1/26. Penile stump advancement as an alternative to perineal urethrostomy after penile amputation.PURPOSE: We describe a method for avoiding perineal urethrostomy, and maintaining penile cosmesis and function after penile amputation. MATERIALS AND methods: Penile reconstruction was performed in 1 patient with traumatic total amputation of the penis and 1 undergoing near total penectomy for carcinoma by advancing the penile stump and covering the resultant phallus with rotational full thickness scrotal flaps. RESULTS: Both patients were able to void while standing, and have intact sensation and erectile capability in the residual neophallus. CONCLUSIONS: Perineal urethrostomy is not necessary after penopubic penile amputation. Advancement of residual cavernosal tissue and skin coverage with scrotal flaps minimize altered body image, and maintain sensation and normal voiding position.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/26. Embolisation of a leaking pseudoaneurysm of the main artery supplying a replanted arm: a case report.A 51-year-old patient suffered a near amputation of the right arm. Replant of the arm was performed and the brachial artery was grafted with a vein. A week later, there was severe bleeding from a leaking pseudoaneurysm at the proximal junction of the grafted artery. This was managed with embolization using coils and resulted in successful obliteration of the pseudoaneurysm without necrosis of the replanted arm.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/26. Treatment of finger avulsion injuries with innervated arterialized venous flaps.Complete degloving injury of the digits not amenable to revascularization may leave poor cosmetic and functional results. We used innervated venous flaps from the dorsum of the foot in two patients with traumatic finger degloving injuries. All the flaps successfully provided coverage over the denuded fingers. Good sensation and nearly full rage of motion of the fingers were obtained. There were no donor-site problems. The advantages of this flap are preservation of a major artery of the donor site, easy elevation without deep dissection, and providing a thin, nonbulky tissue and good sensation. The innervated arterialized venous flap is a useful method that provides functional and cosmetic coverage to the severe avulsion injury of the finger.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/26. Restoration of functional prehension after radial hemihand amputation in a three-year-old child: rationale for and long-term result after great toe transfer.Partial hand amputations are rare injuries among children, causing significant functional impairment. Reports on thumb reconstruction in children and adults are used to develop a reconstruction plan for restoring prehension. While either first or second toe transplantation may be indicated to restore prehension in adults with thumb loss, near universal reluctance to use the great toe in children centers around concern regarding the subsequent function and appearance of the foot. This report details the reconstruction of functional prehension after radial hemihand amputation in a 3-year-old child. Great toe transplantation was used and resulted in neither objective nor subjective donor site morbidity. The rationale for use of the great toe in this child and long-term functional outcome are described.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/26. survival with an arterial pH of 6.57 following major trauma with exsanguinating haemorrhage associated with traumatic amputation.We report the survival of a multiply injured patient with exanguinating haemorrhage and an arterial pH of 6.5, following a road vehicle crash. The previously healthy 38 years old male driver veered off the motorway and collided with a tree. The ambulance arrived at the scene 9 min after being called by an eyewitness and, following rapid extrication from the wreckage; the patient arrived in hospital 27 min later (with a GCS of 6), and was immediately intubated. The patient had suffered near-complete amputation of the left leg at upper femoral shaft level, along with multiple distal fractures and open wounds. He also sustained a head injury and closed displaced fractures of left radius and ulna. The patient received 2 l of crystalloids in the pre-hospital phase. Once in hospital the haemorrhage was controlled with a pressure dressing and intra-venous fluids were kept to a minimum until he was taken promptly to theatre. His initial arterial blood sample revealed a pH of 6.57, pCo(2) of 9.18 kPa, a pO(2) of 70.11 kPa and a base excess of -27.5 mmol l(-1). The co-oximeter Hb was 5.8 g dl(-1). Haemorrhage was controlled in theatre where he was transfused a total of 30 U of blood, 1 pack of platelets, 12 U of fresh frozen plasma, 3.5 l of crystalloids and 1.5 l of colloid. sodium bicarbonate was administered three times. He subsequently remained ventilated in intensive care unit (ICU). Over the following week he survived sepsis, disseminated intravascular coagulation and myoglobinuria (with transient renal failure) attributable to rhabdomyolysis secondary to muscle necrosis. He later underwent diversion colostomy and disarticulating amputation of the left femur after several debridements. After 6 weeks on ICU he made an excellent recovery will full return of his mental abilities. In this case, the serial arterial blood samples obtained were reliable. The lactic acidosis observed was the result of profound tissue hypo-perfusion and its rate of clearance seems to have greater prognostic value than its peak or initial value. Several factors may have contributed to the patient's survival: rapid retrieval from the scene; early intubation with excellent subsequent oxygenation (thus avoiding the dangerous combination of hypoxia and acidosis with synergistic influence on cardiac depression) and limited initial fluid resuscitation in the emergency department with prompt surgical intervention and vigorous restoration of organ perfusion after surgical haemostasis. Immediate operative haemostasis, coupled with restricted fluid administration beforehand and vigorous restoration of organ perfusion afterwards is now replacing the old resuscitation paradigm. Perhaps this shift in practice has helped this patient to survive.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/26. limb salvage after subtotal supramalleolar amputation by initial shortening followed by tibial lengthening.BACKGROUND: We present a patient with a subtotal traumatic supramalleolar amputation of the leg, which was initially treated by a vascular reconstruction with deliberate bone and soft-tissue shortening. methods: To correct the ensuing complex deformity, which consisted of a varus hindfoot, leg length discrepancy and equinus, a staged reconstruction was planned. Initially, the hindfoot varus, in presence of a stiff ankle, was corrected by a supramalleolar osteotomy, followed by a Wagner distraction and finally a correction of the equinus. RESULTS: After a relatively long period of normal functioning, she regained painful minimal ankle function, which necessitated ankle fusion and correction of a pronation deformity. At the most recent follow-up 13 years after the injury, the patient is fully functional and has near normal leg length. CONCLUSION: Although a mangled lower extremity is often a candidate for primary amputation allowing early rehabilitation, in certain cases a good result can be obtained by a creative strategy.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/26. Bilateral severance of thumbs: report of two cases.Management of hand injuries is a common practice but bilateral amputation of thumbs is very rare. We report on two cases of both thumbs amputated by a similar machine. In case 1, the man's left thumb was closed with a composite skin graft because the severance was through the middle of the nail. A wrap-around procedure was performed to reconstruct the right thumb which was infected after a primary V-Y advancement flap. The final results were acceptable. replantation of detached thumbs, if possible, achieves the best functional recovery, which was well demonstrated in Case 2. Although the interphalangeal joints were arthrodesed, the patient was greatly satisfied with the results because of excellent appearance, adequate strength and nearly normal sensation. Prevention of bilateral thumb injuries is important. The paper-cutting machine on which these accidents occurred should be improved in order to prevent further similar catastrophes.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/26. Microsurgical revascularization of almost totally amputated alar wing of the nose.A case of nearly complete amputation of the alar wing is presented whereby a successful arterial revascularization was accomplished using an arterial rerouting technique. Venous stasis was overcome by means of stab-wound wiping. An excellent result was obtained following complete survival of the revascularized segment. The authors conclude that microvascular revascularization should always be attempted whenever possible, even if a skin bridge is preserved in nearly complete amputations of the nose.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
9/26. Successful revascularisation of near total amputation of the upper limb after ten hours of warm ischaemia.Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
10/26. Unilateral Beau's lines associatd with a fingertip crushing injury.Beau's lines are transverse depressions or ridgings of the nail surface that are the result of the temporary arrest of nail matrix formation. They are caused by systemic diseases, local trauma, drugs, and infection. Generally, Beau's lines after a fingertip injury occur on only the affected finger, not on the unilateral extremity. In this report, we present the case of a 36-year-old man who developed transverse ridgings in the nail plates of all five fingers of the affected extremity after a fingertip (thumb) crushing injury. During the follow up, the growth rate of affected fingernails was normal. The transverse ridgings advanced with the linear growth of the nails and eventually disappeared. To the best of our knowledge, no association between unilateral Beau's lines and fingertip injury has been reported in the English literature.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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