A specific, frustrating problem that is treated by all hand surgeons is scarring of tendons. Tendon scarring (adhesions) can occur after direct trauma, infection, or immobilization of digits. These adhesions result in limitation of motion of digits. This often requires surgical release, cutting or removing of the scar around tendons.
Tendons are cord-like structures that travel over long distances within tunnels of tissue. There is no surgical instrument that has been specifically designed for introduction into these tunnels to release the scarred tendons. Surgeons often resort to improvisation by using instruments such as dental scrapers and manipulators to try to gain access to these tight spaces.
Prototypes have been developed, modified and redesigned by NewMedical to meet the demands of surgeons. Clinical testing has resulted in working prototypes. A "kit" with a combination of reusable and disposable pieces is being developed. It will include a unique, ergonomically designed handle that has been researched and designed specifically for the needs of hand surgeons and to satisfy consultant's demands. It is currently being manufactured. The "tips" or "blades" of the device will be disposable and interchangeable. Twelve tips are currently being manufactured. Also, a custom container will be part of the kit.
This device is being developed due to the needs of small bone surgeons. The treatment of small bone fractures of the hand or mandible often requires the use of an external device to maintain the positions of the bones. Also, external devices can be used for 'distraction osteogenesis'. This is a process by which a bone that has a cut made in the centre of it can be made longer by the gradual stretching apart of the two cut parts. This gradual stretching (distraction) allows the formation of new bone with the resultant lengthening of the bone.
An example of this application is the distraction of the mandible (lower jaw bone) of a baby whose mandible is too small at birth. This relatively short mandible can compromise the ability of the baby to breathe.
The problem with current available devices is the large size. The device which has been developed by NewMedical is a fraction of the size of similar devices, but has retained and enhanced the features of competitive devices. The current device weights only 2.3 grams and is constructed of alloys and stainless steel bridging fasteners.
Prototypes have been produced at the NewMedical facilities and have been tested successfully clinically.
The needs of the "hand surgeon" have not been previously addressed specifically. When operating on an extremity, the patient's arm is placed at right angles to the body and supported on a "surgical hand table". It appears, from the critical review and testing of several designs, that the currently available tables have not been designed or manufactured from the surgeon's perspective. Many innovative features are available on current tables, but none is to the satisfaction of the consultants polled.
Specifically, these tables require minimal obstruction to access of the patient by the surgeon, surgical assistants, and related equipment such as radiographic machinery. The table must be light-weight, have easy storage capabilities, and be radiolucent (allow taking of x-rays through the table itself). It must be stable for use in microsurgical procedures where any movement or vibration can hinder the procedure. Yet it must be height adjustable and easily maneuverable to maximize versatility.
In short, a Surgical Hand Table must be "user friendly".
The table currently under refinement by NewMedical meets all these demands. A unique, lightweight polypropylene top has been integrated with rigid stainless steel fasteners. The monolimb construction using a solid locking gas shock with infinite adjustment capabilities has been incorporated with a lightweight aluminum, anodized platform.
Importantly, development costs and prototype costs have been economized with a resultant product that can be competitively priced, but still out-perform the competition in most categories. Clinically testing is on-going.
A LOW-COST way of recording X-ray images electronically could make digital X-rays scanners affordable in the developing world. The method can produce high-resolution digital X-rays for one-tenth of the usual cost.
Digital X-ray machines are prized because the images they produce are simple to analyse, manipulate and store. Most of them work by using a layer of amorphous selenium to convert the X-rays into electric charge. This "charge image" is then recorded using an array of transistors and other electronic components, akin to those used in some digital cameras.
However, the machines are expensive because these arrays have to be large: X-rays cannot be easily focused, so X-ray machines work by recording the shadow of an object rather than a focused image. That means the recording medium, be it an electronic imager or conventional X-ray film, must be at least the same size as the object being scanned. Digitally imaging a human lung, for example, requires an array up to 40 centimetres square with 10 million pixels, which costs as much as $200,000. This puts them well out of reach of most hospitals in the developing world.
A new device developed by John Rowlands and colleagues at the University of Toronto in Ontario, Canada, could slash the cost of high-resolution digital X-rays. This low-cost alternative, which Rowlands calls the "X-ray light valve" consists of a layer of liquid crystal - which is opaque or transparent depending on whether an electric charge is present - covered with a layer of amorphous selenium. These layers are sandwiched between a pair of electrodes which generate an electric field across them.
When an X-ray is taken, the rays that hit the selenium layer generate a charge which is drawn towards the liquid crystal by the electric field. This makes the liquid crystal transparent at those locations. The overall pattern of transparency and opacity can be read off the liquid crystal layer using a light-based digital scanner
After recording the image, the liquid crystal is reset by an electric field that restores its opacity.
Robert Street, an X-ray imaging expert at the Palo Alto Research Center in California, is intrigued. He reckons the X-ray light valve should be relatively cheap to fabricate.
Richard Lanza, an expert in X-ray imaging technology at the Massachusetts Institute of Technology, says the idea is significant because it separates the read-out system from the X-ray mechanism. "Two-thirds of the people in the world will never have a chest X-ray to diagnose a life-threatening illness such as tuberculosis," he says, so cutting the cost of digital X-ray machines in this way could make a big difference.
