Hovius, S.E.R.

Epidemiology and health-care utilisation of wrist fractures in older adults in The Netherlands, 1997-2009 (Article)

2013-04-01T00:00:00Z

Introduction: Wrist fractures are common in older adults and are expected to increase because of ageing populations worldwide. The introduction of plate and screw fixation has changed the management of this trauma in many patients. For policymaking it is essential to gain insight into trends in epidemiology and healthcare utilisation. The purpose of this study was to determine trends in incidence, hospitalisation and operative treatment of wrist fractures. Methods: A population-based study of patients aged 50 years and older using the Dutch National Injury Surveillance System and the National Hospital Discharge Registry. Data on emergency department visits, hospitalisations and operative treatment for wrist fractures within the period 1997-2009 were analysed. Results: In women, the age-standardised incidence rate of wrist fractures decreased from 497.2 per 100,000 persons (95% confidence interval, 472.3-522.1) in 1997 to 445.1 (422.8-467.4) in 2009 (P for trend <0.001). In men, no significant trends were observed in the same time period. Hospitalisation rates increased from 30.1 (28.3-31.9) in 1997 to 78.9 (75.1-82.8) in 2009 in women (P < 0.001), and from 6.4 (6.0-6.8) to 18.4 (17.3-19.5) in men (P < 0.001). There was a strong increase in operative treatment of distal radius fractures, especially due to plate fixation techniques in all age groups. Conclusion: Incidence rates of wrist fractures decreased in women and remained stable in men, but hospitalisation rates strongly increased due to a steep rise in operative treatments. The use of plate and screw fixation techniques for distal radius fractures increased in all age groups.

Comparing scaffold-free and fibrin-based adipose-derived stromal cell constructs for adipose tissue engineering: An in vitro and in vivo study (Article)

2012-12-07T00:00:00Z

Success of adipose tissue engineering for soft tissue repair has been limited by insufficient adipogenic differentiation, an unfavorable host response, and insufficient vascularization. In this study, we examined how scaffold-free spheroid and fibrin-based environments impact these parameters in human adipose-derived stromal cell (ASC)-based adipose constructs. ASCs were differentiated in spheroids or fibrin-based constructs. After 7 days, conditioned medium was collected and spheroids/fibrin-based constructs were either harvested or implanted subcutaneously in athymic mice. Following 7 days of implantation, the number of blood vessels in fibrin-based constructs was significantly higher than in spheroids (93 ± 45 vs. 23 ± 11 vessels/mm2) and the inflammatory response to fibrin-based constructs was less severe. The reasons for these results were investigated further in vitro. We found that ASCs in fibrin-based constructs secreted significantly higher levels of the angiogenic factors VEGF and HGF and lower levels of the inflammatory cytokine IL-8. Furthermore, ASCs in fibrin-based constructs secreted significantly higher levels of leptin and showed a 2.5-fold upregulation of the adipogenic transcription factor PPARG and a fourfold to fivefold upregulation of the adipocyte-specific markers FABP4, perilipin, and leptin. These results indicate that fibrin-based ASC constructs are potentially more suitable for ASC-based adipose tissue reconstruction than scaffold-free spheroids.

Reply (Article)

2012-12-01T00:00:00Z

Diabetes-impaired wound healing is improved by matrix therapy with heparan sulfate glycosaminoglycan mimetic OTR4120 in rats (Article)

2012-10-01T00:00:00Z

Wound healing in diabetes is frequently impaired, and its treatment remains a challenge. We tested a therapeutic strategy of potentiating intrinsic tissue regeneration by restoring the wound cellular environment using a heparan sulfate glycosaminoglycan mimetic, OTR4120. The effect of OTR4120 on healing of diabetic ulcers was investigated. Experimental diabetes was induced by intraperitoneal injection of streptozotocin. Seven weeks after induction of diabetes, rats were ulcerated by clamping a pair of magnet disks on the dorsal skin for 16 h. After magnet removal, OTR4120 was administered via an intramuscular injection weekly for up to 4 weeks. To examine the effect of OTR4120 treatment on wound healing, the degree of ulceration, inflammation, angiogenesis, and collagen synthesis were evaluated. We found that OTR4120 treatment significantly reduced the degree of ulceration and the time of healing. These effects were associated with reduced neutrophil infiltration and macrophage accumulation and enhanced angiogenesis. OTR4120 treatment also increased the collagen content with an increase of collagen type I biosynthesis and reduction of collagen type III biosynthesis. Moreover, restoration of the ulcer biomechanical strength was significantly enhanced after OTR4120 treatment. This study shows that matrix therapy with OTR4120 improves diabetes-impaired wound healing.

Comments to the term "cold-induced vasodilatation" in "laser doppler perfusion imaging of skin territory to reflect autonomic functional recovery following sciatic nerve autografting repair in rats" (Article)

2012-09-17T00:00:00Z

Vascularization of prevascularized and non-prevascularized fibrin-based human adipose tissue constructs after implantation in nude mice (Article)

2012-03-01T00:00:00Z

Adipose regeneration strategies have been hampered by the inability to supply an adequate vascular supply following implantation. Vascularization in vitro, also called prevascularization, is a promising method that could promote the vascularization of engineered adipose tissue constructs upon implantation. In this study we compared the ability of prevascularized-to-non-prevascularized fibrin-based human adipose tissue to promote vascularization. Human adipose tissue-derived stromal cells (ASCs) and different mixtures (1:1, 1:2 and 1:5) of ASCs with human umbilical vein endothelial cells (HUVECs) were cultured in fibrin at two different densities (1.0 × 106and 10 × 106cells/ml) for 7 days. Histological analysis revealed that prevascular structures formed in 1:5 ASC/HUVEC fibrin-based constructs seeded with a total of 10 × 106cells/ml. These constructs and ASC-only constructs were implanted subcutaneously in athymic mice for 7 days and generated lipid-containing grafts. The numbers and densities of blood vessels within the ASC/HUVEC constructs were similar to those of ASC-only constructs. Furthermore, immunostaining studies demonstrated human-derived vasculature within a few of the ASC/HUVEC and ASC-only constructs. A subset of this human-derived vasculature contained erythrocytes, indicating integration with the host vasculature. In conclusion, our study indicated no difference in the rate of vascularization of prevascularized ASC/HUVEC and non-prevascularized ASC-only fibrin-based constructs, suggesting that prevascularization of these fibrin-based constructs does not promote vascularization. Our results further indicated that not only endothelial cells, but also ASCs may contribute to the formation of vascular lumina upon implantation. This finding is interesting, since it demonstrates the possibility of vascularized adipose tissue engineering from a single cell source.

Characterization of a three-dimensional mucosal equivalent: Similarities and differences with native oral mucosa (Article)

2012-02-01T00:00:00Z

The aim of this study was to create and characterize a tissue-engineered mucosal equivalent (TEM) that closely resembles native mucosa. TEM consists of human primary keratinocytes and fibroblasts isolated from biopsies taken from healthy donors and seeded onto a de-epidermized dermis and cultured for 14 days at the air/liquid interface. The structure of TEM was examined and compared with native nonkeratinizing oral mucosa (NNOM). The various components of the newly formed epidermal layer, basement membrane and underlying connective tissue were analyzed using immunohistochemistry. The mucosal substitute presented in this study showed a mature stratified squamous epithelium that was similar to that of native oral mucosa, as demonstrated by K19, desmoglein-3 and involucrin staining. In addition, the expression of basement membrane components collagen type IV, laminin-5 and integrin α6 and β4 in TEM proved to be consistent with native oral mucosa. The expression of PAS, Ki67, K10 and K13, however, appeared to be different in TEM compared to NNOM. Nevertheless, the similarities with native oral mucosa makes TEM a promising tool for studying the biology of mucosal pathologies such as oral mucositis or fibrosis as well as the development of new therapies. Copyright

Low impact of congenital hand differences on health-related quality of life (Article)

2012-02-01T00:00:00Z

Objective: To evaluate health-related quality of life (HRQoL) and its determinants in children with congenital hand differences (CHDs). Design: Survey. Setting: Outpatient clinic of a university hospital. Participants: Children (N=116; age range, 1014y) with CHDs. Interventions: Not applicable. Main Outcome Measures: HRQoL evaluated by child self-reports of the Pediatric Quality of Life Inventory and compared with reference values of healthy peers. Multivariable regression analysis was performed to investigate determinants of HRQoL. Results: All children with CHDs had scores similar to those of healthy peers, except for a lower score on social functioning in children aged 13 to 14 years. Higher ease of activity performance was related to higher HRQoL scores, and presence of comorbidity was related to lower scores on all HRQoL subdomains except for school functioning. Additionally, physical health was influenced by ethnicity, bilateral involvement, and previous surgery; emotional functioning by the number of affected digits; school functioning by age; and total HRQoL by bilateral involvement. Conclusions: Children with CHDs report similar HRQoL as healthy peers. HRQoL decreased in the presence of comorbidity but increased with higher ease of activity performance. Scores on some subdomains were improved by the number of affected digits, but were reduced by age, ethnicity, bilateral involvement, and surgery. Although HRQoL is an important health outcome, it may not be sensitive to detect changes over time or changes after treatment in children with CHDs.

Trends in wrist fractures in children and adolescents, 19972009 (Article)

2011-11-01T00:00:00Z

Purpose: Distal radius and carpal fractures in children and adolescents represent approximately 25% of all pediatric fractures. Incidence rates and causes of these fractures change over time owing to changes in activities and risk factors. The purpose of this study was to examine recent population-based trends in incidence and causes of wrist fractures in children and adolescents. Methods: We obtained data from the Dutch Injury Surveillance System of emergency department visits of 15 geographically distributed hospitals, and from the National Hospital Discharge Registry. This included a representative sample of outpatients and inpatients, respectively. We calculated incidence rates of wrist fractures per 100,000 person-years for each year between 1997 and 2009. Using Poisson's regression, we analyzed trends for children and adolescents 5 to 9, 10 to 14, and 15 to 19 years of age separately for boys and girls. Results: During the study period, incidence rates increased significantly in boys and girls 5 to 9 and 10 to 14 years of age, with the strongest increase in the age group 10 to 14 years. The observed increases were mainly due to increased incidence rates during soccer and gymnastics at school. Conclusions: This population-based study revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period 1997 to 2009. Clinical relevance: With knowledge of the epidemiology of wrist fractures, prevention programs can be improved. From this study, we know that the incidence rate of wrist fractures in childhood is increasing, mainly as a result of soccer and gymnastics at school. Future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes.

Dupuytren's contracture: A retrospective database analysis to determine hospitalizations in the Netherlands (Article)

2011-10-13T00:00:00Z

Background: Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (re)hospitalizations. Methods. From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6). Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Results: Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25%) among 60-79 year old males. The majority (85%) of all hospitalizations were day-case admissions. Of the admitted inpatients (15%) the majority (81%) had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87%) and 78% of patients was treated by a plastic surgeon. During a median (IQR) follow-up of 2.9 (1.8-4.0) years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR) time to first rehospitalization was 0.8 (0.4-1.9) years. Conclusions: This study is a first exploration of Dupuytren's contracture in the Netherlands based on hospitalizations, showing a prevalence of 0.25% among 60-79 year old males. Future studies should also address outpatient procedures to get a complete picture of the treatment of Dupuytren's contracture. In addition, patients not yet treated should be included to be able to estimate the prevalence of Dupuytren's contracture.

MR intensity measurements of nondenervated muscle in patients following severe forearm trauma (Article)

2011-08-01T00:00:00Z

Fluid increases resulting in higher MRI signal intensities in T2-weighted and short tau inversion recovery (STIR) sequences can be used to diagnose nerve injury. By comparing the signal intensities over time, MRI may become a new method for monitoring the healing process. Muscle edema is assessed by comparing the signal intensity of affected muscle with that of nonaffected muscle. However, in severe forearm trauma, the signal of nondenervated muscle may also be increased by wound edema, thus masking the effect of denervation. Hence, the purpose of this study was to investigate the influence of wound edema on muscle signal intensity in 29 consecutive patients examined on a 1.5-T MRI scanner at 1, 3, 6, 9 and 12 months after severe forearm trauma. The long-term course of wound edema and the influence of wound distance were thus investigated using a standardized imaging, calibration and post-processing protocol. The signal intensities of nondenervated intrinsic hand muscles were measured in the affected and contralateral sides. Muscle signal intensities were increased on the trauma side at 1 and 3 months (18% and 7.4%, respectively; p<0.001) and normalized thereafter. In the contralateral hand, no significant signal changes were seen. No relationship was found between wound distance and the severity of wound edema. This study shows that wound edema influences muscle signal intensity comparisons in patients with forearm trauma. When comparing denervated muscle with nondenervated muscle, an additional scan of the contralateral side is indicated during the first 6 months after trauma to assess the extent of wound edema. After 6 months, the ipsilateral side can be used for muscle signal intensity comparisons.

Medium-term cost analysis of breast reconstructions in a single Dutch centre: A comparison of implants, implants preceded by tissue expansion, LD transpositions and DIEP flaps (Article)

2011-08-01T00:00:00Z

Background: Free flap breast reconstruction (BR) is generally believed to be more expensive than implant BR, but costs were previously shown to level out over time due to complications and re-operations. The aim of this study was to assess the economic implications of four BR techniques: silicone prosthesis (SP), implant preceded by tissue expansion (TE/SP), latissimus dorsi transposition with or without implant (LD ± SP) and deep inferior epigastric perforator (DIEP) flap. Methods: A prospective historic cohort study was performed to evaluate intramural medical costs in 427 patients, who had undergone BR between 2002 and 2009. Short- and medium-term complications were incorporated. In addition, 58 patients, who had recently undergone BR, participated in a questionnaire study to prospectively evaluate extramural medical and non-medical costs. Estimates of mean short- and medium-term costs are presented per patient. Results: Intramural medical costs for BR and short-term complications for unilateral DIEP flaps (12,848) and TE/SP reconstructions (12,400) were significantly higher than those for LD ± SP reconstructions (5804), which, in turn, were more expensive than SP reconstructions (4731). In bilateral cases, costs of TE/SP (12,723) and LD ± SP (10,760) reconstructions were comparable, while DIEP flaps (15,747) were significantly more expensive and SP reconstructions were significantly cheaper (6784). Overall, the medium-term costs for complications and additional operations were not significantly different (3017-4503). Extramural medical costs and non-medical costs were approximately 9300 per stage, regardless of technique. Conclusions: Differences in short-term costs between techniques did not level out during follow-up and SP reconstructions remained least expensive. Single-stage SP reconstructions, however, are not suitable for all patients due to high complication rates. Definite implant placement is therefore increasingly preceded by tissue expansion at more comparable costs to autologous BR. Incorporation of non-medical costs into the cost analysis would render two-stage procedures more costly than autologous BR. To achieve the optimal result, careful patient selection is critical. Only in select cases where two options are equally applicable, cost comparison becomes a valid argument for treatment selection.

Heparan sulfate glycosaminoglycan mimetic improves pressure ulcer healing in a rat model of cutaneous ischemia-reperfusion injury (Article)

2011-07-01T00:00:00Z

Pressure ulcers are a major clinical problem, with a large burden on healthcare resources. This study evaluated the effects of the heparan sulfate glycosaminoglycan mimetic, OTR4120, on pressure ulceration and healing. Ischemia-reperfusion (I-R) was evoked to induce pressure ulcers by external clamping and then removal of a pair of magnet disks on rat dorsal skin for a single ischemic period of 16 hours. Immediately after magnet removal, rats received an intramuscular injection of OTR4120 weekly for up to 1 month. During the ischemic period, normal skin perfusion was reduced by at least 60% and at least 20-45% reperfused into the ischemic region after compression release. This model caused sustained skin incomplete necrosis for up to 14 days and led to grade 2-3 ulcers. OTR4120 treatment decreased the area of skin incomplete necrosis and degree of ulceration. OTR4120 treatment also reduced inflammation and increased angiogenesis. In OTR4120-treated ulcers, the contents of vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor beta-1 were increased. Moreover, OTR4120 treatment promoted early expression of alpha-smooth muscle actin and increased collagen biosynthesis. Long-term restoration of wounded tissue biomechanical strength was significantly enhanced after OTR4120 treatment. Taken together, we conclude that OTR4120 treatment reduces pressure ulcer formation and potentiates the internal healing bioavailability.

Biomechanical evaluation of the Pulvertaft versus the 'wrap around' tendon suture technique (Article)

2011-07-01T00:00:00Z

The purpose of this study was to compare the biomechanical properties of a novel wrap around tendon repair method with those of the standard Pulvertaft technique used for tendon reconstructions. Seventy-two porcine extensor tendons were used to create 36 reconstructions in six sets of six repairs, each using one of the two surgical techniques with differing lengths of the reconstructions. All the reconstructions were tested in vitro by cyclic tensile loading, resulting in the time-zero strength. When only the size of the repair and the strength were compared, and length of the reconstruction was not taken in consideration, the 'wrap around' reconstructions were of similar strength but less bulky than the Pulvertaft repairs. In conclusion, the 'wrap around' technique gives a thinner reconstruction which is as strong as, or stronger than the Pulvertaft technique, depending on the amount of weaves.

Extensive percutaneous aponeurotomy and lipografting: A new treatment for dupuytren disease (Article)

2011-07-01T00:00:00Z

Background: Surgical resection of Dupuytren contracture is fraught with morbidity and prolonged recovery. This article introduces a novel minimally invasive alternative for Dupuytren disease and its outcome. Methods: The procedure consists of an extensive percutaneous aponeurotomy that completely disintegrates the cord and separates it from the dermis. Subsequently, the resultant loosened structure is grafted with autologous lipoaspirate. After 1 week of postoperative extension splinting, patients are allowed normal hand use and are advised to use night splints for 3 to 6 months. The authors treated and report on their experience with 91 patients (99 hands) operated on in Miami and Rotterdam; from 50 patients, the authors report on goniometry (average follow-up, 44 weeks). Results: The contracture from the proximal interphalangeal joint improved significantly from 61 degrees to 27 degrees, and contracture from the metacarpophalangeal joint improved from 37 degrees to -5 degrees. Ninety-four percent of patients returned to normal use of the hand within 2 to 4 weeks and 95 percent were very satisfied with the result. No new scars were added, and a supple palmar fat pad was mostly restored. Complications were digital nerve injury in one patient, postoperative wound infection in one patient, and complex regional pain syndrome in four patients. Conclusions: This new minimally invasive technique shortens recovery time, adds to the deficient subcutaneous fat, and leads to scarless supple skin. By its ability to treat multiple rays, it addresses the abnormality in the entire hand. The procedure is safe and effective, especially for primary cases. Currently, comparative prospective randomized studies are in process to fully determine its role in the treatment of Dupuytren contracture.

Cold-induced vasodilatation following traumatic median or ulnar nerve injury (Article)

2011-06-01T00:00:00Z

Purpose: Peripheral nerve injury of the upper extremity frequently causes changes in the thermoregulatory system of the hands and fingers and leads to reports of cold intolerance. In this study, we aimed to measure the influence of median or ulnar nerve injury on cold-induced vasodilatation (CIVD) during prolonged cooling at low temperatures. Methods: We tested 12 patients with a median (n = 6) or ulnar (n = 6) injury 4 to 76 months after nerve repair. The palmar sides of both hands were cooled continuously using a cold plate at 5°C. We measured the skin temperature of the fingers using videothermography and plotted graphs of the temperature changes of the nailbed. The presence of a CIVD reaction was defined as a minimum increase in temperature of 2.5°C starting at the distal phalanx. Furthermore, we measured self-reported symptoms of cold intolerance using the Cold Intolerance Severity Scale questionnaire. Results: A CIVD reaction was absent in the affected digits of 4 patients (follow-up, 637 mo), whereas the CIVD reaction in the uninjured hand was present. The CIVD was present in 6 patients after 50 months' follow-up (range, 2476 mo). Two patients had no CIVD reaction in the injured or uninjured fingers. All patients with a CIVD response had at least diminished protective sensation. Presence of the CIVD reaction did not exclude self-reported symptoms of cold intolerance. Conclusions: After peripheral nerve injury, it is possible to recover the CIVD reaction. This might be an indication of nerve recovery. However, a positive CIVD reaction does not exclude subjective symptoms of posttraumatic cold intolerance. Type of study/level of evidence: Diagnostic III.

Hypoxia preconditioning of tissue-engineered mucosa enhances its angiogenic capacity in vitro (Article)

2011-06-01T00:00:00Z

Improving vascularization of tissue-engineered oral mucosa (TEM) is a major challenge in the field of plastic surgery. Hypoxia is a stimulator of angiogenesis through a number of mechanisms. Therefore, hypoxia is a critical parameter that can be controlled in an effort to improve angiogenesis. In the present study we studied the secretion of a number of angiogenic factors during hypoxia exposure and evaluated the effect of TEM conditioned medium on endothelial cells. TEM was constructed by seeding human oral mucosa keratinocytes and fibroblasts on acellular human donor skin. TEM was exposed to hypoxia during 6, 12, and 24h. Cellular hypoxia was assessed by immunolocalization of the hypoxia-inducible factor-1α. Secretion of vascular endothelial growth factor, placental growth factor (PlGF), tissue inhibitors of matrix metalloproteinases-1 and -2, and the activity of matrix metalloproteinase-9 significantly increased during hypoxia exposure. Moreover, conditioned medium from hypoxic TEM strongly enhanced endothelial cell proliferation and migration. In vitro exposure of TEM to hypoxia improves its capacity to support endothelial cell proliferation and migration, which suggests that hypoxia preconditioning of TEM potentially improves angiogenic responses for in vivo implantation.

A review of topical negative pressure therapy in wound healing: Sufficient evidence? (Article)

2011-04-01T00:00:00Z

Background Topical negative pressure (TNP) therapy has become a useful adjunct in the management of various types of wounds. However, the TNP system still has characteristics of a "black box" with uncertain efficacy for many users. We extensively examined the effectiveness of TNP therapy reported in research studies. Data sources A database search was undertaken, and over 400 peer-reviewed articles related to the use of TNP therapy (animal, human, and in vitro studies) were identified. Conclusions Almost all encountered studies were related to the use of the commercial VAC device (KCI Medical, United States). Mechanisms of action that can be attributed to TNP therapy are an increase in blood flow, the promotion of angiogenesis, a reduction of wound surface area in certain types of wounds, a modulation of the inhibitory contents in wound fluid, and the induction of cell proliferation. Edema reduction and bacterial clearance, mechanisms that were attributed to TNP therapy, were not proven in basic research.

Growth diagrams for individual finger strength in children measured with the RIHM (Article)

2011-03-01T00:00:00Z

Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength. Questions/purposes: We developed growth diagrams for individual finger strength in children. Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model. Results: Because there was no difference in strength between boys and girls and between dominant and non-dominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement. Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development.

Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home (Article)

2011-02-01T00:00:00Z

Objective: At present, the evidence regarding the type of mattress that is the best for preventing pressure ulcers is not convincing. In a single center, prospective, controlled trial we compared a static air overlay mattress (no electric pump needed) on top of a cold foam mattress with a cold foam mattress alone on pressure ulcer incidence in nursing home residents. Methods: 83 Patients were included in the study with a score lower than 12 points on the Norton scale and no pressure ulcer at the start of the study. 42 Patients received a cold foam mattress and 41 patients received a static air overlay on top of that cold foam mattress. Out of bed we standardized the pressure reduction in sitting position by using a static air cushion in both groups. Patients were checked weekly in both groups for pressure ulcers. Only when there were signs of developing a pressure ulcer grade 2 or higher, repositioning by our nursing home pressure ulcer protocol (PU protocol) was put into practice. Results: Seven patients (17.1%) on a cold foam mattress and two (4.8%) on a static air mattress developed a pressure ulcer grade 2 or more. There was no difference regarding pressure ulcer incidence between patients with a high risk (Norton 5-8) and patients with a medium risk (Norton 9-12). In 5 out of 7 patients who developed a pressure ulcer on a foam mattress the ulcers showed no healing using our PU protocol. In the static air group all pressure ulcers healed by regular treatment according to our PU protocol. Conclusions: In this study, static air overlay mattresses provided a better prevention than cold foam mattresses alone (4.8% versus 17.1%). The Norton scores of the patients in both groups did not change during the 6 month trial period. Our decision to use repositioning only when there were signs of a pressure ulcer seems to be acceptable when a static air overlay is in position. However, the score of 17.1% development (incidence) of pressure ulcers in the foam group may stress the need of repositioning when using only this type of mattress.

In reply (Article)

2011-02-01T00:00:00Z

Ultrasound-guided needle positioning near the sciatic nerve to elicit compound muscle action potentials from the gastrocnemius muscle of the rat (Article)

2011-01-15T00:00:00Z

The use of ultrasound-guided electrode positioning in near-nerve myography was investigated. This is a minimally invasive technique that allows repeated measurements to increase accuracy and hence decreases animal numbers. Ultrasound imaging of the sciatic nerve was performed in nine rats using a 55. MHz high-end transducer. Once visualised, a monopolar needle electrode was placed through the skin near this nerve. Upon stimulation, two surface electrodes, placed over the gastrocnemius muscle, recorded compound muscle action potentials (CMAPs). Reproducibility was tested having two teams of investigators perform the recordings consecutively. Reliability of the procedure was determined by comparing the ultrasound method to the conventional technique, which requires an incision through muscle and skin to expose the sciatic nerve. In all animals the sciatic nerve was visible on ultrasound images. Both methods showed CMAP latencies (duration was determined as the time interval between the onset latency and positive peak). The conventional method had a mean latency of 3.4 ± 0.5. ms, our method had a mean latency of 3.3 ± 0.5. ms. Reproducibility was excellent (observed latencies and amplitudes: 3.3 versus 3.3. ms and 25.6 ± 5.1. mV versus 22.5 ± 8.8. mV) resulting in a coefficient of variation for duration of 2.1% and for amplitude 6.7%. Interclass correlation coefficient was 0.828 for duration. Comparing the three different measurements no significant differences were found and our new method can therefore be considered reliable and comparable to the conventional method.Ultrasound-guided near-nerve needle positioning is a reproducible and reliable minimally invasive method for selectively eliciting CMAPs, which allows repeated CMAP measurements for studying nerve regeneration in rats.

Surgical management of neuroma pain: A prospective follow-up study (Article)

2010-12-01T00:00:00Z

Painful neuromas can cause severe loss of function and have great impact on the daily life of patients. Surgical management remains challenging; despite improving techniques, success rates are low. To accurately study the success of surgical neuroma treatment and factors predictive of outcome, a prospective follow-up study was performed. Between 2006 and 2009, pre- and post-operative questionnaires regarding pain (VAS, McGill), function (DASH), quality of life (SF-36), symptoms of psychopathology (SCL-90), epidemiologic determinants and other outcome factors were sent to patients surgically treated for upper extremity neuroma pain. Pain scores after diagnostic nerve blocks were documented at the outpatient clinic before surgery. Thirty-four patients were included, with an average follow up time of 22 months. The mean VAS score decreased from 6.8 to 4.9 after surgery (p < 0.01), 19 (56%) of patients were satisfied with surgical results. Upper extremity function improved significantly (p = 0.001). Neuroma patients had significantly lower quality of life compared to a normal population. Employment status, duration of pain and CRPS symptoms were found to be prognostic factors. VAS scores after diagnostic nerve block were predictive of post-operative VAS scores (p = 0.001). Furthermore, smoking was significantly related to worse outcome (relative risk: 2.10). The results could lead to improved patient selection and treatment strategies. If a diagnostic nerve block is ineffective in relieving pain, patients will most likely not benefit from surgical treatment. Patients should be encouraged to focus on activity and employment instead of their symptoms. Smoking should be discouraged in patients who will undergo surgical neuroma treatment.

Prevascular structures promote vascularization in engineered human adipose tissue constructs upon implantation (Article)

2010-09-01T00:00:00Z

Abstract Vascularization is still one of the most important limitations for the survival of engineered tissues after implantation. In this study, we aim to improve the in vivo vascularization of engineered adipose tissue by pre-forming vascular structures within in vitro-engineered adipose tissue constructs that can integrate with the host vascular system upon implantation. Different cell culture media were tested and different amounts of human adipose tissue-derived mesenchymal stromal cells (ASC) and human umbilical vein endothelial cells (HUVEC) were combined in spheroid co-cultures to obtain optimal conditions for the generation of prevascularized adipose tissue constructs. Immunohistochemistry revealed that prevascular structures were formed in the constructs only when 20% ASC and 80% HUVEC were combined and cultured in a 1:1 mixture of endothelial cell medium and adipogenic medium. Moreover, the ASC in these constructs accumulated lipid and expressed the adipocyte-specific gene fatty acid binding protein-4. Implantation of prevascularized ASC/HUVEC constructs in nude mice resulted in a significantly higher amount of vessels (3717 vessels/mm2) within the constructs compared to non-prevascularized constructs composed only of ASC (3 4 vessels/mm2). Moreover, a subset of the pre-formed human vascular structures (3.6±4.2 structures/mm2) anastomosed with the mouse vasculature as indicated by the presence of intravascular red blood cells. Our results indicate that pre-formed vascular structures within in vitro-engineered adipose tissue constructs can integrate with the host vascular system and improve the vascularization upon implantation.

Early active motion versus immobilization after tendon transfer for foot drop deformity: A randomized clinical trial (Article)

2010-09-01T00:00:00Z

Background: Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes: To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. Methods: We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. Results: We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. Conclusion: In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Evaluation of Function and Appearance of Adults With Untreated Triphalangeal Thumbs (Article)

2010-07-01T00:00:00Z

Purpose: Triphalangeal thumb is a congenital malformation characterized by an additional phalanx of the thumb. Although surgical treatment of this condition is common practice, in the past this was not generally advised. Therefore, a population with an untreated triphalangeal thumb is still present. The purpose of this study is to compare function and appearance of adults with an untreated triphalangeal thumb to a normal population. Methods: Twelve adults with 23 hands with an untreated triphalangeal thumb, unilateral or bilateral, were examined using objective measurements (thumb movement, joint instability, pain, and strength) and subjective measurements (visual analog scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; and Short Form 36 health survey). Results: Objective measurements showed no limitations in range of motion or in grip and pinch strength. No joint instability was found in the interphalangeal joints. Five thumbs had instability in the metacarpophalangeal joint. Strength of the thumb in anteposition was diminished to 64% compared to a normal population. Opposition was diminished to 62%, and metacarpophalangeal joint flexion strength was diminished to 61%. The patients scored lower compared to a normal population for the domain of social functioning in the Medical Outcome Study 36-item short form health survey; the Disabilities of the Arm, Shoulder, and Hand questionnaire showed no differences. Visual analog scale scores for appearance of the thumb were scored low (2.2 of 10) by the adults, in contrast to visual analog scale scores for function (7.7). Conclusions: The examined group of adults with an untreated triphalangeal thumb had adequate thumb movement. Thumb strength was diminished for all specific thumb functions (anteposition, opposition, and thumb flexion), as low as 55%, compared to normal controls. Self-rated scores indicate that patients perceived their functionality as good. The appearance, however, was rated much lower, implying a dislike of the thumb by the patients. This indicates that the main impact of an untreated triphalangeal thumb in daily functioning might not be the diminished function but rather the dissimilar appearance. Type of study/level of evidence: Therapeutic IV.

Prevalence and severity of cold intolerance in patients after hand fracture (Article)

2010-05-01T00:00:00Z

Cold intolerance is a well-known phenomenon that develops in the first months after hand injury and generally does not decrease over time. In this study, we evaluated the prevalence and severity of cold intolerance after hand fracture in 129 patients using the Cold Intolerance Symptom Severity (CISS) questionnaire. Patients with nerve and/or vascular injuries were excluded. The response rate was 59%. The mean CISS score was 23. Pathological cold intolerance, defined as a CISS score over 30, was experienced by 38% of the patients. Cold intolerance is common after hand fractures and can be severely disabling in some patients.

Development and validation of ultrasound speckle tracking to quantify tendon displacement (Article)

2010-05-01T00:00:00Z

Ultrasound can be used to study tendon movement. However, measurement of tendon movement is mostly based on manual tracking of anatomical landmarks such as the musculo-tendinous junction, limiting the applicability to a small number of muscle-tendon units. The aim of this study was to quantify tendon displacement without anatomical landmarks using a speckle tracking algorithm optimized for tendons in long B-mode image sequences. A dedicated two-dimensional multi-kernel block-matching scheme with subpixel motion estimation was devised to handle large displacements over long sequences. The accuracy of the tracking on porcine tendons was evaluated during different displacements and velocities. Subsequently, the accuracy of tracking the flexor digitorum superficialis (FDS) of a human cadaver hand was evaluated. Finally, the in-vivo accuracy of the tendon tracking was determined by measuring the movement of the FDS at the wrist level. For the porcine experiment and the human cadaver arm experiment tracking errors were, on average, 0.08 and 0.05. mm, respectively (1.3% and 1.0%). For the in-vivo experiment the tracking error was, on average, 0.3. mm (1.6%). This study demonstrated that our dedicated speckle tracking can quantify tendon displacement at different physiological velocities without anatomical landmarks with high accuracy. The technique allows tracking over large displacements and in a wider range of tendons than by using anatomical landmarks.

Ultrasonographic Assessment of Long Finger Tendon Excursion in Zone V During Passive and Active Tendon Gliding Exercises (Article)

2010-04-01T00:00:00Z

Purpose: Cadaver and in vivo studies report variable results for tendon excursion during active and passive hand movements. The purpose of this study was to measure long finger flexor digitorum profundus (FDP) tendon excursion during active and passive movement using high-resolution ultrasound images. Methods: The FDP tendon excursion was measured at the wrist level in 10 healthy subjects during full tip-to-palm active and passive flexion of the fingers. Passive movement was performed 2 ways: (1) straight to full fist: passive flexion starting at the metacarpophalangeal joint, followed by proximal interphalangeal and distal interphalangeal joint flexion; and (2) hook to full fist: passive flexion starting at the distal interphalangeal joint, followed by proximal interphalangeal and metacarpophalangeal joint flexion. Tendon excursion was measured using an in-house-developed, frame-to-frame analysis of high-resolution ultrasound images. Results: Median FDP excursion was 24.3 mm, 14.0 mm, and 13.6 mm for active fist, straight to full fist, and hook to full fist movements, respectively. Tendon excursions during active movements was significantly larger than excursions during passive movements (p = .005). The adjusted median tendon excursion was 12.7 mm/100°, 7.5 mm/100°, and 7.4 mm/100° for active fist, straight to full fist, and hook to full fist movements, respectively. Adjusted tendon excursions during active movement were significantly larger than those achieved during passive straight to full fist movement). Adjusted tendon excursions during straight to full fist movements were significantly larger than those achieved during passive hook to full fist movement. Conclusions: Active motion produced 74% and 79% increases in excursions compared to both passive motions in healthy controls. The study results can serve as a reference for evaluating excursions in patients with tendon pathology, including those who have had tendon repair and reconstruction.

Visual feedback and weight reduction of a grip strength dynamometer do not increase reliability in healthy children (Article)

2010-03-18T00:00:00Z

Study Design: Test-retest reliability study on grip strength in children. Introduction: Measuring grip strength in children is difficult because of the weight and size of the instrument, brief attention span, and possible lack of task understanding. Therefore, adaptations to the measurement protocols to improve reliability would be very important for research and clinical evaluation. Purpose: In this study, we compared the reliability of a grip strength dynamometer (Lode dynamometer, Lode BV, Groningen, The Netherlands) using three different protocols. Methods: Test-retest reliability of the American Society of Hand Therapists protocol in 104 healthy children (4-12 years) was compared with the reliability in 63 healthy children of a visual feedback protocol and a suspension protocol reducing weight of the instrument. Results: For the total group, intraclass correlation coefficients for the dominant and nondominant hands were 0.95-0.97 for all protocols, indicating that all three protocols were reliable. Conclusion: No statistically significant difference was found among the reliability of the different protocols, but the suspension protocol produced small but significantly higher force levels. Level of Evidence: Not applicable.

Cognitive capacity: No association with recovery of sensibility by Semmes Weinstein test score after peripheral nerve injury of the forearm (Article)

2010-02-01T00:00:00Z

In the recovery process of sensibility after repair of a peripheral nerve injury of the forearm, not only age but also surgical repair techniques are of importance. If regenerating axons are misdirected, reorganisation or other adaptic processes are needed at the level of the somatosensory brain cortex. These processes are thought to be dependent on the patient's cognitive capacity. We conducted a prospective multicentre study to assess the association between cognitive capacity and recovery of sensibility after peripheral nerve damage of the forearm. Patients with a traumatic peripheral nerve lesion of the forearm and consecutive surgical repair were included. After 12 months, the patients were assessed with respect to recovery of sensibility (Semmes-Weinstein monofilaments) and cognitive capacity, with four tests assessing different aspects of cognitive functioning. Twenty-eight patients (25 male, three female; median age: 28.5 years; range: 15-79 years) with median and/or ulnar nerve injury of the forearm were included in the study. Younger age showed a positive association with sensory recovery (β = -0.845, 95% CI: -1.456 to -0.233; p = 0.01). No association was found between the cognitive-capacity tests used and sensory recovery. The present prospective study did not reveal any association between recovery of sensibility measured by Semmes-Weinstein test score and cognitive capacity. Further studies should be performed to confirm these results.

Growth Diagrams for Individual Finger Strength in Children Measured with the RIHM (Article)

2010-01-01T00:00:00Z

Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength. Questions/purposes: We developed growth diagrams for individual finger strength in children. Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model. Results: Because there was no difference in strength between boys and girls and between dominant and nondominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement. Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development.

Implications for treatment of variations in length of the first metacarpal in different types of triphalangeal thumbs (Article)

2010-01-01T00:00:00Z

Abnormal function in the triphalangeal thumb is partly due to its extra length, which is due not only to the extra phalanx, but also to differences in the length of the first metacarpal. This study investigated whether the additional length of the first metacarpal is influenced by the growth plate location alone, or also by the type of triphalangeal thumb. Fifty-nine hands in 37 patients with triphalangeal thumbs were examined for thumb type (delta 31, trapezoid nine and full type 19), growth plate location and relative length of the first metacarpal. The first metacarpals in all three types of triphalangeal thumbs were significantly longer than in the normal population. The length of the first metacarpal was related to the site of the growth plate. The type of triphalangeal thumb did not affect the length. These findings suggest that a corrective procedure on the first metacarpal should be considered in all types of triphalangeal thumbs.

Palmar Abduction Measurements: Reliability and Introduction of Normative Data in Healthy Children (Article)

2009-11-01T00:00:00Z

Purpose: Previously, we studied normative and reliability data of palmar thumb abduction measurements (conventional goniometry, the Pollexograph thumb, the Pollexograph metacarpal, the Inter Metacarpal Distance, the American Society of Hand Therapists method, and the American Medical Association method) in healthy adults. Because many interventions aiming to improve palmar abduction are performed at an early age, the goal of this study was to assess normative and reliability data of these measurement methods in children. Methods: We performed measurements with the Pollexograph thumb, the Pollexograph metacarpal and Inter Metacarpal Distance in 100 healthy children to acquire normative data. A retest was performed in 63 children to assess intraobserver reliability. Results: Mean active and passive palmar abduction measured with the Pollexograph thumb was 62° (range, 40° to 76°). The range of motion of the Pollexograph metacarpal was smaller (mean 49°, range, 32° to 64°). The mean Inter Metacarpal Distance was 50 mm (range, 36-70 mm). Intraclass correlation coefficients of the Pollexograph thumb, Pollexograph metacarpal, and Inter Metacarpal Distance indicated excellent reliability (intraclass correlation coefficients between 0.85 and 0.92). Conclusions: Normative Pollexograph thumb and Pollexograph metacarpal data showed that means measured in children are comparable to values found in healthy adults. Reliability data indicated that the Pollexograph thumb, the Pollexograph metacarpal, and Inter Metacarpal Distance are also reliable measurement methods in children.

What is the significance of tendon suture purchase? (Article)

2009-08-27T00:00:00Z

Repairs have been performed on porcine flexor tendons and subjected to tensile stress measurements to determine the effects and mechanism of core suture purchase (the length of the suture bite). Eighty-four pig trotter flexor profundus tendons were divided and repaired using four lengths of core suture purchase (1.33, 1, 0.66 and 0.33 cm) using a double modified Kessler repair (four strands, two knots) with a peripheral epitendinous suture. Tendon purchase was achieved by either bilateral equal purchase lengths or with one tendon purchase at a fixed depth of 1 cm. A separate group of tendons were incubated in blood for 24 hours to simulate the wound environment prior to testing. Tensile tests demonstrated a progressive increase of repair strength with purchase length. With the exception of the 0.33 cm group, video analysis demonstrated the mode of failure as suture failure and not due to suture pullout. Therefore, the increase in breaking strength cannot be attributed to a better grip of the tendon ends, but to the mechanical characteristics of the suture polymer. The tendency for the incubated tendons to fail more consistently by pullout rather than suture failure, particularly in the shorter purchase lengths, emphasises the importance of studying tendon purchase in vivo. The significance of ex vivo mechanical testing should be considered with caution.

Long-term reproducibility of phantom signal intensities in nonuniformity corrected STIR-MRI examinations of skeletal muscle (Article)

2009-08-01T00:00:00Z

Object: Nerve regeneration could be monitored by comparing MRI image intensities in time, as denervated muscles display increased signal intensity in STIR sequences. In this study long-term reproducibility of STIR image intensity was assessed under clinical conditions and the required image intensity nonuniformity correction was improved by using phantom scans obtained at multiple positions. Methods: Three-dimensional image intensity nonuniformity was investigated in phantom scans. Next, over a three-year period, 190 clinical STIR hand scans were obtained using a standardized acquisition protocol, and corrected for intensity nonuniformity by using the results of phantom scanning. The results of correction with 1, 3, and 11 phantom scans were compared. The image intensities in calibration tubes close to the hands were measured every time to determine the reproducibility of our method. Results: With calibration, the reproducibility of STIR image intensity improved from 7.8 to 6.4%. Image intensity nonuniformity correction with 11 phantom scans gave significantly better results than correction with 1 or 3 scans. Conclusions: The image intensities in clinical STIR images acquired at different times can be compared directly, provided that the acquisition protocol is standardized and that nonuniformity correction is applied. Nonuniformity correction is preferably based on multiple phantom scans.

The Pollexograph®: A New Device for Palmar Abduction Measurements of the Thumb (Article)

2009-07-01T00:00:00Z

Study Design: Clinical measurement, cross sectional. Purpose: To introduce a new measurement device, the Pollexograph®, to easily measure palmar thumb abduction, and to compare its reliability with conventional goniometry. Methods: Fourteen hand therapists measured palmar abduction of the same healthy subject with the Pollexograph and a conventional goniometer. In addition, intrarater reliability of the Pollexograph was studied in 21 patients with a hypoplastic thumb. Results: Variance between measurements of the same subject measured by the hand therapist was 2-6 times smaller with the Pollexograph compared to conventional goniometry. Pollexograph intrarater reliability in hypoplastic thumb patients was excellent (intraclass correlation coefficient (ICC) = 0.98-0.99). Conclusions: A new tool to measure palmar abduction in clinical care, the Pollexograph, has been introduced. The Pollexograph reduces variability between raters when measuring the same subject compared with conventional goniometry and excellent measurement reliability in hypoplastic thumb patients. Level of evidence: Not applicable.

Influence of core suture geometry on tendon deformation and gap formation in porcine flexor tendons (Article)

2009-05-06T00:00:00Z

The effects of core suture geometry on the mechanics of failure in flexor tendon surgery are investigated. Forty porcine flexor tendons were repaired using a Kessler; a Kessler-Pennington; a double Kessler; a continuous Kessler; and a cruciate repair. At maximum breaking strength, the cruciate repair gapped more then the double Kessler (12.8 mm vs 9.1 mm), but the double Kessler was less strong (37N vs 45 N). Transverse narrowing was 22% and 24% for the Kessler and the Kessler-Pennington, 11% for the double Kessler, and 0% for the continuous Kessler and the cruciate repair. Kessler-type sutures failed by suture breakage and the cruciate repair by pull-out. Under load, the transverse part of the Kessler sutures narrows, allowing longitudinal parts to lengthen, leading to gapping. The double Kessler shortened transverse segment decreases gapping. Eliminating a transverse component (the cruciate repair) decreased gapping, but the cruciate failed at higher loads by suture pull-out.

On the origin of bitemporal hollowing (Article)

2009-05-01T00:00:00Z

INTRODUCTION: Long-term results after cranioplasty for trigonocephaly often show bitemporal hollowing and a residual hypotelorism. Both findings fuel the perception that the growth of the periorbital region and the forehead as a whole continues to be restricted, even after correction. The aim of this study was to evaluate the growth process of the periorbital region after correction for trigonocephaly in the long term. MATERIALS AND METHODS: From 1972 to 2004, 184 patients underwent a cranioplasty for the correction of nonsyndromatic trigonocephaly. Cephalometric analysis was performed in 33 of these patients who had their radiographs taken on the same day as the photograph, at least 1 year postoperative and before the age of 6 years. Cephalic landmarks were used to analyze the growth of the forehead. Because of the lack of standardized cephalograms, growth ratios were used instead of absolute measurements. For visual analysis, normal anteroposterior photographs were used, which were taken on the same day as the radiograph. Two observers evaluated the anteroposterior photographs for the presence and level of temporal hollowing. A score of 0 (normal), 1 (moderate deformity), or 2 (severe deformity) was assigned to each of the photographs. RESULTS: A significant relation was found between a severe deformation seen at postoperative photographic evaluation and a lower growth ratio. The preoperative photo score was not of predicting value for the postoperative growth ratio and therefore, indirectly, for the postoperative photo score. The mean preoperative photo score dropped 5% after surgery. The age at operation had no influence on this postoperative photo score. The experience of the surgeon, however, was a significant contributing factor. CONCLUSIONS: Temporal hollowing seems to be of bony origin and can be explained by skeletal growth inhibition in the affected area. When present immediately after operation, they seem to persist through the years, which makes surgical skill another factor of importance.

Auto-crosslinked hyaluronic acid gel accelerates healing of rabbit flexor tendons in vivo (Article)

2009-03-01T00:00:00Z

This study's purpose was to assess the in vivo effect of auto-crosslinked hyaluronic acid (HA) gel, a natural HA derivative with increased viscosity and tissue residence time, on adhesions and healing of injured and surgically repaired rabbit digital flexor tendons. The second and third right deep digital flexor tendons from 48 rabbits (n = 96 tendons) were cut and repaired with a modified Kessler and running peripheral suture. Animals were randomized to two groups, receiving either HA gel or saline injected around both freshly repaired tendons. After 2, 3, 6, and 12 weeks, six rabbits in each group were euthanized. Tendon pull-out force and breaking strength were measured as a value for adhesion formation and tendon healing, respectively. A histological assessment of adhesions and healing was related to the mechanical results.Asignificantly faster increase in breaking strength was found in HA gel-treated compared to saline-treated tendons; this coincided with a significantly accelerated tissue repair response after injury. No significant difference in adhesion formation was found between the two groups at any time. Our results indicate a significant acceleration of in vivo healing of tendons treated with HA gel. Adhesion formation was unaffected. These results could have important clinical value in promoting rehabilitation after tendon injury.

Palmar Abduction: Reliability of 6 Measurement Methods in Healthy Adults (Article)

2009-03-01T00:00:00Z

Purpose: The aim of the current study was to assess reliability of 6 palmar thumb abduction measurement methods: conventional goniometry, the Inter Metacarpal Distance, the method described by the American Medical Association, the method described by the American Society of Hand Therapists, and 2 new methods: the Pollexograph-thumb and the Pollexograph-metacarpal. Methods: An experienced hand therapist and a less-experienced examiner (trainee in plastic surgery) measured the right hands of 25 healthy subjects. Palmar abduction was measured both passively and actively. Means and ranges for palmar abduction were calculated, and intrarater and interrater reliability was expressed in intraclass correlation coefficients, standard errors of measurement, and smallest detectable differences. Results: Mean active and passive angles measured with goniometry resembled values measured with the Pollexograph-thumb method (approximately 60°). Mean angles found with the Pollexograph-metacarpal method were approximately 48°. Mean active and passive distances for the Inter Metacarpal Distance were 64 mm. Mean active and passive distances found with the American Society of Hand Therapists method were 97 to 101 mm, and mean distances found with the American Medical Association method were 67 to 70 mm for active and passive measurements. Intraclass correlation coefficients for the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance indicated good and significantly higher intrarater agreement for active and passive measurements than intraclass correlation coefficients of conventional goniometry, the American Society of Hand Therapists method, and the American Medical Association method, which showed only moderate agreement. For interrater reliability, the same measurement methods were found to be most reliable: the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance. Conclusions: We found that the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance are the most reliable measurement methods for palmar abduction.

Angiogenic Capacity of Human Adipose-Derived Stromal Cells during Adipogenic Differentiation: An In Vitro Study (Article)

2009-02-01T00:00:00Z

Background: Improving vascularization of engineered adipose tissue constructs is a major challenge in the field of plastic surgery. Although human adipose-derived stromal cells (hASCs) are known to release factors that stimulate new blood vessel formation, detailed information about the effects of adipogenic differentiation on the angiogenic potential of hASCs remains largely unknown. In the present study, we studied the expression and secretion of a large panel of angiogenic factors during hASC differentiation and evaluated the effects of hASC-conditioned medium (hASC-CM) on endothelial cells. Methods: hASCs were cultured on adipogenic medium or basal medium. Conditioned medium was collected, and cells were harvested following 0, 3, 7, 14, and 22 days of culture. The stage of adipogenic differentiation of hASC was assessed using Oil Red O staining, fatty acid binding protein-4 gene expression, and glycerol-3-phosphate dehydrogenase activity. Results: Gene expression of vascular endothelial growth factor (VEGF), placental growth factor, angiopoietin-1 (ANGPT1), angiopoietin-2 (ANGPT2), and protein secretion of VEGF significantly increased during short-term adipogenic differentiation of hASCs. Moreover, conditioned medium from differentiated hASCs strongly enhanced endothelial cell numbers compared to conditioned medium from undifferentiated hASCs. Conclusion: In vitro adipogenic differentiation of hASCs improves their ability to support endothelial viable cell numbers and suggests that hASCs differentiated for a short period potentially improve angiogenic responses for in vivo implantation.

Growth Diagrams for Grip Strength in Children (Article)

2009-01-01T00:00:00Z

Abstract: Grip strength dynamometers often are used to assess hand function in children. The use of normative grip strength data at followup is difficult because of the influence of growth and neuromuscular maturation. As an alternative, infant welfare centers throughout the world use growth diagrams to observe normative growth. The aim of this study was to develop similar growth diagrams for grip strength in children. We measured the grip strength, hand dominance, gender, height, and weight of 225 children, 4 to 12 years old. We developed separate statistical models for both hands of boys and girls for drawing growth curves. Grip strength increased with age for both hands. For the whole group, the dominant hand produced higher grip strength than the nondominant hand and boys were stronger than girls. The grip strength of boys and girls differed between 2 and 19 N for the different age groups. Because grip strength measurements are accompanied by a rather large variance, the growth diagrams (presenting a continuum in grip strength) make it possible to better observe grip strength development with time corresponding to a more exact age. Depending on the accuracy needed, the use of one combined diagram could be considered. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Digital Rewarming Patterns After Median and Ulnar Nerve Injury (Article)

2009-01-01T00:00:00Z

Purpose: Posttraumatic cold intolerance (CI) is a frequent and important sequel after peripheral nerve injury. In this study, it is hypothesized that altered rewarming patterns after peripheral nerve injury are related to the degree of posttraumatic CI. This hypothesis is tested by quantitatively comparing rewarming patterns of the digits in controls and in median or ulnar nerve injury patients and by investigating relationships between rewarming patterns, sensory recovery, and CI. Methods: Twelve median or ulnar nerve injury patients with a follow-up of 4 to 76 months after nerve repair and 13 control subjects had isolated cold stress testing of the hands. Video thermography was used to analyze and compare rewarming patterns of the injured and uninjured digits after cold stress testing. Temperature curves were analyzed by calculating the Q value as an indicator of heat transfer (temperature added during the first 10 minutes after start of active rewarming) and the maximum slope. Results: Test-retest reliability was 0.64 and 0.79, respectively, for the Q value and maximum slope. High Q values and maximum slopes were interpreted as the presence of active rewarming. Patients with return of active rewarming had better sensory recovery and lower Blond McIndoe Cold Intolerance Severity Scale (CISS) scores. Better sensory recovery was correlated with lower CISS scores. Conclusions: Test-retest reliability of cold stress testing was good, and we found a difference in rewarming patterns between nerve injury patients and controls. The presence of active rewarming in the nerve injury patients was related to sensory recovery and fewer complaints of posttraumatic CI.

Reliability of Hand Strength Measurements Using the Rotterdam Intrinsic Hand Myometer in Children (Article)

2008-12-01T00:00:00Z

Purpose: Grip strength and pinch strength measurements are often used to assess hand function. However, both measure a number of muscle groups in combination, and grip strength in particular is dominated by extrinsic hand muscles. The Rotterdam Intrinsic Hand Myometer (RIHM) was recently introduced to measure the force that individual fingers and thumb can exert in different directions. The aim of this study was to establish the reliability of these measurements with use of the RIHM in children. Methods: Sixty-three healthy children between 4 and 12 years of age participated in this study. The RIHM was used to measure thumb palmar abduction, thumb opposition, thumb flexion at the metacarpal-phalangeal (MP) joint, index finger abduction, and little finger abduction. A retest was performed with an average test-retest interval of 26 days. Results: For the thumb, palmar abduction strength had intraclass correlation coefficients (ICCs) of .98 for both hands. For both thumb opposition and flexion at the MP joint, ICCs were .97 for the dominant hands and .98 for the nondominant hands. Index finger abduction had ICCs of .94 and .95 and little finger abduction had ICCs of .90 and .92 for the dominant and nondominant hands, respectively. The smallest detectable differences for dominant and nondominant hands respectively were thumb palmar abduction, 15% and 15%; thumb opposition, 12% and 9%; thumb flexion (at the MP joint), 12% and 9%; abduction of the index finger, 17% and 17%; and little finger abduction, 26% and 26%. Conclusions: We found that the RIHM was reliable for use in children. Intraclass correlation coefficients and smallest detectable differences were comparable with those obtained with use of the RIHM in adults and with values found for pinch and grip strength in children. Because the RIHM measures more specific aspects of hand function than grip and pinch, adding the RIHM to measurement protocols may contribute to a more complete overview of a child's hand function.

Significant reduction in neural adhesions after administration of the regenerating agent OTR4120, a synthetic glycosaminoglycan mimetic, after peripheral nerve injury in rats: Technical note (Article)

2008-11-01T00:00:00Z

Object. Extradural and intraneural scar formation after peripheral nerve injury frequently causes tethering and compression of the nerve as well as inhibition of axonal regeneration. Regenerating agents (RGTAs) mimic stabilizing and protective properties of sulphated glycosaminoglycan toward heparin-binding growth factors. The aim of this study was to assess the effect of an RGTA known as OTR4120 on extraneural fibrosis and axonal regeneration after crush injury in a rat sciatic nerve model. Methods. Thirty-two female Wistar rats underwent a standardized crush injury of the sciatic nerve. The animals were randomly allocated to RGTA treatment or sham treatment in a blinded design. To score neural adhesions, the force required to break the adhesions between the nerve and its surrounding tissue was measured 6 weeks after nerve crush injury. To assess axonal regeneration, magnetoneurographic measurements were performed after 5 weeks. Static footprint analysis was performed preoperatively and at Days 1, 7, 14, 17, 21, 24, 28, 35, and 42 postoperatively. Results. The magnetoneurographic data show no significant difference in conduction capacity between the RGTA and the control group. In addition, results of the static footprint analysis demonstrate no improved or accelerated recovery pattern. However, the mean pullout force of the RGTA group (67 ± 9 g [mean ± standard error of the mean]) was significantly (p < 0.001) lower than that of the control group (207 ± 14 g [mean ± standard error of the mean]). Conclusions. The RGTAs strongly reduce nerve adherence to surrounding tissue after nerve crush injury.

Hand Function and Activity Performance of Children with Longitudinal Radial Deficiency (Article)

2008-11-01T00:00:00Z

Background: The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two. Methods: We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined. Results: The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance. Conclusions: Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.

Ultrasound-guided near-nerve neurography for early evaluation of nerve regeneration (Article)

2008-09-30T00:00:00Z

For early assessment of axonal outgrowth after trauma, the nerve is surgically exposed to enable compound nerve action potential (CNAP) recordings across the lesion site. Near-nerve neurography, with needle electrodes placed transcutaneously near the nerve, could be a minimally invasive alternative if the needle placement procedure and low reproducibility are improved. We developed ultrasound-guided near-nerve neurography, which facilitates needle placement, and assessed its potential for evaluating nerve regeneration. Measurements were performed at varying times after crush lesion of the peroneal nerve of 25 rabbits. To test if ultrasound-guided near-nerve signals could be measured prior to muscle reinnervation, they were compared with recordings of compound muscle action potentials. A comparison with conventional intra-operative CNAP recordings was made by measuring nerve signal amplitude with both techniques and by assessing reproducibility. In all cases where intra-operative signals could be measured, near-nerve signals were also detected. Compound nerve activity could be recorded after 5 weeks, whereas compound muscle activity appeared after approximately 8 weeks. Reproducibility was slightly better for near-nerve than for intra-operative recordings. We conclude that ultrasound-guided near-nerve neurography is able to assess nerve regeneration well before compound muscle activity can be detected. Its accuracy and reproducibility are similar to those of conventional intra-operative recordings.

Application of infrared thermography for the analysis of rewarming in patients with cold intolerance (Article)

2008-09-09T00:00:00Z

Cold intolerance is a serious long-term problem after injury to the ulnar and median nerves, and its pathophysiology is unclear. We investigated the use of infrared thermography for the analysis of thermoregulation after injury to peripheral nerves. Four patients with injuries to the ulnar nerve and four with injuries to the median nerve (4-12 years after injury) immersed their hands in water at 15C for 5 minutes, after which infrared pictures were taken at intervals of 2-4 minutes. The areas supplied by the injured nerves could be identified easily in the patients with symptoms of cold intolerance. At baseline temperature distribution of the hand was symmetrical, but after testing the injured side warmed up much slower. We concluded that the infrared profile of the temperature of the hand after immersion in cold water is helpful to assess thermoregulation after injury to peripheral nerves.

Triplicated thumbs: a rarity? (Article)

2008-09-01T00:00:00Z

Triplication of the thumb is supposed to be a rare condition and a complex form of radial polydactyly. However, we encountered an unusually high number of triplicated thumbs at our unit. Is triplication of the thumb indeed a rare condition? In our study, 121 patients with radial polydactyly were recorded between 1933 and 2005. In nine patients of this group, triplicated thumbs, either unilateral or bilateral, were identified. This complex type of radial polydactyly occurs in various forms. A total of 11 triplicated thumbs were found, and all cases were combined with triphalangeal components. Only one of these 11 triplicated thumbs could be classified according to currently used classifications. In all cases, aberrant rays were excised, thumb length and alignment restored by osteotomies, joints were stabilised, tendons reinserted and nails and nail walls corrected if necessary. Also, in all cases, a correction of triphalangeal components was carried out. Triplications are a rarity, and have only been presented in single case reports. We found that triplicated thumbs are not so rare. The likely explanation for this is the identification of a genetic isolate (a deformity located at chromosome 7q36) with radial polydactyly and triphalangeal thumbs in the southwest region of the Netherlands. Treatment for the presented triplicated thumbs was based on the same general principles as for less complex forms of radial polydactyly (i.e. to assemble useful elements of the separate [partial] thumbs to reconstruct one functioning, stable thumb).

The role of topical negative pressure in wound repair: Expression of biochemical markers in wound fluid during wound healing (Article)

2008-07-01T00:00:00Z

The clinical effects of topical negative pressure therapy (TNP) on wound healing are well described in numerous articles. While the mechanism(s) of action are not completely understood, it is postulated that reduction of local and interstitial tissue edema, increased perfusion of the (peri-) wound area, changed bacterial composition, and mechanical stimulation of the woundbed contribute to the clinical success. Our hypothesis is that with the removal of excessive fluid, proteolytic enzymes negatively influencing the healing process are removed. Our aim was to assess whether the concentrations of albumin, matrixmetalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase (TIMP-1) were different between wounds treated with TNP and conventional gauze therapy. We analyzed wound fluid samples of 33 wounds treated with either TNP therapy (n=15) or conventional therapy (n=18) on albumin, pro- and activated MMP-9, TIMP-1, and the ratio of total MMP-9/TIMP-1. Albumin levels were found to increase significantly in acute wounds compared with chronic wounds; however, no difference could be found on comparing TNP with conventional therapy. We did find significantly lower levels of pro-MMP-9 and lower total MMP-9/TIMP-1 ratio in TNP-treated wounds during the follow-up of 10 days. These data strongly suggest that TNP therapy influences the microenvironment of the wound.

Age-specific reliability of two grip-strength dynamometers when used by children (Article)

2008-05-01T00:00:00Z

Background: The Jamar dynamometer and the Martin vigorimeter, two instruments often used to assess grip strength, have good validity and reliability when employed to evaluate adults. Grip strength measurements are often performed to assess children with hand disorders. However, the reliability of these measurements when used to assess children under the age of twelve years is unknown. In addition, it is not clear whether reliability differs between younger and older children. The purpose of this study was to establish test-retest reliability for different age groups and to determine which instrument is the most reliable. Methods: One hundred and four children from a primary school were included. Subjects were divided into three groups: four to six, seven to nine, and ten to twelve years of age. The grip strength of both hands was measured with the Lode dynamometer (equivalent to the Jamar dynamometer) and with the Martin vigorimeter. The mean of three maximum voluntary contractions was recorded for all measurements. A retest was performed after a mean interval of twenty-nine days. Results: In the total group, the intraclass correlation coefficient for the Lode dynamometer was 0.97 (95% confidence interval, 0.95 to 0.98) for the dominant hand and 0.95 (95% confidence interval, 0.92 to 0.96) for the nondominant hand and the intraclass correlation coefficient for the Martin vigorimeter was 0.84 (95% confidence interval, 0.77 to 0.89) for the dominant hand and 0.86 (95% confidence interval, 0.80 to 0.90) for the nondominant hand. The intraclass correlation coefficients in the different age groups were lower than those in the total group because of a lower between-subject variation. The normalized smallest detectable difference between the test and retest values was approximately 25% for the Lode dynamometer and approximately 31% for the Martin vigorimeter. Conclusions: Both the Lode dynamometer and the Martin vigorimeter are reliable instruments with which to measure the grip strength of children under twelve years of age; however, the Lode dynamometer has better test-retest reliability. Furthermore, comparison of the smallest detectable differences showed the Lode dynamometer to be a more accurate instrument. Copyright

A Classification System of Radial Polydactyly: Inclusion of Triphalangeal Thumb and Triplication (Article)

2008-03-01T00:00:00Z

Purpose: Radial polydactyly is a congenital anomaly with a wide range of manifestations. Current classifications do not have the capacity to classify all different types of radial polydactyly when combined with triphalangeal components. The objective of this study was to test an adjusted classification and nomenclature that allows classification of triphalangeal components and triplication in radial polydactyly. Methods: Patients from 1993 to 2006 with radial polydactyly (N = 104), a total of 121 affected hands, were identified from the hospital database. All x-rays were carefully examined and classified according to the existing classifications for radial polydactyly and a modified classification. In the modified nomenclature, Wassel's level of duplication is preserved. Type VII and VIII are assigned for partial or complete duplication of the carpal bones according to Buck-Gramcko. Triplication and triphalangeal components can be assigned to each type of radial polydactyly by suffixes. Symphalangism, deviation, and hypoplasia can also be classified. Triplication on different levels of the thumb is classified by determining and including the different types of the original Wassel classification. Results: Eighteen thumbs could not be classified according to existing classifications for radial polydactyly with triphalangeal components or triplication. Using the proposed classification, all patients could be classified. Conclusions: We propose a modified classification that is a practical and utilitarian scheme for nomenclature of radial polydactyly and that may assist comparison of treatment outcomes and individual cases. Type of study/level of evidence: Diagnostic II.

Cold intolerance following median and ulnar nerve injuries: prognosis and predictors (Article)

2007-08-01T00:00:00Z

This study describes the predictors for cold intolerance and the relationship to sensory recovery after median and ulnar nerve injuries. The study population consisted of 107 patients 2 to 10 years after median, ulnar or combined median and ulnar nerve injuries. Patients were asked to fill out the Cold Intolerance Severity Score (CISS) questionnaire and sensory recovery was measured using Semmes-Weinstein monofilaments. Fifty-six percent of the patients with a single nerve injury and 70% with a combined nerve injury suffered abnormal cold intolerance. Patients with no return of sensation had dramatically higher CISS-scores than patients with normal sensory recovery. Females had higher CISS scores post-injury than males. Cold intolerance did not diminish over the years. Patients with higher CISS scores needed more time to return to their work. Age, additional arterial injury, site or type of the injury and dominance of the hand were not found to have a significant influence on cold intolerance.

Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: A prospective randomised trial (Article)

2007-06-01T00:00:00Z

Background: Vacuum-assisted closure wound therapy (vacuum therapy) has been used in our department since 1997 as a tool to bridge the period between debridement and definite surgical closure in full-thickness wounds. We performed a prospective randomised clinical trial to compare the efficacy of vacuum therapy to conventional moist gauze therapy in this stage of wound treatment. Methods: Treatment efficacy was assessed by semi-quantitative scoring of the wound conditions (signs of rubor, calor, exudate and fibrinous slough) and by wound surface area measurements. Tissue biopsies were performed to quantify the bacterial load. Besides this, the duration until 'ready for surgical therapy' and complications encountered during therapy and postoperatively were recorded. Results: Fifty-four patients were included (vacuum n = 29, conventional n = 25). With vacuum therapy, healthier wound conditions were observed. Furthermore, a tendency towards a shorter duration of therapy was found, which was most prominent in late-treated wounds. In addition, the wound surface area reduced significantly faster with vacuum therapy. Surprisingly, these results were obtained without a decrease in the number of bacteria colonising the wound. Complications were minor, except for one case of septicaemia and one case of increased tissue necrosis, which compelled us to stop vacuum therapy. For the treatment of full-thickness wounds, vacuum therapy has proven to be a valid wound healing modality.

Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections (Article)

2007-06-01T00:00:00Z

Purpose: Evaluation of objective and subjective functional follow-up results of intraoral radial forearm free flap reconstructions. Methods: A total of 149 patients had received radial forearm free flaps between January 1996 and December 2005. Seventy-two patients completed a European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35 (EORTC H&N35) in the follow-up study. Patients were divided according to location of defect (anterior or posterior) or irradiation. Thirty-nine patients with anterior positioned flaps received standardised physical examinations. Results: Flap survival was 99.3%. Complications were divided in early (<2 weeks; 23%) and late complications (20%). Most common complications were dehiscence or fistula, responding well to conservative treatment. Analysis of questionnaire subscales showed no statistically significant differences between anterior and posterior defects. Irradiation showed significant impairment for the ability to smell and taste. No important donor site impairment was found. Conclusion: The radial forearm free flap is an adequate method for reconstructions after resection of intraoral malignancies. Subjective functional outcome seemed to be defined by adjuvant radiotherapy, patient coping and, to a lesser extent, flap bulk for anterior defects.

Comparison of Instruments to Assess Hand Function in Children With Radius Deficiencies (Article)

2007-04-01T00:00:00Z

Purpose: For treatment evaluation of children with radius deficiencies (RDs), standardized assessment of hand function in performing activities is required. Instruments to measure hand function have been developed for other diagnoses. The current study aimed to find additional evidence for validity, reliability, and usefulness of these instruments for children with RDs. Methods: In this study, 20 children with RDs (aged 4-12 years) participated; 16 were boys, and 13 children were unilaterally affected. Children were assessed using the Assisting Hand Assessment, the Unilateral Below Elbow Test, the Prosthetic Upper Extremity Functional Index, and ABILHAND-Kids. Construct and convergent validity of the instruments were studied focusing on predefined hypotheses and relationships with other instruments and the therapist's global assessment. Test-retest reliability was assessed in 10 children by means of the intraclass correlation coefficients and the smallest detectable differences. Results: For children with RDs, the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index appeared to be the most valid function test and questionnaire according to the relationships found with type of RD, functional hand grips, and the therapist's global assessment of hand function. Regarding test-retest reliability, intraclass correlation coefficients ranged from 0.82 to 0.91, and smallest detectable differences were acceptably small. Conclusions: The current results contribute to the evidence that the instruments, especially the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index, provide valid and reliable results in children with RDs. Type of study/level of evidence: Diagnostic I.

Impairment and Disability After Severe Hand Injuries With Multiple Phalangeal Fractures (Article)

2007-01-01T00:00:00Z

Purpose: Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. Methods: The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores. Results: Seventy-eight patients with 228 phalangeal fractures were available for testing, with a mean follow-up period of 7.5 years. No statistically significant correlation existed between the AMA impairment ratings for the hand and the DASH module scores. There were weak correlations between the AMA impairment ratings for the arm and total body and the DASH module function scores. Conclusions: The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.

Measuring surgical outcomes in congenital craniofacial surgery: An objective approach (Article)

2007-01-01T00:00:00Z

Assessment of surgical outcome in congenital craniofacial malformations is necessary to evaluate treatment efficiency since the results of early surgery are influenced by surgical technique and timing. Available outcome measurements all have their limitations, especially for application in congenital craniofacial malformations. Therefore a new outcome measurement was developed, in which each facial unit is scored in a standardized way. For each facial unit, deformities of shape or contour, malposition and soft tissue involvement were evaluated, besides scoring for specific congenital malformations of that area. The final result was tested on pre- and postoperative photographs of patients with rare facial clefts and reliability and validity were demonstrated. The new developed instrument showed the ability to provide quantification of outcome. Because of its properties it can serve as an instrument to compare outcome between techniques, surgeons and centers in a more objective and standardized way. Copyright

Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study (Article)

2001-09-01T00:00:00Z

Long-term subjective and objective outcomes of 24 tendon interposition arthroplasties in 17 patients and 32 trapeziometacarpal (TMC) arthrodeses in 26 patients were compared retrospectively in a standardized manner. Tendon interposition arthroplasty led to complications less often (27%) than TMC arthrodesis (39%). Patients in the tendon interposition arthroplasty group reported significantly less pain, less temperature intolerance, and better thumb mobility and were more satisfied with pain symptoms than patients in the arthrodesis group. Patients undergoing tendon interposition arthroplasty had better thumb opposition, interphalangeal joint mobility, and radial and palmar TMC joint range of motion. No statistically significant differences were found in tip pinch, key pinch, and grip strength between the 2 groups. Proximal first metacarpal collapse occurred in the tendon interposition patients without affecting subjective or objective outcome. Seven of 25 patients with TMC arthrodesis had pseudarthrosis. Tendon interposition arthroplasty seems to be preferable to TMC joint arthrodesis for the treatment of TMC arthritis.

The dorsal branch of the ulnar nerve: An anatomic study with surgical application (Article)

1996-12-01T00:00:00Z

Mcp analysis and its role in the treatment of congenital hand malformations (Article)

1996-12-01T00:00:00Z

Allogeneic transplantation of the radial side of the hand in the rhesus monkey : technical, functional and immunological aspects. (Doctoral Thesis)

1991-05-22T00:00:00Z

As this is the era of transplantation it is inevitable that the field of allogeneic transplantation for the reconstruction of the upper extremity is explored also. This double-thesis deals with a number of aspects concerning allogeneic transplantation of the radial side of the hand in a rhesus monkey model. In the introduction the reasons for investigating the possibility of hand transplantation from one individual to another are clarified. In particular, the reasons why experiments in a nonhuman primate model were preferred, are explained. Should hand transplantation in man ever be performed, three major questions will always be foremost: is allogeneic transplantation of such a composite tissue allograft technically feasible, can allograft acceptance by the host be established, and if so will sensory and functional recovery occur? These questions inspired the authors to perform the experimental work presented. An attempt was made to integrate the major multi-disciplinary facets, clinically as well as preclinically. S.E.R. Hovius focussed on the technical and functional aspects of transplantation of this composite tissue allograft. H.P.J.D. Stevens examined the immunological aspects of this subject, and new ways to improve the immunosuppressive regimen for transplantation. Prior to the rationale of the experiments an introduction with regard to these aspects is presented