Surgical technique: hemi-extensor carpi radialis brevis tenodesis for stabilizing the midcarpal joint in Ehlers-Danlos syndrome.

Patients with the hypermobility type of Ehlers-Danlos (EDS-HT) often complain of wrist pain, usually originating from subluxations. As a result of the laxity, wrist function in these patients can be highly limited. This paper presents a surgical technique that stabilizes the lunocapitate joint with the use of an extensor carpi radialis brevis strip. Five patients with confirmed EDS-HT were treated with an extensor carpi radialis brevis tenodesis for their midcarpal instability. Two patients presented with complications following surgery, one major and one minor. This paper presents a potentially satisfactory surgical solution to recurrent midcarpal instability in EDS-HT patients and demonstrates that the use of an autologous tendon might be feasible in spite of a background of abnormal collagen metabolism.

Incidence of 'Incidentalomas' in over 100 consecutive CT angiograms for preoperative DIEP flap planning.

The gold standard in breast reconstruction is the deep inferior epigastric perforator (DIEP) flaps, although muscle-sparing tranverse rectus abdominis myocutaneous (TRAM) flaps are still being performed due to variations in the abdominal vasculature and to reduce flap complications. Recently, there has been a rise in interest in preoperative imaging, in particular, by means of computer tomography angiogram (CTA). CTA has been shown to delineate the vascular anatomy, improve preoperative decision making and possibly reduce operating time and constitutes a routine preoperative investigation in our unit. Of the 104 consecutive patients who had undergone CTA prior to breast reconstruction, we have found a 13% incidence of unexpected findings or 'incidentalomas' in otherwise asymptomatic women. None were malignant, but changes to the initial operative plan included deferring immediate breast reconstruction, further surgery and further investigations for these incidentalomas. We recommend that all women are counselled of the possibilities of incidentalomas prior to CTA. Furthermore, clinicians need to be receptive to the possibility of a delayed or alternative reconstruction, and closely liaise with other specialties to avoid damage to the deep inferior epigastric vasculature.

Laundry detergent and possible nonaccidental injury.

Nonaccidental injury is always a concern when children present with unusual injuries. The case of a child who presented with a partial thickness burn secondary to prolonged contact with a liquid biological laundry detergent is described. Initially there was some doubt as to whether the agent in question could cause this injury but a small experiment on a volunteer confirmed it was possible.

Sewing hot and cold: successful replant of a hand in a patient who developed malignant hyperthermia intraoperatively.

We report a case in which a patient developed malignant hyperthermia (MH) during surgery to replant his hand. His condition was stabilised without the need to cease the procedure which continued for a further 6 h. MH and traumatic amputation of a hand are both rare emergencies. This case demonstrates that, MH may be controlled to allow a lengthy operation to be completed.