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Ann Plast Surg 2020 Mar 19. Epub 2020 Mar 19.

From the Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing.

Background: The hand and wrist are most often in contact with electrical currents and thus most vulnerable to severe electrical burns. The treatment of such severe injury via surgical intervention remains a big challenge because of the vast tissue necrosis and the segmental vascular injury. The flow-through lateral-thigh free flap has been used effectively to resurface these defects and to reconstruct segmental vascular defects. Read More

BMC Musculoskelet Disord 2020 Jan 18;21(1):40. Epub 2020 Jan 18.

Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.

Background: The purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.

Methods: Testing was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Read More

Ulus Travma Acil Cerrahi Derg 2020 Jan;26(1):123-129

Department of Emergency and First Aid, European Vocational High School, İstanbul-Turkey.

Background: Upper extremity amputations are usually not life-threatening, but they negatively affect the life quality of the victim. In addition to the functional disabilities of upper extremity amputation, disfigurements frequently cause psychological and social debilitations.

Methods: Between 2007-2015, fourteen cases were admitted to emergency with total major amputation of the upper extremity. Read More

Zhonghua Shao Shang Za Zhi 2019 Nov;35(11):776-783

Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.

To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. Read More

Cureus 2019 Oct 7;11(10):e5858. Epub 2019 Oct 7.

Plastic and Reconstructive Surgery, University of Texas Health Science Center, Houston, USA.

Indications for upper-extremity replantation include wrist-level and wrist-proximal amputations, due to the devastating loss of function incurred from these severe injuries. Decisions regarding replantation must be made expeditiously at these proximal levels in an effort to minimize ischemia time. This decision-making process becomes more complicated when a patient presents following intentional self-amputation of an extremity, especially in the setting of an associated mood disorder, psychiatric illness, and/or frank psychosis. Read More

Plast Reconstr Surg 2019 11;144(5):878e-911e

Daegu, Republic of Korea From the W Institute for Hand and Reconstructive Microsurgery and the Department of Plastic and Reconstructive Surgery, W General Hospital.

Learning Objectives: After reading this article, participant should be able to: 1. Describe the technique of replantation for very distal amputation of the digit and salvage procedures for venous drainage. 2. Read More

Anticancer Res 2019 Oct;39(10):5663-5668

Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, U.S.A.

Background/aim: Osteosarcoma of the upper extremities is rare, and characteristics in this location have not been described before. We aimed to analyze the characteristics and survival rate of osteosarcoma of the upper extremities.

Materials And Methods: A retrospective cohort study was performed by querying the National Cancer Database. Read More

Cureus 2019 Jul 17;11(7):e5164. Epub 2019 Jul 17.

Dermatology, Pakistan Air Force Hospital, Islamabad, PAK.

Introduction Traumatic amputation of the upper limb has significant associated morbidities and disabilities. After successful replantation surgery, the micro-surgeons' tasks are far from over. The replanted and revascularized segments have numerous functional restrictions and need various corrective secondary procedures. Read More

Skeletal Radiol 2019 Oct 15;48(10):1643-1649. Epub 2019 Apr 15.

Imaging Institute, Cleveland Clinic, 9500 Euclid Ave. A21, Cleveland, OH, 44195, USA.

Myxofibrosarcoma is a malignant fibroblastic soft tissue neoplasm containing a variable amount of myxoid stroma that commonly presents as a slow-growing mass in elderly patients. The neoplasm may be superficial or deep to the muscle fascia and characteristically has an infiltrative growth pattern with a dominant or multinodular mass. We describe an unusual case of high-grade myxofibrosarcoma of the wrist and forearm that infiltrated the muscles, tendons, and wrist joint, causing bone erosions. Read More

Hand Clin 2019 05;35(2):143-154

Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, 12631 East 17th Avenue, C309 (Room 6414), Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado, Anschutz Medical Center, 12631 East 17th Avenue, C309 (Room 6414), Aurora, CO 80045, USA. Electronic address:

Level of injury plays a significant role in decisions to perform replantation, with improved function, nerve regeneration, and decreased rate of reperfusion injury for injuries at the distal forearm or wrist compared with proximal injuries. The principles of a functional and sensate outcome dictate replantable parts, whereas patient comorbidity, expectations, and safety dictate patient candidacy. Vascular grafts are an expected part of the operation, and the contralateral arm or a lower extremity should be prepped into the surgical field. Read More

J Hand Surg Am 2019 Jun 4;44(6):525.e1-525.e8. Epub 2019 Feb 4.

Carolinas Medical Center, Atrium Health, Charlotte, NC; Reconstructive Center for Lost Limbs, OrthoCarolina Hand and Wrist Center, Charlotte, NC. Electronic address:

Targeted muscle reinnervation (TMR) is a surgical technique that improves modern myoelectric prosthesis functionality and plays an important role in the prevention and treatment of painful postamputation neuromas. Originally described for transhumeral amputations and shoulder disarticulations, the technique is being adapted for treatment of transtibial, transfemoral, transradial, and partial hand amputees. We describe a new technique for forearm TMR following transradial amputation with an emphasis on selecting nerve transfer patterns, managing sensory nerves, improving terminal soft tissue coverage, and employing pattern recognition technology. Read More

JBJS Case Connect 2018 Oct-Dec;8(4):e92-5

Western Orthopaedics, Denver, Colorado.

Case: A 49-year-old right-hand-dominant man sustained an auger-related injury that resulted in open dislocation at the left wrist and palm, with complete amputation of the distal aspect of the forearm and the hand. The injury at the elbow included instability with an ulnar coronoid fracture, posterior dislocation of the ulna, and posterolateral dislocation of the radius. To restore stability of the forearm stump and elbow, we performed a complete resection of the radius, open reduction and internal fixation of the coronoid tip, a repair of the lateral collateral ligament, and transfer of the distal biceps tendon to the coronoid. Read More

IEEE Trans Neural Syst Rehabil Eng 2018 12 13;26(12):2333-2341. Epub 2018 Nov 13.

Osseointegrated transradial prostheses have the potential to preserve the natural range of wrist rotation, which improves the performance of activities of daily living and reduces compensatory movements that potentially lead to secondary health problems over time. This is possible by enabling the radius and the ulna bone to move with respect to each other, restoring the functionality of the original distal-radioulnar joint. In this paper, we report on psychophysics tests performed on an osseointegrated transradial amputee with the aim to understand the extent of mobility of the implants that is required to preserve the natural forearm rotation. Read More

Pol Przegl Chir 2018 May;90(4):1-5

Uniwersytet Medyczny w Gdańsku Katedra i Klinika Ortopedii i Traumatologii Narządu Ruchu.

The paper summarizes 32 months (January 2014 - August 2016) of activity of the Replantation Service for hand amputation in Poland. Over this period a total of 568 cases of total and subtotal amputations as well as other complex injuries to the hand were referred. Of these, 354 referrals (62%) were accepted and 214 (38%) rejected. Read More

Injury 2018 Oct 22;49(10):1805-1809. Epub 2018 Aug 22.

Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC 29425, United States; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC 29425, United States. Electronic address:

Background: All terrain vehicle accidents are a common cause of trauma admission and often associated with extremity injuries. However specifics of injury patterns to the upper extremity has not previously been described. A multicenter, retrospective study was conducted to determine the frequency and distribution of upper extremity injuries sustained from ATV accidents. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017 10;31(10):1220-1224

Department of Vascular Surgery, Chengde Medical College Affiliated Hospital, Chengde Hebei, 067000, P.R.China.

Objective: To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter.

Methods: Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). Read More

Medicine (Baltimore) 2018 Mar;97(11):e0118

The Sauvé-Kapandji procedure is a reliable option for patients with various disorders of the distal radioulnar joint (DRUJ). However, postoperative pain over the proximal ulnar stump frequently develops during forearm rotation or when lifting heavy objects, although many clinically satisfactory results have been reported. This stump pain has been suggested to result from dynamic instability of the proximal ulnar stump. Read More

Zhonghua Shao Shang Za Zhi 2017 Dec;33(12):738-743

Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.

To explore the methods and effects of wound repair and functional reconstruction of high-voltage electrical burns in wrists. From January 2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were hospitalized, with 118 wrist wounds including 21 of type Ⅰ, 69 of type Ⅱ, 9 of type Ⅲ, and 19 of type Ⅳ. According to the wrist injuries, different surgical operations were performed. Read More

Ulus Travma Acil Cerrahi Derg 2017 Nov;23(6):525-527

Department of Plastic Reconstructive and Aesthetic Surgery, İnönü University Turgut Özal Medical Center, Malatya-Turkey.

Degloving hand injuries present challenging situations to hand surgeons as they present with difficulties in reconstructive microsurgery, particularly in multiple digital injuries. Time is a limiting factor when multiple degloving finger amputations are present. Thus, we proposed a repair method for multiple degloving finger injuries that involves coverage with a distal-based reverse forearm flap of all injured fingers in a two-stage procedure. Read More

Eplasty 2017 21;17:e10. Epub 2017 Mar 21.

Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL.

Postsurgical pyoderma gangrenosum is a rare but potentially devastating condition for surgical patients. While pyoderma gangrenosum has 2 subtypes, typical and atypical, each can be further classified by its heralding features. These include ulcerative, pustular, bullous, and vegetative. Read More

Sci Rep 2017 02 7;7:42161. Epub 2017 Feb 7.

Ultrasound Department, The International Peace Maternity &Child Health Hospital of China Welfare Institute, 200030, Shanghai, China.

We explored the value of the metacarpal bone plane in screening for serious fetal forearm and hand deformities, excluding simple polydactyly and dactylion deformity, by ultrasonographic examination. Observed the second to fifth metacarpal bone plane of fetuses in 20,139 pregnant women at a gestational age of 16 to 30 weeks in The International Peace Maternity &Child Health Hospital of China Welfare Institute (IPMCH). There was a total 138 cases of fetal forearm and/or hand deformity among the 20,139 pregnant women. Read More

Medicine (Baltimore) 2017 Jan;96(3):e5939

aDepartment of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University bDepartment of Hand Surgery, Zhejiang Province People's Hospital, Hangzhou, Zhejiang Province, P. R. China.

Introduction: Intramuscular hemangioma (IMH) is a rare congenital soft tissue tumor. Here, we report a case of IMH patient who had undergone several surgeries and other treatments that were all ineffective before he visited us.

Clinical Findings: This IMH patient was a 16-yearold male who was born with a tumor of unknown size in his right hand and forearm. Read More

J Biomech 2016 12 27;49(16):3901-3907. Epub 2016 Oct 27.

UNC-NC State Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695, USA.

Simple, lumped-parameter musculoskeletal models may be more adaptable and practical for clinical real-time control applications, such as prosthesis control. In this study, we determined whether a lumped-parameter, EMG-driven musculoskeletal model with four muscles could predict wrist and metacarpophalangeal (MCP) joint flexion/extension. Forearm EMG signals and joint kinematics were collected simultaneously from 5 able-bodied (AB) subjects. Read More

J Hand Surg Eur Vol 2017 May 25;42(4):377-381. Epub 2016 Aug 25.

1 Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.

Giant cell tumour of the distal radius is a locally aggressive lesion. In this study, we performed a wrist arthrodesis reconstruction with an ipsilateral double barrel segmental ulnar bone graft combined with a modified Sauve-Kapandji procedure for a giant cell tumour of the distal radius. From January 2007 to September 2013, we followed eight patients for a mean duration of 36 months. Read More

Neuroscience 2016 08 9;330:403-9. Epub 2016 Jun 9.

Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, Canada; Department of Rehabilitation, Laval University, Québec, Canada. Electronic address:

Sensorimotor reorganization is believed to play an important role in the development and maintenance of phantom limb pain, but pain itself might modulate sensorimotor plasticity induced by deafferentation. Clinical and basic research support this idea, as pain prior to amputation increases the risk of developing post-amputation pain. The aim of this study was to examine the influence of experimental tonic cutaneous hand pain on the plasticity induced by temporary ischemic hand deafferentation. Read More

J Rehabil Res Dev 2016 ;53(3):345-58

Information Systems Institute at the University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland;.

Improving the functionality of prosthetic hands with noninvasive techniques is still a challenge. Surface electromyography (sEMG) currently gives limited control capabilities; however, the application of machine learning to the analysis of sEMG signals is promising and has recently been applied in practice, but many questions still remain. In this study, we recorded the sEMG activity of the forearm of 11 male subjects with transradial amputation who were mentally performing 40 hand and wrist movements. Read More

IEEE Trans Neural Syst Rehabil Eng 2017 01 4;25(1):68-77. Epub 2016 May 4.

Decoding finger and hand movements from sEMG electrodes placed on the forearm of transradial amputees has been commonly studied by many research groups. A few recent studies have shown an interesting phenomenon: simple correlations between distal phantom finger, hand and wrist voluntary movements and muscle activity in the residual upper arm in transhumeral amputees, i.e. Read More

Indian J Orthop 2016 Mar-Apr;50(2):213-7

Department of Spinal Surgery, Queens hospital, Nottingham, U.K.

Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones) along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a "signature pattern injury" caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Read More

Ann Plast Surg 2016 Feb;77 Suppl 1:S12-5

From the *Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; †Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital; ‡Faculty of Medicine, College of Medicine, Kaohsiung Medical University; Departments of §Internal Medicine, ∥Rehabilitation, ¶Pathology, #Psychiatrics, **Radiology, ††Orthopedics, ‡‡Anesthesia, and §§Pharmacology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Purpose: Hand transplantations have been initiated and have been encouraged by promising results for more than 1 decade. The aim of this study was to present the first case of hand transplantation performed in Taiwan.

Materials And Methods: On September 3, 2014, we transplanted the left distal forearm and hand of a brain-dead managed 37 years to a man aged 45 years who had traumatic amputation of the distal third of his right forearm 30 years ago. Read More

Neuroscience 2016 Jan 10;312:48-57. Epub 2015 Nov 10.

Louis Pierquin Centre of the Regional Institute of Rehabilitation, Nancy, France.

After limb amputation, patients often wake up with a vivid perception of the presence of the missing limb, called "phantom limb". Phantom limbs have mostly been studied with respect to pain sensation. But patients can experience many other phantom sensations, including voluntary movements. Read More

Transplantation 2016 Jan;100(1):233-8

1 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico. 2 Secretaría de Salud del Distrito Federal, Mexico City, Mexico. 3 Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico. 4 Hospital Angeles Mocel, Mexico City, Mexico. 5 Physical Medicine and Rehabilitation, Mexico City, Mexico.

Background: Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire.

Methods: We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. Read More

Rev Esp Cir Ortop Traumatol 2015 Sep-Oct;59(5):343-7. Epub 2014 Dec 19.

Departamento de Ortopedia Pediátrica, Hospital Shriners para Niños, Ciudad de México, México.

Purpose: The purpose of this study is to determine the prognostic factors of a satisfactory functional outcome in patients using upper extremity prosthetics with a proximal third forearm stump, and above, level of amputation.

Materials And Methods: All patients with longitudinal deficiencies and traumatic amputations of upper extremity with a level of amputation of proximal third forearm and above were included. A total of 49 patients with unilateral upper extremity amputations that had used the prosthetic for a minimum of 2 years were included in the protocol. Read More

Plast Surg (Oakv) 2014 ;22(1):9-13

Division of Plastic Surgery, McMaster University, Hamilton, Ontario ; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario ; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario.

Background: Long-term outcomes of major upper extremity replantations are infrequently reported. It is believed that replantation is indicated for amputations at all levels in children and for all distal amputations in adults. Replantations of arm or proximal forearm amputations in adults are controversial. Read More

Plast Reconstr Surg 2014 Oct;134(4):713-20

New York, N.Y.; and Linkou, Taiwan From the Hospital for Special Surgery and Chang Gung Memorial Hospital, Chang Gung Medical College.

Background: Little literature currently exists on reconstructive strategies following successful upper extremity replantation. The authors hypothesized that the type of secondary surgery would vary predictably depending on mechanism and amputation level.

Methods: The authors performed a retrospective review of upper extremity replantations performed at their institution between 2003 and 2012. Read More

Hand Surg 2014 ;19(2):227-9

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

The advantage of preserving the distal radioulnar joint in wrist disarticulation is that full forearm rotation is possible if the joint is intact, which improves the capability of the amputee. The Sauvé-Kapandji procedure has been performed to treat rheumatoid or post-traumatic chronic instability and/or arthritis of the distal radioulnar joint. We report a patient with wrist disarticulation that presented to us with limited supination of the wrist due to an injured distal radioulnar joint. Read More

J Vasc Surg 2014 Aug 18;60(2):410-7. Epub 2014 Mar 18.

Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Electronic address:

Objective: Limited evidence exists to guide clinical management of acute finger ischemia (AFI). To further inform diagnostic evaluation and decision making, we evaluated anatomic findings, procedural management, and amputation-free survival in an institutional cohort of patients with AFI.

Methods: Consecutive patients undergoing transfemoral upper extremity angiography for AFI were identified. Read More

Exp Brain Res 2014 Jul 19;232(7):2143-54. Epub 2014 Mar 19.

School of Applied Physiology, Georgia Institute of Technology, 555 14th Street NW, Atlanta, GA, 30318, USA.

Our previous work demonstrated that the action encoding parietofrontal network, which is crucial in planning and executing motor tasks, is less active in prosthesis users who imitate movements of intact actors (mismatched limb) versus prosthesis users (matched limb). Such activation could have behavioral consequences in prosthesis users rehabilitating with intact therapists. The goal was to identify behavioral effects of matched versus mismatched limb action imitation in naïve users of prostheses. Read More

Ir J Med Sci 2014 Dec 28;183(4):643-7. Epub 2014 Jan 28.

Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai, 200233, People's Republic of China.

Introduction: The purpose of this study is to evaluate the clinical outcomes in patients with forearm rotation limitation after successful wrist-level revascularization who underwent a modified Sauvé-Kapandji (S-K) procedure.

Methods: This was a retrospective review of the clinical records of nine patients (three women, six men) after successful wrist-level revascularization who underwent late restoration of forearm rotation. All patients were evaluated using a Mayo Modified Wrist Score. Read More

J Wrist Surg 2013 Aug;2(3):271-5

Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Background Malignant tenosynovial giant cell tumors (GCTs) are extremely rare, and their etiology is unknown. However, this type of malignancy is associated with high metastasis and mortality rates. Therefore, the treatment of choice is wide excision. Read More

Tech Hand Up Extrem Surg 2013 Dec;17(4):228-31

Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA.

The field of vascularized composite allotransplantation has developed for more than a decade. Investigators are defining patient selection criteria, transplant indications, immunologic regimens, and tolerance. The majority of the current reported hand transplantations have been for treatment of distal forearm or hand amputations. Read More

IEEE Trans Neural Syst Rehabil Eng 2014 May 7;22(3):522-32. Epub 2013 Oct 7.

We assessed the ability of four transradial amputees to control a virtual prosthesis capable of nine classes of movement both before and after a two-week training period. Subjects attended eight one-on-one training sessions that focused on improving the consistency and distinguishability of their hand and wrist movements using visual biofeedback from a virtual prosthesis. The virtual environment facilitated the precise quantification of three prosthesis control measures. Read More

J Orthop Surg (Hong Kong) 2013 Aug;21(2):245-8

Department of Orthopaedics, BS Medical College, West Bengal, India.

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually occurs in the mucous membranes of nose, nasopharynx, and eyes, and less commonly in extra nasal sites such as skin, bones, genitalia, and even the internal organs. Rhinosporidiosis occurs in the wrist joint with isolated bony involvement is rare. Read More

J Hand Surg Am 2013 Oct 17;38(10):2055-67. Epub 2013 May 17.

Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada. Electronic address:

Many modalities exist for diagnosing and treating lipofibromatous hamartoma (LFH), with no clear consensus. This is the first comprehensive study to review the existing literature on LFH of the median nerve and to suggest a systematic approach to its diagnosis and treatment. An electronic and manual search was conducted on Medline, Embase, Google Scholar, Current Contents, and Science Citation Index for original and review articles in English or French, from 1946 to November 2012. Read More

J Plast Reconstr Aesthet Surg 2013 Oct 5;66(10):1428-31. Epub 2013 Mar 5.

Department of Hand and Plastic Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 0UX, United Kingdom.

Following traumatic bilateral arm amputation in a 46-year-old woman, orthotopic replantation was not possible. The patient underwent replantation of the left forearm to the right proximal forearm. At two years she has a sensate hand, with good recovery of her long flexors of the hand and wrist extensors. Read More

Acta Neurochir Suppl 2013 ;117:73-8

Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine of University of São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.

Introduction: Most authors perform the implantation of epidural electrodes for motor cortex stimulation (MCS) under general anesthesia, using navigation merely based on anatomic landmarks or in combination with intra-operative sensory evoked potentials (SEP) for functional localization. However, intra-operative SEP can only provide the localization of central sulcus in patients who present sensory pathways which are at least partially preserved. Conversely, there are massive deafferentation pain syndromes (e. Read More

Case Rep Pathol 2012 3;2012:353215. Epub 2012 Nov 3.

Department of Pathology, J.S.S. Medical College, J.S.S. University, Karnataka, Mysore, 570015, India.

Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. Read More

Arch Orthop Trauma Surg 2012 Dec 11;132(12):1797-805. Epub 2012 Aug 11.

Department of Plastic and Hand Surgery, University of Bern, Inselspital Bern, Freiburgstrasse, 3010 Bern, Switzerland.

Introduction: Micro- or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes.

Materials And Methods: Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. Read More

Brain Res 2012 Aug 26;1468:11-28. Epub 2012 Mar 26.

Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, 855 Monroe Avenue, Memphis, TN 38163, USA.

We examined the physiological representation of the forelimb in the cuneate nucleus (CN) of forelimb-intact young adult rats (n=38) as the first part in a series of studies aimed at understanding the possible role that CN plays in delayed cortical reorganization that follows forelimb amputation. Metabolic labeling with cytochrome oxidase (CO) and electrophysiological mapping were used to examine the relationship between the structural and functional organization of CN. CN is a cylinder-shaped structure that lies bilaterally in the brainstem and extends nearly 4mm in the rostrocaudal direction. Read More

Handchir Mikrochir Plast Chir 2012 Jun 11;44(3):171-4. Epub 2012 Jun 11.

Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland.

Adult fibrosarcoma is a rare malignant soft-tissue neoplasm occurring in middle-aged to elderly adults. We present a case of recurrent tumor involving the wrist, which was treated by wide excision including resection of the scaphoid and radio-lunate fusion, followed by coverage of soft tissue defect with a free flap. Despite macro- and microscopic adequate tumor resection, recurrence of the neoplasm occurred at 6 months and eventually amputation of the forearm was performed. Read More

Hautarzt 2012 Apr;63(4):278-82

Hautklinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.

A 35-year-old man presented with swelling, indurations and nodules on the thumb, wrist and fingers of the right hand. History revealed that the findings were slowly progressive and had been present for at least eight years. Histopathologic analysis of a nodule showed a diffuse infiltrate with atypical spindle-shaped cells and expression of cytokeratin, epithelial membrane antigen (EMA) and CD34; the diagnosis of epithelioid sarcoma (ES) was made. Read More