1/54. Full-thickness burn to the hand from an automobile airbag.An 18-year-old male was involved in a single car motor vehicle accident in which the driver's side airbag was deployed. He presented to the trauma center with complex injuries to the left hand, lacerations to the scalp, and a full-thickness burn to the ulnar aspect of the right hand that included the hypothenar area and the fifth digit. The patient was admitted to the trauma center and received immediate consultation from the burn service. He underwent debridement and split-thickness skin grafting of 50 cm2 of the right hand on postburn day 3. The graft became necrotic and the patient underwent debridement of the skin and the abductor minimi muscle of the right hand on postburn day 32. Split-thickness skin grafting and release of flexion contracture were successfully completed 18 days later. The police and fire departments reported that the airbag showed signs of thermal destruction. Upon request, Honda motors submitted information from the TRW safety systems and material safety data sheet (Mesa, Ariz, issued 1989) that showed that airbag canisters contain the chemicals sodium azide and cupric oxide. water may react with sodium azide to form highly toxic and explosive hyfrazoic acid. These chemicals are converted to sodium hydroxide, which can cause significant chemical burns. In addition, these chemicals may ignite when exposed to live electrical wires or temperatures greater than 300 degrees F. We conclude that burns associated with damaged deployed airbags in motor vehicle accidents may be the results of both chemical and thermal injury. The extent of the burn wound may be underestimated, as our case illustrates. Full-thickness burns resulting from airbag deployment may require more aggressive initial debridement and treatment.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/54. Physical therapy after hand injuries.The nuances of physical therapy necessary in the trauma patient are discussed. This article also discusses either the treatment of fractures via therapy or the treatment of nerve, tendon, or arterial injuries. It also describes physical therapy guidelines relevant to the patient with hand trauma and reviews communication between the physician and therapist in managing these patients. Intervention concepts are illustrated through case studies of patients with complex hand injuries.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/54. Serratus anterior free fascial flap for dorsal hand coverage.Reconstruction of the dorsal surface of hand defects requires thin, pliable, well-vascularized tissue with a gliding surface for the extensor tendon course. Fasciocutaneous or fascial flaps are the two surgical options. Fascial flaps present the advantages of thinness and low donor site morbidity. The authors present 4 cases of serratus anterior free fascial flap (SAFFF) used to cover the dorsum of the hand. The SAFFF with skin graft has many advantages for a fascial flap: long, constant vascular pedicle; very thin, well-vascularized tissue; low donor site morbidity; and the possibility of simultaneous donor and recipient site dissection. Furthermore, it can be associated with other flaps of the subscapular system for complex reconstructions. Of the 4 observations described, 2 used associated flaps, 1 used the SAFFF with a latissimus dorsi flap, and 1 used a scapular bone flap with the SAFFF. One flap was lost due to an electrical lesion to the forearm vessels.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/54. Serratus fascia "sandwich" free-tissue transfer for complex dorsal hand and wrist avulsion injuries.The serratus anterior fascia was used as a free-tissue transfer in four patients for the reconstruction of dorsal hand defects. All patients had multiple open metacarpal fractures with extensor tendon injuries. The fascia was used to "sandwich" the extensor tendons in a bed of areolar gliding tissue to avoid adhesions. The mean follow-up was 2 years. There were no complications and all flaps survived completely. All flaps were grafted with meshed split-thickness skin at the time of transfer with a 100 percent take in all cases. A good functional result was noted in all patients. This free-tissue transfer is recommended for complex injuries to the dorsum of the hand associated with soft-tissue defects.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
5/54. Catfish spine envenomation: a case report and literature review.Catfish spine envenomations are common injuries, reported in both freshwater and saltwater. Such injuries are complex puncture wounds, often complicated by severe infection. signs and symptoms range from simple local pain and bleeding to systemic manifestations with hemodynamic compromise. Care and treatment involve aggressive pain management, judicious wound cleansing, prophylactic antibiotics, and close follow-up. A case of catfish spine envenomation from a freshwater catfish is presented here.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/54. Clinical applications of the posterior rectus sheath-peritoneal free flap.Soft-tissue injuries involving the dorsum of the hand and foot continue to pose complex reconstructive challenges in terms of function and contour. Requirements for coverage include thin, vascularized tissue that supports skin grafts and at the same time provides a gliding surface for tendon excursion. This article reports the authors' clinical experience with the free posterior rectus sheath-peritoneal flap foil dorsal coverage in three patients. Two patients required dorsal hand coverage; one following acute trauma and another for delayed reconstruction 1 year after near hand replantation. A third patient required dorsal foot coverage for exposed tendons resulting from skin loss secondary to vasculitis. In all three patients, the flap was harvested through a paramedian incision at the lateral border of the anterior rectus sheath. After opening the anterior rectus sheath, the rectus muscle was elevated off of the posterior rectus sheath and peritoneum. When elevating the muscle, the attachments of the inferior epigastric vessels to the posterior rectus sheath and peritoneum were preserved while ligating any branches of these vessels to the muscle. Segmental intercostal innervation to the muscle was preserved. The deep inferior epigastric vessels were then dissected to their origin to maximize pedicle length and diameter. The maximum dimension of the flaps harvested for the selected cases was 16 X 8 cm. The anterior rectus sheath was closed primarily with non-absorbable suture. Mean follow-up was 1 year, and all flaps survived with excellent contour and good function in all three patients. Complications included a postoperative ileus in one patient, which resolved after 5 days with nasogastric tube decompression.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/54. Combined free toe and free deep inferior epigastric perforator flap for reconstruction of the thumb and thumb web space.To repair a complexly injured hand with composite loss of the thumb and the thumb web space in one stage, the combined transfer of a free second toe and a free deep inferior epigastric perforator flap was designed. It was used to simultaneously reconstruct the thumb and thumb web space of the injured hand in five cases. All flaps survived and there were no complications at any donor site after the reconstructions. In follow-up averaging 35.6 months, the final functional and cosmetic outcomes of the reconstructed thumbs and thumb web spaces were satisfactory. Results demonstrated that the combined transfer of a free second toe and a free deep inferior epigastric perforator flap is a valid method for simultaneous reconstruction of the thumb and the thumb web space of the injured hand.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/54. Use of three free flaps based on a single vascular pedicle for complex hand reconstruction in an electrical burn injury: a case report.The use of conjoint flaps based on the dorsalis pedis artery enabled a transfer of 3 free flaps-dorsalis pedis flap, fillet flap of the second toe, and trimmed large toe-to reconstruct a severely traumatized hand in a 12-year-old girl. High-voltage electrical burn injury had caused a large wound over the volar wrist and exposed the flexor tendons and median/ulnar nerves. In addition, she suffered a partial loss of the thumb and had an open wound at the base of the index finger. The application of the conjoint flaps restored hand function in a one-stage procedure.- - - - - - - - - - ranking = 4keywords = complex (Clic here for more details about this article) |
9/54. Innovative techniques in bony reconstruction to facilitate hand salvage.Mutilating injuries of the hand and congenital hand anomalies can present challenging reconstructive scenarios for salvage and restoration of function. During a 5-year period from 1993 to 1997, the plastic and reconstructive surgical unit of East Carolina University Medical Center was presented with a series of unique reconstructive challenges as a result of complex hand injuries that resulted in unexpected opportunities for the salvage of distal components. These traumatic injuries were unique in that, although devastating to the hand, they left the opportunity for salvage of distal vascularized and sensate components of the hand. Other unique challenges arose as a result of patients who did not want to pursue alternative reconstructive options such as toe-to-hand transfers or pollicization. These cases are presented to emphasize alternative algorithms to standard hand reconstruction in complex scenarios. Three patients presented with distal viable (vascularized and sensate) phalangeal components with proximal complex bony defects, 1 patient presented with a complex thumb defect and declined standard therapy, and 1 patient presented with a congenital thumb anomaly and declined standard therapy. All flaps survived and all hands were saved. These patients illustrate the clinical feasibility of osteocutaneous and free osseous grafting to provide strut stabilization in metacarpal defects and to preserve an opposable post after thumb amputation or thumb anomaly.- - - - - - - - - - ranking = 4keywords = complex (Clic here for more details about this article) |
10/54. Traumatic axial dislocation of the carpus: a case report of transscaphoid pericapitate transhamate axial dislocation.Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. The disruption pattern was different from those of previously reported cases. Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion (ROM) exercise are the treatment of choice in such complex injuries.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
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