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Background: Open carpal tunnel release is the gold standard treatment for carpal tunnel syndrome. However, there are complications related to the long incision. Method: We report the results from a mini-incision open carpal tunnel release with simple instruments. Results: There were no complications in our small series, improvement of scores was shown at four-week follow-up, and cosmetic results were satisfactory. Conclusions: Mini-incision carpal tunnel release is one option to treat carpal tunnel syndrome.

We report a method of resurfacing the degloved thumb from the base of the thumb up to the interphalangeal joint level using two neurovascular island flaps from the adjacent sides of the long and the ring fingers, nourished by the third common neurovascular pedicle. This twin flap was used successfully in seven patients. The reconstruction gave adequate static two-point discrimination of 10 mm at 6 weeks without complaints of neuroma pain, painful scars or cold intolerance.

Tourniquet tolerance is affected by the method of exsanguination. Two commonly used methods, tight elastic bandaging and limb elevation, were tested to determine their effects on upper extremity tourniquet tolerance in 23 healthy adult volunteers. We found that tourniquet tolerance was significantly lower among the bandaging group compared with the limb elevation group (average 19.4 min and 24.1 min, respectively). Overall, the tourniquet tolerance was not affected by hand dominance or arm circumference.

Allografts were used to replace excised bone segments affected by giant cell tumour of the hand in three patients. The tumour involved the second, third and fourth metacarpals and the capitate in one case; the first metacarpal and the trapezium in one, and the proximal phalanx of the index in one.All had histological confirmation of diagnosis. One patient had recurrence one year after marginal resection of his third metacarpal and required resection of the two adjacent metacarpals and the capitate. He had no recurrence two years after the secondary treatment. The other two had no recurrence at two and three years after their primary procedures. Their affected hands were functioning well.

A 32-year-old woman presented with a 1-year history of severe paroxysmal pain, point tenderness and sensitivity to cold in her left thumb. On examination, a faint bluish lesion in the middle, radial subungual region of the left thumb was observed (figure 1A). Love's pin test was positive when pressure was applied with a pencil tip or pinhead on the lesion. She experienced excruciating pain, whereas pressure applied slightly to one side of it elicited no pain. We suspected a vascular tumour and exploratory surgery was performed by a dorsal, transungual approach. After complete removal of the nail plate, a reddish-blue lesion was evident at the nail bed (figure 1B). Histopathological examination demonstrated an encapsulated, well-defined mass to be a …

Glomus tumors are uncommon, benign, small neurovascular neoplasms derived from glomus bodies in the reticular dermis. Glomus bodies are found throughout the body to regulate body temperature and skin circulation; however, they are concentrated in the fingers and the sole of the foot. The typical presentation is a solitary nodule in the subungual or periungual area of the distal phalanx. The primary treatment of choice is surgical removal. We investigated expression of vascular endothelial growth factor (VEGF) using immunohistochemistry in glomus tumors of the fingers. All five glomus tumor samples were positive for VEGF expression. VEGF immunoreactivity was largely localized to the cytoplasm of tumor cells, suggesting a contribution of VEGF to the vascularization of glomus tumors.

We treated 110 fractures of the middle third of the clavicle in 108 patients aged between 14 and 66 years, by fixation with 2 mm Kirschner wires. The wire was introduced, using an air drill and a telescoping guide, from the medial into the lateral fragment. The medial end of the wire which perforated the anterior cortex of the medial fragment was bent backwards to prevent migration into the lung or mediastinum. In cases of nonunion and acute fracture in which a bone gap was present, bone graft was laid around the fracture site after internal fixation. All the fractures united. No wires broke but in three patients one migrated before union was achieved. Twenty-one patients failed to return for removal of the wire; nine of them had radiological evidence of union before they were lost to follow-up.

The teaching policy of facult of medicine, chulalongkorn university had long been established, with frequently up-to-date to provide the learning and teaching opportunity to medical students and teaching personnels and even the postgraduate training course. At the same time, the faculty had a commitment to increase its numbers of high quality medical graduates and post graduate medical students. The teaching and training course must be shortened and concise to fulfil the new trends of teaching curriculum which was recently re-arranged in this faculty. The world-wide, available contemporary technology, information and communication technology (ICT), is considered to utilized their ability. Learning and teaching by this technological trends are increasing in recent years in many developed and developing countries. Students, trainees and educators can access these new modern technology in anytime and anywhere by connecting internet network, and also by this way, they can continue their medical learning, training and gaining up-to-date medical technique and knowledge till their life. The process of utilizing and incorporating these available programme techniques, such as, hypertext, webboard, chat room and e-mails, for education purpose, is named as e-learning, or some may called it, e-education, e-school, etc.

Thirty-six patients with avulsions of upper roots of the brachial plexus underwent transfer of a single fascicle from the ulnar nerve to the proximal motor branch of the biceps muscle to restore elbow flexion. The mean period of follow-up was 22 months. The average reinnervation time for the biceps muscle was 3.3 months. Thirty-four patients achieved biceps strength of Medical Research Council grade 3 or better. The operative results in the patients with C5, C6 avulsions were better than those with C5, C6, C7 avulsions. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination and the strength of flexion of the wrist on the affected side was not worse than before surgery in any patient.

Ten arterialized venous toenail flaps with two venous pedicles, one of which was anastomosed to a digital artery and the other to a dorsal vein of the finger, were used in nine patients to reconstruct nail loss due to trauma. Four flaps were taken from the lateral part of the big toe and six flaps from the second toe. Four toenail flaps with pulp and three flaps with the distal half of distal phalanx were used. Nine flaps survived completely and one had partial necrosis. All showed excellent aesthetic and functional results except for one case with minimal deformity in growth of the nail. The mean operating time was 2 hours.

Since January 1990, 237 replantations or revascularizations have been attempted in 192 patients with distal traumatic amputations of the digits. The amputations were complete in 182 digits and incomplete in 55 digits. Sixty-three amputations were in zone I and 174 in zone II (Tamai’s classification). The overall success rate was 91%. Twelve digits failed in zone I and ten in zone II. We conclude that zone I and zone II replantation or revascularization is quick and worthwhile, providing acceptable sensation, appearance and near-normal function.