1/10. Free toe pulp transfer for digital reconstruction after high-pressure injection injury.We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/10. pantoea agglomerans as a cause of septic arthritis after palm tree thorn injury; case report and literature review.We report the case of a 14 year old healthy boy, who was admitted six weeks after being injured by a palm tree thorn, with limping caused by pain and swelling in his right knee. An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. pantoea agglomerans was identified in the synovial fluid. The patient underwent two arthrotomies and was treated with amoxicillin-clavulanate intravenously for three weeks. The postoperative course was uneventful, and joint function returned to normal. A review of the literature between 1953 and 2002 revealed that bacterial growth after plant thorn injuries is reported infrequently. Yet when reported, pantoea agglomearns is the most common organism found. Therefore, it must be considered and suspected in "aseptic" cases of arthritis, when there is a history of a plant thorn injury. We also emphasise the efficacy of ultrasound examination in these cases to identify the presence and location of a plant thorn.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
3/10. A systematic approach to medical decision-making of uncommon clinical pictures: a case of ulcerative skin lesions by palm tree thorn injury and a one-year follow-up.In clinical practice, the clinician is challenged with symptoms and/or signs at times apparently insoluble by diagnostic and/or therapeutic means. We propose that in these cases, we have to use an EBM approach in which evidence may be looked up in every available clinical report and bibliographic databases are used for searching that evidence. We report on a case of ulcerative skin lesions apparently insoluble by expert dermatologists following a conventional diagnostic and therapeutic process. We use this case report for illustrating a systematic approach to resolve diagnostic and therapeutic questions using a bibliographic database search (like medline and EMBASE). Both a systematic approach to bibliographic databases and a critically appraised topic on case reports (or case series) are needed to 'rehabilitate' low-level evidences (that is a case report or case series) to a higher level when we approach decision-making of uncommon clinical pictures. We demonstrate the possibility of using bibliographic databases to search and retrieve useful information for decision-making of uncommon clinical pictures. The method we have proposed can be applied in every area of the world, especially in rural areas. Finally, an internet-shared database of uncommon clinical pictures with critically appraised topics could be useful in saving more time.- - - - - - - - - - ranking = 4keywords = palm (Clic here for more details about this article) |
4/10. A chronic nocardial infection following conservative treatment of a high pressure injection injury of air.We present a case of recurrent cutaneous nocardiosis following a high pressure air injection injury which was treated conservatively. The patient subsequently developed multiple chronic granulomatous nodules in the palm and dorsum of the hand requiring repeated surgical debridements and long term antibiotics for complete resolution. Some reports suggest that high pressure injection injuries of air or water run a benign course and may be treated conservatively. However, inoculation by high pressure injection injury of air or water may result in chronic infections, which cause significant morbidity and are a therapeutic challenge. Although uncommon, they may be avoided by adherence to established treatment principles which include prompt recognition, realisation of its severity and aggressive treatment by open wound management, even for seemingly innocuous trauma or inoculum.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/10. mycobacterium fortuitum midpalmar space abscess: a case report.A case report of a midpalmar abscess from mycobacterium fortuitum is presented. It appeared 4 weeks after a penetrating nail injury to the palm and wrist and resolved with chemotherapeutic and surgical treatment.- - - - - - - - - - ranking = 6keywords = palm (Clic here for more details about this article) |
6/10. Recognition of acutely lacerated ulnar nerve-median nerve palmar communicating branch. A case report.A 32-year-old man incurred a porcelain faucet handle laceration to the palm, including the third common digital nerve and an adjacent large communicating sensory ramus to the third common digital nerve from the superficial ulnar nerve. This case is the first reported recognition and repair of a freshly lacerated communicating ramus.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
7/10. Nailgun injuries of the hand.Nailgun injuries of the digits and palm are an occupational hazard for carpenters. Sixty-five percent of all nailgun injuries have been reported to involve the hand. Clinically they can be further classified into three types, varying with the injury and the prognosis. Prompt nail removal after i.v. antibiotics, minimal wound debridement, operative curettement of the nail tract with removal of any foreign material, irrigation, open wound drainage, and nonoperative treatment of skeletal injuries resulted in healing without infection and with good function in seven cases.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/10. Salvage of superficial palmar avulsion.Avulsion injuries of the hand caused by moving rollers usually create a distally or, less commonly, a laterally based skin flap. Progressive necrosis in the distant part of the flap usually occurs because of arterial insufficiency and venous stasis over the next 2 to 3 weeks. From 1991 to 1994, we applied the concept of the "arterialized venous flap" to salvage the palmar tissue by revascularizing the superficial palmar venous network with an arterial anastomosis in eight patients. Six of the flaps survived completely and two had a small strip of marginal necrosis which healed secondarily. When compared with conventional methods, this method can remarkably improve the circulation of the flap and provide a better cosmetic and functional result for the highly specialized palmar tissue.- - - - - - - - - - ranking = 7keywords = palm (Clic here for more details about this article) |
9/10. True aneurysms of the palmar arch of the hand: a report of two cases.We report on two cases of true aneurysms of the palmar arch, both of which were post-traumatic. One was due to repetitive blunt trauma and the other to a glass cut wound. Both aneurysms were detected clinically as pulsating masses without functional disorders. The presence of elastic fibres and smooth muscle in the aneurysm wall proved it to be a true aneurysm. Both aneurysms were excised and replaced by a vein graft from the foot.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
10/10. Penetrating pencil injury: an unusual case of child abuse.OBJECTIVE: We report an unusual case of penetrating pencil injury in a young child that turned out to be a case of physical abuse. METHOD: This is a case report with review of the literature. RESULTS: A 4-year-old boy was brought by his mother to the accident and emergency department for a penetrating wound of the right hand. He was said to have injured himself during a fall at home while holding a sharpened lead pencil. The pencil broke after penetrating the hypothenar eminence, leaving the graphite tip embedded in the palm. On surgical exploration, a piece of graphite measuring 1.3 cm was removed. The injury was actually inflicted by his mother because he failed to complete his homework properly. Deep penetrating injuries associated with the lead pencil are uncommon events in the medical literature. They are often reported as accidental and usually involve the oropharynx and the orbit. CONCLUSION: Deep penetrating injury with a pencil is unusual in childhood and the public should be made aware of the possibility of nonaccidental injury.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
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