Browsing by Author "Solomons, Michael"

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    Percutaneous Puncture of Flexor Sheath Ganglions: An Assessment of Recurrence
    (2020) Najjaar, Azzaam; Hudson, Donald; Solomons, Michael; McGuire, Duncan
    Background Flexor tendon sheath ganglions (FTSG) comprise up to 15% of hand ganglions. The management is split between two schools of practice: percutaneous puncture or surgical excision. The literature is equivocal as to which holds true superiority in terms of recurrence rates. The cost of surgical excision is higher and the recovery is longer. In addition, surgery also brings with it the potential for surgical complications, both immediate and long term. Percutaneous puncture can be performed at the time of the initial consult and an immediate return to normal activity with no down-time for the patient. The aim of this study is to assess the recurrence rate after percutaneous puncture. We also describe our employed technique. Method The technique for percutaneous puncture involved the use of a 25-gauge needle for ganglion puncture, no sclerosant or corticosteroid was injected, and an immediate post-procedure mobilisation protocol was employed. Patients were identified from clinical records and were followed up at a minimum of six months to check for recurrence. Results Eighteen patients were included in the study, 12 females and 6 males. The majority of FTSG were found to occur in the middle finger. Two patients experienced a recurrence. Both were successfully treated with a repeat puncture. No patients experienced a complication. Conclusion In our study, we show a low recurrence rate obtained with percutaneous puncture of FTSG using a simple technique. No complications were noted in our cohort on follow-up. We, therefore, recommend employing it as a first line treatment in the management of FTSG.
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    Pyrocarbon proximal interphalangeal joint arthroplasty
    (2011) Mcguire, Duncan Thomas; Solomons, Michael
    Arthritis of the proximal interphalangeal joint of the hand can be debilitating disease resulting in pain and stiffness. Treatment is initially conservative but with diseasse progression surgical treatment often becomes necessary. Arthroplasty is one of the surgical options available.
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    Surface replacement of proximal interphalangeal joint (SR-PIPJ) arthroplasty - A case series
    (2016) Jordaan, Pieter Willem; Solomons, Michael; Mcguire, Duncan Thomas
    Surface replacement (SR) proximal interphalangeal joint replacement consists of a cobalt-chrome alloy component articulating with an ultra-high molecular weight polyethylene component. After experiencing a high rate of subsidence and complications with a pyrocarbon implant, our unit has changed to the cemented SR system in the hope of decreasing these complications. The main aim of this study was to determine whether this change in practice has led to a decrease in subsidence and complications. A retrospective chart review was performed including 43 joints in 28 patients. Subsidence was noted in 26% of the joints and complications in 31% of the joints. Even though subsidence remains a problem, the change in implant has led to a decrease in subsidence and other complications.
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    The flaws of laser Doppler in negative-pressure wound therapy research
    (2014) Kairinos, Nicolas; McKune, Andrew; Solomons, Michael; Hudson, Donald A; Kahn, Delawir
    Recent studies, using modalities other than laser Doppler, have indicated that perfusion during negative-pressure wound therapy (NPWT) is reduced, contrary to world literature. The aim of the present study was to evaluate whether the measuring technique of the laser Doppler could be influenced by the compressive nature of NPWT dressings and whether this could explain the conflicting findings. A hypothesis that it may be possible for laser Doppler to record similar readings to those obtained during NPWT by merely compressing tissues manually was tested on 12 NPWT dressings, with each undergoing an alternating series of manual compressive forces and NPWT (−125 mmHg). During the periods of NPWT (n = 12), the mean perfusion recording increased in five experiments, reduced in six, and remained unchanged in one. During the period when manual pressure was applied (n = 12), there was a mean increase in perfusion in six experiments and a reduction in six. The type of change in perfusion (increase or decrease) was the same for both NPWT and manual pressure in 10 of the 12 experiments. In conclusion, laser Doppler can incorrectly record increased perfusion when tissues are compressed, implying that it is flawed in the field of NPWT research as tissues are always compressed to some degree by the NPWT dressing.