Eur J Plast Surg (2004) 27:194 DOI 10.1007/s00238-004-0645-7 IN VI TED C OMMENTARY D. Evans Commentary on “Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis” by Scheker LR, Boland MR Published online: 8 July 2004 Springer-Verlag 2004 The technique of ligament suspension after trapeziectomy method of soft tissue reconstruction may be the important described in this paper by Scheker and Boland represents factor. In particular, Davis et al. question the importance considerable sophistication of the original concept of of preventing proximal migration of the metacarpal, and “ligament reconstruction—tendon interposition” (LRTI) there may be grounds to speculate on the ability of a described by Burton and Pellegrini . The elaboration of ligament reconstruction, however strong to start with, to the routing of the tendon slip of FCR is ingenious, and has prevent gradual migration over the long term. the purpose of providing more direct ligamentous control All series of trapeziectomy will have a small propor- of the metacarpal base to prevent both dorsal subluxation tion of disappointing results, and for some the reason may and proximal migration of the metacarpal, and a cushion be amenable to prevention; persistent scaphotrapezoid between the first and second metacarpal bases. arthritis can be anticipated by joint excision, and first There is no doubt that the procedure is technically metacarpal adduction deformity avoided by maintaining more demanding. After more than 200 operations it is not control of a hypermobile first MP joint, either with a surprising that a master-surgeon such as Dr Scheker temporary k-wire during the period of splintage, or by MP makes the operation appear simple, but any surgeon plan- fusion. ning to embark on this procedure in preference to more Any surgeon who feels that he or she can master simple versions of the operation should be prepared for Scheker and Boland’s technique can be confident that the some difficulty in matching Dr Scheker’s expertise, and results will be among the best achievable, but those plan- his results. It would certainly be advisable for a less ex- ning to change from a method that works for them should perienced surgeon to observe the operation in the hands of be aware of the increased complexity and technical de- an experienced exponent. mands of this operation. Dr Scheker’s results, taken together with the large size of the series, are impressive, and compare well with those reported by Tomaino et al.  in a small series, although References the latter noted some fall in power over 9 years compared 1. Burton RI, Pellegrini VD (1986) Surgical management of basal to 6, and there is some confusion in their paper about the joint arthritis of the thumb. Part II. Ligament reconstruction preoperative and postoperative key pinch measurements with tendon interposition arthroplasty. J Hand Surg [Am] which make direct comparison difficult. 11:324–332 The opposite approach to Dr Scheker’s is to simplify 2. Tomaino MM, Pellegrini VD, Burton RI. (1995) Arthroplasty of the basal joint of the thumb. Long-term follow-up after rather than elaborate the reconstruction, and Davis et al. ligament reconstruction with tendon interposition. J Bone Joint  have shown no difference between their results with or Surg Am 77:346–355 without LRTI. Long-term results are not yet available. 3. Davis TR, Brady O, Barton NJ, Lunn PG, Burke FD (1997) The results in terms of pain relief are not obviously dif- Trapeziectomy alone, with tendon interposition or with liga- ferent from Scheker and Boland’s, although the meth- ment reconstruction? J Hand Surg [Br] 22:689–694 ods of evaluation are not easily comparable. Davis et al. showed much less improvement in strength, so the precise D. Evans ( ) 6 Cumberland Avenue, Slough, SL2 1AL, UK e-mail: email@example.com Tel.: +44-175-353-0146
European Journal of Plastic Surgery – Springer Journals
Published: Aug 1, 2004
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