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A case of a concealed malignant fibrous histiocytoma (pleomorphic type) in the biceps muscle causing spontaneous rupture is presented. The different types of malignant fibrous histiocytoma are described.

The use of two-staged flexor tendon grafting for the late reconstruction after severance of both flexor ten­ dons in zone II in the finger is well established. 1 If the procedure takes place a few months or more after the initial injury, most of the flexor tendon sheath is nar­ rowed and scarred, and in many instances it is impos­ sible to pass the silicone rod under the pulley system. If the rod is to be placed outside the confines of the flexor sheath, an adequate pulley system has to be recon­ structed to prevent later bow stringing of the grafted flexor tendon. The relative importance of the individual pulleys as has been studied by Doyle and Blythe 2 dem­ onstrates that at least two pulleys, A-2 and A-4, should be reconstructed or even more for optimal efficiency. Many techniques have been used to reconstruct the pulleys over the silicone rod. 3 , 4 Most use grafts taken either from the remnants of the flexor tendons, the pal­ maris tendon, or fascia lata. These have to be properly sutured or fixed to the fibroosseous floor of the sheath. The "belt loop" technique by use of the palmar plates of the joints produces a good local material in the right location to comply with the desired needs of pulley reconstruction. The surgical technique is to open the finger through a zig zag incision. The remnants of the severed tendons in zone II are excised. The palmar aspects of the palmar plates of the joints are exposed. The palmar plate is incised twice in each joint. Two

The resurfacing of three severely degloved fingers, by a two stage cross arm flap operation, to maintain length and function is described.

An effective way to treat painful "neuromas in continuity" in the palm is to reroute the nerve under the lumbrical muscle. In two patients this has completely cured their symptoms.

A specially designed tensiometer was employed to compare the mechanical efficiency of normal and reconstructed pulley systems in the thumb and the fingers. The "belt loop" technique for reconstruction was used in five fresh cadavers. A total of 10 thumbs and 40 fingers were dissected, and after a measured pull on the proximal tendon the yielded power output at the tip was compared with the normal and reconstructed systems. A mean of 10% loss of power in the reconstructed system in the thumb and 40% of power in the fingers, with excellent range of motion and no bow stringing was recorded.

A case of selective paralysis of shoulder muscles with its reconstructive procedure, is presented. The deltoid, infra- and supraspinatus paralysed, leaving one of the steering group of muscles around the shoulder—the subscapularis—intact, made the transfer of the trapezius to deltoid feasible, utilizing a modification of Saha's technique. An excellent result with full range of motion of the paralysed shoulder has been achieved.

The carpal tunnel of 50 cadavers (100 hands) was dissected. Macroscopic finding included 14 median nerves with pressure signs (in 4 cadavers, unilaterally and 5 bilaterally). In three cadavers, marked synovitis was seen around the tendons and the nerve; in one, lipoma was evident; and in the rest, thickening of the volar carpal ligament was seen. Microscopic examination of the compressed nerves showed concentric thickening of the perineurium, thrombosis of veins, and intrafascicular fibrosis. In one nerve, the thickening of the perineurium was not concentric, but only at that part of the fascicle adjacent to the volar carpal ligament in an "onion peel" form.

Malignant histiocytoma in childhood is extremely rare, and a case of a malignant histiocytoma of the arm of a four year old boy is herewith reported.

A short review of the literature and the possible causes of osteoma cutis, a rare tumor, is followed by a case report.

BY using metacarpal block anaesthesia many surgical procedures on the finger, such as suture of cut wounds, tip injuries, reconstruction of nail deformities, excision of benign tumours and treatment of scar contractures, may be performed. The application of this simple tourniquet provides the desired bloodless field. After the hand has been cleaned and a sterile operating field obtained, local anaesthetic is injected. The patient’s hand is covered with a sterile rubber glove, and the glove tip of the finger to be operated on is snipped off. By rolling back the glove finger to its base (Fig. I) the finger itself is progressively compressed from tip to base proximally and becomes exsanguinated (Fig. 2). The rolled rubber band acts as a tourniquet throughout the operation and is cut transversely at the end of the procedure. The pressure of the rubber band does not appear to jeopardise the neurovascular bundles, as some 200 routine operations have proven. The technique is contra-indicated in the event of infection of the finger as the squeezing of the blood proximally may cause spread of the infection. The same applies to malignant tumours.