers of the hand. Attention is called to the fact, that a minimal requirement of the reconstruction, performed on the severe, multiply amputated hand, should be the formation of a "basic hand", and that at the planning of such operations the aim may be the reconstruction of the function of the hand only. Among the methods presented the most modern methods, requiring microvascular surgical technique, are also shown. Although the right of using these is obvious, the older, however well proved methods should not be forgotten either. The possibilities of finger replantation are described didactically; considering the extent of this theme however authors did not strive to completeness.

[Substitution of the thumb by transplantation of the second toe]. / Hüvelykujj-pótlás második lábujj átültetésével.

Authors perform for the substitution of the thumb beside several other operations the transplantation of the second toe. The transplantation is carried out with the reconstruction of the arterial circulation, built on the I. metatarsal artery. Until now 18 substitutions of the thumb were carried out. The etiology of the lack of the toe is variable, in the great majority it is of traumatic origin however purulent process and attempt of suicide occur. With the observation of the rules of structural reconstruction good functional result may be reached. In more than a third of the cases both the sensitivity and the mobility are excellent. The use of this method is suggested first of all in cases where alternative substituting operations are out of question.

[Injuries to the knee extensors. Rupture of the patellar tendon and the quadriceps]. / A térdízületi extensor apparátusának sérülései. Patella-in és quadriceps ruptura.

Authors discuss, based on the experiences of their 18 cases, the injuries of the knee extensors. 5 ruptures of the quadriceps and 9 of the lig. patellae propr. were observed in the 14 cases controlled. Based on their own experiences and the standpoints of the literature they suggest the operative therapy within 6 hours in the open injury and within 1-5 days following the accident in closed cases. The experiences, the operative technique, the viewponts of the aftercare and the end results are described.

[Substitution of soft tissue defects of septic origin on the back of the hand by transplantation of a free composite flap]. / A kézhát szeptikus eredetü lágyrész defektusának pótlása komposit lebeny szabad átültetésével.

Authors report on substitution of severe skin and extensor tendon defect on the back of the hand, developed after a II. grade open septic metacarpal fracture. For the covering of the defect of the soft tissue the paratenon--tendon--skin free flap unit was used, supplied by the a. dorsalis pedis. In one operation the skin in full thickness and the extensor tendons could be substituted at the same time the suppuration was eliminated and the pseudarthroses stabilized with lamellar osteosynthesis.

Aimed application of antibiotics in treating hand infections.

Surgical exploration is of prime importance in treating hand infections. In addition, it is essential to apply up-to-date and adequate antibiotic treatment. Authors employed antibiotics during the treatment of hand infections of 65 various aetiologies and types by considering the antibiotic sensitivity spectrum of the most frequent pathogens as also the effective concentration of the antibiotic acting in the inflammatory focus. For assessing effective antibiotic concentrations, samples were collected during exploration from the inflammatory tissues, and based on their assessments, it was pointed out that an adequate inhibitory antibiotic concentration cannot be reached by each antibiotic by applying it in the usual dose and way. The use of certain antibiotics is recommended in view of the most frequent pathogens of hand infections, of the spectrum of the antibiotic selected by the authors as well as in that of the measured tissue antibiotic concentrations in the dosage used by them. The effective application as well as dosage are also published. Regarding that, in practice, antibiotic treatment should be started according to the nature of the disease without knowing the spectrum of resistance and the pathogen, it is considered important for them to select initially, beside the surgical treatment, an antibiotic which is probably effective and is capable of entering in a sufficient amount the focus of inflammation.

[Results of replantation of limbs]. / Végtag-replantációink eredményei.

Authors describe 7 cases of limb replantation in their material. The field of indication is reviewed, the early postoperative complications and the possibilities of their treatment are discussed. The means of reaching the possible best results are examined. The ways of performing the possible optimal limb replantation are scheduled on the basis of their own experiences.

[Use of a distally pedicled radial artery as an island flap for covering traumatic skin losses]. / Disztálisan nyelezett artéria radiális szigetlebeny alkalmazása akut traumás börhiányok fedésére.

Authors performed plastic operation using lower arm insulated flap with distal pedicle in 2 cases for covering traumatic skin defects on the dorsal side of the hand. Attention is called to the advantages of this method. Beside the shorter time of treatment in many cases a series of operations can be avoided by the primary covering with an insulated flap.

[Model studies of the antibiotic release of gentamycin, tobramycin and cephalothin polymethylmethacrylate beads in vivo]. / Modellversuche zur Antibiotikaabgabe von Gentamycin-. Tobramycin- und Cephalothin-Polymethylmethacrylatkugeln in vivo.

Gentamycin-, tobramycin-, and cephalothin-polymethylmethacrylat beads were implanted into a bone cavity of the rabbit tibia. The antibiotic release of the implants was observed by measure of the antibiotic concentration of the secretion respectively of the neighbouring bone tissue in the surroundings of the beads produced by punction. An antibiotic concentration about 1 microgram/ml could be measured with gentamycin and tobramycin for 120 to 150 days and with cephalothin for 30 to 50 days in the surroundings of the beads.

[Selective denervation of the wrist joint]. / A csuklóízület szelektív denervációja.

The long-lasting pains of the wrist cause many times problems in the everyday trauma treatment. They are also frequently encountered by orthopedists, internists and rheumatologists. The pain is most frequently the characteristic symptom of osteoarthritis of the wrist, however it may appear without an accident (as a part of destructive and systemic disease, damaging the joints) too. Based on the paper published by WILHELM in 1966 we have performed in this Institute selective denervation of the wrist in 77 cases, with good results in 45 per cent. Our material is analysed in etiologic groups, giving light to the field of indication of this operation, that can be considered most generally as an alternative solution versus radiocarpal and intercarpal arthrodesis. This paper reports beside the description of the method on our favourable experiences, that are published in hope of a more wide spreading of the method.

[Finger replantation]. / Ujj replantációk.

Authors performed from 1979 to 1989 on 89 fingers of 65 patients replantation or revascularization operations after total or partial amputations. The procedure was unsuccessful in 16 cases. The operation was successful in 82 per cent and this corresponds to the literary data. It is stressed that the operative result depends not from the survival of the finger but from the functional end result.