Clinical Study Between Percutaneous Ultrasound-Guided Release and Open Classic Surgery in Treating Multiple Trigger Fingers

Background

A trigger finger is recognized as the most common hand tendinopathies that reduce functional ability. The present study compares the clinical outcomes of open classic release surgery with ultrasound-guided percutaneous surgery in cases of multiple finger involvement.

Materials and Methods

A cohort study has been performed from March 2019 to December 2020 by participating 34 trigger finger patients with multiple involvements. These patients were treated using classical open release and ultrasound-guided percutaneous release methods and both methods were compared in patients. The pain severity and functional ability obtained from the quick disabilities of the arm, shoulder, and hand (Quick-DASH) test scores were compared.

Results

The pain intensity in the classical open surgery patients was not significantly different from the ultrasound-guided group, and a one-month follow-up showed that the pain intensity in the ultrasound-guided patients was significantly less than in the other group (P = 0.02). Besides, no significant difference was observed between the functional abilities before and after the one-month follow-up. Indeed, the two groups had the same situations. Also, the recovery time in the ultrasound-guided percutaneous release group was significantly faster than in the other group. These cases had statistical differences as P = 0.001 and P < 0.001, respectively. The surgical release was 100% successful in both groups. The patients' satisfaction rates in the ultrasound-guided and open classic surgery treatment methods were 94.1 and 76.4%, respectively.

Conclusions

Classical open release and ultrasound-guided percutaneous surgery could successfully treat multiple trigger fingers. However, ultrasound-guided percutaneous surgery provided faster recovery and less pain intensity than the other method.

Management of Symptomatic Lipoma of the Hand: A Case Series and Review of Literature

Soft tissue lipoma is one of the most common benign tumors rarely forming in hand. In this study, 11 cases of symptomatic hand lipoma were investigated. The chief complaint was a palpable mass in all 11 patients, out of whom 6 (55%) cases presented with neurological symptoms, including paresthesia and numbness in the median, ulnar, and superficial radial nerve pathways. One patient had an intramuscularly painful forearm with a large mass presentation. In the finger, the clinical manifestations were radial anesthesia of the finger. The mass sizes were above 5 cm3 and less than 5 cm3 in seven and four patients, respectively. The mean follow-up period was 25 months. No patient demonstrated a recurrence during the follow-up period. Although lipoma is a benign tumor and often presents itself as a palpable mass in the hand, it can cause neurological symptoms and decreased function. Regardless of the size of the tumor, mass removal can prevent symptoms.

The Incidence of Ossified Superior Transverse Scapular Ligament during Nerve Transfer through Posterior Shoulder Approach

BACKGROUND

The purpose of this study was to assess the incidence and importance of bony bridge that covers the supra scapular notch during posterior approach to transfer accessory nerve to suprascapular nerve.

METHODS

Between 2010 and 2015, the frequency and importance of suprascapular bony bridge instead of transverse ligament was assessed among patients with brachial plexus injury candidate to shoulder function restoration by accessory to suprascapular nerve transfer through posterior approach.

RESULTS

Forty three patients, 41 male and 2 female, (mean age: 32.5 years, range 14 to 36) were included in this study. Five male patients (11.6%) had a complete bony rim on the superior scapular notch. Suprascapular nerve release needed osteotomy of the bony bridge and related equipment.

CONCLUSION

Although all previous cadaveric studies among different ethnic groups had reported the prevalence between 0.3 to 30% of suprascapular canal, this in vivo study showed the incidence of 11.6%. Preoperative alertness about this variation could make the exploration and release of the suprascapular nerve easier and reduce the risk of nerve injury or failing to anatomize it.

LEVEL OF EVIDENCE

IV.

Contralateral medial pectoral nerve transfer with free gracilis muscle transfer in old brachial plexus palsy

BACKGROUND

There is a very small chance of success for nerve reconstruction in patients with old total brachial plexus palsy who visit after 2 y or suffer from flail upper extremity after the failure of previous operations.

MATERIALS AND METHODS

For these individuals, the surgeon has to find a recipient motor nerve to perform free gracilis muscle transplantation. In this study, contralateral medial pectoral nerve from the intact side was transferred to the damaged side as a recipient nerve. Then, in the second operation, approximately 15 mo later, the free gracilis muscle transfer was performed. The gracilis muscle was removed and transferred to provide elbow and finger flexion.

RESULTS

In a retrospective study (over 10 y), we reviewed 68 patients for whom this method had been performed. After 1 y, the results were investigated using the Medical Research Council grading system. Five patients did not participate in the study, and the muscle underwent necrosis in two patients. M3 and M4 muscle power was regained in 26 (42.6%) and 21 (34.4%) patients, respectively.

CONCLUSIONS

Contralateral pectoral nerve transfer followed by free muscle transplantation can be a good option for patients with old total brachial plexus palsy.

Synchronous Soleus and Reverse Sural Flap for Large Soft Tissue Defect Reconstruction of Leg

BACKGROUND

Extended Soft tissue defect of leg including middle and distal parts always has been a challenge for many plastic surgeons and also a frustrated problem for patients and families. To introduce the use of the soleus muscle and reverse sural flaps as synchronous surgical treatment alternative of the leg bone exposure with large soft tissue defect, this study was conducted.

METHODS

The medical records of patients undergoing transposition of the soleus muscle for treating exposed bone in the leg and simultaneous sural flap were retrospectively analyzed from January 2009 to July 2014, while gathering information on the used muscle was to cover the lesion.

RESULTS

Twelve patients with varying ages between 22 and 58 years (10 males and 2 females) were enrolled. The main initial injury was trauma (84.8%), consisting of tibia and/or fibula fractures. Only 1 patient developed insignificant distal flap necrosis who was treated subsequently with surgical debridement and flap re-advancement.

CONCLUSION

The treatment of bone exposure with local muscle flaps (soleus and sural) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay. Sometimes, this method may be applied instead of free tissue transfer.

The Mid-Term Changes of Pulmonary Function Tests After Phrenic Nerve Transfer

BACKGROUND

In the restoration of elbow flexion, the phrenic nerve has proven to be a good donor, but considering the role of the phrenic nerve in respiratory function, we cannot disregard the potential dangers of this method.

OBJECTIVES

In the current study, we reviewed the results of pulmonary function tests (PFT) in four patients who underwent phrenic nerve transfer.

PATIENTS AND METHODS

We reviewed the results of serial spirometry tests, which were performed before and after phrenic nerve transfer surgery.

RESULTS

All patients regained Biceps power to M3 strength or above. None of our patients experienced pulmonary problems or respiratory complaints, but a significant reduction of spirometric parameters occurred after surgery.

CONCLUSIONS

This study highlights the close link between the role of the phrenic nerve and pulmonary function, such that the use of this nerve as a transfer donor leads to spirometric impairments.

Nerve stripper-assisted sural nerve harvest

BACKGROUND

Sural nerve has the favorite length and size for nerve graft interposition. Here two techniques, that is, "stocking seam" and "stair-step" or "stepladder," have been used for harvesting sural nerve. The first technique results in an unsightly scar at the posterior calf, and the latter one takes a long time to perform and exert undue traction to the graft during harvesting. The purpose of this article is to describe our experience in harvesting the sural nerve by a nerve stripper.

PATIENTS AND METHODS

A nerve stripper was used for harvesting sural nerve in 35 adult patients (in 6 patients, sural harvesting was done bilaterally), 27 men and 8 women. Thirty-one sural nerve harvests were done by closed technique (i.e., harvesting of sural nerve only by two incisions, one in the posterior of the lateral malleolus and the other in popliteal fossa), in 8 others by limited open technique, and in 2 cases, there was early laceration of the sural nerve at the beginning of the study. The contralateral sural nerve was harvested in one patient and medial antebrachial nerve in another by open technique.

RESULTS

The mean length of the retrieved sural nerve was 34.5 cm in the closed technique group and 35 cm in the limited open technique group. We detected advancing Tinel's sign in all nerve stripper-assisted sural nerve harvested group members in both the closed and limited open groups.

CONCLUSION

Sural nerve harvesting by the nerve stripper is a reliable and simple technique, and it is applicable as a routine technique. Applying controlled rotatory movements of the nerve stripper instead of pushing can result in satisfactory harvesting of the sural nerve without early laceration.

Comparison of three different methods of dressing for partial thickness skin graft donor site

BACKGROUND

Split- thickness skin graft is one of the most common operations in plastic surgery. It is always painful and patient discomfort from donor site often is more significant than recipient site. There is not still a standard method for treatment of the donor site. The purpose of this study was to determine the best method of dressing the donor site among three different methods with respect to the rate of healing, pain, secretion, infection and cost.

METHODS

The study includes 60 patients that were randomly divided into three groups. Donor site and thickness of the graft was the same and were dressed with one of the methods including Method A: Paraffin fine mesh gauze, Method B: Nitrofurazone soaked fine mesh gauze and Method C: Dry fine mesh gauze. Each method included an intermediate layer of sterile plastic sheet witch was covered with 10 layers of dry gauze. Comparison with respect to the rate of healing, pain, secretion, infection and cost was done.

RESULTS

Thirty seven patients were men and 23 were women. The mean age of the patients was 27.2 years. There was a significant difference between three methods in average time of repair and superiority of dressing with Method B was noted. Pain severity was the least in Method B and difference between the methods was significant. Dressing with Method B had the least secretion and there was a statistically significant difference between three methods. There was no statistically significant difference in cost of the management.

CONCLUSION

This study showed that dressing the donor site with nitrofurazone ointment soaked gauze used as the first layer of dressing and intermediate layer of sterile plastic sheet which was covered with 10 layers of dry gauze was the best method of dressing and had the least complications.

The first hand transplantation in iran

Nowadays, hand transplantation is a very challenging procedure for surgeons and researchers worldwide. Despite many problems that may occur after this surgery, some centers continue to practice this highly sophisticated procedure. Herein, we report on a 38-year-old man who received hand transplant from a 24-year-old brain-dead man. This patient had lost his right hand from the lower one-third of forearm six years before after a trauma from a mincing machine. Team members organized pre-operative research, cadaver dissection, legal consultation, religious permission and discussion to patient. This procedure was done by 15 Khordad Plastic Surgery Transplant team on February 27, 2013 for the first time in Iran.

Presence of the functional CASPASE-12 allele in Indian subpopulations

Most humans lack a functional CASP12 gene, with the nonfunctional variant (CASP12p1), found in 100% of the Caucasian and east Asian population, and in approximately 80% of people of African descent. However, 20% of Africans carry an intact allele of CASP12, which produces a full-length pro-enzyme and increases the risk of sepsis. We examined CASP12 allele distribution in persons from central and southern Asia and found that CASP12 was significantly present in members of the Dravidian language group, particularly in persons from the Indian state of Tamil Nadu.

Flexor tendon retrieval in zone I and II: a new modified technique

In this article we set out to describe a simple and modified Sourmelis technique for tendon retrieval in zone I and II. In this modified technique, a long loop of nylon suture is used and hence there is no need for the stage 4 of Sourmelis technique. The purpose of this paper is to illustrate this modification.

The running Y-V plasty for treatment of linear and cord-like burn contractures

Linear and cord-like burn scar contractures are commonly treated by severing the scar in a transverse direction and skin grafting or performing Z-plasties. However, skin grafts may result in suboptimal take and contract gradually and the Z-plasty requires undermining flaps in scarred skin which may lead to the distal tip necrosis. In this article the authors present their experience with multiple Y-V plasty technique. From May 2005 to September 2009, 44 linear and narrow cord-like burn contractures in various regions of upper and lower extremities of 32 patients were treated by multiple Y-V plasty technique. The contracted scars were treated successfully in all of the patients. No major post-operative complications or contracture recurrence were observed during the follow up period of 6 to 24 months in this series of patients. By creating a longer length, running Y-V plasty can relax the contracted scar. Considering the advantages and excellent results in the treated patients in this study group, and also other presented series, multiple Y-V plasty can be recommended as a very useful and safe technique for the treatment of linear and cordlike burn contractures.

End-to-side anastomosis for limb salvage in the single artery of a traumatized extremity

BACKGROUND

The purpose of this article is to describe and highlight our experience of end-to-side anastomosis technique in such cases for limbs salvage in the single artery of a traumatized extremity with free-flap transfer.

METHODS

Thirty-two traumatized patients in need of free-flap transfer for their extremity reconstruction were referred to our hospital from March 2006 to November 2008. Angiography was performed in all patients. A single artery was confirmed in 11 cases (Gustilo IIIC). End-to-side anastomosis was applied for limb salvage in single-artery extremity reconstruction, such as preserving recipient's flow and preserving donor's flow in 11 patients.

RESULTS

The anastomosis arteries included the popliteal artery (n=3), posterior tibial artery (n=2), peroneal artery (n=5) and radial artery (n=1). The mean time from the injury to the flap reconstruction was 34 days. All patients had severe fracture or bone deficit plus soft tissue defect. Postoperative hospital stay was 12-18 days. Time interval between the injury and referral was 27-45 days. Split thickness skin graft was performed in eight patients.

CONCLUSION

Free-flap transfer by end-to-side anastomosis for limb salvage with a single artery is a safe procedure, so a vein graft and T and Y shape anastomosis are not necessary.

Comparison of sole to palm reconstruction using the combined medial plantar and medial pedis free flaps and abdominal pedicle flap for extensive palm injuries

The coverage of soft- tissue defects of the hand specially volar side needs special consideration. Although certain local flaps have been described and used for resurfacing the palm, Extensive injury requires distant or free flaps for coverage. Abdominal pedicle flap has been traditionally used for extensive hand injuries, however there is no doubt that one of the ideal tissues for resurfacing the volar of hand is plantar tissue. We reconstructed the hand with a new procedure of combined medial plantar and medial pedis free flap , and compared it with 15 cases, whom their extensive palm injuries reconstructed with abdominal pedicle flap. The result was significantly better in respect to sensation, Texture of the Hand and patient satisfaction in compare of abdominal flap.

Multiple trigger fingers in a musician: a case report

Trigger finger is a common disease which particularly occurs in middle-aged women. We present a rare case of a male musician with six trigger fingers (five in the left hand and one in the right hand). Mostly these fingers had been used for playing the guitar. The patient had previously been treated with local steroid injections in his fingers, however no response was seen. Therefore, we performed a surgical procedure. Four weeks after surgery, the patient could play the guitar without discomfort in his hands.

Division of the first dorsal compartment of the hand into two separated canals: rule or exception?

BACKGROUND

Tendon entrapment of the first dorsal compartment of the wrist, the de Quervain disease, is a common cause of wrist and hand pain and disability. A group of 50 consecutive patients operated for the treatment of de Quervain disease from 2003 through 2006 were prospectively studied to determine the variation in the pattern of the first extensor compartment.

METHODS

Eighty-six percent of the patients were females, and 14% were males. In 80% of the cases the nondominant and in 20% the dominant hand was involved. These interesting findings may rule out the occupation's relation to de Quervain disease.

RESULTS

Our study revealed that the compartment is completely separated into two canals in 86% of the patients which was significantly higher than that reported in similar studies.

CONCLUSION

The existence of two separated compartments for abductor pollicis longus and extensor pollicis brevis tendons should be considered as a common finding during operation to prevent incomplete treatment and recurrence of the symptoms.

Effects of enhanced external counterpulsation on anginal symptoms and improvements in objective measures of myocardial ischaemia

BACKGROUND

Enhanced external counterpulsation (EECP) is a novel, potentially beneficial adjunct therapy used for angina pectoris. We assessed the efficacy of this method in relieving angina and improving objective measures of myocardial ischaemia.

METHODS

All patients (67) who referred for EECP to Shahid Chamran Hospital, Isfahan, Iran from 2002 to 2005 were included. Demographic data, coronary artery disease (CAD) risk factors and baseline angiographic data were collected. Anginal symptoms, Canadian Cardiovascular Society (CCS) functional class, echocardiographic parameters (ejection fraction, left ventricular end-diastolic and end-systolic diameters) and exercise test duration before and after the treatment were compared.

RESULTS

Seventy-seven per cent of patients who had undergone EECP had a positive clinical response. Exercise test duration and CCS functional class improved after the treatment. However, EECP had no significant effect on echocardiographic parameters. Efficacy was independent of age, gender, CAD risk factors, prior CCS functional class and echocardiographic parameters. Patients without left main artery involvement and those who had at least one non-obstructed artery demonstrated a greater likelihood of improvement.

CONCLUSION

The results of this study suggested that EECP is a safe, well tolerated, and significantly effective treatment for angina pectoris.

Effect of heterozygous beta-thalassaemia trait on coronary atherosclerosis via coronary artery disease risk factors: a preliminary study

BACKGROUND

Thalassaemia is considered the most common genetic disorder worldwide. An association between the heterozygous beta-thalassaemia trait and myocardial infarction has previously been observed. However, the relationship between heterozygous beta-thalassaemia and atherosclerosis, considering other coronary artery disease (CAD) risk factors, has remained unclear.

METHODS

A case-control study was conducted to evaluate the hypothesis that thalassaemia minor affects the likelihood of atherosclerotic plaque formation. Blood counts and blood chemistry data as well as traditional risk factors from 1,363 patients referred to heart centres for coronary angiography were recorded. Heterozygous beta-thalassaemia was diagnosed by the presence of hypochoromic-microcytic anaemia, ferritin levels > 12 ng/ml and haemoglobin-A2 levels > 3.5.

RESULTS

Chi-squared analysis showed that the prevalence of heterozygous beta-thalassaemia was not significantly different between patients with and without CAD (p > 0.05). Multivariate logistic regression analysis using CAD as the dependent variable and traditional risk factors, haematocrit, ferritin levels and heterozygous beta-thalassaemia as independent variables, did not show any significant difference either. Independent two-tailed student's t-tests showed that haematocrit levels were statistically different (p = 0.000) between CAD(+) and CAD(-) groups, but low-density lipids (LDL), high-density lipids (HDL), triglycerides (TG), total cholesterol and serum ferritin levels were not statistically different (p > 0.05).

CONCLUSION

The prevalence of heterozygous beta-thalassaemia in the case group was not significantly different from the control group. This case-control study did not support the hypothesis that thalassaemia minor affects the likelihood of atherosclerotic plaque formation.

Uric acid: a risk factor for coronary atherosclerosis?

BACKGROUND AND OBJECTIVES

It is uncertain whether high serum uric acid levels are a true independent risk factor for coronary atherosclerosis or whether the association is due to other confounding variables. We therefore studied the relationship between elevated serum uric acid levels and coronary atherosclerosis after adjustment was made for confounding factors such as age, gender, body mass index, smoking, lipid profile, blood pressure and blood glucose levels.

METHODS

A cross-sectional study was conducted on 240 patients referred for coronary angiography to heart centres in the Shahid-Chamran and Sina hospitals, Isfahan, Iran. Blood chemistry data as well as traditional risk factors and uric acid levels were measured at enrollment. We used vessel, stenosis and extent scores to indicate the degree of coronary artery involvement.

RESULTS

This study was conducted on 240 patients with a mean age of 56 +/- 10.9 years (66% male; 37% female) who underwent coronary angiography. Student's t-test analyses revealed that there were significant differences in the mean uric acid levels between male and female patients (p = 0.001). We found no statistically significant correlation between serum uric acid levels and coronary atherosclerosis (p > 0.05). In addition, multivariate logistic regression analyses, using coronary atherosclerosis as dependent variable and traditional risk factors and uric acid levels as independent variables, did not show any significant difference.

CONCLUSION

These findings indicated that uric acid is not associated with coronary atherosclerosis. Any correlation reported in other studies was probably due to the relationship between high serum uric acid levels and other cardiovascular risk factors.

Article

Human dentin consists of protein and mineral phases in the form of a collagen network reinforced with apatite. The bonding of materials to dentin, an important goal of dental materials research, can be achieved by the reaction of adhesion promoters with either of these phases. Our group is concerned with such bonding, and has used surface-sensitive instrumentation to elucidate the nature of a variety of surface treatments of dentin. Here, we discuss some of our findings, with particular emphasis on the kinetics of surface demineralization and deproteination, the reaction of formaldehyde with collagen, and the reaction of organophosphate with dentin apatite. The ramifications of our findings will be examined.Key words: dentin, adhesion, vibrational spectroscopy, atomic force microscopy.