The present study describes the concepts of arteriovenous (A-V) loupes prior to microsurgical free flap transfer in a selected high-risk group of patients. A one-stage concept was employed in 26 patients; 5 patients underwent two-stage flap transfer. Seven thrombotic occlusions of the A-V fistula or flap vessels were recorded; 6 patients underwent successful revision. Overall flap survival was 96.8% and compared favorably to reports in the literature. Defect coverage could be achieved in all but one case. It can be concluded from the data that in selected high-risk patient groups, i.e., following radiation, compound trauma, chronic infection, or multiple comorbidities, the creation of an A-V fistula prior to flap transfer may facilitate innovative reconstructive solutions.

Metacarpal fractures are frequently immobilized for several weeks in forearm plaster cast, even after operative stabilisation. The purpose of this study was to assess the results after early functional treatment using metacarpal braces. 87 patients with 105 metacarpal fractures were included in a prospective study from February 1997 until November 2000. The AO-classification of the fractures was assessed for all patients: n=33 A1,n=9 A2,n=3 A3, n=27 B1,n=6 B2,n=7 B3,n=10 C1,n=7 C2, n=3 C3.Exclusion criteria were tendon or nerve injuries,pathological fractures (tumor or metabolic),additional digital fractures of the same ray,and a patients age of less then 18 years. All fractures were treated operatively. 73 patients (84%) were recruited for follow up after an average period of nine months. Average grip strength reached 96% (Jamar II) for the power grip, 97% for the three finger and 98% for the pinch grip compared to the contra-lateral side in the group where the dominant hand was affected. It was 88% for the power grip, 91% for the three finger grip and 94% for the pinch grip after injury of the non-dominant hand. The mean postoperative pain score on the visual analog scale was 0.2 for resting conditions, 0.8 for motion and 2.2 under stress.A decreased total range of motion was observed in 15 of 73 patients (21%). The average DASH score reached 6.5 points. Physical therapy was required for an average of 6.7 weeks. Only 41% of the patients with early functional treatment required further physical therapy after removal of the brace. The metacarpal brace used in this series protects from direct trauma,and provides a high patients comfort.It has no disadvantages considering fracture retention compared to conventional plaster casts or splints. The need for physical therapy is reduced after functional fracture bracing.Thus, the metacarpal brace has proven to be a suitable tool for early functional treatment after operative stabilisation of metacarpal fractures.

This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher's and Kleinert and Verdan's evaluation systems, the results were graded as "excellent" and "good" in more than 94%, and as "satisfactory" in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.

Soft tissue coverage over the exposed Achilles tendon requires an optimal solution for each patient to achieve an aesthetically pleasing result and acceptable function. Microvascular free flaps can be used to reconstruct medium and large defects and to provide gliding tissue for the Achilles tendon. The complication rate of microvascular flaps is comparable with that of local flaps.