1/123. Z-plasty closure of the donor defect of the radial forearm free flap.The radial forearm is a popular free flap site for reconstruction of head and neck defects, because of its abundant, pliable, skin component and an available, extended, vascular pedicle. In addition, vascularized composite flaps, including a segment of radius, can be designed for skeletal stabilization. The donor-site defect can involve various complications, including loss of skin graft, unsatisfactory appearance, numbness, and radial fracture. Recent advances in reducing donor-site defect problems have included the use of rotation skin flaps, local muscle rotation, and soft-tissue expansion; however, each of these has its own limitations. Two cases are presented in which radial forearm donor site defects, measuring less than 4 cm x6 cm, were primarily closed successfully with z-plasties based on the longitudinal skin incision. Each patient has regained preoperative mobility, and prompt primary healing was achieved without complications.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/123. Neurotologic evaluation of facial nerve paralysis caused by gunshot wounds.facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck. We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis--including direct injury, compression, fracture, and concussion of the temporal bone--were demonstrated by audiologic, radiologic, and surgical findings. hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.- - - - - - - - - - ranking = 1.0192633176605keywords = fracture, compression (Clic here for more details about this article) |
3/123. Fourteen shots for a suicide.A 56-year-old man is discovered unconscious in a pool of blood in the kitchen of his house. According to findings, the man used a 22 long Rifle to fire 14 shots at his thorax with trajectories going from front to back, from right to left and on a nearly horizontal level. All the projectiles got into the left front side of his thorax and came out just under the back of his left armpit. One of them then got through his left arm and fractured his left humerus. According to the findings made on the premises and the position of the bloodstains, we think that man put his rifle against the wall, resting on a pipe. He fired, unloading two clips into his thorax. He had to handle the bolt of the rifle before each shot. To reload, he took the bullets which were on the nearby table on which blood marks can be seen. When reloading at a certain moment, he sat down in his armchair and when he wanted to stand up, he leaned on the armrests, on which blood marks can be seen. The last bullet was probably the one which went through his left arm, preventing him from keeping on shooting. His death, caused by a hypovolemical shock, was obviously very slow.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
4/123. 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 = 1keywords = fracture (Clic here for more details about this article) |
5/123. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.- - - - - - - - - - ranking = 0.096316588302696keywords = compression (Clic here for more details about this article) |
6/123. Management of a gunshot wound to the face resulting in a mandibular body fracture with burying of a bicuspid crown into the tongue.Gunshot wounds to the maxillofacial region are unpredictable and run the gamut from minor injuries to severe mutilating and life threatening injuries. This patient although unfortunate to have been the victim of mistaken identify resulting in the gunshot wound, was fortunate that the bullet hit his bicuspid, which probably served to deflect its path away from vital structures, thus saving his life. This accounts for the buried bicuspid crown found in the midline of the body of the tongue. Rigid internal fixation of maxillofacial fractures minimizes risks to the airway that may occur if patients are in post-operative maxillo-mandibular fixation during the post-anesthetic recovery phase. In addition, the use of rigid internal fixation speeds up the recovery and the patient's ability to return to function after surgery. Above, we presented an interesting case of a mandibular anterior body fracture resulting from a gunshot wound in the face and resulting in the burying of a bicuspid crown in the substance of the tongue, treated under general nasoendotracheal anesthesia and the use of rigid internal fixation (EDCP).- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
7/123. Unstable cervical spine without spinal cord injury in penetrating neck trauma.Cervical spine instability in the neurologically intact patient following penetrating neck trauma has been considered rare or non-existent. We present a case of a woman with an unstable C5 fracture without spinal cord injury after a gunshot wound to the neck. Considerations regarding the risk of cervical spine instability are discussed, as well as suggestions for a prudent approach to such patients.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/123. Refractory spinal cord injury induced gastroparesis: resolution with erythromycin lactobionate, a case report.erythromycin lactobionate (ERY), a macrolide antibiotic, has been the focus of investigation as a new gastrointestinal prokinetic agent. In individuals who are able-bodied (AB), ERY has shown promise in various forms of gastroparesis (GP). Recent evidence suggests that medications used to stimulate intestinal motility in individuals who are AB have had similar results in those individuals with spinal cord injury (SCI). Medications that have been used in the past for GP in SCI include metaclopramide, neostigmine, and bethanechol. In this observation, a patient with T-6 paraplegia, who developed GP secondary to acute SCI, is presented. During his hospital stay, the patient was treated with gastric decompression, bowel rest, H2 blockers, intravenous metaclopramide, and eventually required parenteral nutritional support. ERY was started and symptoms abated. At this point, the nasogastric tube was removed and oral feeding was successfully started. This case report is the first to describe a patient with refractory SCI-induced GP who responded to intravenous ERY. Further study in this area is warranted.- - - - - - - - - - ranking = 0.019263317660539keywords = compression (Clic here for more details about this article) |
9/123. Cruciate paralysis, hypothesis for injury and recovery.STUDY DESIGN: Case report and review of the literature. OBJECTIVES: Discuss a case of cruciate paralysis, a review of the literature and the hypotheses regarding the pathogenesis and recovery in spinal cord injuries that cause disproportionate weakness of the upper extremities. SETTING: Thomas Jefferson University Hospital, philadelphia, PA, USA. methods: Case report. RESULTS: A case of cruciate paralysis is presented involving a 59-year-old female who experienced a gunshot wound to the face. Initial motor exams revealed mild lower limb weakness and absent upper limb function with an upper limb modified American Spinal Injury association motor score of 0/50 (a modified impairment scale using half point muscle grades). Spinal imaging revealed fractures of the C1 anterior ring and the odontoid process, both associated with multiple bullet fragments. No spinal surgery was performed and she was placed in halo fixation. By 3 weeks she had regained enough upper limb function to manipulate large objects with her left hand and move her right hand. At that time, her upper limb asia score was 16/50. By 5 weeks, her upper limb modified asia motor score had improved to 31.5/50 and she began manipulating feeding utensils, writing legibly, and brushing her teeth with her left hand. CONCLUSIONS: In this case report we present a patient's motor and functional recovery. We also discuss the hypothesis that the acute central cord syndrome and cruciate paralysis are a likely result of similar pathologic mechanisms and that good functional outcome resulted from an initially disabling trauma.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/123. Keyhole defect production in tubular bone.Fracture characteristics, reported primarily for the cranium, are valuable indicators of bullet direction. A bullet striking the vault tangentially produces an irregular opening, termed a "keyhole defect." with the circular portion of the defect being the initial point of impact. Identifying this feature in tubular bone (long bone) can also demonstrate bullet direction and the position of the bone at the time of the shooting. This case study involving a tangential shot (i.e., a keyhole fracture) to the humerus demonstrates some of the same fracture mechanics seen in the cranium.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
| | Next -> |