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Background: After flexor tendon repair, tendon gapping or rupture may be replaced by joint stiffness and poor function. After surgical repair of injured flexor tendons, botulinum toxin type A was injected into the forearm flexor muscles. This selectively decreased the force of muscle contraction. During this period of partial muscle denervation, patients could generate enough force to allow for early active mobilization (with its attendant benefits) but insufficient force to induce gapping or rupture of the repaired tendon. Methods: Eighteen adult patients with zone 2 flexor tendon injuries (34 digits) were studied prospectively for up to 3 years. Tendons were repaired using the modified Kessler technique and marked with stainless steel wire. Botulinum toxin was injected into the appropriate proximal flexor muscle belly under localizing electromyographic control. A matched cohort consisted of 53 patients (104 digits). Results: Results were assessed according to range of joint motion (Kleinert and Verdan criteria) and electromyographic and radiologic studies. Ninety-four percent had excellent results and 6 percent of digits had good results. There were no patients with fair or poor results. Average active range of motion was 244 degrees at 18 months. No gapping or ruptures occurred and no tenolyses were required. The control group of matched controls (modified Kessler repair; no botulinum injection) showed that 81 percent of digits had excellent results, 6 percent had good results, 8 percent had fair results, and 6 percent had poor results. Conclusions: Botulinum toxin injection statistically significantly improves the results of flexor tendon repair. The authors have termed this technique "chemoprotection" of flexor tendon repairs.

Botulinum toxin A (BTA) has been used beneficially for the treatment of a large number of spastic conditions. Its use in the management of the hand in children with Cerebral Palsy has not been widely reported. Five recent articles are reviewed and compared with our early and later work in this regard. It is difficult to standardize results due to the great individual variation found in these patients. Although methods of assessment varied in the studies, conclusions were that its use in selected muscles could greatly benefit children with Cerebral Palsy from both functional and cosmetic point of view.

Objective This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon. Patients Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months). Interventions The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps. Results Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions. Conclusions A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.