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The reverse ALT flap technique showed good results in the treatment of patients with skin and soft tissue defects around the knee and shin. Variations of the anastomoses and branching patterns of the db-LCFA may influence flap survival. Additional preoperative vascular evaluations would be helpful in defining the most compatible area from which to harvest the flap.

The most common technique used for non-surgical treatment of trigger fingers is the direct injection of steroids into the flexor tendon sheath over the metacarpal head. However, this method causes more pian to the patient and can result in tendon rupture due to insertion of needle into the tendon. Carlson and Curtis described the mid-axial injection technique which is simple and relatively painless. We aim to compare the pain result from the injection between these two methods. The prospective randomised control trial study was designed. There were 103 trigger fingers included in the study which were divided into two groups: the conventional technique of injection (CI technique) and the mid-axial injection technique (MAI technique). The visual analogue scale for pain score had been recorded at the time of injection: one, three and six weeks. The complication after injection and the recurrent symptoms within one year were also recorded. The Student's t-test, Chi-squared and Fisher-exact analysis were used for statistical testing. The results showed that the mean VAS pain scores immediately after needle insertion were 40.19 +/- 23.3 and 48.39 +/- 26.5 in the MAI and CI technique groups, respectively. The MAI technique was less painful than the CI technique (p < 0.05). There were no complications from the injections in both methods. However, the recurrent rate seems to be higher in the conventional technique (p = 0.23). We concluded that the MAI injection technique provided less pain result than the CI technique and there were no complications from this injection technique.

Background: Shoulder and elbow motions can affect ulnar nerve strain. However, there is no evidence that links this kind of strain to specific activities. The purpose of this study was to examine ulnar nerve strain at the elbow resulting from normal daily activities. Methods: This study was conducted using thirty fresh frozen cadaveric elbows from subjects who had no deformities or history of previous upper extremity surgery. Strain was calculated based on nerve elongation. Ulnar nerve strain at the elbow from motion related to common daily activities was measured in both normal nerves and nerves in which gliding motion was restricted. The results of these measurement were then compared. Results: Activities related to extreme elbow and shoulder motions, such as cellular phone use, yielded an average strain of 6.3%. In addition, we found that nerve strain increased significantly in conditions in which gliding motion was restricted. Nerve strain due to motion associated with cellular phone use, for example, rose by 69.1%. Conclusions: Elbow flexion and shoulder abduction in daily activities are associated with increases in ulnar nerve strain, but this may not cause permanent damage to the nerve. After nerve gliding motion had been restricted, nerves that normally exhibited less strain often had even increased higher levels of strain than those nerves that normally exhibited high strain.

Congenital metacarpal synostosis is a rare congenital anomaly in the hand, especially in our area. There were several reports of surgical techniques for correction deformities. We report this rare condition in our hospital and treatment with the metacarpal osteotomy and double bone blocks technique of grafting.