Aim: The management of complex dorsal hand wounds with extensor tendon loss is controversial. Treatment has focused on soft tissue coverage, but there is limited evidence comparing immediate vs. staged tendon reconstr...Aim: The management of complex dorsal hand wounds with extensor tendon loss is controversial. Treatment has focused on soft tissue coverage, but there is limited evidence comparing immediate vs. staged tendon reconstruction. This review evaluates existing literature to determine the optimal management of composite hand defects. Methods: A MEDLINE database review was performed including objective measurements such as number of operations, total active motion, grip strength, days to maximum range of motion (ROM), and return to work. Data extraction included demographics, surgical techniques, complications, and relative outcome. We compared primary and secondary staged reconstruction to correlate any significant differences in outcome and determine optimal timing and technique for extensor tendon reconstruction. We extracted information on flap types including regional and free tissue transfer with tendinous components vs. staged tendon grafts. Results: Comparison of outcomes showed that patients with immediate reconstruction had fewer operations, faster return to maximum ROM, and greater chance of returning to work. The most successful single stage flaps include the radial forearm, suitable for reconstructing one to three tendons and the dorsalis pedis for three or four tendons;however, there were significantly more complications in immediate reconstruction particularly regarding donor site morbidity. Pedicled flaps had better total active motion. The two-stage approach resulted in acceptable functional outcomes without significant complications. ;Conclusion: Immediate cutaneous tendinous flaps have clear advantages over staged approaches for reconstruction ofcomposite dorsal hand wounds. Benefits include less operations, faster time to maximum ROM, and higher percent of patients returning to work;however, significantly more flap related complications were seen. Immediate pedicled radial forearm provided the best total active motion with least complications. When patient circumstances dictate, a fascial perforator free flap offers a suitable environment for staged tendon grafts with good functional outcomes reported albeit longer time to achieve them.展开更多
We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal ...We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.展开更多
背景:随着生物力学、微创技术及再生医学的发展,手部肌腱修复技术不断创新,过去20年,研究关注传统修复技术的优化及新型修复材料应用,提高了手部肌腱修复效果与功能恢复水平。目的:通过文献计量学分析评估过去20年手部肌腱修复技术的全...背景:随着生物力学、微创技术及再生医学的发展,手部肌腱修复技术不断创新,过去20年,研究关注传统修复技术的优化及新型修复材料应用,提高了手部肌腱修复效果与功能恢复水平。目的:通过文献计量学分析评估过去20年手部肌腱修复技术的全球研究现状及发展趋势,识别研究热点及演变方向。方法:通过Web of Science核心合集数据库筛选2005-2024年手部肌腱修复领域的研究文献,采用文献计量学方法进行分析,数据通过Microsoft Excel整理,使用R语言Bibliometrix包分析出版趋势,使用VOSviewer可视化关键词共现及合作网络,CiteSpace用于识别研究热点及其时间演变。结果与结论:过去20年间,手部肌腱修复领域的研究呈现出波动增长趋势,其中美国、中国和欧洲为主要的研究贡献国家,美国在全球研究网络中占据中心地位。屈肌腱修复研究主要集中在生物力学和新修复材料的开发,而伸肌腱研究则重点关注术后功能恢复与复杂损伤修复。近年来,生物材料和再生医学逐渐成为研究热点,推动了精准医疗在肌腱修复中的应用。未来,跨学科合作与先进材料的结合将进一步优化手部肌腱修复技术。展开更多
Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need t...Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need therapy after nerve damage. The procedure is specifically useful in restoring motion to the hand after surgical repairs to the extensor muscle and tendons. Mirror therapy rewires the brain by making the restored limb remember hand motions by observing the motions of a normal hand. The concept of a mirror image is that the movement of the uninjured arm forms the illusion of the same movement in the affected arm. Efforts to repeat hand movements elicit the same reaction in the affected hand in what is referred to as Hebbian learning. This case study evaluated MT’s effectiveness in motion restoration after a glass injury. This case study showed restoration of normal hand motions in a patient following surgery to repair a glass cut to the arm. Surgery repaired the lacerated extensor tendon and radial nerve. The muscle belly was repaired, and a graft fixed the nerve gap. Once the arm healed, the patient underwent rehabilitation in mirror therapy to restore normal function in his hand. After conducting mirror therapy, the pain was eliminated, and the patient restored normal function of moving the hand and finger extension. In addition, the therapy could be conducted at home without needing a professional. The effectiveness of mirror therapy was seen in the functional restoration of hand and finger movement. The process is also less complicated as it can be performed at home.展开更多
Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent in...Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.展开更多
Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options...Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.展开更多
目的探讨采用不同手术方法治疗陈旧性Ⅱ区伸肌腱损伤的临床效果,选择最佳手术方法。方法2006年5月-2014年5月采用不同手术方法治疗68例各类陈旧性Ⅱ区伸肌腱损伤患者。男50例,女18例;年龄18~52岁,平均36岁。致伤原因：挫伤50例,撕脱伤11...目的探讨采用不同手术方法治疗陈旧性Ⅱ区伸肌腱损伤的临床效果,选择最佳手术方法。方法2006年5月-2014年5月采用不同手术方法治疗68例各类陈旧性Ⅱ区伸肌腱损伤患者。男50例,女18例;年龄18~52岁,平均36岁。致伤原因：挫伤50例,撕脱伤11例,烧伤7例。左侧21例,右侧47例。指别：示指18例,中指21例,环指24例,小指5例。受伤距二次手术时间1.5个月~1年,平均6.75个月。其中患指主动不能伸直、被动活动尚可伸直者32例,采用中央束直接修补法;主、被动均不能伸直者18例,采用侧束交叉缝合（8例）或Littler-Eaton修复法（10例）;Ⅱ区伸肌腱缺损者11例,采用肌腱移植修复方法;烧伤后伴指间关节挛缩7例,采用终点切断术。结果术后切口均Ⅰ期愈合。68例均获随访,随访时间3~12个月,平均6.9个月。3例出现了不同程度的肌腱粘连,均相应出现不同程度疼痛,嘱患者继续理疗至康复。2例分别于术后3周和1个月时复发,中央束再松驰,再次行伸指肌腱紧缩术治疗。术后3~6个月采用手指总活动度（total active motion,TAM）功能评定标准评价疗效：优52例,良11例,可3例,差2例,优良率92.6%。结论对陈旧性Ⅱ区伸肌腱损伤,严格选择适应证、采用正确治疗方法及术后康复,可获得满意疗效。展开更多
基金Paul J.Weatherby,BS and Pablo L.Padilla,MD University of Texas Medical Branch,301 University Blvd.Galveston,TX 77555.Paul J.Weatherby and Pablo L.Padilla,assisted with literature review data collection and compilation
文摘Aim: The management of complex dorsal hand wounds with extensor tendon loss is controversial. Treatment has focused on soft tissue coverage, but there is limited evidence comparing immediate vs. staged tendon reconstruction. This review evaluates existing literature to determine the optimal management of composite hand defects. Methods: A MEDLINE database review was performed including objective measurements such as number of operations, total active motion, grip strength, days to maximum range of motion (ROM), and return to work. Data extraction included demographics, surgical techniques, complications, and relative outcome. We compared primary and secondary staged reconstruction to correlate any significant differences in outcome and determine optimal timing and technique for extensor tendon reconstruction. We extracted information on flap types including regional and free tissue transfer with tendinous components vs. staged tendon grafts. Results: Comparison of outcomes showed that patients with immediate reconstruction had fewer operations, faster return to maximum ROM, and greater chance of returning to work. The most successful single stage flaps include the radial forearm, suitable for reconstructing one to three tendons and the dorsalis pedis for three or four tendons;however, there were significantly more complications in immediate reconstruction particularly regarding donor site morbidity. Pedicled flaps had better total active motion. The two-stage approach resulted in acceptable functional outcomes without significant complications. ;Conclusion: Immediate cutaneous tendinous flaps have clear advantages over staged approaches for reconstruction ofcomposite dorsal hand wounds. Benefits include less operations, faster time to maximum ROM, and higher percent of patients returning to work;however, significantly more flap related complications were seen. Immediate pedicled radial forearm provided the best total active motion with least complications. When patient circumstances dictate, a fascial perforator free flap offers a suitable environment for staged tendon grafts with good functional outcomes reported albeit longer time to achieve them.
文摘We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.
文摘背景:随着生物力学、微创技术及再生医学的发展,手部肌腱修复技术不断创新,过去20年,研究关注传统修复技术的优化及新型修复材料应用,提高了手部肌腱修复效果与功能恢复水平。目的:通过文献计量学分析评估过去20年手部肌腱修复技术的全球研究现状及发展趋势,识别研究热点及演变方向。方法:通过Web of Science核心合集数据库筛选2005-2024年手部肌腱修复领域的研究文献,采用文献计量学方法进行分析,数据通过Microsoft Excel整理,使用R语言Bibliometrix包分析出版趋势,使用VOSviewer可视化关键词共现及合作网络,CiteSpace用于识别研究热点及其时间演变。结果与结论:过去20年间,手部肌腱修复领域的研究呈现出波动增长趋势,其中美国、中国和欧洲为主要的研究贡献国家,美国在全球研究网络中占据中心地位。屈肌腱修复研究主要集中在生物力学和新修复材料的开发,而伸肌腱研究则重点关注术后功能恢复与复杂损伤修复。近年来,生物材料和再生医学逐渐成为研究热点,推动了精准医疗在肌腱修复中的应用。未来,跨学科合作与先进材料的结合将进一步优化手部肌腱修复技术。
文摘Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need therapy after nerve damage. The procedure is specifically useful in restoring motion to the hand after surgical repairs to the extensor muscle and tendons. Mirror therapy rewires the brain by making the restored limb remember hand motions by observing the motions of a normal hand. The concept of a mirror image is that the movement of the uninjured arm forms the illusion of the same movement in the affected arm. Efforts to repeat hand movements elicit the same reaction in the affected hand in what is referred to as Hebbian learning. This case study evaluated MT’s effectiveness in motion restoration after a glass injury. This case study showed restoration of normal hand motions in a patient following surgery to repair a glass cut to the arm. Surgery repaired the lacerated extensor tendon and radial nerve. The muscle belly was repaired, and a graft fixed the nerve gap. Once the arm healed, the patient underwent rehabilitation in mirror therapy to restore normal function in his hand. After conducting mirror therapy, the pain was eliminated, and the patient restored normal function of moving the hand and finger extension. In addition, the therapy could be conducted at home without needing a professional. The effectiveness of mirror therapy was seen in the functional restoration of hand and finger movement. The process is also less complicated as it can be performed at home.
文摘Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.
文摘Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.
文摘目的探讨采用不同手术方法治疗陈旧性Ⅱ区伸肌腱损伤的临床效果,选择最佳手术方法。方法2006年5月-2014年5月采用不同手术方法治疗68例各类陈旧性Ⅱ区伸肌腱损伤患者。男50例,女18例;年龄18~52岁,平均36岁。致伤原因：挫伤50例,撕脱伤11例,烧伤7例。左侧21例,右侧47例。指别：示指18例,中指21例,环指24例,小指5例。受伤距二次手术时间1.5个月~1年,平均6.75个月。其中患指主动不能伸直、被动活动尚可伸直者32例,采用中央束直接修补法;主、被动均不能伸直者18例,采用侧束交叉缝合（8例）或Littler-Eaton修复法（10例）;Ⅱ区伸肌腱缺损者11例,采用肌腱移植修复方法;烧伤后伴指间关节挛缩7例,采用终点切断术。结果术后切口均Ⅰ期愈合。68例均获随访,随访时间3~12个月,平均6.9个月。3例出现了不同程度的肌腱粘连,均相应出现不同程度疼痛,嘱患者继续理疗至康复。2例分别于术后3周和1个月时复发,中央束再松驰,再次行伸指肌腱紧缩术治疗。术后3~6个月采用手指总活动度（total active motion,TAM）功能评定标准评价疗效：优52例,良11例,可3例,差2例,优良率92.6%。结论对陈旧性Ⅱ区伸肌腱损伤,严格选择适应证、采用正确治疗方法及术后康复,可获得满意疗效。
