Traditionally open extensor tendon injuries in zones III to V (PIP to MP joints) have been treated with repair and immobilization in extension for 4 to 6 weeks. Early controlled motion protocols have been successfully used in zones VI and VII of the extensors. An early controlled mobilization protocol combined with strong repair for zones III to V extensor tendon lacerations was studied prospectively.

From 1999 to 2003, 27 extensor tendon lacerations in 26 patients, mean age 34 years (range 14–70), were treated using dynamic extension splinting. Inclusion criteria were zone III to V, complete lacerations involving the extensor mechanism and possibly the dorsal capsule (without associated fractures or skin deficits) in patients without healing impairment. All injuries were treated in the emergency department with a core Kessler-Tajima suture and continuous epitendon suture. After an initial immobilization in a static splint ranging from 5 days (for zone V) to 3 weeks (for zone III), controlled mobilization was initiated with a dynamic splint that included only the injured finger. The patient was weaned off the dynamic splint 5 weeks after the initial trauma. The patients were treated in an outpatient basis and did not attend any formal physiotherapy program.

The mean follow up was 16 months (range 10–24 months). No ruptures or boutoniere deformities were observed and no tenolysis was necessary. The mean TAM was 242deg for the fingers and 119deg for the thumbs. The mean grip and pinch strength averaged 85% and 88% that of the contralateral unaffected extremity. 77% of the patients achieved a good or excellent result in Miller’s classification. The mean loss of flexion was found to be greater than the mean extension deficit.

The protocol described above was found to be safe, simple, functional, cost effective and reproducible for zone III to V simple extensor tendon injuries. Success is based on strong initial repair, close physician observation and a cooperative patient. The addition of physiotherapy for patients with flexion deficits in the period immediately after dynamic splinting may ameliorate results.

Purpose: We perform the results of the operative treatment of cubital tunnel syndrome, and a retrospective review of the surgical options of in situ decompression of the ulnar nerve, release and anterior transposition of the ulnar nerve and ulnar nerve release and partial medial epicondylectomy.

Material and Methods: Seventy four patients, 52 male and 22 female, (78 elbows), were treated surgically from October 1991 to November 2002.The mean age was 51 years (range, 13 to 72 years). Sixty four patients were assessed postoperatively with mean follow-up 80 months (range 6–139 months). Twenty patients underwent in situ decompression of the ulnar nerve, 34 patients release and anterior transposition and 14 ulnar nerve release and partial medial epicondylectomy. According to the McGowing evaluation system were classified in Grade I, none, Grade II, 38 patients and Grade III 26 patients. The 64 patients were evaluated clinically and 16 of them by EMG studies postoperatively.

Results: Sixty one patients had had subjective improvment of their symptoms. Thirty seven patients (57.8%) excellent, 21 patients (32.8%) good, 3 patients (4.6%) fair and 3 patients (4.6%) poor results. (Wilson & Krout). The comperative results among the surgical options of our study showed improvement in the subjective outcome of 32 out of 34 patients who had release and anterior transposition of the ulnar nerve. From the 20 patient who had in situ decompression of the ulnar nerve, 19 had improvement and from the rest 14 patients who had had ulnar nerve release and partial medial epicondylectomy, they all had improvement.

Conclusions: The results for the patients in this study who had ulnar nerve release and partial medial epicondylectomy, are comparable in good results with other operative treatment options for the cubital tunnel syndrome.

Purpose: The first 50 free flap operations performed at our clinic by the same surgical team were reviewed and assessed as to the cause and location of the defects, donor sites, complications and results. An attempt was then made to determine what could be learned from this experience.

Material and Methods: There were 46 males and 4 females who underwent free flap operations (mean age, 28.5 years; range 6 to 56 years). The lower extremity was the most frequent site of defect (72.5%). The next most frequent sites were the arm and the hand (27.5%). Trauma was by far the most common cause. Latissimus dorsi and forearm flap were the most useful flaps. Fractures in the wound were present in 26 patients.

Results: The fate of the flaps has been analysed. In two latissimus dorsi flap emergency re-exploration was performed and were successfully managed. Two flaps, underwent necrosis, due to thrombosis at the site of arterial anastomosis. Two flaps were lost due to inappropriate blood flow of the recipient vessels. Other complications included pressure ulcer, infection, and hematoma. The overall survival rate of the 50 cases was 92%.

Discussion: Limb reconstructive surgery has significantly improved and expanded with the use of microsurgical techniques. Evaluation of the recipient vessels is always the first priority. The choice of the flap, specially regarding the length and size of the pedicle is also very crucial in order to achieve good results. In addition important factors seemed to be: improvement in techique of micro-vascular anastomosis, diseased vessels, vascular spasm, hypotension, postoperative edema, and hematoma. We believe that an “orthoplastic” approach in covering soft tissue defects is beneficial.