Faculty Bibliography

The management of upper limb amputations is an important part of the practice of surgery of the hand. Reattachment of parts has opened dramatic new potentials, but elective amputation and wound closure after traumatic loss remain frequent and important operations. The negative aura surrounding these unpleasant events favors their quick disposition, but they demand the same measured judgement, technical skill, and concern that any reparative hand operation requires. Many basic surgical principles related to amputation are well established and must be followed. The difference in surgery under war conditions and civilian practice, where careful surveillance is possible, must be appreciated. Secondary procedures must be proposed on the basis of very careful study of the circumstances and the needs of each patient, above all avoiding unrealistic attempts at reconstruction. The aesthetics and the psychological impact cannot be ignored. Success can be measured only by the patient's recovery in a global sense, that is, how well he or she resumes normal life

Amputation is an unpleasant affair, generating a very negative aura that must be consciously combated. It requires the same careful consideration, planning, and technical skills required by any reparative hand surgery. For optimal care, the surgeon needs not only to be comprehensively trained in hand surgery but also to be knowledgeable about prosthetic possibilities and to appreciate the psychological impact on the patient. Thoughtful and concerned management can do much to reduce the loss in a global sense, and the only measure of success is how well the patient is reintegrated into normal life

The goal of cosmetic blepharoplasty is to obtain an improvement in the appearance of the eyelids without causing functional or symptomatic alterations in the patients. Patients with undiagnosed problems in tear production who have cosmetic blepharoplasties are a common source of extremely dissatisfied patients with alarming ocular symptoms. Although keratoconjunctivitis sicca is the most common manifestation of an abnormal tear film state, there are other conditions of which the eyelid surgeon should be aware. Knowledge of methods used in the diagnosis of states of tear deficiency will allow the surgeon to better select candidates for cosmetic eyelid procedures

Patients with severe mandibular prognathism are best managed with a combined orthodontic-surgical approach. In our patients, the orthodontic treatment consisted of six to eighteen months of presurgical preparation, which in some patients may accentuate the dental deformity. This is done to provide two well-aligned dental arches that will fit accurately at surgery. The surgical procedure used was an oblique subcondylar osteotomy. This was followed by six to eight months of orthodontic treatment to complete dental alignment. Thirty patients were treated using this combined approach, with excellent results and few complications

Single fibres were dissected from the dorsal spinal roots of the nerves serving the brachial plexus in African green monkeys. The dermatomal organization of these spinal nerves was deduced from data concerning the receptive fields of 2834 single afferent fibres. These data were collected in an attempt to reconcile some of the discrepancies that exist in published descriptions of the dermatomes in primates; our results and the literature reviewed suggest that the cutaneous region served by one spinal nerve is actually much wider and much more variable in location than is generally recognized. This makes any summary diagram a misleading indicator of the true complexity of the spinal innervation of the upper limb. In spite of this variability among individuals, within any specific individual there is a regular and orderly progression of innervation which allows prediction of the region served by a particular spinal nerve when information concerning the site of innervation of adjacent nerves is available. The territory of each myotome tended to be larger than the dermatome of the same spinal nerve. Most muscles of the limb received afferent innervation from three to four different spinal nerves. Further, the territory of the myotome did not of necessity coincide with the dermatome of the same spinal nerve. Even those nerves innervating the hand still innervated axial muscles. These observations have important implications for the diagnosis of spinal nerve injuries