Early active mobilisation versus immobilisation after extrinsic extensor tendon repair: A prospective randomised trial.

BACKGROUND: Whether to splint the extensor tendon repairs or to mobilise them early is debatable. Recently, mobilisation has shown favourable results in a few studies. This study was aimed to compare the two favoured protocols (immobilisation vs. early active motion) in Indian population. PATIENTS AND METHODS: Between June 2005 and June 2007, patients with extensor tendon injuries in zones V-VIII were randomly distributed in two groups: Group A, early active motion; and group B, immobilisation. Their results at 8 and 12 weeks and 6 months were compared. RESULTS: Patients in early active motion group were found to have better total active motion and early return to work. This difference was statistically significant up to 12 weeks, but not at 6 months. CONCLUSION: Early active motion following extensor tendon repair hastens patients' recovery and helps patients to gain complete range of motion at earlier postoperative period. With improved grip strength, the early return to work is facilitated, though these advantages are not sustained statistically significantly over long term.

Complex extensor tendon injuries: early active motion following single-stage reconstruction.

This study presents a retrospective evaluation of patients managed with single-stage repair following complex extensor tendon injuries. Over a 2-year period, 21 extensor tendons were reconstructed in 18 patients with complex hand injuries in zones V-VII. All eight patients needed soft tissue cover. Active mobilisation was started in the first week. Total active motion (TAM) at 4 weeks was a mean of 159 degrees (SD 21.57) and at 6 weeks it was 202.6 degrees (SD 13.26). Average TAM at 8 weeks was 223.8 degrees (SD 16.46) and 249.5 degrees (SD 14.38) at 12 weeks. Grip strength at 12 weeks and 6 months was around 75% and 90% of the contralateral normal hand in most of the patients. Single-stage reconstruction of complex extensor tendon injuries seems to reduce morbidity in terms of hospitalisation, and reduced cost of treatment. It also helps to achieve better functional outcome in the early postoperative period.

Early use of microvascular free tissue transfer in the management of electrical injuries.

High-tension electricity can cause devastating injuries which may result in major soft-tissue loss, limb loss and sometimes major threat to life. Deep structures may be exposed and require flap cover, but microvascular flap transfer in electrical burn has a comparatively high-failure rate. This article aims to evaluate the outcome of early reconstruction of such injuries using free tissue transfer. In the course of 3 years (2004-2006), 16 free tissue transfers were performed in 13 cases of electrical injury from 24h to 3 weeks after trauma. All flaps survived except one. The failure was due to vascular erosion and secondary haemorrhage. There was no incident of vascular occlusion. Thus, if wound debridement is meticulous and microvascular anastomosis is performed well away from the trauma site, free flaps should survive as well in electrical burn cases as in any other.

One-stage reconstruction of post-electrical burn forearm and hand defects using microsurgical transfer of an ulnar neuromyotendinocutaneous unit.

Three cases of high-voltage electrical burns of the wrist and forearm were reconstructed, using vascularized ipsilateral ulnar nerve transfers to median-nerve defects. Two of these cases utilized composite ulnar neuromyotendinous flap transfers, with the muscle (flexor carpi ulnaris) bridging the gap between the flexor muscle bellies and tendons. Sensory recovery in the hand was excellent in all three cases.

Free split iliac-bone flap transfer based on the superior gluteal vessels: anatomy and case reports.

Large bone flaps for free transfer can be successfully and safely harvested based on the deep branch of the superior gluteal artery. The anatomy is consistent, the vessels are large, and the complications of this technique are minimal.