Vascular and Endovascular Surgery Publication May 2010 44: 315-318

One very important aspect of Plastic & Reconstructive Surgery is the management of complex wounds of the lower extremity. It is of paramount importance for the Plastic & Reconstructive Surgeon to work in close collaboration with Vascular Surgeons in the management of these complex wounds.

I have found that in addition to Vascular Surgeons, close collaboration with other medical specialist such as Orthopedic Surgeons, Infectious Disease Doctors, Internal Medicine, and Renal Physicians is important to optimizing patient outcome.

Brian P. Dickinson, M.D.

www.drbriandickinson.com

Hand Surgery:Flexor Pollicis Brevis

Hand Surgery:Flexor Pollicis Brevis

The flexor pollicis brevis is an intrinsic muscle of the hand that originates from the flexor retinaculum of the wrist and tubercle of the trapezium. The muscle inserts on the radial side at the base of the proximal phalanx of the thumb. The recurrent branch of the median nerve and the deep branch of the ulnar nerve provide motor innervation that allows the flexor pollicis brevis to flex the thumb at the first metacarpophalangeal joint.

Laceration of the flexor pollicis brevis due to trauma significantly impairs hand function as the patient is unable to fully oppose the thumb to the small finger.

I prefer repairing the tendon of the flexor pollicis brevis tendon with 3.0 and 4.0 nylon suture with a modified Kessler stitch and horizontal mattress sutures. A 5.0 epitendinous suture allows an adequate contour to the repair and facilitates opposition of the thumb to the small finger.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Microsurgery. Nerve Repair

Microsurgical nerve repair and use of the operating microscope is a particular area of interest for me and has become a significant part of my practice. I enjoy the optics of the Carl Zeiss Pentero microscope. The Pentero provides adequate resolution for nerve repair on the magnitude of 2mm and even less.

Peripheral nerve injuries in the upper and lower extremity are common with the frequent physical activity in southern California. Activities such as biking, surfing, motorcycles, climbing, as well as occupational hazards can cause peripheral nerve injury.

In the photograph above, the blue background contains a grid with 1 mm squares, allowing the surgeon to assess the dimensions of the injured nerve.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Hand & Microsurgery: Flexor Tedon Injuries

http://www.drbriandickinson.com/

While I enjoy all aspects of plastic and reconstructive surgery, hand and microsurgery are particularly enjoyable as the anatomical dissections closely resemble the diagrams in the text books. In fact, surgery of the hand is what stimulated my interest in plastic & reconstructive surgery. I find that I use mostly the techniques taught to me by Dr. Miachael Hausman, Dr. Prosper Benhaim, and Dr. Neil F. Jones.

I find that studying and performing surgery of the hand, improves techniques for microsurgical breast reconstruction and vice versa.

It is important when repairing flexor tendons in zone II of the hand, to preserve the A2 and A4 pulleys. After fenestrations have been made in the synovium between the pulley system of the hand the injured flexor tendon can be easily identified. Occasionally I have found that the cruciate pulleys often need to be partially excised so that adequate purchase can be made on the flexor tendons to ensure a strong and durable repair.

Immediate post-operative mobilization with the Duran protocol is important to ensure adequate flexor tendon gliding.

Brian P. Dickinson, M.D.
http://www.drbriandickinson.com/