Vein grafting in fingertip replantations

In this retrospective study, the survival rates of fingertip replantation with and without vein grafting were evaluated along with their postoperative functional and cosmetic results. One hundred twenty‐one‐fingertip amputations were performed in 103 patients between September 2002 and July 2007. Thirty‐four amputated fingertips were replanted without vein grafting, while 87 amputated fingertips were replanted with vein grafting for arterial and/or venous repairs. The overall survival rates of the replantations with and without vein grafting were 90% (78/87) and 85% (29/34), respectively. The survival rates were 88% (36/41) with venous repair, 93% (25/27) with arterial repair, and 89% (17/19) with both. Nineteen patients without vein grafting and 48 patients with vein grafting had a follow‐up period of more than one year. Good cosmetic and functional outcomes were observed in both groups of patients. The results show that vein grafting is a reliable technique in fingertip replantations, showing no significant difference (P > 0.05) in survival between those with and without vein grafting. Furthermore, no significant difference (P > 0.05) in survival was found between cases with vein grafts for arterial and/or venous repairs. In fingertip replantations with vein grafting, favorable functional and esthetic results can be achieved without sacrificing replantation survival. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

Subciliary incision and skin-muscle eyelid flap for orbital fractures

The lower eyelid skin-muscle flap is now widely used for cosmetic blepharoplasty, primarily because of the ease and speed of dissection it offers. We have used the same technique as a surgical approach in fractures of the orbital floor and rim. In a large clinical series seen over a three and a half-year period, no major complications were noted. This approach provides simple, extremely rapid exposure of the injured area and is an excellent alternative to other approaches to this site.     

Brachial plexus injury in Thailand: A report of 520 cases

Between October 1984 and October 1993, 520 patients with traumatic brachial plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male and 34 female patients. Eighty-two percent of the injuries were caused by motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot, stabbing, and other means. The initial physical examination revealed 332 (63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred twenty-seven patients were treated conservatively, 43 patients were observed before definitive treatment was given, and 350 patients were treated by operative means. Four hundred and twenty-one surgical procedures were performed, consisting of 314 neurotisations (250 spinal accessory, 14 plexo-plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic, and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle transfers combined with neurotisations, and 30 musculotendinous transfers. Motor functional recovery of patients followed up for more than 2 years was evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In patients with neurotisation, the spinal accessory (to supra-scapular, axillary, and musculocutaneous), intercostal (to musculocutaneous), phrenic (to suprascapular, axillary, and musculocutaneous), and plexo-plexal methods gave a significant number of good results. © Wiley-Liss, Inc. © 1995 Wiley-Liss, Inc.     

Mekong malaria. II. Update of malaria, multi-drug resistance and economic development in the Mekong region of Southeast Asia

In an expansion of the first Mekong Malaria monograph published in 1999, this second monograph updates the malaria database in the countries comprising the Mekong region of Southeast Asia. The update adds another 3 years' information to cover cumulative data from the 6 Mekong countries (Cambodia, China/Yunnan, Lao PDR, Myanmar, Thailand, Viet Nam) for the six-year period 1999-2001. The objective is to generate a more comprehensive regional perspective in what is a global epicenter of drug resistant falciparum malaria, in order to improve malaria control on a regional basis in the context of social and economic change. The further application of geographical information systems (GIS) to the analysis has underscored the overall asymmetry of disease patterns in the region, with increased emphasis on population mobility in disease spread. Of great importance is the continuing expansion of resistance of P. falciparum to antimalarial drugs in common use and the increasing employment of differing drug combinations as a result. The variation in drug policy among the 6 countries still represents a major obstacle to the institution of region-wide restrictions on drug misuse. An important step forward has been the establishment of 36 sentinel sites throughout the 6 countries, with the objective of standardizing the drug monitoring process; while not all sentinel sites are fully operational yet, the initial implementation has already given encouraging results in relation to disease monitoring. Some decreases in malaria mortality have been recorded. The disease patterns delineated by GIS are particularly instructive when focused on inter-country distribution, which is where more local collaborative effort can be made to rationalize resource utilization and policy development. Placing disease data in the context of socio-economic trends within and between countries serves to further identify the needs and the potential for placing emphasis on resource rationalization on a regional basis. Despite the difficulties, the 6-year time frame represented in this monograph gives confidence that the now well established collaboration is becoming a major factor in improving malaria control on a regional basis and hopefully redressing to a substantial degree the key problem of spread of drug resistance regionally and eventually globally.     

Endoscopic transumbilical subglandular augmentation mammaplasty

This technique has provoked many controversial comments. With modification and adequate clinician training and experience, however, the results can improve, and complications can be minimized. The author's complications occurred in the early stages of the use of this method; as experience was gained, they decreased. Furthermore, fewer and less severe complications occurred when the techniques were modified, including using instrument dissection before tissue expansion, better patient selection, early massage, and more frequent postoperative follow-up visits. In addition, this method leaves no scar at the breast and allows a quicker recovery. Most patients who underwent this procedure have been pleased with their results. Transumbilical endoscopic bilateral augmentation mammaplasty is an attractive alternative technique, and with careful patient selection, operative modification, and technical expertise, results can be achieved comparable with an open subglandular augmentation.     

Clinical applications of venous flaps in the reconstruction of hands and fingers

In recent years, the venous flap has been highly regarded in microsurgical and reconstructive surgeries, especially in the reconstruction of hand and digit injuries. It is easily designed and harvested with good quality. It is thin and pliable, without the need of sacrificing a major artery at the donor site, and has no limitation on the donor site. It can be transferred not only as a pure skin flap, but also as a composite flap including tendons and nerves as well as vein grafts. All these advantages make it an optimal candidate for hand and digit reconstruction when conventional flaps are limited or unavailable. In this article, we review its classifications and the selection of donor sites, update its clinical applications, and summarize its indications for all types of venous flaps in hand and digit reconstruction.     

Brachial plexus injuries in the adult. nerve transfers: the Siriraj Hospital experience

A strategy that uses the selective combination of neurotizations can yield a moderate degree of shoulder and elbow control. Even though some wrist and finger movement can occasionally be achieved by the current methods of neurotization,the results in terms of restoration of useful hand function are still far from satisfactory. The use of intraplexal and contralateral plexal neurotization combined with free-functioning muscle transfer and the better understanding of central-peripheral function integration may provide more purposeful hand function in the future.