In the future, further study is needed to determine the best use of chemical peels in this indication.

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To evaluate the safety of inserting Kirschner wires into bones or across joints in a setting other than a completely sterile operating theatre, a prospective study of all hand fractures treated by closed reduction and internal fixation was conducted in a mid-city Emergency Department. Indications for percutaneous fixation were displaced, unstable long bone fractures of the hand. 71 fractures in 68 patients were treated, and in 91% the fixation crossed a joint. No patient developed osteomyelitis or pyarthrosis, and there was no deep pin track sepsis. Seven patients with open fractures healed without infection or delayed union. Patients in whom data were available obtained 90% to 95% of the motion of the contralateral digit. The taboo against percutaneous fixation of fractures in a non-operating theatre setting is not warranted. The procedure can be performed with minimal complications in an out-patient setting.

Functional outcome after transmetacarpal replantations and revascularizations is discouragingly poor and often associated with a high incidence of intrinsic-related complications. In order to explore the hypothesis that intrinsic muscle ischemia may play a significant role, we revisited the vascular anatomy of the lumbrical and interosseous muscles. Six fresh-frozen cadaver hands were injected with latex-barium sulfate, and dissections were performed focusing on the contributions of the deep and superficial palmar arches and their branches to the intrinsic muscle vasculature. We found that the lumbrical muscles are supplied from both their volar and dorsal surfaces by both the superficial and deep palmar arches in both axial and segmental fashions. The dorsal and volar interossei receive their major blood supply from the deep arch and metacarpal arteries without any distinct pattern of axial or segmental vessels. These minute vessels cannot be repaired and are not reconstituted even with arch reconstruction. Moreover, with injuries distal to the arch, dissection of the digital arteries further disrupts this blood supply. These anatomic findings may have significant implications in clinical replantation and revascularization.

No abstract