Youn-Tae Roh

Spontaneous anterior interosseous nerve syndrome: clinical analysis of eleven surgical cases

Abstract The aetiology of anterior interosseous nerve (AIN) syndrome and an optimal treatment strategy remain controversial. Eleven patients with spontaneous AIN syndrome, who were treated by surgical exploration, were reviewed at a mean of 32.5 months after the operation. Eight men and three women were included in the study. None of the patients had a history of trauma and there was no evidence of a neuropathy other than AIN syndrome. Six patients showed complete paralysis of the flexor pollicis longus (FPL) and the flexor digitorum profundus of the index finger (FDS1). Five patients had incomplete paralysis, with isolated lesions of the FPL in two and the FDP1 in three. Surgery was performed 7.8 months after the onset of paralysis. The most common structure of nerve compression was a fibrous band of the flexor digitorum sublimis muscle. However, no definitive compression site or anatomic abnormality could be found in four patients. Ten of the 11 patients had recovered muscle strength above grade 4 within 12 months of the operation. Good results were obtained in 10 patients and fair in only one at final assessment. Four patients (one man and three women) raised cosmetic concerns due to excessive scar formation on the upper forearm. Surgical exploration is recommended only in cases where AIN syndrome is apparent, no other neuronal lesions are apparent, and where there was no recovery after 6 months of conservative treatment. Careful preoperative examination is essential to avoid misdiagnosis and inappropriate operation, particularly in cases of incomplete AIN syndrome.

Symmetrical peripheral gangrene of all fingers and toes: creating a thumb by on-top plasty in a difficult situation

A 19-year-old woman presented as an emergency with a 1-day history of severe vaginal bleeding, abdominal pain and fever. The day before, she had undergone dilatation and curettage for a termination of pregnancy. She rapidly deteriorated into septic shock and multi-organ failure and was admitted to the intensive care unit (ICU). She developed disseminated intravascular coagulation and adult respiratory distress syndrome requiring high dose inotropes and haemofiltration. Cultures grew Enterobactor cloacae. By day 10, she had developed ischaemic necrosis of all fingers and toes. These were managed conservatively until a clear level of demarcation was achieved and she was stable enough to undergo surgery. After 7 weeks of ICU management, her condition had improved and blood cultures were negative. The gangrene had progressed and amputation was considered inevitable (Figure 1(a)). Initially, she underwent bilateral toe amputation. Two weeks after the first operation, bilateral digital amputations were carried out. The right digits were amputated at the level of the metacarpophalangeal joints and the left digits were amputated at the level of