Tahseen Cheema - Academia.edu (original) (raw)

Papers by Tahseen Cheema

Research paper thumbnail of Hypothenar skin grafts for fingertip reconstruction

The Journal of Hand Surgery, Sep 1, 1984

Full-thickness skin grafts from the hypothenar area were used to reconstruct 25 digits in a group... more Full-thickness skin grafts from the hypothenar area were used to reconstruct 25 digits in a group of 20 patients. The results were evaluated objectively and subjectively at an average of 9.5 months after operation for seusibility, durabilityv and appearance. Eighty-six percent of the patients had two-point discrimination of 10 mm or less, with one half of them having two-point discrimination of less than 6 mm. All patients had good protective coverage and no ulcer formation. All patients could differentiate between coarse and smooth texture, although only one third had texture discrimination equal to that of normal digits. None of the patients complained of hypersensitivity. The donor site was cosmetically acceptable i.n all cases. The use of hypothenar full-thickness grafts provides an acceptable method for fingertip reconstruction, particularly in instances of palmar and lateral pulp loss in which there is insufficient tissue available for local advancement.

Research paper thumbnail of The Medial Plantar Artery Flap: A Series of Cases over 14 Years

Journal of Foot & Ankle Surgery, Nov 1, 2012

Research paper thumbnail of The Distally Based Sural Artery Flap for Ankle and Foot Coverage

Journal of Foot & Ankle Surgery, 2007

The sural artery flap is a distally based fasciocutaneous flap that has many advantages to offer ... more The sural artery flap is a distally based fasciocutaneous flap that has many advantages to offer for coverage in the foot and ankle area. It has the largest arc of rotation of all the regional flaps and does not require sacrifice of any major artery, and moderate-to-large-sized defects can be covered adequately. The dissection technique is simple, and donor site morbidity is minimal. We report our experience with 17 cases. Age range was from 13 to 56 years. Ten (59%) defects were posttraumatic, 3 (17%) were related to reconstructive surgery of the foot or tendon Achilles', 2 (11%) resulted from tumor resection, and 1 each were from infection and gunshot wound. The smallest flap was 6 ϫ 4 cm and the largest was 15 ϫ 12 cm, with the average size being 11 ϫ 7.5 cm. In 5 cases, the donor site was closed primarily, and in other cases, split-thickness skin graft was needed. The short saphenous vein was included in the pedicle in all cases. There was no incidence of complete flap necrosis. Follow-up ranged from 3 to 30 months. Two cases (12%) developed partial superficial necrosis. In 1 case, there was partial wound dehiscence that needed debridement and repair. Another case had postoperative discharge, which subsided after removal of the calcaneal plate. None of the patients complained of any functional problem related to loss of sensation along the lateral border of the foot. The sural island flap is a reliable, safe, and easy method of providing soft tissue coverage in the area of the foot and ankle.

Research paper thumbnail of Dynamic Effects of Joint-Leveling Procedure on Pressure at the Distal Radioulnar Joint

The Journal of Hand Surgery, Jul 1, 2005

Research paper thumbnail of Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency

Cureus, Aug 8, 2023

Introduction Loss of radius either due to trauma or infection results in a deformity resembling a... more Introduction Loss of radius either due to trauma or infection results in a deformity resembling a congenital radial club hand. This deformity results in difficulty to perform hand functions and cosmetic appearance and is called acquired radial club hand. There are a few case reports for the treatment of this severe deformity, but there are no proper guidelines for the management of this disease. From our experience, we decided to provide treatment guidelines for acquired radial club hand. Objectives To evaluate the outcome of radial deformity treatment in acquired radial club hand injuries and develop a treatment algorithm. Patients and methods It is a case series study of 11 patients with acquired radial club hand. It was conducted at a tertiary care hospital in Pakistan, from year 2016 to 2022. Basic principles of management of infection and trauma were followed. For the treatment of radial deformity, different options were opted according to the type of deformity, following the principles of treatment of congenital radial club hand. The outcome was graded on functional activity, pain, and bony union. Results Out of 11 patients, 36.36% showed excellent results, 27.27% showed good results, 27.27% showed fair results, and 9.09% showed poor results. Results were excellent in all patients with avascularized bone graft and distraction lengthening, with or without the Darrach procedure. Of the patients in whom distraction lengthening was performed, one patient showed excellent results while the other patient achieved similar results after the Darrach procedure of ulnar shortening. In the case of one bone formation by radioulnar synostosis, the results were variable. Two of the patients showed good outcomes while the other two had fair outcomes. Results in the case of ulnar centralization were mixed with good, fair, and poor results in one patient each. After three months of follow-up, 87% of the patients showed fair to excellent results. Conclusion With our experience, we recommend an algorithm for the treatment of acquired radial club hand.

Research paper thumbnail of Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency

Research paper thumbnail of Volkmann’s Ischemic Contracture

The Professional Medical Journal, 2014

Objective: To share our experience of post-circumferential Volkmann’s IschemicContracture (VIC) o... more Objective: To share our experience of post-circumferential Volkmann’s IschemicContracture (VIC) of the forearm seen in our setup. Design: A descriptive case series study.Setting: National Orthopedic Hospital, Bahawalpur, Pakistan. Period: January 2005 toDecember 2013. Methodology: A total of 42 patients were registered during the study period.Patients with VIC of the forearm resulting from direct circumferential compression were includedin the study. Patients who developed VIC of forearm indirectly secondary to arm pathology orother causes were excluded from the study. Assessment was made by detailed history, clinicalexamination and radiographs of the involved extremity. The age, sex, duration, side and type ofcontracture, length and width of forearm and resulting deformities were all documented on adetailed proforma. Patients were categorized into three types accordingly. Results: Forty twopatients comprising 29 males and 13 females were seen. Their ages ranged from 1 to 53 yearswi...

Research paper thumbnail of Chapter-02 Elements of complexity in hand injuries: what makes a hand injury complex?

Complex Injuries of the Hand, 2014

Research paper thumbnail of Simulated Osteotomy of the Trapezium Reduces Radial Subluxation and Improves Contact Pressure Distribution Across the Thumb Carpometacarpal Joint in Lateral Pinch

ASME 2010 Summer Bioengineering Conference, Parts A and B, 2010

Joint laxity and radial subluxation of the metacarpal on the trapezium have been associated with ... more Joint laxity and radial subluxation of the metacarpal on the trapezium have been associated with arthritis of the carpometacarpal (CMC) joint of the thumb. In normal flexion and extension of the thumb, the ligaments and the joint are minimally stressed. However, in opposition and lateral pinch (key pinch), the two surfaces rotate on each other, generating an unequal surface stress. Over time, the unequal stresses lead to an asymmetrical wear pattern. This leads to increased strain on the ligaments and may lead to subluxation over time.1 Surgical treatment of early arthritis of the CMC joint includes ligament reconstruction or first metacarpal extension osteotomy to decrease joint laxity. Once laxity exists, joint degeneration is accelerated.2 The long-term impact of painful CMC arthritis on activities of daily living can be debilitating.

Research paper thumbnail of Chapter-16 Secondary reconstruction in complex hand injuries

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-13 Skin coverage in complex hand injuries

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-06 Principles of treating complex hand injuries

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-03 Complex hand injuries: evaluation and diagnosis

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-01 Introduction

Complex Injuries of the Hand, 2014

Research paper thumbnail of Hand involvement in Navajo neurohepatopathy: a case report

HAND, 2010

We report a case of Navajo neurohepatopathy with severe involvement of the hands. It is a progres... more We report a case of Navajo neurohepatopathy with severe involvement of the hands. It is a progressive sensorimotor neuropathy with distal weakness, areflexia, and reduced sensation in the extremities associated with acral mutilation. The role of possible surgical intervention is demonstrated in this case.

Research paper thumbnail of One-stage osteoplastic reconstruction of the thumb

Techniques in hand & upper extremity surgery, 2009

One-stage osteoplastic reconstruction of the thumb is based on a reverse-flow forearm osteocutane... more One-stage osteoplastic reconstruction of the thumb is based on a reverse-flow forearm osteocutaneous flap. It is indicated in traumatic loss of the thumb at or around metacarpophalangeal joint level in situations where replacement with a toe is not feasible or patient desires against such a transfer. It is relatively an easier method of thumb reconstruction and does not require microsurgical expertise. Donor-site morbidity is small. Complications include delayed wound healing at donor site, radius fracture, and venous congestion. This technique is a useful reconstruction option for traumatic loss at the middle-third level of the thumb.

Research paper thumbnail of Reverse-Flow Posterior Interosseous Flap—A Review of 68 Cases

HAND, 2007

We are reporting our 10-year experience with 68 patients. Sixty-six flaps were of fasciocutaneous... more We are reporting our 10-year experience with 68 patients. Sixty-six flaps were of fasciocutaneous type and two were of osteofasciocutaneous type. These flaps were used for volar and dorsal traumatic hand defects, first web space reconstruction, thumb reconstruction, and repair of congenital anomalies. Sixty flaps (88.24%) had complete uneventful take-up. Four flaps developed partial necrosis, whereas four flaps suffered complete necrosis. The single most important factor for flap survival in our experience has been inclusion of at least two perforators to supply the skin pedal. The proximal flap dissection has a learning curve and all of our poor results were in the early part of our experience. We believe that posterior interosseous fasciocutaneous flap (PIF) is a versatile and reliable option for the challenging problems of hand soft-tissue coverage.

Research paper thumbnail of The posterior tibial island flap for coverage in complex injuries of the lower extremity

Research paper thumbnail of Anatomy of Irreducible Metacarpophalangeal Joint Dislocation in a Cadaver Model

The Journal of Hand Surgery, 2009

Research paper thumbnail of Opening Wedge Trapezial Osteotomy as Possible Treatment for Early Trapeziometacarpal Osteoarthritis: A Biomechanical Investigation of Radial Subluxation, Contact Area, and Contact Pressure

The Journal of Hand Surgery, 2012

Purpose Radial subluxation and cartilage thinning have been associated with initiation and accele... more Purpose Radial subluxation and cartilage thinning have been associated with initiation and accelerated development of osteoarthritis of the trapeziometacarpal joint. Few investigators have reported on the benefits of opening wedge trapezial osteotomy for altering the contact mechanics of the trapeziometacarpal joint as a possible deterrent to the initiation or progression of osteoarthritis. We used cadaveric specimens to determine whether opening wedge osteotomy of the trapezium was successful in reducing radial subluxation of the metacarpal base and to quantify the contact area and pressure on the trapezial surface during simulated lateral pinch. Methods We used 8 fresh-frozen specimens in this study. The flexor pollicis longus, abductor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis brevis/opponens pollicis tendons were each loaded to simulate the thumb in lateral pinch position. We measured radial subluxation from anteroposterior radiographs before and after placement of a 15°wedge. We used real-time sensors to analyze contact pressure and contact area distribution on the trapezium. Results Center of force in the normal joint under lateral pinch loading was primarily located in the dorsal region of the trapezium. After wedge placement, contact pressure increased in the ulnar-dorsal region by 76%. Mean contact area increased in the ulnar-dorsal region from 0.05 to 0.07 cm 2 , and in the ulnar-volar region from 0.003 to 0.024 cm 2. The average reduction in joint subluxation was 64%. Conclusions The 15°opening wedge osteotomy of the trapezium reduced radial subluxation of the metacarpal on the trapezium and increased contact pressure and contact area away from the diseased compartments of the trapezial surface. Trapezial osteotomy addresses the 2 preeminent theories about the initiation and progression of osteoarthritis. Clinical relevance By reducing radial subluxation and altering contact pressure and contact area, trapezial osteotomy may prove an alternative to first metacarpal extension osteotomy or ligament reconstruction in early stages of degenerative arthritis of the trapeziometacarpal joint.

Research paper thumbnail of Hypothenar skin grafts for fingertip reconstruction

The Journal of Hand Surgery, Sep 1, 1984

Full-thickness skin grafts from the hypothenar area were used to reconstruct 25 digits in a group... more Full-thickness skin grafts from the hypothenar area were used to reconstruct 25 digits in a group of 20 patients. The results were evaluated objectively and subjectively at an average of 9.5 months after operation for seusibility, durabilityv and appearance. Eighty-six percent of the patients had two-point discrimination of 10 mm or less, with one half of them having two-point discrimination of less than 6 mm. All patients had good protective coverage and no ulcer formation. All patients could differentiate between coarse and smooth texture, although only one third had texture discrimination equal to that of normal digits. None of the patients complained of hypersensitivity. The donor site was cosmetically acceptable i.n all cases. The use of hypothenar full-thickness grafts provides an acceptable method for fingertip reconstruction, particularly in instances of palmar and lateral pulp loss in which there is insufficient tissue available for local advancement.

Research paper thumbnail of The Medial Plantar Artery Flap: A Series of Cases over 14 Years

Journal of Foot & Ankle Surgery, Nov 1, 2012

Research paper thumbnail of The Distally Based Sural Artery Flap for Ankle and Foot Coverage

Journal of Foot & Ankle Surgery, 2007

The sural artery flap is a distally based fasciocutaneous flap that has many advantages to offer ... more The sural artery flap is a distally based fasciocutaneous flap that has many advantages to offer for coverage in the foot and ankle area. It has the largest arc of rotation of all the regional flaps and does not require sacrifice of any major artery, and moderate-to-large-sized defects can be covered adequately. The dissection technique is simple, and donor site morbidity is minimal. We report our experience with 17 cases. Age range was from 13 to 56 years. Ten (59%) defects were posttraumatic, 3 (17%) were related to reconstructive surgery of the foot or tendon Achilles', 2 (11%) resulted from tumor resection, and 1 each were from infection and gunshot wound. The smallest flap was 6 ϫ 4 cm and the largest was 15 ϫ 12 cm, with the average size being 11 ϫ 7.5 cm. In 5 cases, the donor site was closed primarily, and in other cases, split-thickness skin graft was needed. The short saphenous vein was included in the pedicle in all cases. There was no incidence of complete flap necrosis. Follow-up ranged from 3 to 30 months. Two cases (12%) developed partial superficial necrosis. In 1 case, there was partial wound dehiscence that needed debridement and repair. Another case had postoperative discharge, which subsided after removal of the calcaneal plate. None of the patients complained of any functional problem related to loss of sensation along the lateral border of the foot. The sural island flap is a reliable, safe, and easy method of providing soft tissue coverage in the area of the foot and ankle.

Research paper thumbnail of Dynamic Effects of Joint-Leveling Procedure on Pressure at the Distal Radioulnar Joint

The Journal of Hand Surgery, Jul 1, 2005

Research paper thumbnail of Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency

Cureus, Aug 8, 2023

Introduction Loss of radius either due to trauma or infection results in a deformity resembling a... more Introduction Loss of radius either due to trauma or infection results in a deformity resembling a congenital radial club hand. This deformity results in difficulty to perform hand functions and cosmetic appearance and is called acquired radial club hand. There are a few case reports for the treatment of this severe deformity, but there are no proper guidelines for the management of this disease. From our experience, we decided to provide treatment guidelines for acquired radial club hand. Objectives To evaluate the outcome of radial deformity treatment in acquired radial club hand injuries and develop a treatment algorithm. Patients and methods It is a case series study of 11 patients with acquired radial club hand. It was conducted at a tertiary care hospital in Pakistan, from year 2016 to 2022. Basic principles of management of infection and trauma were followed. For the treatment of radial deformity, different options were opted according to the type of deformity, following the principles of treatment of congenital radial club hand. The outcome was graded on functional activity, pain, and bony union. Results Out of 11 patients, 36.36% showed excellent results, 27.27% showed good results, 27.27% showed fair results, and 9.09% showed poor results. Results were excellent in all patients with avascularized bone graft and distraction lengthening, with or without the Darrach procedure. Of the patients in whom distraction lengthening was performed, one patient showed excellent results while the other patient achieved similar results after the Darrach procedure of ulnar shortening. In the case of one bone formation by radioulnar synostosis, the results were variable. Two of the patients showed good outcomes while the other two had fair outcomes. Results in the case of ulnar centralization were mixed with good, fair, and poor results in one patient each. After three months of follow-up, 87% of the patients showed fair to excellent results. Conclusion With our experience, we recommend an algorithm for the treatment of acquired radial club hand.

Research paper thumbnail of Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency

Research paper thumbnail of Volkmann’s Ischemic Contracture

The Professional Medical Journal, 2014

Objective: To share our experience of post-circumferential Volkmann’s IschemicContracture (VIC) o... more Objective: To share our experience of post-circumferential Volkmann’s IschemicContracture (VIC) of the forearm seen in our setup. Design: A descriptive case series study.Setting: National Orthopedic Hospital, Bahawalpur, Pakistan. Period: January 2005 toDecember 2013. Methodology: A total of 42 patients were registered during the study period.Patients with VIC of the forearm resulting from direct circumferential compression were includedin the study. Patients who developed VIC of forearm indirectly secondary to arm pathology orother causes were excluded from the study. Assessment was made by detailed history, clinicalexamination and radiographs of the involved extremity. The age, sex, duration, side and type ofcontracture, length and width of forearm and resulting deformities were all documented on adetailed proforma. Patients were categorized into three types accordingly. Results: Forty twopatients comprising 29 males and 13 females were seen. Their ages ranged from 1 to 53 yearswi...

Research paper thumbnail of Chapter-02 Elements of complexity in hand injuries: what makes a hand injury complex?

Complex Injuries of the Hand, 2014

Research paper thumbnail of Simulated Osteotomy of the Trapezium Reduces Radial Subluxation and Improves Contact Pressure Distribution Across the Thumb Carpometacarpal Joint in Lateral Pinch

ASME 2010 Summer Bioengineering Conference, Parts A and B, 2010

Joint laxity and radial subluxation of the metacarpal on the trapezium have been associated with ... more Joint laxity and radial subluxation of the metacarpal on the trapezium have been associated with arthritis of the carpometacarpal (CMC) joint of the thumb. In normal flexion and extension of the thumb, the ligaments and the joint are minimally stressed. However, in opposition and lateral pinch (key pinch), the two surfaces rotate on each other, generating an unequal surface stress. Over time, the unequal stresses lead to an asymmetrical wear pattern. This leads to increased strain on the ligaments and may lead to subluxation over time.1 Surgical treatment of early arthritis of the CMC joint includes ligament reconstruction or first metacarpal extension osteotomy to decrease joint laxity. Once laxity exists, joint degeneration is accelerated.2 The long-term impact of painful CMC arthritis on activities of daily living can be debilitating.

Research paper thumbnail of Chapter-16 Secondary reconstruction in complex hand injuries

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-13 Skin coverage in complex hand injuries

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-06 Principles of treating complex hand injuries

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-03 Complex hand injuries: evaluation and diagnosis

Complex Injuries of the Hand, 2014

Research paper thumbnail of Chapter-01 Introduction

Complex Injuries of the Hand, 2014

Research paper thumbnail of Hand involvement in Navajo neurohepatopathy: a case report

HAND, 2010

We report a case of Navajo neurohepatopathy with severe involvement of the hands. It is a progres... more We report a case of Navajo neurohepatopathy with severe involvement of the hands. It is a progressive sensorimotor neuropathy with distal weakness, areflexia, and reduced sensation in the extremities associated with acral mutilation. The role of possible surgical intervention is demonstrated in this case.

Research paper thumbnail of One-stage osteoplastic reconstruction of the thumb

Techniques in hand & upper extremity surgery, 2009

One-stage osteoplastic reconstruction of the thumb is based on a reverse-flow forearm osteocutane... more One-stage osteoplastic reconstruction of the thumb is based on a reverse-flow forearm osteocutaneous flap. It is indicated in traumatic loss of the thumb at or around metacarpophalangeal joint level in situations where replacement with a toe is not feasible or patient desires against such a transfer. It is relatively an easier method of thumb reconstruction and does not require microsurgical expertise. Donor-site morbidity is small. Complications include delayed wound healing at donor site, radius fracture, and venous congestion. This technique is a useful reconstruction option for traumatic loss at the middle-third level of the thumb.

Research paper thumbnail of Reverse-Flow Posterior Interosseous Flap—A Review of 68 Cases

HAND, 2007

We are reporting our 10-year experience with 68 patients. Sixty-six flaps were of fasciocutaneous... more We are reporting our 10-year experience with 68 patients. Sixty-six flaps were of fasciocutaneous type and two were of osteofasciocutaneous type. These flaps were used for volar and dorsal traumatic hand defects, first web space reconstruction, thumb reconstruction, and repair of congenital anomalies. Sixty flaps (88.24%) had complete uneventful take-up. Four flaps developed partial necrosis, whereas four flaps suffered complete necrosis. The single most important factor for flap survival in our experience has been inclusion of at least two perforators to supply the skin pedal. The proximal flap dissection has a learning curve and all of our poor results were in the early part of our experience. We believe that posterior interosseous fasciocutaneous flap (PIF) is a versatile and reliable option for the challenging problems of hand soft-tissue coverage.

Research paper thumbnail of The posterior tibial island flap for coverage in complex injuries of the lower extremity

Research paper thumbnail of Anatomy of Irreducible Metacarpophalangeal Joint Dislocation in a Cadaver Model

The Journal of Hand Surgery, 2009

Research paper thumbnail of Opening Wedge Trapezial Osteotomy as Possible Treatment for Early Trapeziometacarpal Osteoarthritis: A Biomechanical Investigation of Radial Subluxation, Contact Area, and Contact Pressure

The Journal of Hand Surgery, 2012

Purpose Radial subluxation and cartilage thinning have been associated with initiation and accele... more Purpose Radial subluxation and cartilage thinning have been associated with initiation and accelerated development of osteoarthritis of the trapeziometacarpal joint. Few investigators have reported on the benefits of opening wedge trapezial osteotomy for altering the contact mechanics of the trapeziometacarpal joint as a possible deterrent to the initiation or progression of osteoarthritis. We used cadaveric specimens to determine whether opening wedge osteotomy of the trapezium was successful in reducing radial subluxation of the metacarpal base and to quantify the contact area and pressure on the trapezial surface during simulated lateral pinch. Methods We used 8 fresh-frozen specimens in this study. The flexor pollicis longus, abductor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis brevis/opponens pollicis tendons were each loaded to simulate the thumb in lateral pinch position. We measured radial subluxation from anteroposterior radiographs before and after placement of a 15°wedge. We used real-time sensors to analyze contact pressure and contact area distribution on the trapezium. Results Center of force in the normal joint under lateral pinch loading was primarily located in the dorsal region of the trapezium. After wedge placement, contact pressure increased in the ulnar-dorsal region by 76%. Mean contact area increased in the ulnar-dorsal region from 0.05 to 0.07 cm 2 , and in the ulnar-volar region from 0.003 to 0.024 cm 2. The average reduction in joint subluxation was 64%. Conclusions The 15°opening wedge osteotomy of the trapezium reduced radial subluxation of the metacarpal on the trapezium and increased contact pressure and contact area away from the diseased compartments of the trapezial surface. Trapezial osteotomy addresses the 2 preeminent theories about the initiation and progression of osteoarthritis. Clinical relevance By reducing radial subluxation and altering contact pressure and contact area, trapezial osteotomy may prove an alternative to first metacarpal extension osteotomy or ligament reconstruction in early stages of degenerative arthritis of the trapeziometacarpal joint.