Dupuytren's disease in African-Americans.

Seventeen African-American patients were operated on for Dupuytren's contracture over a 14-year period. Six-month minimum follow-up was available for 16 patients. The initial deformity, and results of surgical release of Dupuytren's contracture in this population was similar to that described in North Europeans.

Forearm replantation--long-term functional results.

The replantation of amputated extremities is justified only by the ultimate good function and appearance of the replanted part. This paper is a critical review of our clinical experience with forearm replantation and revascularization in 6 patients over the past ten years. All replanted parts survived. The long-term functional results of the forearm replants are analyzed. Return of function depends on nerve regeneration. The functional outcome in the first patient was unsatisfactory due to poor motor and sensory return. Specific attention directed to careful primary neurorrhaphy in subsequent cases yielded favorable results. We believe that two factors in particular are central in achieving good functional results in forearm replantation--careful repair of the severed major peripheral nerves, and postoperative hand rehabilitation programs.

Replantaion of portions of four fingers-long-term functional results.

We present a seven-year follow-up of a previously published case of 4-finger replantation in one hand. Replantation of the digits proved justified, yielding favorable results in sensory return, motor function, and appearance. We note that finger replantations distal to the proximal interphalangeal joint are associated with better functional results than those at more proximal levels. Impaired motion of the distal interphalangeal joint does not appreciably restrict the function of the hand, provided adequate range of active movement is preserved at the metacarpophalangeal and proximal interphalangeal joints. An uninjured proximal interphalangeal joint is critical in achieving favorable motor return after finer replantation. Technical excellence in digital nerve repair contributes to favorable sensory axonal regrowth. Digital replantation distal to the proximal interphalangeal joint may be viewed as primary microneurovascular reconstruction of a problem finger amputation stump. We believe, in the case of sharp amputation distal to an intact proximal interphalangeal joint, that single-digit replantation is indicated, given the likelihood of favorable functional and aesthetic results.

Severe ischemia of the hand following radial artery catheterization.

Percutaneous radial artery catheterization for blood gas monitoring and continuous arterial pressure recording has become a common place procedure in the management of critically ill patients. Five patients with severe ischemia after cannulation have been encountered in the past 20 months, four of whom lost segments of one or more digits. Review of the events preceding and during radial artery cannulation allowed elucidation of the following principles: radial artery catheterization should be preceded always by a negative Allen test; the catheter should be removed after 12 to 18 hours, especially if the patient is critically ill, is hypercoagulable, or has impaired tissue perfusion; the superficial temporal artery is safer to use and permits long-term cannulation (5 to 7 days) without ill effect; and agressive approach to assessing flow and arterial reconstruction is essential if severe ischemic symptoms occur during or after radial artery catheterization. Ancillary measures, including cervicodorsal sympathetic block, intravenous low molecular weight dextran and heparin, and intra-arterial reserpine and fibrinolysin, may improve palmar circulation but should not be substituted for both noninvasive and angiographic study of arterial flow, followed by surgical restoration of flow, when indicated.