Robert C. Wray

A comparison of conjunctival and subciliary incisions for orbital fractures.

Abstract Although complications of conjunctival incisions have been described (Tenzel and Miller, 1971; Converseet al., 1973; Tessier, 1973; Habal and Chaset, 1974; Lynchet al., 1974), there has been no documentation of complications following subciliary incisions. This study was undertaken to compare those 2 most commonly used incisions for exposure of fractures of the infraorbital rim and the orbital floor.

Clinical treatment of partial tendon lacerations without suturing and with early motion.

Partial lacerations of flexor tendons in chickens come out the strongest and glide best if they are not sutured and not immobilized. We treated 17 patients with 20 partial flexor tendon lacerations by not suturing the tendon and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 percent of the cross-sectional area. Sixteen of obtained excellent function of the digit, and one obtained good to excellent function. This technique should be used only in cooperative patients.

Median nerve compression and trigger finger in the mucopolysaccharidoses and related diseases.

Patients with Hurlers syndrome (MPS-1H), I-cell disease (ML-II) and pseudo-Hurlers syndrome (ML-III) had median nerve compression and triggering of the fingers which limited finger extension. To our knowledge, this combination has not been reported previously in patients with mucopolysaccharidoses and related disorders. In all of our 3 cases the median nerve was compressed by thickened flexor tenosynovium. Synovectomy and resection of the volar carpal ligament improved the hand function in all, including the mentally retarded patient with Hurlers syndrome. Release of the fibroosseous tunnel in two patients was followed by an increased range of motion (but not full extension). A fourth patient, without a mucopolysaccharide storage disorder, also had the combination of trigger finger and carpal tunnel syndrome.

Management of acute hand injuries : a biological approach

The multitude of modern imaging techniques has made pediatric neuroradiology increasingly complex. This book aims to help practitioners choose the best one for their patients.

Treatment of Impending Nipple Necrosis Following Reduction Mammaplasty

Despite careful preoperative planning and accurate surgery, nipple necrosis may follow reduction mammaplasty. Impending nipple necrosis developed following translocation of the nipple and areola on a dermal pedicle in two patients. An excellent result was obtained by converting the nipple-areola complex to a full-thickness graft and removing the avascular portion of the breast. We recommend this technique to the surgeon whose patients develop impending nipple necrosis after reduction mammaplasty.

Lateral-volar finger flap for the treatment of burn syndactyly.

To completely open the web space in burn syndactyly and provide tissue that is pliable and elastic, we describe a flap from the lateral and volar surfaces of an adjacent finger which will completely cover the opened defect. The results of this procedure in 24 web spaces are reported.

Restoration of Elbow Flexion

The authors review the anatomy, surgical technique and the physical factors involved in the restoration of elbow flexion. They conclude that there are distinct mechanical advantages to Clarks method of transfer of muscle from the pectoralis major.

Effect of continuous load on the mechanical properties of tendon adhesions

The restoration of tendon gliding after tendon repair or grafting is dependent upon alteration of the scar about the tendon. Application of a load (active range of motion exercises) is used clinically to effect this alteration. Using the chicken as a model, we are attempting to define the optimal timing, quantity and duration of the load. In these initial experiments, the effects of application of a continuous load for forty eight hours were evaluated in eighty nine chickens. A continuous load applied for forty eight hours had no significant effect on motion of repaired tendons or the scar “stiffness”.

Silastic frameworks in total reconstruction of the auricle.

Abstract Sixteen Silastic ear frameworks have been implanted in 14 patients for the correction of microtia; 13 (81 per cent) of these frames have been removed; 11 were removed due to necrosis of skin overlying the frame and 2 were removed due to infection. Greater care in creation of the pocket for the framework and suturing the framework to the temporal fascia might decrease the incidence of exposure of the Silastic frameworks.