Reparative Surgery of Severed Tendons and Nerves of the Hand

Surgical Clinics of North America, December 1947. book extract. Fair. Volume 27 of Surgical Clinics of North America, Issue 6, December 1947, extracted pages 1474-1485 - stapled. Rubber stamp stain on first page. FIRST TWO PARAGRAPHS: OUR present time, defined sometimes as the "mechanized- age," accountsfor a great number of injuries and infections of the hand. It isestimated that in industry more than one third of all accidents involvethe hands; a fairly high percentage result in severance of tendonsand nerves. Loss of function from neglect on the part of thepatient, or more often from ill-timed, ill-planned and inexperiencedsurgery, means, in the majority of patients, a decrease in his earningcapacity. Hence, the responsibility of the surgeon, who takes care ofthe patient with an injured hand, is great.Unfortunately, it is not uncommon that lesions of the hand aretreated by young, surgically inexperienced physicians; a fairly commonexample is the intern, who sutures a lacerated tendon in an inadequatelyequipped outpatient department without any assistant,under local anesthesia, without a tourniquet applied, and with resultswhich are far from satisfactory. To quote another example outof a large group of patients who exhibit disastrous results of ill-timedand ill-planned surgery: Flexor sublimis and profundus tendons weresevered at the level of the flexor crease of the first interphalangealjoint. The skin wound was transverse and small, and primary repairwas performed. The original incision had to be lengthened. This wasdone by adding a longitudinal incision across the first incision. (Thecorrect extension of the original incision would have been the bayonetincision of Figure 436 B). The result was a cross incision on the volarsurface of the finger with formation of four flaps. The points of theHaps, meeting each other in the center, broke down; the underlying repairedtendon sloughed; the finger became stiH from adhesions andtoo long immobilization, and finally had to be amputated proximal tothe first interphalangeal joint.