We reviewed 40 patients who underwent V-Y skin flap reconstruction following distal fingertip skin loss.Of the patients 35 were males and 5 females with an average age of 35 years at operation.Surgery was performed as an emergency in all patients.In all cases a single digit was involved.The majority of the injuries were transverse amputations.Mean advancement of the flap was 12 mm.At the follow-up evaluation (mean 2 years),8 patients complained of pain (2 with functional impairment),15 complained of cold intolerance,and 5 had nail deformities.Sensibility of advanced skin was normal in 28 cases,while two-point discrimination averaged 7 mm.This discrimination was virtually identical to contralatertal digits in 25 of the cases.Overall 28 patients were satisfied with their results,while the rest of them were mildly displeased,either with the functional impairment or with the appearance of the involved digits.

The reported results for primary lumbar disc surgery in open standard technique are succesful in 80–95% of patients, while after repeated surgery range from 28 to 81%.

The best clinical results occur when there is an indication of neurological impairment, nerve root compression and radiological confirmation. We report the results of a retrospective study on 54 patients, aged 30 – 65 years, who were presented with recurrence of symptoms and operated on for a 2nd or 3rd time after a previous discectomy, between the period 1990 to 2001.

Objective: The aim of the study is to determine the factors that influence the results after repeated surgery and to analyse those that lead to failure.

Material and Methods: The 54 patients were submitted in a detailed clinical and radiological examination (CT-scan, MRI, EMG) in an attempt to determine the exact indication for re-operation.

The preoperative findings for the revision surgery were: Radiculopathy secondary to a new herniation, 14 patients.

Due to recurrent disc prolapse at the same level, 9 patients.

Due to lateral recess stenosis, 12 patients.

Instability secondary to a previous wide laminectomy, 4 patients.

No obvious cause, probably due to fibrosis, 5 patients. Multiple root syndrome due to a tumor, 1 patient. Cauda equina syndrome due to an hematoma 1 patient.

The follow-up of the patients ranges between 1–12 years and the results of the revision surgery are classified according to Finnegan’s classification.

Results: From the 54 patients, 30 had a good result (56.6%), 16 fair (29.4%) and 8 poor (15%)

Forty-six patients rated the revision surgery worthwhile (85%).

Conclusions: The factors with good prediction of the results were:

Relief of pain more than 6 months after the previous surgery.

Sciatica > Low back pain.

Nerve root compression from a new herniation in another level or recurrence at the same.

Lateral recess stenosis.

Good correlation of the clinical and radiological findings.

The factors with bad prediction were

The intra-operative fibrosis.

Pain relief less than 6 months

The bad psychological condition of the patients.

Instability of the thumb trapeziometacarpal joint is a major factor in the cause of degenerative disease. Surgically stabilized joint should be subject to less shear forces and hence, will be less likely to develop degenerative changes. The results of volar ligament reconstruction were assessed in 12 patients (8 men- 4 women). The average age at surgery was 35 years. All thumbs were radiographic stage I. All had failed conservative treatment with splinting and anti-inflammatory medication. Operativelly a strip of Flexor Carpi Radialis tendon was used for ligament reconstruction according to the technique described by Eaton, Glickel and Littler. The follow-up period averaged 7 years. At final follow-up 8 thumbs were stage I, 3 were stage II, and one was stage III. Ten patients were at least 90 % satisfied with the results of the surgery and only two had symptomatic thumb basal joint.