1/97. Acute carpal tunnel syndrome from thrombosed persistent median artery.We report a case of acute carpal tunnel syndrome from thrombosis of a persistent median artery caused by blunt trauma. The sudden onset of numbness in the median nerve distribution with pain in the fingers in a young adult may provide clues to the diagnosis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/97. Stigmata: part I. shame, guilt, and anger.The aesthetic surgeon may occasionally be consulted by a patient who wishes to discuss what can be done for the scars of self-inflicted wounds on the forearms. These scars are popularly referred to as "hesitation marks" or "suicide gestures." Unlike patients suffering from factitial ulcers or Munchhausen syndrome, these patients will admit to the physician that the scars are the result of self-inflicted wounds. These scars often consist of multiple, parallel, white lines extending up and down the forearms (usually volar surface), with more on the nondominant side. Although the pattern of these scars is apparently what drives these patients to the aesthetic surgeon for relief (because even lay people identify these scars as self-inflicted suicide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany that prompted this report. Once the symbolic meaning of these scars was broached, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflicted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own stories and propose guidelines and warnings for the aesthetic surgeon.- - - - - - - - - - ranking = 32.440945682207keywords = injury (Clic here for more details about this article) |
3/97. Vascular injuries of the upper extremity.Vascular injuries of the upper extremity represent approximately 30% to 50% of all peripheral vascular injuries. The majority of injuries are to the brachial artery, and 90% of injuries are due to penetrating trauma. Return of function is often related to concomitant injury to peripheral nerves. However, timely restoration of blood flow is essential to optimize outcome. The diagnosis is made by physical examination and limited Doppler ultrasonography. Arteriography may be helpful if there are multiple sites of injury. Anticoagulation with heparin should be given if not otherwise contraindicated. Revascularization should be completed within the critical ischemic time: 4 hours for proximate injuries and 12 hours for distal injuries. Revascularization methods include resection and primary repair or resection with an interposition graft. The sequence of repair of multiple injuries to the extremity begins with arterial revascularization followed by skeletal stabilization and nerve and tendon repair.- - - - - - - - - - ranking = 66.881891364414keywords = injury, nerve (Clic here for more details about this article) |
4/97. The farmer's wife and the salmon fork: a near miss for the median nerve.This case history illustrates how a farmer's wife accidentally impaled her forearm on a salmon fork with barbs. Despite the fact that the barbs were not obvious to the rescuing firemen, they had the good sense to transfer the patient with the fork in situ and well supported to prevent traction injury. Any effort to remove the fork at the time of injury would have resulted in complete division of the median nerve.- - - - - - - - - - ranking = 69.881891364414keywords = injury, nerve (Clic here for more details about this article) |
5/97. Twenty-five-year follow-up evaluation of an active silicone/Dacron tendon interposition prosthesis: A case report.A 19-year-old man sustained a severe avulsion wound of the dominant distal forearm, dividing the radial and ulnar arteries, median and ulnar nerves, and all flexor tendons. Initial treatment consisted of revascularization. Shortly thereafter he had sural nerve grafting of the median and ulnar nerves. This was followed by insertion of a silicone/Dacron tendon interposition prosthesis to reconstruct a 4-cm deficit in the flexor profundus tendons and the flexor pollicis longus tendon. Six weeks thereafter an opposition transfer using the extensor indicis proprius and a Brand type 2 intrinsic transfer using the extensor carpi radialis longus and a plantaris tendon graft were performed. Several months later an attempt was made to remove the prosthesis. It was encased in scar tissue, however, and left in place. Evaluation 25 years later revealed that the flexor tendons and prosthesis were functioning well.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
6/97. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.- - - - - - - - - - ranking = 66.336833886428keywords = injury, nerve injury, nerve (Clic here for more details about this article) |
7/97. Free temporoparietal fascial flap for coverage of a large palmar forearm wound after hand replantation.A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.- - - - - - - - - - ranking = 51.336833886428keywords = injury, nerve injury, nerve (Clic here for more details about this article) |
8/97. Unusual development of acute compartment syndrome caused by a suction injury: a case report.There have been recent reports of acute compartment syndrome secondary to suction injuries of the hands of children. We report the case of a 68-year-old patient who developed an acute compartment syndrome of the forearm after his arm had been sucked into an exhaust port. He was treated by emergency fasciotomies and the wound was closed five days later with a small skin graft. His recovery was uneventful.- - - - - - - - - - ranking = 129.76378272883keywords = injury (Clic here for more details about this article) |
9/97. Penetrating injury to the terminal branches of the posterior interosseous nerve with nerve grafting.We report two cases of penetrating injuries to the terminal branches of the posterior interosseous nerve in the forearm. Repair using nerve grafts in both cases were followed by complete recovery.- - - - - - - - - - ranking = 139.76378272883keywords = injury, nerve (Clic here for more details about this article) |
10/97. Flow-through use of the osteomusculocutaneous free fibular flap.A case of a forearm defect resulting from a high-velocity firearm injury was reconstructed by flow-through free transfer of the osteomusculocutaneous fibular flap harvested from the remaining stump of the patient's left leg that was amputated below the knee. The dimensions of the bone defect and damage to anatomic structures of more than one type (including ulnar artery, ulnar bone, and overlying soft tissue) were the reasons for the treatment approach with a composite tissue transfer including vascularized bone. Preoperative radiographic and angiographic examination revealed that the amputation stump offered a fibular shaft with adequate length and a peroneal artery patent up to the most distal point of the bone. Instead of the usual osteocutaneous fibular harvest, flap harvest was performed in an osteomusculocutaneous manner with incorporation of a segment of soleus muscle with an overlying skin paddle. In addition to the replacement of the bone defect, transfer of the flap in a flow-through manner reestablished the dual blood supply of the hand by replacing the ulnar artery gap, whereas the muscle and skin of the flap allowed three-dimensional reconstruction of the complex defect. In severe injuries of the upper extremity, flow-through free transfer of the fibular flap provides not only replacement of the resulting composite defect but also may offer salvage, or at least revascularization, of the extremity when complicated by arterial damage.- - - - - - - - - - ranking = 32.440945682207keywords = injury (Clic here for more details about this article) |
| | Next -> |