Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis

The records of 75 patients admitted with pyogenic flexor tenosynovitis at two academic centers were reviewed. The functional outcomes of patients who received intraoperative irrigation only (n = 20) and those that had both intraoperative irrigation and continuous postoperative irrigation (n = 55) were compared. There were no statistically significant differences between the outcomes in the two groups.

Use of free-tissue transfer in the treatment of median sternotomy wound infections: retrospective review

The incidence of sternal wound infection following median sternotomy is 0.4 to 5 percent. Debridement and closure of the wounds with local and regional muscles, such as a pectoralis or a pedicled rectus abdominis, have been the mainstay of surgical treatment. Often, both pectoralis major muscles and the superior portion of a rectus abdominis muscle must be used to close large sternal wounds. Loss of these major muscles can be both debilitating and cosmetically disfiguring. Free-tissue transfer can be employed to limit the amount of tissue needed to fill the sternal defect. The authors present a series of 12 free-tissue transfers used in 11 patients to close large sternal defects in this subset of patients. Total flap loss occurred in one patient. Partial loss of the skin island was noted in three patients. Two patients developed abdominal hernias after rectus abdominis free flaps. Free-tissue transfer offers the ability to close these large wounds, using one muscle, in those patients where pedicled rectus abdominis flaps are not available.

The Visor Flap: Preservation of Length in Finger Amputations

Finger amputations at various levels are common injuries. A wide variety of surgical procedures have been described to obtain closure of open finger wounds. Preservation of length, sensate padding and innocuous scars are among the important goals of finger amputation coverage to maintain adequate function of the injured hand. A new technique in closure of the transverse finger amputation is reported. The visor flap is a bipedicled dorsal flap that takes advantage of the dorsal branches of the volar digital neurovascular bundles to achieve the goals of closure for finger amputations.

Ulnar Artery Entrapment of the Median Nerve

Entrapment of the median nerve is a common focal neuropathy. Many etiological factors have been implicated in this neural compression including inflammation, synovial hypertrophy, ligamentous or fascial bands, tumours, aberrant muscles, trauma, endocrinopathies and vascular lesions. Marked elongation and torsion of the peripheral arteries is an extremely rare cause of this focal neuropathy. A unique case of median nerve entrapment by the ulnar artery in the distal forearm is presented.

Therapeutic fasciectomy for eosinophilic fasciitis

Eosinophilic fasciitis is an uncommon and potentially debilitating sclerodermalike connective tissue disorder. A patient is presented for whom medical and pharmacological management had failed to prevent the progression of forearm pain, fibrosis, and flexor contractures. Definitive management with forearm fasciectomy resolved the pain and contractures of the hand. Therapeutic fasciectomy may be a consideration earlier in the course of this disease to ameliorate its debilitating factors. The literature is reviewed.

Management of nonmelanoma skin tumors of the hand

A wide variety of tumors can afflict the hand. Nonmelanoma skin tumors are common and usually benign. The most common malignant tumor of the hand is a SCC. Whether benign or malignant, these need neoplasms and are often initially symptomatic, presenting as an area of discoloration or excoriation. The tumor mass may become disfiguring or impair function. It behooves all hand surgeons to be aware of these nonmelanoma skin tumors and to secure prompt recognition and early treatment, thereby optimizing long-term results.

Factors influencing MAC reduction after cardiopulmonary bypass in dogs

BACKGROUND

Anaesthetic requirements may be reduced following surgery employing cardiopulmonary bypass (CPB). This study, in dogs, determined the role of a) volatile agents (enflurane [E] vs isoflurane [I]), b) oxygenator (bubble [B] vs membrane [M]), and c) presence [FL] vs absence [NoFL] of an in-line arterial filter in the bypass circuit in altering anaesthetic requirements following CPB.

METHODS

Male mongrel dogs were anaesthetized with either enflurane (n = 24) or isoflurane (n = 24). They were randomly assigned to one of eight groups (n = 6 per group); Group 1 (E/B/FL), Group 2 (E/M/FL), Group 3 (E/M/NoFL), Group 4 (E/B/NoFL), Group 5 (I/M/FL), Group 6 (I/B/FL), Group 7 (I/M/NoFL) or Group 8 (I/B/NoFL). MAC was determined using the tail-clamp method at hourly intervals, twice before and three times after a one hour normothermic perfusion using aortoatrial cannulation and CPB.

RESULTS

Prior to CPB, MAC was reproducible (enflurane: MAC1 2.17 +/- 0.29 vs MAC2 2.14 +/- 0.28%; isoflurane: MAC1 1.42 +/- 0.31 vs MAC2 1.41 +/- 0.33%) and differed among groups only for the volatile agent employed. Following CPB, MAC was reduced in all groups (P < 0.05 vs pre-CPB measurements) except Group 1 (E/B/FL). The degree of MAC reduction in other groups ranged from 39-64% and was not different based on type of agent employed, use of a membrane or bubble oxygenator, or presence or absence of an in-line arterial filter.

CONCLUSION

In dogs, MAC reduction following CPB was variable, not related to type of volatile agent employed, use of a membrane or bubble oxygenator, or presence or absence of an in-line arterial filter. The explanation for reductions in anaesthetic requirements following CPB in this model remains speculative.