The view of Rousseau as a romantic for whom history is a fatal acquisition negating what is most essential and valuable in human nature has been powerfully renewed in many recent interpretations. It remains possible, however, to reinterpret Rousseau's view of history as both the key to the whole of his work and his most important contribution to the tradition of radical political thought. The identification of history with fatality is insufficient and misleading in as much as it misunderstands both the substance and the import of his philosophical anthropology. Rousseau's critique of liberalism and the Enlightenment rests not simply upon an intuitive transcendence of civilized artifice, but upon the first major attempt to construct a historical anthropology which, by undoing the identification of man with bourgeois man, poses the problem of human historicity as a social process entailing increasing alienation and repression. The ambivalence surrounding historicity as an ontological dimension is not, however, resolved until Emile which establishes, in principle, distinctions between alienation and objectification, and surplus and basic repression.
Aim: The management of complex dorsal hand wounds with extensor tendon loss is controversial. Treatment has focused on soft tissue coverage, but there is limited evidence comparing immediate vs. staged tendon reconstruction. This review evaluates existing literature to determine the optimal management of composite hand defects. Methods: A MEDLINE database review was performed including objective measurements such as number of operations, total active motion, grip strength, days to maximum range of motion (ROM), and return to work. Data extraction included demographics, surgical techniques, complications, and relative outcome. We compared primary and secondary staged reconstruction to correlate any significant differences in outcome and determine optimal timing and technique for extensor tendon reconstruction. We extracted information on flap types including regional and free tissue transfer with tendinous components vs. staged tendon grafts. Results: Comparison of outcomes showed that patients with immediate reconstruction had fewer operations, faster return to maximum ROM, and greater chance of returning to work. The most successful single stage flaps include the radial forearm, suitable for reconstructing one to three tendons and the dorsalis pedis for three or four tendons; however, there were significantly more complications in immediate reconstruction particularly regarding donor site morbidity. Pedicled flaps had better total active motion. The two-stage approach resulted in acceptable functional outcomes without significant complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.