Further evidence for treatment of recalcitrant neuropathy of the upper limb with autologous vein wrapping.

The treatment of entrapment neuropathy in the upper extremity with surgical decompression has generally provided good results. Recurrence of symptoms, however, is not uncommon, and its management is both challenging and difficult. Autologous vein graft wrapping is an alternative technique, and it is recommended for the treatment of recalcitrant upper limb nerve compression in which 2 or more previous surgical procedures have failed to resolve the problem. Each patient underwent both subjective and objective evaluation. To our knowledge, this is the largest reported single series of vein wrapping cases in the upper limb outside the United States and the first to report results using the well-validated patient evaluation measure.

Perianal Paget's disease-Report of a rare case.

INTRODUCTION: Perianal extra-mammary Paget's disease is a rare skin disorder of unknown aetiology, which is frequently associated with malignancy. This case report draws attention to this rare condition and comments upon its diagnosis and treatment. PRESENTATION OF CASE: A 64-year-old otherwise fit man, presented to us in 2006 with one-year-long history of perianal irritation. On examination there was an erythematous discoid skin lesion in the right perianal area. The lesion was excised with wide margins and the defect closed with a local transposition flap. Histology confirmed extra-mammary Paget's disease (EMPD) with a focus of invasion showing a well-differentiated mucinous adenocarcinoma. Adjuvant therapy was not advised. On follow-up in 2011, a small irregular skin lesion, well away from the previous excision site was noted on the left perianal area. Biopsies from this lesion confirmed EMPD with no focus of invasion. Once again wide local excision with closure using local transposition flap was undertaken. Long term follow up has been advised. DISCUSSION: The optimal treatment for Perianal Paget's disease (PPD) remains controversial. Surgery is the commonest modality used with wide local excision being the treatment of choice for resectable disease. We report herein a short review of various therapies reported so far in the management of this rare disorder. CONCLUSION: A thorough initial evaluation and long-term follow-up is essential to identify recurrence and the development of other related malignancies.

The ski jump deformity of the distal phalanx: a new entity?

A case of a congenital hand anomaly is presented in which the distal phalanx of the little finger was curving dorsally in the sagittal plane. This may be the first reported case. A surgical approach to correct it is described.

Aberrant position of the ulnar nerve within the carpal canal.

A case is presented where both the ulnar nerve and palmaris profundus tendon were found within the carpal tunnel during routine open decompression for carpal tunnel syndrome.

Rehabilitation of the replanted upper extremity.

A concise protocol for the rehabilitation of the upper extremity after replantation is presented with special emphasis in the early mobilization of the hand.