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The Surgical Release of Dupuytren’s Contracture Using Multiple Transverse Incisions
Hyunjic Lee,어수락,조상헌,Neil F. Jones 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.4
Dupuytren’s contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren’s contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren’s contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren’s contracture from 2006 to 2011were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren’s contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore,segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren’s contracture.
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배병만,어수락,김인규,고성훈,Neil F. Jones 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.1
Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss.Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.
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The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions
Lee, Hyunjic,Eo, Surak,Cho, Sanghun,Jones, Neil F. Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.4
Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
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Burton Harry,Iliadis Alexios Dimitrios,Jones Neil,Saini Aaron,Bystrzonowski Nicola,Vris Alexandros,Pafitanis Georgios 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.5
This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of “spare parts” in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed “lowering the level of the amputation” from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying “spare-parts” surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.
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Pollicization of the Middle Finger
Bahk, Sujin,Eo, Su Rak,Cho, Sang Hun,Jones, Neil Ford The Korean Society for Microsurgery 2015 Archives of reconstructive microsurgery Vol.24 No.2
Purpose: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. Materials and Methods: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. Results: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. Conclusion: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.
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JO, Chang Yong,Choe, Seung Joo,Knowles, David,Jones, Neil 대한금속재료학회(대한금속학회) 1998 METALS AND MATERIALS International Vol.4 No.5
The second generation DS alloy, CM186LC is used in the as-cast and double aged condition which has creep-rupture properities equivalent to the first generation single crystal alloys CMSX-2 and CMSX-3. In production cast vane components have to be subjected to a brazing treatment for joining into pairs. The, effect of the brazing treatment and modified brazing treatment (heat treatment) on mechanical properities at high temperature was studied in accordance with microstructure. Brazing treatments gave no effect on tensile properities and creep failure mode of DS CM186LC, although a small decrease in stress-rupture life was observed. Creep failure was related to the solidified microstructure. Creep cracks began at the grain boundary normal to the applied stress, especially at the γ/γ' eutectic phase on grain boundaries. Most of γ/γ' eutectics which had solidified at the last stage of casting, had microporosity which became a crack initiation site during creep. MC carbide reaction with the matrix y was observed in the creep failed specimens.
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