Hand Surgery:Flexor Pollicis Brevis

The flexor pollicis brevis is an intrinsic muscle of the hand that originates from the flexor retinaculum of the wrist and tubercle of the trapezium. The muscle inserts on the radial side at the base of the proximal phalanx of the thumb. The recurrent branch of the median nerve and the deep branch of the ulnar nerve provide motor innervation that allows the flexor pollicis brevis to flex the thumb at the first metacarpophalangeal joint.

Laceration of the flexor pollicis brevis due to trauma significantly impairs hand function as the patient is unable to fully oppose the thumb to the small finger.

I prefer repairing the tendon of the flexor pollicis brevis tendon with 3.0 and 4.0 nylon suture with a modified Kessler stitch and horizontal mattress sutures. A 5.0 epitendinous suture allows an adequate contour to the repair and facilitates opposition of the thumb to the small finger.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Microsurgery. Nerve Repair

Microsurgical nerve repair and use of the operating microscope is a particular area of interest for me and has become a significant part of my practice. I enjoy the optics of the Carl Zeiss Pentero microscope. The Pentero provides adequate resolution for nerve repair on the magnitude of 2mm and even less.

Peripheral nerve injuries in the upper and lower extremity are common with the frequent physical activity in southern California. Activities such as biking, surfing, motorcycles, climbing, as well as occupational hazards can cause peripheral nerve injury.

In the photograph above, the blue background contains a grid with 1 mm squares, allowing the surgeon to assess the dimensions of the injured nerve.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Deep Inferior Epigastric Perforator Flap Publications

Reconstruction of Total Laryngopharyngectomy Defects with Deep Inferior Epigastric Perforator Flaps:

Otway Louie, Brian Dickinson, Jay Granzow, J. Brian Boyd

Journal of Reconstructive Microsurgery. 25(9):555-558, November 2009

It is truly a great honor and distinct pleasure to publish in the Journal of Reconstructive Microsurgery with Dr. Otway Louie, Dr. Jay Granzow, and Dr. J. Brian Boyd. I received outstanding microsurgical training from them during my time training at Harbor-UCLA.

Brian P. Dickinson, M.D.

Hand & Microsurgery:Fight Bite

http://www.drbriandickinson.com/

The "fight bite" injury typically occurs during altercations where the clenched fist of one individual comes into contact with the incisor teeth of another individual.

These injuries can be serious for two reasons: 1. There is often a laceration of the extensor tendon that crosses the metacarpal joint that strikes the teeth, 2. There is often an injury to the underlying joint capsule that not only causes injury to the joint capsule, but also introduces bacteria into the joint.

I prefer to treat these injuries in stages, with the first stage being washout, irrigation, debridement of the joint followed by antibiotics. Once there has been no declaration of infection I find it safe to proceed with repair of the extensor tendon. The goal is to minimize extensor lag and permit full flexion of the digit.

Brian P. Dickinson, M.D.
http://www.drbriandickinson.com/