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In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from cerebral palsy, spinal cord injury, cerebrovascular accident and traumatic or anoxic brain injury. While several diagnostic tools and management strategies have been described for upper limb spasticity, evidence-based practice guidelines do not currently exist due to low patient volume and a paucity of surgeons routinely performing surgeries in UMN syndrome patients. As such, expert consensus may help provide guidance for patients, therapists and clinicians alike. In this article an expert panel was assembled, and the Delphi method was utilized to present diagnostic considerations, define operative indications, discuss surgical treatment modalities and encourage a standard set of outcome measures for patients with upper extremity spasticity. [ABSTRACT FROM AUTHOR]

Introduction: Amniotic constriction bands occur in approximately one in every 15,000 live births and is graded using the Patterson Classification system. Methods: A case series of all patients with amniotic constriction band that presented to Alder Hey Children's Hospital was compiled between the years 1993 and 2012, data was described and a classification system developed. Results: Thirty seven patients were identified. Of these 17 had amniotic constriction confined to the upper limbs and three of the lower limbs only. Seventeen had both upper and lower limb deformity. Twenty eight children underwent surgical intervention whilst nine to date have not. Conclusion: Constriction band of the upper limb was the most common with lower limb bands the least. There is no agreement on the nomenclature of this condition making amalgamation of the literature problematic. A more specific classification of upper limb bands has been suggested which includes anatomical location and depth of band. [ABSTRACT FROM AUTHOR]

During surgical exploration and release of the muscles, an anomalous fusiform muscle was found originating from the tendon of the FPL, heading to the ring finger and flexing the distal interphalangeal joint (Figure 1). Anatomically distinct from the anomalous tendon slips described by [2], the accessory muscle in our patient actually originated from the FPL and inserted in the ring finger. [Extracted from the article]

Introduction: Accurate assessment and resuscitation of a major burn injury is a difficult task for inexperienced clinicians, yet essential for patient outcome. The commonly used Lund and Browder Chart (LB) offers an accurate tool but is the start of a series of 19 calculations required to begin fluid resuscitation at the bedside. 'Mersey Burns' (MB) is an Application (App) for use on smartphones and tablets designed to improve the assessment and resuscitation of adults and children following burn injury. The App allows clinicians to shade the burn pattern onto the screen in real time, and then generate detailed fluid protocols as well as an email that can be sent to a receiving Burns Unit. The study evaluated the effectiveness of this technology compared to current paper based methods (LB). Methods: Under ethical approval, Senior Undergraduate Medical Students with no previous experience of burns management were recruited from the Liverpool University. Students were given a one-hour lecture on burn management and fluid resuscitation involving demonstrations of both the LB and Mersey Burns application. They then assessed a simulated patient with 20% Total Body Surface Area (TBSA) burn devised by Whiston Hospital Prosthetic Department. Students then assessed the size of burn and calculation fluid resuscitation timed using both LB with a calculator, and MB. Students completed surveys assessing ease of use, confidence in output, preference in the emergency setting, speed, accuracy, ease of calculation and ease of shading of the two methods. Statistical analysis comprised one-way-ANOVA, student t-tests and chi-square tests. Results: 30 students took part. The variation in TBSA between students was similar between LB and MB (p=0.39). Average time of calculation was 11.8 minutes for LB and 4.6 minutes for MB (p<0.05). Total fluid volumes, were more likely to be correct using MB than LB (p<0.05). Students were more confident in the output, found calculations easier to perform, found overall use easier, felt accuracy to be superior, found ease of shading to be superior and felt that calculations were quicker using MB (p<0.05). Discussion and Conclusions: Early, accurate assessment of major burn injury saves lives. The challenge is to support doctors in Emergency Departments, who encounter serious injuries infrequently, to rapidly assess, treat and transfer. Our solution is to harness agile technology using tablets and smartphones to manage these patients and share the details with a receiving Burns Unit by email. Mersey Burns is the first UK Healthcare App carrying a CE Mark from MHRA. It allows fluid calculations to be performed more quickly and accurately than Lund and Browder charts when used by burns care naive medical students. Students found the application to be easier, quicker and more accurate to use and would prefer to use it in the emergency setting. This suggests a useful role for the App in the care of burns patients by inexperienced staff providing both confidence and timely delivery of care. It further highlights the novel use of technology to train the next generation of burns care clinicians. [ABSTRACT FROM AUTHOR]

This report presents a girl with a lipoblastoma of a finger presenting as a macrodactyly. Documented inflammation of the digit at birth raises suspicion of neo-adipogenesis, which is recognised in lipomas. This case highlights a rare site for lipoblastomas and explores a potential aetiopathogenesis. [ABSTRACT FROM AUTHOR]

There is currently no consensus on the treatment of cold intolerance in extremities in post-trauma patients. We aim to present two cases where botulinum toxin type A injections were used to improve symptoms of cold intolerance. Botulinum toxin type A (Allergan) was injected into the area around the palmar digital neurovascular bundle on both sides of the affected finger. We performed this in two patients, and both had good improvement of symptoms. One patient was discharged, and the other remained under routine follow-up with potential yearly botulinum injections to aid symptoms during the winter months. Both patients are pleased with their outcomes and report significant improvement from the low-risk treatment. In both described cases, injections of botulinum toxin had a significant effect on their symptoms. We conclude that botulinum toxin type A may be used as a treatment modality to improve symptoms of cold intolerance after trauma., Competing Interests: No benefits in any form have been received or will be received related directly to this article., (Crown Copyright © 2024 Published by Elsevier Inc. on behalf of The American Society for Surgery of the Hand.)

Background: Distal digital replantation and revascularisation remains one of the demanding microsurgical procedures due to the difficulty of vascular anastomosis. Venous congestion is the most commonly encountered problem after replantation due to the difficulty of venous anastomosis in traumatic injuries. Heparin, among other drugs, is commonly used to facilitate venous drainage and prevent thrombosis. However, systemic heparin can be contraindicated in some patients. The senior author has experience of subcutaneous heparin injection for venous congestion in thirteen patients., Methods: An amount of 1 ml of calcium heparin (25,000 U) was mixed in 2.4 ml of normal saline making a solution that has 1000 U per 0.1 ml. 1000 U (0.1 ml) of the solution was injected directly into the congested replanted digits. This was repeated twice daily until venous congestion improved., Results: All the congested replanted digits survived without systemic side effects. There were no local side effects of the treatment. The PT and APTT have shown slight increase but they remained within the normal range. Haemoglobin levels have dropped slightly but no patients were at any risk of developing anaemia or needed blood transfusion., Conclusions: Subcutaneous heparin injections can salvage the replanted digits when venous congestion is a warning flag for replantation failure. It is safe and very efficient in patients where systemic heparin cannot be administered. However, this article shows the results in only thirteen patients which is a small number to show the efficacy, safety, and side effects.

Introduction: The formation of cutaneous carcinoma has been shown to rely on neovascularization, with angiogenesis being implicated in the invasive process of skin malignancy and metastasis. To date, studies of angiogenesis have generally been limited to in vitro, animal (often murine), or postexcision histopathologic models., Methods: To demonstrate the angiogenic progression of human tumors in vivo, this study has used the Spectrophotometric Intracutaneous Analyser (SIAscope; Biocompatibles, Surrey, United Kingdom) to produce parametric images of 250 nonmelanoma skin cancers and 13 actinic keratoses. This provides a history, in images, of the vascular basis of skin cancer formation., Results and Conclusions: While displaying that the in vitro findings of angiogenesis are indeed occurring in vivo in humans, this technique also suggests a practical means to allow accurate application and monitoring of antiangiogenic therapy. In addition, it raises the possibility of differentiating superficial from nonsuperficial nonmelanoma skin cancers in an office-based setting, thus allowing accurate usage of surgical or nonsurgical treatment methods.

We present a report of an anatomical variation, the function of which is unclear. An anomalous, independent tendon to the thumb was accompanied by an accessory supernumerary tendon to the extensor indicis. This particular variation has not previously been described and was discovered during routine dissection of a male cadaveric upper limb. It is important to revisit these variations of anatomy as they may be relevant to explain clinical signs or during surgical procedures as detailed in this report.