1/49. upper extremity salvage using the tensor fascia lata flap: report of two cases.The tensor fascia lata pedicled flap was successfully used to salvage 3 severely injured upper extremities in 2 patients. Both patients had undergone 3 prior free tissue transfers without complete closure of their wounds. All 3 tensor fascia lata flaps (2 myocutaneous, 1 myofascial) survived entirely. We believe this flap offers a distinct advantage compared with the groin flap when pedicled flap coverage of the upper extremity is required.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
2/49. Post-traumatic distal nerve entrapment syndrome.Eleven patients with paralysis of muscle groups in the upper or lower extremity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. patients were seen within an average of 8 months after trauma (minimum 3 months and maximum 2 years after). Nerve lesions were caused either by gunshot, motor-vehicle accident, and other direct trauma or, in one case, after tumor excision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on testing over the "classic" (distal) anatomic nerve entrapment sites only. After surgical release through decompression of the nerve compression site distal to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor function (M4/M5) was achieved in 63 percent of all cases. Twenty-five percent had no or only poor improvement in motor function, despite a good sensory recovery. Those patients in whom nerve compression sites were surgically released before 6 months after trauma had an improvement in almost all neural functions, compared to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with subsequent distal nerve compressions is provided, using the "double crush syndrome" hypothesis.- - - - - - - - - - ranking = 1.8173612280417keywords = gunshot (Clic here for more details about this article) |
3/49. Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report.A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed.- - - - - - - - - - ranking = 7keywords = wound (Clic here for more details about this article) |
4/49. Reconstruction of burn scar of the upper extremities with artificial skin.The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the food and Drug Administration, artificial skin (Integra) has been available in taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skin were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental skin turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
5/49. Trans-thoracic venous bullet embolism.Bullet emboli from peripheral wounds occur with sufficient frequency that they must be considered in every case of missile injury not accompanied by an exit wound. A case is presented which demonstrated a venous migration of such a bullet from the axillary vein into the femoral vein through the heart, presumably by gravity.- - - - - - - - - - ranking = 2keywords = wound (Clic here for more details about this article) |
6/49. Early decompression fasciotomy in the treatment of high-voltage electrical burns of the extremities.Based on a knowledge of electropathophysiology, a recommended treatment has been proposed for the management of extensive high-voltage electrical burns. Early, aggressive, surgical intervention consisting of adequate decompression fasciotomy and wound debridement has been emphasized as the first line of treatment. Frequent redebridements under general anesthesia are important to the preservation of viable tissue. Early coverage procedures or attempts at primary closure following decompression are contraindicated in high-voltage injuries. This method of treatment in eight cases of high-voltage, electrical injury has preserved viable tissue, decreased the incidence of fatal sepsis and renal shutdown, decreased patient morbidity, and generally facilitated patient rehabilitation.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
7/49. Heroic procedures in vascular injury management: the role of extra-anatomic bypasses.The insertion of an extra-anatomic bypass graft is an accepted operative technique in highly selected patients with atherosclerotic occlusive disease and contraindications to in situ grafting. In similar fashion, the technique should be considered in injured or septic patients with large soft tissue defects or wound infections overlying arterial repairs or involving native arteries. The combination of vigorous debridement of injured or infected soft tissue and insertion of an extra-anatomic bypass graft allows for appropriate care of the wound without concern for further injury to the now-displaced arterial repair.- - - - - - - - - - ranking = 2keywords = wound (Clic here for more details about this article) |
8/49. Pedicled groin flaps for upper-extremity reconstruction in the elderly: a report of 4 cases.The pedicled groin flap is a useful, versatile flap for coverage of wounds of the hand and distal forearm. It produces predictable results with a procedure that is much less difficult to perform and takes less time than a free-tissue transfer. Contrary to the general belief that the groin flap should not be used in the elderly because of the risk of shoulder stiffness, we found satisfactory results with this procedure in 4 elderly patients (age range, 59-75 y) when immediate shoulder mobilization was instituted and physical therapy was continued during flap maturation and pedicle division.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
9/49. Repeated upper limb salvage in a case of severe traumatic soft-tissue and brachial artery defect.We present the case of a 9-year-old male patient who suffered a gunshot injury to the right arm. The patient arrived in shock, his right arm severely traumatized, with soft-tissue loss involving the anterior surface and both sides of the right arm. The humerus was exposed. There was brachial artery defect and damage to the lateral fibers of the median nerve. The mangled extremity severity score (MESS) was 8 points. The patient was treated with general resuscitation, blood transfusion, and debridement. A venous graft, 12 cm in length, to bridge the brachial artery defect, and tendon transfer, triceps to the biceps, was performed in one step. Postoperatively, there was a normal radial pulse, normal skin color, normal temperature, and normal movement of the fingers without pain. Unfortunately, the patient then sustained a second trauma to the right arm 3 weeks later, rupturing the graft. This time he lost 1,500 cc of blood. After another blood transfusion, we performed a second reverse saphenous vein graft. The patient stayed at the hospital for 3 weeks. At follow-up 12 months later, the limb has good function and, except for the presence of a scar and skin graft, is equal in appearance to the left side.- - - - - - - - - - ranking = 1.8173612280417keywords = gunshot (Clic here for more details about this article) |
10/49. Case report of a homicide by a shotgun loaded with unusual ammunition.Reported is the case of a man killed by a neighbor with a shotgun loaded with a unusual ammunition. The cartridge contained several shots chained together by metallic wires. Such ammunition has been used for hunting purposes but is now banned, so it can be handmade only. The joined pellets produce a wound with features that are different from those of a wound made by a regular load of pellets. Several interpretive problems are caused by the unknown number of pellets contained in the shell and the effects of the wire holding the shot together.- - - - - - - - - - ranking = 2keywords = wound (Clic here for more details about this article) |
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