Bruce N. Bailey

The behaviour of free muscle and musculocutaneous flaps after early loss of axial blood supply

Clinical experience has shown that a very large part of a free muscle, musculocutaneous or even osseo-musculocutaneous flap which loses its axial blood supply at ten days may survive. Vascularisation of muscle-containing flaps from the base is progressive and when a free-flap appears avascular on surface inspection careful tangential excision of the dead tissue will usually reveal surviving tissue in the deeper layers that will accept a split-skin graft or even another flap. Four illustrative cases are presented and discussed in detail.

Stenosis of the nostrils: A report of three cases

Summary Three cases of stenosis of nostrils are reported. One of them was due to cicatrisation following chemical burns, the second one resulted from fibrosis following repeated surgical procedures on his left nostril, and the third was a sequel of smallpox. Treatment by excision of scar tissue and Thiersch grafting is described. The importance of the use of prosthesis to maintain the nostrils in an over-corrected position in the post-operative period is stressed.

Ulnar nerve compression caused by a reversed palmaris longus muscle

A case of ulnar nerve compression at the wrist caused by a reversed palmaris longus muscle is reported. We are not aware of any previous reports of ulnar nerve compression due to this particular muscle anomaly.

Ectopic scrotum—A case report

Summary A case of unilateral ectopic scrotum present on the medial side of the right thigh is reported. Its association with Group III cleft of lip and palate and web contracture of lower limbs is stressed.

Accessory palmaris longus muscle causing ulnar nerve compression at the wrist

An accessory palmaris muscle that arose from the base of the fifth metacarpal passed proximally and inserted into the palmaris longus tendon. In its course it compressed the ulnar nerve and vessels. It was detached proximally and folded on itself to provide hypothenar bulk. The entrapment symptoms were relieved.

Forearm Muscle Herniae and their Treatment

Three cases of forearm muscle hernia are described. Their aetiology differed but, in all three, symptoms were sufficiently severe to interfere with the patients work. Surgical repair of the myocoeles, by closure of the fascial defects using lata onlay grafts or an interweave of palmaris longus tendon, produced complete resolution of symptoms and enabled the patients to return to full employment.

Trigger wrist: Report of two cases

Summary Two cases of trigger wrist in rheumatoid hands are reported and a possible explanation is given for the rarity of the condition.

Acute posterior interosseous nerve palsy caused by bleeding from an arteriovenous malformation

A fifteen-year-old boy with a long-standing history of congenital arteriovenous malformation in his left arm was seen with an acute posterior interosseous nerve palsy. Exploration showed this to be caused by bleeding from a congenital arteriovenous malformation in the radial tunnel. Decompression and evacuation of the haematoma resulted in full recovery.

The healing of split-skin donor sites

Summary The causes and avoidance of delayed healing of split-skin donor sites are discussed. A method of obtaining uniform early healing is described.

Silastic sheet interposition arthroplasty for the painful rheumatoid wrist: a long-term review

Silastic sheet interposition arthroplasty was performed in 20 patients with persistently painful but stable wrists. Synovial recurrence with progression of symptoms was seen in one patient. Quantitative analysis of pain demonstrated an 87% improvement in their perception of pain in the remaining 19 patients, with an average follow-up of 8.5 years. The postoperative range of motion was 58 degrees Total Active range of Motion (TAM) (range 27 degrees - 97 degrees). Nine patients showed later ulnar translocation of the carpus, and 10 patients had continuing carpal collapse. There was no relation between these changes and the degree of pain relief at the radio-carpal joint. Those patients operated on within 18 months of the onset of symptoms showed a significantly greater post-operative range of motion (68 degrees) compared to those whose symptoms had persisted from 2 to 4 years (48 degrees).