Floor plan - 2013 Annual Meeting - American Association for Hand ...

Management of the Central Extensor Tendon on the Surgical Approach for Exposure of the
Proximal Interphalangeal Joint: A Biomechanical Study
Institution where the work was prepared: University of New Mexico, Department of Orthopaedics, Albuquerque,
NM, USA
Deana Mercer; Keikhosrow Firoozbakhsh; Alex Carvalho; Moheb S. Moneim; University of New Mexico
PURPOSE:
Since 1966 silicone implant arthroplasty has been used to treat arthritis of the PIP joint as an alternative to fusion. The volar approach
to expose this joint spares the extensor mechanism at the cost of increased risk to neurovascular structures. In the dorsal approach, the
extensor mechanism must be carefully handled, reattached and then protected during rehabilitation. Several surgical techniques have
been used to handle the extensor mechanism. Swanson et al. recommended midline incision of the central tendon followed by release
of the lateral insertion on the middle phalanx and then reattachment to the base of the middle phalanx. Our clinical experience led us
to a new surgical technique; splitting then repairing the extensor mechanism without bone reattachment as recommended by Swanson.
The purpose of this study was to biomechanically compare strength and function of this technique with that of Swanson.
METHODS:
Four pairs of fresh-frozen cadaveric hands were used. The index, long and ring finger were harvested for testing. Twelve digits (3 digits
x 4 hands) were designated as control and were used to measure the fixation strength of Swanson's procedure. The other 12 digits of
the paired hands were designated as experimental and were used to measure the fixation strength of the proposed new technique.
RESULTS:
The fixation strength mean ± SD were 4.74 ± 0.46 N/mm for the control group and 4.62 ± 0.30 for the experimental group. The results
were not statistically different, p=0.45.
DISCUSSION:
The simple repair of the central slip without the bone reattachment preserves the function of the extensor mechanism on the PIP joint.
In our clinical cases we haven't noticed any increase in the incidence of extensor lag or boutonniËre deformity as a result of that. This
technique can also be applied for fracture fixation in the area.
Treatment of Chronic Digital Ischemia with Direct Microsurgical Revascularization
Institution where the work was prepared: Northwestern University, Chicago, IL, USA
Zol Kryger, MD; Vinay Rawlani; Gregory A. Dumanian; Northwestern University
INTRODUCTION:
Chronic digital ischemia of the fingers is a painful debilitating condition that untreated can progress to functional loss and even amputation.
Direct revascularization techniques require microsurgery, however, these procedures are quite distinct from free tissue transfer and replantation.
The literature is lacking an adequate description of how best to perform this uncommon procedure. The authors present their technique
for treating digital ischemia using a radial to digital artery bypass graft performed in a bloodless field under tourniquet and microscope.
METHODS:
This procedure was performed in six consecutive patients (four with occlusive collagen vascular disease, one with diabetic peripheral
vascular disease, one with hypercoagulable state), all of whom had ischemic digits with ulceration, pain, and dry gangrene and who
were unmanageable under conservative medical or surgical therapy. The outcomes were resolution of fingertip ulcers, avoidance of
more proximal amputations, and elimination of ischemic pain.
RESULTS:
Successful outcomes were obtained in all six patients, and the grafts have remained patent with an average follow up 17 months as
confirmed by a hand-held Doppler examination. All patients had salvage of the revascularized finger, and resolution of the ulcers and
rest pain. The mean tourniquet time was 100 minutes.
CONCLUSION:
Digital revascularization using a radial to digital artery bypass is a straightforward, reproducible technique for the treatment of patients
suffering from refractory chronic digital ischemia.
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