Disorders of the Hand: Volume 1: Hand Injuries by Ian A. Trail, Andrew N.M. Fleming
By Ian A. Trail, Andrew N.M. Fleming
Disorders of the Hand describes the suggestions for analysis appropriate to a few of the problems of the hand and the way proof dependent findings effect scientific perform. therapies together with surgical procedure are mentioned intimately and scientific pearls are given in each bankruptcy.
Hand accidents are comprehensively coated during this first of 4 volumes, whereas hand reconstruction, nerve compression, irritation and arthritis, swelling and tumours, congenital hand defects and surgical options are incorporated within the book's 3 sister volumes.
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Additional info for Disorders of the Hand: Volume 1: Hand Injuries
Normal nerve anatomy and microanatomy will be considered, as will the science of nerve division and repair. A. M. 1007/978-1-4471-6554-5_2, © Springer-Verlag London 2015 23 24 crush or traction will also be discussed and developments in the fields of nerve grafting, nerve conduits and neuroprotection will be reviewed. Nerve Anatomy and Microanatomy Nerve Micro-Anatomy The basic cellular component of a nerve is a neuron, consisting of a cell body and an axon. The cell body of a motor neuron lies in the anterior horn of the spinal cord whilst sensory neuron cell bodies reside in the dorsal root ganglion.
However, despite the presence of Schwann cells, their functionality remains to be defined fully. Any impairment of axon-Schwann cell signaling could contribute significantly to the failure of nerve repair. Protection of Motor Neurons and Sensory Neurons Following Injury When considering reconstruction of major nerve function following injury, the principle aim remains motor recovery. However, sensory recovery is also important if a satisfactory functional outcome is to be achieved. In recent years it has been established that central loss of neurons contributes to poor nerve recovery [16–18], and this is time and site dependent.
Sepsis Toxins produced by pneumococcal and meningococcal sepsis result in sluggish peripheral blood flow, vasoconstriction and hypercoagulation. These features are often accentuated in a very ill patient by vasopressive medical therapy such as noradrenalin. The result is bilateral distal ischaemia that is mainly managed expectantly and may include splinting the hand and wrist in a safe position and passive manipulation of joints to ensure optimum potential for functional recovery. There has been a recent discussion regarding the benefit of “prophylactic fasciotomies” or skin and soft tissue releases in order to reduce the risk of amputation [57–60] (Fig.