1/62. Iliac to popliteal artery bypass through the iliac wing: An alternative extracavitary route for management of complex groin injuries.Extracavitary bypass through the iliac wing allows placement of the grafts into the posterior thigh and is another alternative route when an obturator bypass is not possible, or an axillary-popliteal bypass is to be avoided. The transiliac wing bypass is relatively simple and easy to perform. The bypass route is short and direct, has excellent inflow, and is accompanied by minimal neurological or bleeding risks. An illustrative case is presented with a complete description of the operative technique. review of the literature is also included.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/62. Gunshot wound to the penis: the need for corporal exploration.Although the overall incidence of penetrating penile injuries is relatively low, these injuries may present complex management problems and should be managed with attention to long-term cosmetic and functional considerations. In this article we present an unusual case of a gunshot wound to the penis and emphasize the importance of bilateral corporal exploration and possible repair to avoid erectile dysfunction and penile deformity.- - - - - - - - - - ranking = 0.25keywords = complex (Clic here for more details about this article) |
3/62. 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 = 1.25keywords = complex (Clic here for more details about this article) |
4/62. Retained digital foreign body after a pellet gun injury.A symptomatic foreign body embedded in the human body can be a frustrating problem for physician and patient alike. A unique case of a retained foreign object resulting from a pellet gun injury has been presented. Although the course of treatment in this case was uncomplicated, it is important to understand the complexities of the human body's response to foreign bodies.- - - - - - - - - - ranking = 0.25keywords = complex (Clic here for more details about this article) |
5/62. Planned complex suicide: report of three cases.Three cases of planned complex suicide in a 3-year period are reported. A 40-year-old man was found dead, in his garage, hanging by his neck, with a gunshot in the head from a pen gun. A 50-year-old man was found dead in the sea with a gunshot to his head. A third man was found in a field hanging by a tree and burned. The investigation of the scenes and the methods used pointed toward a suicidal etiology. The main difference between planned complex suicide and those cases defined in medicolegal literature as combined suicides lies in the complex mechanism used by the victim as a protection against the failure of one of the mechanisms.- - - - - - - - - - ranking = 1.75keywords = complex (Clic here for more details about this article) |
6/62. Saddam's revenge: a post-gulf war casualty.Artillery weapons are designed to inflict death and destruction by way of fragmentary and blast injuries. As pieces of modern machinery, they are also capable of causing serious injury by their very complex nature. The authors present a case analysis of an artillery piece that caused a projectile death without a shell.- - - - - - - - - - ranking = 0.25keywords = complex (Clic here for more details about this article) |
7/62. Executive amnesia in a patient with pre-frontal damage due to a gunshot wound.This paper reports the case of a young patient with extensive pre-frontal damage in whom we tested the hypothesis that intensive training improves executive performance as assessed by the wisconsin Card Sorting Test (WCST). As long as her declarative memory, complex perceptual abilities and global cognitive status were spared, we surmised that any deficit in executive learning would have occurred in relative isolation. We showed that her abnormal performance on the WCST, both on the standard as well as on the post-instruction condition, was due to an impairment of shifting attention across perceptual dimensions (extra-dimensional). In contrast, her ability to shift attention within perceptual categories (intra-dimensional) was spared, as were her declarative memory, object and visuospatial perception, oral language comprehension and praxis (ideomotor, tool use and constructional). This case supports the hypothesis that executive amnesia is a type of amnesic disorder distinct from the classic amnesic syndrome due to mamillo-temporomedial damage. As such, it is probably closely related to procedural learning and may depend on the same fronto-subcortical loops that mediate the actual execution of behaviour.- - - - - - - - - - ranking = 0.25keywords = complex (Clic here for more details about this article) |
8/62. Stereolithography: a historical review and indications for use in the management of trauma.BACKGROUND: Stereolithography (SL) is a new adjunct for treatment planning in complex maxillofacial trauma. It uses an argon/ion laser to polymerize acrylic resin models of reformatted computerized tomographic radiographs. SL provides superior anatomical detail and translucency, and it can be sterilized and transported to the operative field, if necessary. DISCUSSION: A review of the historical development of SL technology is presented, along with three clinical cases, showing the advantages of SL models in the treatment of patients with complex maxillofacial trauma. CONCLUSION: SL technology provides superior understanding of anatomic relationships, the ability to perform presurgical simulation of the proposed procedure, preoperative adaptation of biomaterials, decreased time in the operating room and associated patient morbidity, and improved residency training and patient education. The primary disadvantages of SL are availability and cost.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
9/62. 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 = 0.25keywords = complex (Clic here for more details about this article) |
10/62. Combined endovascular and open repair of a penetrating innominate artery and tracheal injury.Endovascular therapy affords the opportunity to decrease surgical morbidity and improve operative planning in complex penetrating injuries of the chest. In this case report we describe a hemodynamically stable patient with a single gunshot wound to the base of the neck (zone I), with combined vascular and tracheal injuries. We present a novel approach to the repair of this type of injury using combined endovascular and open techniques.- - - - - - - - - - ranking = 0.25keywords = complex (Clic here for more details about this article) |
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