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Although new techniques and innovative approaches in hand surgery are increasing in number and popularity, the ultimate aim of achieving improved functions may not be fulfilled. On the other hand, perfect functional results are not achieved, not because of inability to use recent technology, but because of deficient skills, e.g. on basic incisions, tendon repair, or nerve repair.

Zone two flexor tendon repair remains challenging with significant outcome variation using recognised techniques. Tendon adhesion formation results in poor outcomes and rehabilitation regimes aim to limit this. Some repairs augment strength, but increasing bulk mitigates against movement. This novel epitendinous technique causes tendon inversion with potential gliding benefits and improved outcomes.

60 porcine tendons were randomised to a 2-stranded modified Kessler or a 4-stranded Adelaide repair, then sudivided into three different circumferential technique groups: locked running, Silfverskiold, or a new inverting repair. Tendon load to failure (LTF), 2 mm gap formation, bulking effect and method of failure were analysed during digital tensiometry.

Four-stranded repairs demonstrated better LTF than 2-stranded techniques. The inverting epitendinous and Silfverskiold repairs showed higher LTF characteristics than the locked running suture, and better tissue holding capacity.

The inverting repair has similar properties to commonly used suturing methods and the conformation creates a smooth inverted repair.

The problem of size discrepancy between vessels during microvascular procedures is well known. Inability to successfully overcome this problem can lead to turbulent flow at the anastomotic site with consequent thrombosis. Various techniques have been described to overcome this problem. We describe two techniques that have been used for over two decades in our institution. Both these techniques enable the surgeon to overcome far more significant size mismatches than other available techniques while still allowing for end-to-end anastomosis.

Background: Headless screw is frequently used for scaphoid fracture fixation. Aim of the study was to assess the correlation between the axial length of the scaphoid and the axial length of the middle phalanx of index, middle, ring and little finger so as to provide an indirect method to assess the length of the scaphoid and thereby the length of the screw.

Methods: Thirty five fresh frozen cadavers with seventy wrists and hands were dissected. The age, sex and side were recorded. The axial length of the scaphoid, axial length of the middle phalanx of index, middle, ring and little finger were recorded and a correlation was assessed. Five cadavers were randomly selected and radiographs of the hand were done. Pearson coefficient correlation was assessed between the axial length of the middle phalanx of ring finger on a radiograph and actual length of middle phalanx.

Results: A significant positive correlation was noted between the axial length of the scaphoid and the axial length of the middle phalanx of ring finger (r = 0.646), also a positive correlation between the axial length of middle phalanx of ring finger on a radiograph and the axial length of the scaphoid measured by vernier caliper (r = 0.91).

Conclusions: A preoperative radiograph of the wrist with hand will help us indirectly assess the axial length of the scaphoid by measuring the axial length of the middle phalanx of ring finger.

This paper presents the applications of the spectrogram, Wigner distribution and wavelet transform analysis methods to the second cardiac sound S2 of the phonocardiogram signal (PCG). A comparison between these methods has shown the resolution differences between them. It is found that the spectrogram Short-Time Fourier Transform (STFT) cannot detect the two internals components of the second sound S2 (A2 and P2, atrial and pulmonary components respectively). The Wigner Distribution (WD) can provide time-frequency characteristics of the sound S2, but with insufficient diagnostic information as the two components (A2 and P2) are not accurately detected, appearing to be one component only. It is found that the wavelet transform (WT) is capable of detecting the two components, the aortic valve component A2 and pulmonary valve component P2, of the second cardiac sound S2. However, the standard Fourier transform can display these components in frequency but not the time delay between them. Furthermore, the wavelet transform provides more features and characteristics of the second sound S2 that will hemp physicians to obtain qualitative and quantitative measurements of the time-frequency characteristics.

Tendon grafting is a key component of hand reconstructive procedures. Commercially produced tendon harvesters facilitate this grafting process but are not always available. We present an innovative technique that allows tendon harvest to be undertaken using equipment readily available in all hospitals. Only a scalpel blade and a plastic Yankauer suction tip are required. Two simple and rapid modifications are made to the suction tip using the blade prior to its use. The described tool has been conceived, refined and used successfully by the authors, without complications, and allows tendon harvest via the standard minimally invasive approach associated with a conventional harvester. Creating this improvised harvester is neither challenging nor time-consuming, and this cheap and effective substitute allows tendon grafts to be harvested using a minimal access approach in environments where a traditional harvester is not available, or not sterile.

Background: Treatment of muscle belly lacerations remains a problem for surgeons. Inadequate repair of lacerations can cause functional disability. To date, there is no consensus on the method of repair for these injuries. We have previously described a technique of repairing mid-substance muscle belly lacerations. The aim of this study was to determine the ultimate strength of an intact muscle belly and to compare the anchor suture (AS) technique with the modified Kessler (MK) technique.

Methods: Fifteen fresh frozen hind-legs from adolescent pigs were divided into three groups and used for the testing. Each group consisted of five specimens. Group one was the intact control group, group two was repaired with the MK technique and group three was repaired with the AS technique. Following repair, the muscles were secured in a custom-made fixation apparatus and underwent linear tensioning at a rate of 25 mm/min, generating a load-displacement curve for each specimen. The data regarding ultimate strength, modes of failure and number of intact suture/anchor constructs (for groups 2 and 3) was calculated.

Results: The ultimate strength of the intact muscle group of was found to be 608.1 ± 107.9  N. This was significantly (p < 0.05) higher than the pull-out strength of the MK and AS groups. The pull-out strength of the AS group was 143.1 ± 36.7 N, nearly twice that of the MK group 69.8 ± 16.4 N (p = 0.11). Suture pull-out was the most common mode of failure.

Conclusions: The AS technique was found to have both higher strain and nearly twice the ultimate pull-out strength compared to the MK repair group. We suggest the AS technique as a viable technique for mid-substance muscle belly repairs.

Laminectomy was the original technique used to treat cervical spondylosis. Results were varied, with patients improving in many instances, while in others various problems were encountered. The numerous series of patients that underwent this procedure were difficult to compare because of wide variations in the operative procedures and patient selection that was used. Frequently, conditions other than spondylosis were included, further confusing an evaluation of the results.

The devlopment of relatively simple techniques for an anterior approach to the cervical spine reduced interest in laminectomy as a treatment for spondylosis. Clinical results were encouraging since the main pathology is usually ventral to the spinal cord, and can be attacked directly. As more vertebral segments were treated and longer patient follow-up became available, the limitations of anterior surgery have become clearer, along with its advantages and indications.

A re-evaluation of laminectomy occurred, prompted by several factors. Biomechanical studies have increased our understanding of individual elements allowing the surgeon to better evaluate the result expected from anatomical and biomechanical changes due to a surgical procedure. A better knowledge of the signs and symptoms of spondylosis have improved patient selection with the aid of MRI and CT scanning, which highlight the pathology.

This improved knowledge stimulated a re-evaluation of laminectomy and the realization that it is an important treatment for spondylosis. It is especially valuable when long segments of spine are degenerated and the objective is adequate treatment while preserving neck motion.

This chapter attempts to define the indications and techniques in order to achieve good results from laminectomy as a treatment for cervical spondylosis.