166 Injury: the British Journal of Accident Surgery Vol. 10/No. 2

This article describes the same principle applied on a smaller scale to splint and elevate the hand following the operation of fasciectomy. Experimental work supported the clinical impression that swelling was thereby reduced.

This would seem to be a simple and convenient method for elevation and splintage following injury as well as following elective surgery on the hand.

Ward C. M. (1977) Vacuum splintage of the hand. Hand 9, 7 I.

Fixation after arthrodesis Two groups of patitnts were treated (15 in each group) using K-wires or a :ompression screw to achieve stability after arthrodesis of the distal interphalangeal joint. The screw method allowed the patient to return to work sooner and needed a shorter immobilization time. However, the success rate in each group was almost identical.

Engel J., Tsur H. and Farin I. (1977) A comparison between K-wire and compression screw fixation after arthrodesis of the distal interphalangeal joint. ['last. Reconstr. Surg. 60, 611.

Release of the carpal tunnel In this series of 429 cases of carpal tunnel syndrome, release of the median nerve was performed through a longitudinal incision in the palm stopping short of the wrist skin. Exposure of the nerve is then followed by a neurolysis of the median nerve 'excising a segment of the thickened epineurium circumferentially to reveal the fascicles of the n e r v e . . . '. In only 4 of the 429 cases were the symptoms not relieved.

Ariyan S. and Watson H. K. (1977) The palmar approach for the visualization and release of the carpal tunnel. ['last. Reconstr. Surg. 60, 539.

Plastics Porcine xenografts This paper presents a discussion of experience with 230 patients involving 336 applications of fresh frozen porcine xenograft to donor sites as a primary dressing. The area was usually exposed to the air after 24h. The graft was allowed to dry up and slough off, usually within 14 days. Immediate applica- tion of this dressing reduces bleeding from the donor site, infection of the site is virtually eliminated and healing is facilitated.

Aronoff M., Fleishman P. and Simon B. S. (1976) Experience in the application of porcine xenografts to split skin graft donor sites. J. Trauma 16, 280.

Toe-to-finger transplants A case is reported in which two toe-to-finger trans- plants were done on one hand using the second toes

of both feet, in a 38-year-old engineer. The plantar digital artery, traced proximally to the plantar metatarsal artery, was used in preference to the dorsal digital artery, traced back to the dorsalis pedis artery.

Ohtsuka H., Torigal K. and Shioya N. (1977) Two toe-to-finger transplants in one hand. ['last. Reconstr. Surg. 60, 561.

Replantation Service

This remarkable paper must be read in the original text. It is based on unrivalled experience in a superbly organized unit which has just completed its three hundredth replantation.

Biemer E., Duspiva W., Herndl E. et al. (1978) Early experiences in organizing and running a Replantation Service. Br. J. Plast. Surg. 31, 9.

Photomicrography through the operating microscope The author describes the details that he has found essential for obtaining good photomicrographs for documentation and/or publication. This paper is particularly relevant to those engaged in microsurgica] work in the operating theatre and research laboratory.

Acland R. D. (1977) Photomicrography through the operating microscope. Plast. Reconstr. Surg. 60, 730.

Latissimus dorsi myocutaneous flap In the repair of extensive radionecrosis affecting the shoulder, a myocutaneous flap using the latissimus dorsi muscle supplied by the subscapular artery (through its circumflex scapular and thoracodorsal branches) can be fashioned and moved with safety to cover astonishingly large defects. Three typical examples are described with a good anatomical de- scription and drawing of the flap.

Mendelson B. C. and Masson J. K. (1977) Treat- ment of chronic radiation injury over the shoulder with latissimus dorsi myocutaneous flap. ['last. Reconstr. Surg. 60, 681.

Viability of arterialized flaps The value of fluorescein was confirmed in the study of 285 arterialized flaps: some of these were axial cutaneous flaps (159), the remainder were axial myocutaneous flaps. The interest of this particular paper is the accuracy with which the viability of tissues including muscle can be predicted. This is of obvious importance now that compound myo- cutaneous flaps are becoming popular.

McCraw J. B.; Myers B. and Shanklin K. D. (1977) The valve of fluorescein in predicting the viability of arterialized flaps. Plast. Reconstr. Surg. 60, 710.