1/6. 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 = 1keywords = muscle (Clic here for more details about this article) |
2/6. Tragic case of a dog bite in a young child: the dog stands trial.The authors present the tragic case of an 18-month-old child who was bitten by a dog, causing amputation of the forearm and substantial damage to the cutaneous muscle on his back, shoulder, thorax, and neck. A free latissimus dorsi flap was performed to preserve the humerus from which the periosteum had been torn away. A series of cutaneous expansions were then undertaken to graft skin back onto the back, the armpit, and the shoulder stump, to allow for a mechanical prosthesis. A study of the literature on this subject proves that dog bites are more frequent and serious (sometimes even fatal) in young children than in adults. In view of the current legislation, it would seem that the public health authorities are doing little to resolve this distressing problem.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/6. The use of surface electromyographic techniques in assessing musculoskeletal disorders in production operations.The use of surface electromyographic (SEMG) techniques in evaluating production line workstations is illustrated through the use of two case studies. Evaluation procedures are introduced. The results illustrate how SEMG can be used to document the strain upon muscles of the neck and shoulders and how workstations may be altered to comply with government regulations.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
4/6. A new method: perforator-based tissue expansion for a preexpanded free cutaneous perforator flap.Recent advances in concepts of preexpanded free flaps have made it possible to replace larger postburn contracture area. Free anterolateral thigh (ALT) cutaneous perforator flaps are popular due to constant, reliable anatomy and various clinical applications in our department. Combination of preexpansion, perforator-based prefabrication of tissue expansion and a free anterolateral thigh flap is first introduced and developed to resurface the large territory of postburn cervical contracture in a 33-year-old female patient with second to third degree flame burn with a 45% total body surface area (TBSA) involvement. The limited lateral flexion and rotation was noted despite aggressive rehabilitation for 6 months. The 650cm(3) kidney-shaped tissue expander was inserted around the myocutaneous perforator under the fascia via the midlateral thigh incision in first stage. Two months later right lateral neck scar (size=25cm x 13cm) was excised after serial clinic saline injection. The preexpanded free flap (size=29cm x 15cm) combined with z plasty and capsulectomy was harvested and covered in the contracture defect. A flap totally survived. One-staged resurfacing was achieved with immediate postoperative improvement. The hospital stay was 6 days. The donor site was closed primarily. After 6 months follow-up, the functional improvement was assessed as follows: an increase in rotation of 14 degrees (preoperative 74 degrees to postoperative 88 degrees ); and an increase in lateral flexion of 10 degrees (preoperative 30 degrees to postoperative 40 degrees ). The prefabrication of the free cutaneous perforator flap by perforator-based tissue expansion above the muscle has several advantages: (1) it provides accurate and safe expansion without damage of any perforator compared with the blunt dissection; (2) larger territory of free flaps can be used for burn reconstruction; (3) donor site is primarily closed with low tension; (4) it is not a random expanded flap due to direct expansion of specific skin territory around the perforator. The disadvantages are two-staged procedures, complications of tissue expansion (e.g. infection, extrusion), the possibility of compression of pedicles.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
5/6. A reliable approach to the closure of large acquired midline defects of the back.A systematic regionalized approach for the reconstruction of acquired thoracic and lumbar midline defects of the back is described. Twenty-three patients with wounds resulting from pressure necrosis, radiation injury, and postoperative wound infection and dehiscence were successfully reconstructed. The latissimus dorsi, trapezius, gluteus maximus, and paraspinous muscles are utilized individually or in combination as advancement, rotation, island, unipedicle, turnover, or bipedicle flaps. All flaps are designed so that their vascular pedicles are out of the field of injury. After thorough debridement, large, deep wounds are closed with two layers of muscle, while smaller, more superficial wounds are reconstructed with one layer. The trapezius muscle is utilized in the high thoracic area for the deep wound layer, while the paraspinous muscle is used for this layer in the thoracic and lumbar regions. Superficial layer and small wounds in the high thoracic area are reconstructed with either latissimus dorsi or trapezius muscle. Corresponding wounds in the thoracic and lumbar areas are closed with latissimus dorsi muscle alone or in combination with gluteus maximus muscle. The rationale for systematic regionalized reconstruction of acquired midline back wounds is described.- - - - - - - - - - ranking = 7keywords = muscle (Clic here for more details about this article) |
6/6. Muscle flap closure for salvage of complex back wounds.STUDY DESIGN. The use of muscle flaps for closing complex thoracolumbar and lumbar spine wounds was studied retrospectively. Five patients in whom traditional, conservative treatment modalities did not work underwent a variety of muscle flap closures with successful healing. OBJECTIVES. patients with complicated back wounds ranging from exposed hardware to post-traumatic defects were treated initially with conservative treatments. The authors evaluated the efficacy of applying techniques and knowledge gained from complex lower extremity wound coverage of back wounds. SUMMARY OF BACKGROUND DATA. Six muscle transfer procedures were performed on five patients. All patients were closed with local muscle flaps using the trapezius and latissimus dorsi muscles. methods. Success was defined as a closed stable wound that needed no future surgery nor allowed the primary defect to heal before hardware removal. There was no evidence of chronic infection. Surgical hardware was salvaged in one of three patients. RESULTS. All were successfully closed and have been followed up to 30 months without evidence of recurrence. CONCLUSIONS. The cases presented illustrate the usefulness of rotation flaps when there is an extensive soft tissue defect that has exposed neural, osseous, and foreign structures. The use of local transposition muscle flaps as an adjunct in closing complex back wounds has been very successful in our experience. Although recurrent infection may occur, this technique has facilitated the establishment of a soft tissue envelope to achieve short- and long-term wound healing.- - - - - - - - - - ranking = 6keywords = muscle (Clic here for more details about this article) |