Victoria Rose

Visual Estimation of Finger Angles: Do we Need Goniometers?:

Seventy-one plastic surgeons and therapists, of varying levels of seniority and experience, were asked to examine a resin cast of an adult male hand and use estimation to measure the angles of the metacarpophalangeal and interphalangeal joints of each digit. Visual estimation by all subjects was inaccurate by a mean of approximately 25% (median percentage error 22, range 1–100). Consultants were the most accurate, whilst physiotherapists were the least. Regular goniometer users were no more accurate. However, hand surgery experience correlated with accuracy, as did a stated interest in hand surgery. Although visual accuracy improves with experience, it is still an inaccurate technique. We, therefore, recommend that goniometers should be used for measuring angles in hand surgery patients.

Delayed skin grafting utilizing autologous banked tissue

In performing bowel flaps for voice reconstruction, it is common practice to delay skin grafting to allow for swelling and monitoring. Harvesting the skin graft at the time of reconstruction and banking it at its donor site allows for later transfer at bedside. Ten patients between January and July of 2006 had skin harvested from their thigh at the time of intestinal transfer and banked at the donor site. Transfer of the graft from donor to recipient site was carried out at bedside between the third and eighth postoperative day with sedation and analgesia. Elevation of the graft was well tolerated and take was over 95% in all cases without related complications. At follow-up between 5 and 12 months all grafts had healed. This is a reliable technique for skin storage in diverse clinical applications or when traditional skin banking cannot be performed because of tissue banking regulations.

Percutaneous extensor tendon division.

A 29-year-old film researcher presented to our department with an inability to fully extend his non-dominant index finger. Two days earlier whilst sawing through a piece of wood, the handsaw slipped on to the dorsum of his left hand. He attended his local casualty department, where it was decided that his cutaneous injury required no treatment and he was discharged. On examination there was an extensor lag at the MCPJ of his left index finger of 30◦ (Fig. 1a) with a line of saw-tooth impressions visible in the skin over the shaft of his second metacarpal bone (Fig. 1b). Surgical exploration was carried out under regional anaesthesia and a complete division of both extensor indicis and extensor communis to the index finger in zone VI was found (Fig. 1d). These were repaired with core mattress and epitendinous continuous sutures. He underwent early mobilization and regained full functional activity.