Connecting the two areas of the hand and digits are the interdigital web spaces that serve as a transition zone and maintain a specific shape and architecture that facilitates the unique patterns of human prehension. In reconstructing a degloving injury that involves the fingers, hand, and interdigital webs, consideration must be given to the function of each of these three regions. The authors present a case report illustrating their management of an extensive degloving injury of the hand and fingers.
Symptomatic progression of congenital ulnar nerve hypoplasia in association with an anomaly of the brachial plexus is uncommon. The authors present such a case involving an 11-year-old girl, who presented with a complaint of progressive numbness and hand weakness occurring in less than 6 months' time. Physical examination revealed limb hypoplasia, neurologic abnormalities, and a palpable hypoplastic ulnar nerve at the level of the cubital tunnel. An additional intraoperative finding was an anomalous brachial plexus. This combined case of congenital ulnar nerve hypoplasia, brachial plexus anomaly, and symptomatic progression, is discussed in the context of other literature.
The authors present 20 microvascular flaps based on arteriovenous perfusion, harvested from the distal anterior forearm, and configured in three different designs. Indications were small palmar, dorsal, and commissural defects, when other conventional procedures were not available; problematic cases of open reduction internal fixation with skin defect; and when aggressive rehabilitation was needed. The follow-up varied between 6 and 28 months. Some degree of vascular congestion was observed in 100 percent of the flaps, and those changes were classified in a progressive form. Coverage was judged as stable, thin, and pliable in 75 percent of the cases in the series; aggressive rehabilitation was started promptly in all cases where this was possible. On average, an additional 2.4 hr were required for the original procedure. This flap demands little technical expertise for any microsurgical surgeon, and does not sacrifice any important donor vessel. The flap should not be followed-up by conventional monitoring methods instead, simple palpation of the pulse, Doppler auscultation, or PPG are required.
The first reported case of live-donor nerve transplantation is presented, performed in an 8-month-old infant with global obstetric brachial plexus palsy (OBPP) and four root avulsions who had undergone prior sural nerve autografting at 3 months. Cross-chest C7 nerve transfer and temporary tacrolimus/prednisone immunosuppression were utilized. Acute rejection was prevented, with no observable complications from the immunosuppressive medications, ipsilateral deficits resulting from the use of the contralateral C7 root as a donor nerve, or untoward effects on growth and development occurring over a 2-year follow-up period. Although some return of sensory and motor responses on nerve conduction studies was documented, the failure to observe a clinically significant functional improvement in the affected limb directly attributable to the transplant may have been due to performing the procedure too late and/or inadequate follow-up. Results of additional cases performed earlier than in this patient with longer follow-up will need to be evaluated to determine whether the procedure proves to be a viable therapeutic option for treatment of global OBPP with four or five root avulsions.
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