[The dorsoradial flap: a new flap for hand reconstruction. Anatomical study and clinical applications]. / Le lambeau dorsoradial : un nouveau lambeau pour la reconstruction des pertes de substance de la main. Etude anatomique et application clinique.

The authors report a new cutaneous flap harvested from the dorsal and distal quarter of the forearm: the dorsoradial flap. The vascularisation type of the cutaneous paddle belongs this flap to the anterograde and axial family flaps. The anatomical study carried out on thirty six fresh cadaver upper arms showed a constant and a consistent cutaneous collateral branch of the radial artery which arises at the apex of the first intermetacarpal space. Two anatomical types were recorded according to the origin of the dorsoradial artery: type I (84% of cases), the vessel arises directly from the radial artery; type II (16% of cases), it arises from a common trunk with the first dorsal intermetacarpal artery. Those anatomical findings does not influence the flap operative technique, the flap design and the location of the pedicle pivot point. The dorsoradial artery emerges vertically from the apex of the first intermetacarpal space, crosses the angle between the extensor pollicis longus tendon laterally and the extensor carpi radialis longus tendon medially and turns proximally towards the distal radio-ulnar joint. Over the dorsal aspect of the wrist, the dorsoradial artery enters the subcutaneous tissue, runs parallel to the extensor pollicis longus tendon at three millimeters in a medial position, passes over the medial collateral branch of the superficial radial nerve and irrigates all the distal and dorsal quarter of the forearm. The artery is consistently accompanied by two comitantes veins, which assume the venous drainage of the cutaneous territory. The flap paddle is designed over the distal dorsal forearm quarter, between the dorsal crease of the wrist distally, the ulnar crest medially and the radial crest laterally. All this skin territory can be harvested and supplied by the dorsoradial pedicle, but we always should deal with the needs of the defects reconstruction and the morbidity of the donor site. The vascular pedicle is outlined between the distal radio-ulnar joint and the apex of the first intermetacarpal space with a minimum of one centimeter width. The surgical procedure is carried out under a tourniquet without an upper arm exsanguination. The skin is firstly dissected over the vascular pedicle through an S shape incision; it is lifted on the dermo-hypodermis plan preserving all the superficial venous network with the pedicle. The flap is elevated from proximal to distal including the dorsal forearm fascia. Over the dorsal extensor retinaculum, the dissection is underwent close to it elevating all the subcutaneous tissues. The medial collateral branch of the superficial radial nerve should be identified and respected. At the distal border of the dorsal retinaculum, the extensor pollicis longus and the extensor carpi radialis longus tendons are identified and retracted. The pedicle dissection goes deeper between this two tendons towards the first web space. It takes all the areolar tissue around the pedicle in order to preserve the venous network of the cutaneous paddle. The donor site is closed primarily if the skin width does not exceed 3 cm or grafted secondarily. Its large rotational arc allows the cutaneous paddle to cover the dorsal hand and metacarpo-phalangeal long fingers defects, the dorsal aspect of the thumb and the first intermetacarpal space. It can also safely reach the palmar aspect of the wrist. We report four clinical cases where the dorsoradial flap was successfully applied. This preliminary clinical experience exhibits the vascular network reliability and the operative technique simplicity of this new cutaneous flap. We believe that it should be added to the armamentarium of the reconstructive hand surgeon and considered as a useful tool for soft tissue hand and thumb reconstruction defects.

[The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease]. / La plastie d'expansion en Oméga Oméga: une nouvelle technique de traitement chirurgical de la ténosynovite de De Quervain.

The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide the pulley and to reconstruct it suturing the different flaps. It can generate adherences between the extensor tendons, the overlying skin and the collateral branches of the radial nerve. The authors present a new and original plasty procedure of the first extensor compartment pulley, the "Omega" Omega plasty. It consists to liberate the anterior attachment of the pulley over the anterior lip of the styloïd process respecting its continuity with the periosteum flap. This conservative procedure is very interesting; it permits enough expansion of the tunnel volume decompressing the extensor tendons as a treatment of the De Quervain disease and respecting the anatomy and the continuity of the osteo-fibrous tunnel. This technique is simple, reliable and respects the first ray extensor tendons gliding physiology and biodynamic. In spite of our short clinical experience with only ten cases, all the patients retrieve a normal function of the thumb with complete disappearance of the first ray tenderness and pain without any complications. These preliminary results are encouraging and push us to consider the "Omega" plasty as a first choice for the surgical treatment of the De Quervain tenosynovitis.

[The Omega "Omega" pulley plasty. A new technique to increase the diameter of the annular flexor digital pulleys]. / La plastie d'expansion en Oméga "Omega". Une nouvelle technique d'expansion des poulies annulaires du tunnel digital fléchisseur.

The authors report a new technique of pulley plasty of the flexor digital system. It is not an operative procedure to reconstruct a damaged pulley but an original way to expand the volume of an intact pulley in order to adapt its volume to the diameter of the repaired flexor tendon. The flexor tendons ruptures in Verdan zone II and particularly in Tang zones IIA and IIB are often accompanied by an osteofibrous tunnel injury. Initially, the tendon sheath closure was advised after tendons repair. This sheath recovery had to have an effect on tendons nutrition by establishing the synovial cavity continuity and particularly to protect the tendons from adhesions formation. The closure of the digital tube was rapidly shown to be unnecessary creating an obstacle to the tendons movements without any effect on tendons healing. In primary tendon management, the tendon repair is associated with an increase of the tendon diameter. An incongruence appears with the surrounding digital tube with gliding resistance complicating the tendon injury recovery. In secondary tendon injury management, the flexor digital tube is subject to healing and inflammatory process. This situation with the absence of the flexor tendon generates a retraction with a collapse of the digital tunnel over the injured area. This incongruence between the repaired flexor tendons and the narrowed digital tube required a release of the retracted zone to restore an adequate volume. The only way reported is the "Venting" of a part or the total length of the pulley. This procedure even if it resolves the tendon gliding resistance, is still unacceptable. Indeed it destroys an important anatomical structure of the flexor tendon dynamic system. The flexor pulley Omega plasty "Omega" consists in releasing the lateral palmar attachment of the pulley enhancing its internal volume and increasing the flexor tendon gliding area. The digital tube is composed by the succession of five annular and three cruciform pulleys. The cruciform pulleys are thin and flexible. They retract during the digital flexion assuring the continuity of the digital tube, while the annular pulleys are thicker and fill a biomechanical function. There are two types of annular pulleys: the joint pulleys as A1, A3 and A5; they are attached to the palmar plates of the MP, PIP and DIP joints respectively. During the digital movement, they retract approximately 50% of their length. The osseous pulleys as A2 and A4 are fixed over the lateral and palmar borders of the first and the second phalanx respectively. It is on these pulleys that the Omega plasty is practised. The operative procedure is simple. It consists on a periosteal dissection over the one lateral border of the phalanx. The liberation is undergone palmarly releasing the lateral attachment of the pulley. It respects the anatomical continuity of the pulley and its mechanical properties. Indeed, the continuity of the pulley is fully respected with the periosteal flap of the digital tube floor maintaining sufficient attachment to the pulley to resist to the flexor tendon forces. The level of the flexor tendon injury and the digit position during the initial trauma will determine the level of tendon resistance and where the pulley plasty must be made. If the flexor zone II injury occurred with the digit in an extension position, the tendon conflict appears with the A2 pulley, while it arises with the A4 pulley if the digit was in flexed position. The Omega plasty creates the ideal conditions for an optimal flexor tendon movement recovery. It is a simple and a reproducible procedure. It doesn't distort the mechanical properties of the pulley and the digital tube. We used this pulley Omega plasty fifteen times in twelve patients. In 60% of the cases, the injury concerned the dominant hand, and in 67% of the cases, it was a work accident. In eight of our cases, the omega plasty was done in emergency at the same time of flexor tendon repair, while in the other seven cases, the pulley Omega plasty accompanied the late flexor tendon repair forgotten during the initial trauma management. In ten cases, the plasty concerned the A4 annular pulleys, while in the other five cases, it concerns the A2 annular pulleys. Four cases necessitate a secondary tenolysis three months after the tendon repair. Two patients moved out and cannot be included in our results. On the thirteen-remainder cases, nine retrieved a full digital flexion particularly those who underwent digital tenolysis, while the other four cases retrieved a satisfying digital function in spite of the partial DIP flexion. In our hand, the pulley Omega plasty "Omega" becomes almost a systematic procedure in conjunction with the flexor tendon repair. It offers the ideal conditions for a tendon healing and a physiological flexor tendons motion recovery.

[Introduction to the knowledge of subcutaneous sliding system in humans]. / Introduction à la connaissance du glissement des structures sous-cutanées humaines.

The mobility of our body structures is so intrinsic and natural to us that we tend to take it for granted. The very fact of being able to pinch your skin and lift it, then let it go and see it return to its initial shape and texture in just a few seconds may seem banal enough until you begin to think of all the elements involved. The same is true when you bend your fingers and think of the movement of the flexor tendon across the palm without external translation. For decades, scientists thought that the skin was simply an elastic structure with loose connective tissue and a more or less virtual space. However, in biomechanical terms, this explanation is very vague. These old concepts developed more than 50 years ago have evolved thanks to the impact of research at the microscopic level, and the global, mesospheric concept has been abandoned. And yet, surgical dissection in vivo demonstrates that there are only tissue connections, simply a histological continuum without any clear separation between skin and hypodermis, the vessels, the aponeurosis and the muscles. In fact, visible everywhere are structures, which ensure a gliding movement between the aponeurosis, the fat structures and the dermis. As they studied this system of gliding between the various organs, in particular at the level of the tendons, the authors noted the existence of a type of system composed of cables and veil-like structures that they term the Multimicrovacuolar Collagen Dynamic Absorption System (MCDAS). This system looks totally chaotic in organization and seems to function in a manner far removed from traditional mechanical structures. The functional unity of this sliding system is dependent upon a polyhedral three-dimensional crisscrossing in space of the microvacuoles, whose collagen envelope is type 1 or type 4 and whose content is made up of proteoglycoaminoglycans. The dynamic of this multimicrovacuolar system allows all of the subtle movements that occur within the body, thanks to its pre-stressed nature and the molecular fusion-scission-dilacerations that it is capable of. In this way, the system is mobile, can move quickly and interdependently, and is able to adapt is plasticity. This notion of microvacuoles is a fascinating one because it provides an explanation for the system's space-filling ability. The matter is composed of elements. However, although they seem to be arranged in a haphazard manner, this is not the case. In fact, they occupy space in an optimal manner. If we accept this notion of microvacuoles, then it becomes possible to explain certain pathologies occurring with age, such as edema, obesity, aging and inflammation. This sliding system is to be found everywhere in the body and would seem to be the basic network of tissue organization. For this reason, it should be thought of in global terms. Since it constitutes the inseparable link and occurs in all living structures and at many levels, could it be that it the basic architectural design of Life?

Extensive F-18 FDG uptake in metastatic spindle cell carcinoma of the lung.

A 77-year-old man with stage IIB squamous cell carcinoma of the lung underwent right upper lobectomy. One month later he was examined for right chest pain, dyspnea, cough, and weakness. A roentgenogram showed nondiagnostic diffuse opacification of his right lung cavity. An F-18 FDG positron emission tomographic (PET) study revealed extensive uptake in the right pleural area, left adrenal gland, right axilla, and soft tissues consistent with extensive local recurrence and metastatic disease. Biopsy of a right chest soft tissue lesion showed spindle cell carcinoma, a rare variant of squamous cell carcinoma.

The physical activity scale for the elderly (PASE): evidence for validity.

We assessed the validity of the Physical Activity Scale for the Elderly (PASE) in a sample of sedentary adults (56 men, 134 women, mean age +/- [SD] 66.5+/-5.3 years) who volunteered to participate in a randomized controlled trial on the effect of aerobic conditioning on psychological function. Construct validity was established by correlating PASE scores with physiologic and performance characteristics: peak oxygen uptake, resting heart rate and blood pressure, percent body fat, and balance. The mean PASE scores were higher in men than in women (men = 145.8+/-78.0; women = 123.9+/-66.3, P<0.05), and in those age 55-64 years compared with those age 65 years and over (55-64 = 144.2+/-75.8; 65 and over = 118.9+/-63.9, P<0.05). PASE scores were also significantly higher in those who did not report a chronic health condition (cardiovascular disease, hypertension, cancer, or recent surgery). PASE scores were significantly associated (P<0.05) with peak oxygen uptake (r = 0.20), systolic blood pressure (r = -0.18) and balance score (r = 0.20). No significant associations of PASE score and diastolic blood pressure, resting heart rate, or percent body fat were noted. These results provide additional evidence for the validity of the PASE as a measure of physical activity suitable for use in epidemiology studies on the association of physical activity, health, and physical function in older individuals.

Age-related variability in body composition methods for assessment of percent fat and fat-free mass in men aged 20-74 years.

INTRODUCTION: Assessing body composition is important because of the association between excess body fat or obesity and the increased risk for coronary artery disease, diabetes, hyperlipidaemia and hypertension. Methodological differences among indirect body composition techniques are a source of variability that can affect estimations of fat-free mass (FEM) or percent fat, especially for different age groups. PURPOSE: This study examined the effect of age on the estimation of body composition by three methods based on the two-component model. One hundred and fifty-three men were placed into 5-year age groups from 20-24 to 70-74 years. Body composition was assessed by hydrodensitometry (underwater weighing; 40K spectroscopy (K40) and anthropometry. RESULTS: Day-to-day reliability was excellent for each method. Correlation coefficients between methods, independent of age, ranged from r= 0.71 (K40 and UWW) to r = 0.83 (UWW and anthropometry) for% fat and from r = 0.76 (K40 and anthropometry) to r = 0.90 (UWW and anthropometry) for FFM. Correlations between techniques weakened and showed greater variability as age increased. UWW produced the highest % fat and lowest FFM for the different age groups, while K40 and anthropometry yielded similar body composition values. All three methods detected age-related differences in % fat; however, only UWW determined a significant age effect in FFM. The greatest discrepancies between the methods occurred for the oldest age groups (60-74 years), but noticeable differences began occurring after the age of 40. CONCLUSIONS: Each method produced reliable data. Care should be taken when choosing any method based on the two-component model, especially when different age groups are being examined, since estimating % fat and FFM is dependent on the age-related chemical composition of an individual and the limitations of each method.

The clinical importance of the anaerobic energy system and its assessment in human performance.

The anaerobic energy system is involved in providing energy for all forms of physical activity. The relevance of this system to human performance and physical fitness throughout the age spectrum is underscored here and contrasted with the aerobic energy system. The anaerobic system responds to high-intensity training with biochemical, neural, and anatomic adaptations. Unlike the aerobic system, this response tends to be primarily a local phenomenon with little systemic adaptation. An important factor distinguishing anaerobic training from aerobic training is the intensity of the exercise dose. For anaerobic training to occur, the dose must be of high intensity and performed to near-exhaustion. The anaerobic system can be indirectly assessed by performance tests, such as a vertical jump or stair climb, or more directly by supramaximal bicycle tests. The impact of recent research regarding the trainability of the anaerobic system, particularly in the elderly population, is encouraging. The elderly respond to anaerobic training and, as a result, their independence, quality of life, and safety from falls can be improved. While little is known about anaerobic rehabilitation after injury, it is known that isokinetic and performance tests may be considered normal after rehabilitation, despite incomplete rehabilitation of the anaerobic system. Thus, appropriate application of the anaerobic system assessments and training principles is an important aspect of sports medicine practice.

Preexercise meal composition alters plasma large neutral amino acid responses during exercise and recovery.

This study was designed to determine the effect of ingesting three preexercise meals on energy metabolism during exercise and recovery and to relate metabolic perturbations to subjective and objective measurements associated with central fatigue. Twelve subjects consumed isoenergetic meals consisting of oat, wheat, or corn cereals 90 min before cycling. A fasting trial served as the control. Blood samples and cognitive function, perceived hunger, and sleepiness measurements were obtained before and after feeding and during recovery when self-selected food intake was also measured. After meal ingestion, plasma insulin was lower for oat than for wheat or corn whereas the ratio of tryptophan to large neutral amino acids (LNAAs) for corn was less than for all others. During exercise, the tryptophan-LNAA ratio increased from preexercise values for the fasting and wheat trials, but exercise performance was unaffected. During recovery, tryptophan:LNAA increased from postexercise values in fasting trials. Also, hunger and fatigue ratings were greater in fasted subjects, but self-selected food intake measured at the end of the recovery period was not different among groups. We conclude that preexercise meal consumption affected tryptophan:LNAA before, during, and after exercise, but these changes were not sufficient to alter physical and cognitive performance.

Oat, wheat or corn cereal ingestion before exercise alters metabolism in humans.

This study was designed to determine metabolic and physical performance responses to ingestion of pre-exercise meals with different macronutrient and fiber profiles. Twelve physically active subjects (6 males and 6 females) were used to investigate the metabolic and physical performance consequences of consuming pre-exercise meals consisting of oat, corn, or wheat cereals. A fasting trial served as the control, and all subjects received each treatment in a Latin-square design. Blood samples were drawn before and 85 min after meal ingestion, during 90 min of cycling exercise (60% VO2peak), after a 6.4 km performance ride, and during 60 min of recovery. Expired air samples were collected to determine nutrient utilization. Resting carbohydrate oxidation rates and plasma insulin concentrations after oat ingestion were less than after wheat, and corn and wheat ingestion, respectively (P < 0.05). During exercise, the change in plasma glucose from pre-exercise was greater after consuming wheat and corn compared with oat (P < 0.05), and it was inversely related to pre-exercise plasma insulin concentration (r = -0.55, P = 0.0001). Plasma free fatty acid concentrations were inversely related to plasma lactate concentrations (r = -0.58, P = 0.0001). Free fatty acid concentrations and fat oxidation were greater in fasting trials than all others, but performance ride times did not differ among treatments. Plasma branched-chain amino acid concentrations resembled their respective meal profiles throughout exercise, the performance ride, and recovery. These results indicate that pre-exercise meal composition can influence glucose homeostasis during early exercise and plasma branched-chain amino acid concentrations over a substantial range of metabolic demands.

Isometric intermittent endurance of four muscle groups in men aged 20-74 yr.

Muscular endurance of upper and lower extremities may provide a more practical measure of muscle function related to normal daily activity than measures of strength, especially with the elderly. Maximal isometric intermittent endurance of the finger flexors, thumb abductors, dorsiflexors, and plantar flexors were characterized by peak force, impulse, percent total impulse, and percent force decrement in men aged 20-74 yr. Volunteers (N = 153) were placed into appropriate 5-yr age groups: 20-24, 25-29, ..., 70-74 yr. The intermittent endurance task consisted of 11 consecutive, 2-s maximal contractions, each separated by 3-s rest. Age group differences within each 2-s interval as well as differences in endurance were determined by ANOVA, and after adjusting for differences in body composition, by ANCOVA. The lower extremities had the greatest declines in absolute measures of force within each 2-s interval, and declines occurred earlier than previously reported. When values were expressed as percent change over the entire endurance task, there was generally no age group difference in force or impulse; however, there were significant muscle group differences. In conclusion, declines in absolute measures of force occurred at different ages depending on the muscle group; however, relative measures of muscular endurance were maintained for all age groups but varied by muscle group location.

Contributions of exercise, body composition, and age to bone mineral density in premenopausal women.

The purpose of this cross-sectional study were to determine whether exercisers have greater bone mineral density (BMD) than nonexercisers, whether aerobic dancers have greater BMD than walkers, and to determine the contributions of energy expenditure, body composition, and dietary factors to spine and femur BMD. Measurements were obtained on 93 eumenorrheic women (walkers N = 28; aerobic dancers, N = 34; nonexercisers, N = 31) ages 25-41 yr; lumbar spine and proximal femur BMD, body composition, physical activity, and nutrient intakes. Mean height, weight, and body mass index and median age and calcium intakes were similar for the three groups. Mean (+/- SD) values of the spine, total femur, and femoral neck BMD, respectively, were: walkers (1.092 (+/- 0.098), 0.947 g.cm-2), dancers (1.070 (+/- 0.124), 0.990 (+/- 0.104), 0.908 (+/- 0.106) g.cm-2), and nonexercisers (1.020 (+/- 0.112), 0.887 (+/- 0.073), 0.792 (+/- 0.089) g.cm-2) multiple regression analyses indicated that exercise contributed to spine (P = 0.018), total femur (P =0.012), and femoral neck (P < 0.0001) BMD, whereas type of exercise (aerobic dance vs walking) did not (P > 0.05). Total femoral BMD was influenced by exercise (P = 0.012) and energy expenditure (P = 0.023), while vertebral BMD was influenced by age (P = 0.0067), body weight (P = 0.017), and exercise (P = 0.018). These findings suggest that walking and aerobic dance exercise may provide physically active premenopausal women with greater lumbar and femoral BMD than sedentary females.

Age-related patterns in body composition for men aged 20-79 yr.

Fat-free body mass has been reported to decline by 30% between the ages of 30 and 70 yr, whereas body weight increases until age 50 yr. This study examined the age-related patterns in body composition, specifically its two components, fat-free body mass and fat mass, in 157 men aged 20-79 yr. Total body composition was assessed by hydrodensitometry and subcutaneous fat was measured with skinfolds. Approximately 15 men were tested in each of the 12 5-yr age groups (20-24, 25-29, 30-34, ... 75-79 yr). Body density, as determined by underwater weighing, was lower successively from the youngest to oldest age groups; men below age 40 yr had significantly higher (P < 0.01) body densities than the older men. Although there was a gradual decline in fat-free body mass with increasing age, there was not a significant age group effect until age 70 yr. Fat mass gradually increased with increasing age; men above age 40 yr had significantly higher (P < 0.01) total body fat when compared to the younger men. Subcutaneous body fat was similar at the distal limb locations for each age group; however, the proximal trunk locations, especially the abdomen, demonstrated significantly (P < 0.01) higher skinfold thicknesses with increasing age. In conclusion, fat-free body mass was maintained to a later age than previously reported; thus, the age-related decline in body density could be attributed to an age-related increase in body fat.

[Simple and composite ulnar transplants in reconstructive surgery of the hand]. / Les transplants cubitaux simples et composites en chirurgie reconstructrice de la main.

Over several years, the authors have devised a technique for compound island transplants of ulnar origin, harvested from the forearm's lower third, with reverse flow vascularization. Because of the variety of arterial ramifications, these transplants can consist: either of a simple cutaneous, superficial flexor tendon or ulnar fragment transplant, or, when associated, of compound cutaneous-tendinous, cutaneous-osseous and even cutaneous-tendinous-osseous transplants. These transplants, based on the clinical experience of 192 cases, can be used by retrograde rotation for a variety of indications, such as loss of skin cover, digital surface reconstruction or treatment of scaphoid pseudoarthrosis. But their main indication, as it represents a basic difference with other retrograde flaps, is the possibility of an island transplant of several superficial flexors complete with sheats, for the reconstruction of the fingers' flexing system in a single surgical act. This is all the more interesting as it is still technically possible to combine it with a cutaneous flap, so that the tendinous and cutaneous problems can be solved simultaneously. This technique permits reconstruction of the fingers' flexor system based on another concept, i.e. by using a vascularized tendinous transplant, and under different conditions since a single surgical act is required, thus saving long periods of sick leave, with functional results which compare with those of traditional techniques.

Mesovascularized island flexor tendon: new concepts and techniques for flexor tendon salvage surgery.

Hand surgeons have long sought ways of avoiding adhesions in flexor tendon repair. We report a new concept in tendon surgery--the use of flexor tendons with perfect mesotendon blood supply and an inherent gliding mechanism composed of the paratendon and the common carpal sheath to minimize adhesions during tendon healing. This technique, inspired by reversed ulnar island forearm transfers, makes use of the flexor superficialis of the ring finger, which is supplied by a vascular mesotendon emerging from the ulnar pedicle just before Guyon's canal, and ensures a perfect blood supply, a favorable environment for suturing, and, consequently, impressive digital excursion.

The effect of test protocol instructions on the measurement of muscle function in adult women.

Consideration of the anatomy of the nervous system and events (ie., age, physical training, motor learning) that invoke changes in neural regulatory mechanisms and other bodily systems renders the impact of the type of instruction used to elicit a maximal effort in the assessment of muscle function across age, among different muscle groups, and for different parameters of muscle function tenuous. Hence, the efficacy and effect of using two types of instructions (rate vs. strength) on the assessment of the isometric functional capacity of six muscle groups were examined in women (N = 143) aged 25-74 years. The subjects were categorized by age into 10, 5-year groups. Measures of maximal force (MF), maximal rate of force increase (MR), total impulse (TI), time to MF (MFT), time to MR (MRT), and plateau time (PLT, time between 90% MF and MF) were obtained from the force-time recordings of maximal voluntary isometric contractions of the finger flexors, thumb extensors, elbow flexors and extensors, and ankle dorsiflexors and plantar flexors. Repeated measures analyses of variance indicated that instruction type influenced (p < .05) the magnitude and pattern of the force-time recordings, with the degree of difference dependent upon the muscle group and parameter of muscle function examined. Use of the rate instruction yielded greater MRs (40.9-541.0 N/sec) than the strength instruction. The strength instruction elicited greater MFs (6.4-326.7 N), longer MFTs (0.72-1.50 sec), MRTs (0.05-0.15 sec) and PLTs (0.31-0.79 sec), and greater TIs (25.1-1,079.8 N-sec) than the rate instruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Mineral and water content of the fat-free body: effects of gender, maturation, level of fatness, and age.

Variability associated with the effects of gender, level of fatness (LOF), maturation (ML), and age on the mineral (MFFB) and water (WFFB) content of the fat-free body (FFB) was investigated in 188 males and 144 females, aged 8 to 17 years. Measures of body density, bone mineral content, total body water, and skin-fold thicknesses were obtained. FFB was calculated using a multicomponent model based on body density and adjusting for variability in body water and mineral content. Subjects were classified by ML as prepubescent, pubescent, and postpubescent. Subjects were also grouped by LOF as lean, average, and obese based on percentile rankings from the age-related norms of the National Children and Youth Fitness Study. Least squares multiple regression analysis using weighted orthogonal contrasts to account for sample size differences revealed significant (p<.01) gender, ML, gender x LOF, and gender x ML effects for MFFB; however, no significant (p>.05) effects between, or within, gender were noted for WFFB. Significant ML, and nearly significant (p>.056) LOF x ML, effects were found for MFFB in the males. In contrast, only ML was significant within the female sample for MFFB. These results were upheld when age, rather than ML, was used in the analysis. The overall relative increase in MFFB across ML was greatest in the obese (17.4%, 9.3%) and least in the lean (11.3%, 6.3%) males and females, respectively. A significant increase in MFFB across ML was observed in both genders; however, the pattern and magnitude of increase is dependent upon LOF considered. Hence, consideration of gender, ML, LOF and age is essential in estimating body composition in children.