11/70. Case report of a homicide by a shotgun loaded with unusual ammunition.Reported is the case of a man killed by a neighbor with a shotgun loaded with a unusual ammunition. The cartridge contained several shots chained together by metallic wires. Such ammunition has been used for hunting purposes but is now banned, so it can be handmade only. The joined pellets produce a wound with features that are different from those of a wound made by a regular load of pellets. Several interpretive problems are caused by the unknown number of pellets contained in the shell and the effects of the wire holding the shot together.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
12/70. A clinical experience with perforator flaps in the coverage of extensive defects of the upper extremity.Traditional skin free flaps, such as radial arm, lateral arm, and scapular flaps, are rarely sufficient to cover large skin defects of the upper extremity because of the limitation of primary closure at the donor site. Muscle or musculocutaneous flaps have been used more for these defects. However, they preclude a sacrifice of a large amount of muscle tissue with the subsequent donor-site morbidity. Perforator or combined flaps are better alternatives to cover large defects. The use of a muscle as part of a combined flap is limited to very specific indications, and the amount of muscle required is restricted to the minimum to decrease the donor-site morbidity. The authors present a series of 12 patients with extensive defects of the upper extremity who were treated between December of 1999 and March of 2002. The mean defect was 21 x 11 cm in size. Perforator flaps (five thoracodorsal artery perforator flaps and four deep inferior epigastric perforator flaps) were used in seven patients. Combined flaps, which were a combination of two different types of tissue based on a single pedicle, were needed in five patients (scapular skin flap with a thoracodorsal artery perforator flap in one patient and a thoracodorsal artery perforator flap with a split latissimus dorsi muscle in four patients). In one case, immediate surgical defatting of a deep inferior epigastric perforator flap on a wrist was performed to immediately achieve thin coverage. The average operative time was 5 hours 20 minutes (range, 3 to 7 hours). All but one flap, in which the cutaneous part of a combined flap necrosed because of a postoperative hematoma, survived completely. Adequate coverage and complete wound healing were obtained in all cases. Perforator flaps can be used successfully to cover a large defect in an extremity with minimal donor-site morbidity. Combined flaps provide a large amount of tissue, a wide range of mobility, and easy shaping, modeling, and defatting.- - - - - - - - - - ranking = 0.5keywords = wound (Clic here for more details about this article) |
13/70. Free fillet flap of the hand for elbow preservation in nonreplantable forearm amputation.The use of non-replantable amputated parts for reconstruction of the stump is a well-established technique. The use of a free fillet flap of the hand and forearm for elbow preservation in massive trauma of the upper extremity is reported in two cases. These free flaps allowed for covering and preserving a functional elbow and a more useful stump.- - - - - - - - - - ranking = 0.51030531852241keywords = stab (Clic here for more details about this article) |
14/70. The random fasciocutaneous flap for upper extremity coverage.Rapid and appropriate healing of any upper extremity wound is essential for preservation of normal hand function. If vascularized tissue must be used, local cutaneous flaps nourished by the multiple perforators to the fasciocutaneous plexus avoid the complexity of microsurgical tissue transfers or prolonged immobilization required for distant pedicled flaps. For small or moderate-sized defects, assuming that adequate adjacent deep fascia has remained intact, these simple, rapidly elevated, so-called random fasciocutaneous flaps deserve initial consideration, as demonstrated in all 11 cases in this reported series.- - - - - - - - - - ranking = 0.5keywords = wound (Clic here for more details about this article) |
15/70. Emergency free-flap transfer for reconstruction of acute complex extremity wounds.Nine patients with complex extremity injuries were treated with emergency free-flap transfers over a 3 1/2-year period. The transferred emergency free flaps were performed to cover exposed vital structures. All flaps survived without infection. Complete and careful assessment of the systemic condition of the patient and the nature of the injured extremity is mandatory. Emergency free-flap transfers may salvage the limb or finger and may improve the functional and aesthetic results with the shortest possible hospital stay.- - - - - - - - - - ranking = 2keywords = wound (Clic here for more details about this article) |
16/70. Coverage of traumatic chest-wall defect using a fasciocutaneous forearm flap: case report.Complete, stable chest-wall reconstruction was accomplished in a single operative procedure, using a fasciocutaneous free forearm flap based on the brachial artery. This allowed coverage of an extensive chest-wall defect.- - - - - - - - - - ranking = 0.51030531852241keywords = stab (Clic here for more details about this article) |
17/70. The adipofascial turnover flap for elbow coverage.Closure of soft tissue defects in the vicinity of the elbow with exposed bone or joint remains a difficult problem. Local adipofascial turnover flaps covered by a skin graft were successfully used to reconstruct two elbow defects. The flap's base was placed 1.5 to 2.0 cm from the wound edge. The flap-to-base area ratio, which is an important index of flap survival, in addition to the traditional length-to-width ratio were 3.25 and 3.3, respectively. The undermined skin of the flap donor site was preserved rather than discarded as in the conventional deepithelialized turnover flap. The primary benefits of this flap are that it is an easy and rapid one-stage procedure, it requires limited immobilization of the involved joint, and it leaves an inconspicuous donor site scar. The motion of the elbow joint was not impeded because the adiposal component of the flap faced the exposed vital structures. The padding is not thick, but is sufficient to cover and protect the elbow. The flap is especially indicated for small- to medium-sized, complicated elbow wounds.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
18/70. Sharp force fatalities: suicide, homicide or accident? A series of 21 cases.Cases at study comprise 21 sharp force fatalities (9 suicides--7 m and 2 f; 8 homicides--5 m and 3 f; 2 accidental deaths--1 m and 1 f; 2 uncertain cases--2 m), examined from 1993 to 2002. suicide age range was 17-75 years, mean 42.4; in seven cases the age was upper 40. Scene of death was at home in six cases, at open place in two, during hospitalisation in one. Incised wounds were pre-eminent in suicides. Homicides showed multiple stab wounds. The two accidents were caused by "glassing". Uncertain cases were a small stab wound to the chest and an eviration.- - - - - - - - - - ranking = 2.5206106370448keywords = stab, wound (Clic here for more details about this article) |
19/70. Lethal injuries occurring during illegal break-ins.Individuals who undertake criminal activity are often at risk of injury for a variety of reasons. Two cases are reported where individuals who were engaged in illegal breaking and entering activities sustained stab wounds from broken window glass and died of exsanguination. The cases both involved young males who were under the influence of alcohol and/or drugs and who sustained relatively minor tissue damage that had fatal consequences due to a variety of coincident factors. Critical location of wound sites over major vessels resulted in rapid bleeding that was enhanced by vasodilator effects of alcohol and stimulant effects of amphetamines. In addition, adrenergic effects of being engaged in illegal activities, and the subsequent pain from the wounds, may also have contributed to accelerated heart rate and blood loss. Failure to appreciate the potential effects of such wounds, which may initially have appeared relatively minor based on their small size, added to an impaired ability to apply first aid or seek appropriate medical assistance, may also have been due to the combined effects of drugs, alcohol, and concerns regarding the illegal nature of the underlying activity. Such a scenario constitutes a specific subgroup of offender injury that could be termed the break, enter, and die syndrome.- - - - - - - - - - ranking = 2.5103053185224keywords = stab, wound (Clic here for more details about this article) |
20/70. Delayed microsurgical reconstruction of the extremities for complex soft-tissue injuries.The treatment of severe wounds of the extremities, characterized by large posttraumatic tissue loss, represents a clinical problem difficult to resolve, especially when the lesion is surrounded by large areas of ischemic distrophic tissue which progressively aggravate and extend the initial lesion, with frequent exposure of bone and joint structures making the amputation of the limb an inevitable outcome. The authors present their experience based on combined treatments by medical support methods such as hyperbaric oxygen (HBO) and vacuum-assisted closure therapy (VAC) and microsurgical reconstruction of the limbs, within a precise therapeutic protocol. The use of this protocol in appropriate times and ways allowed us to successfully treat severe posttraumatic sequelae of the limbs, avoiding the delayed healing typical of these pathologies, both on the donor site of the flap and on the repaired area, and avoiding unsuitable microsurgical reconstruction of limbs, allowing satisfactory morpho-functional restoration and a reduction of the hospitalization period.- - - - - - - - - - ranking = 0.5keywords = wound (Clic here for more details about this article) |
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