Cases reported "Burns"

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11/19. The use of adjunctive hyperbaric oxygen in treatment of orthopedic infections and problem wounds: an overview and case reports.

    We summarize indications, contraindications, and therapeutic guidelines for the use of adjunctive hyperbaric oxygen therapy (HBO) in problem wounds and selected orthopaedic infections. Three typical cases that all were successfully treated with HBO are presented: a chronic osteomyelitis which was a sequela to an open tibia fracture, a second- and third-degree burn injury of the entire lower extremity, and a case of chronic osteomyelitis in an insulin-dependent diabetic.
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ranking = 1
keywords = tibia
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12/19. Salvage of both lower extremities using simultaneous bilateral gastrocnemius and soleus muscle flaps: a case report.

    We present a case of bilateral lower limb salvage in a young man with extensively exposed tibial bone following thermal injury. The medial head of the respective gastrocnemius muscle was used to cover the proximal third of debrided tibia, and the soleus muscle was used for the middle third coverage of each leg. This provided adequate, stable soft-tissue coverage for full recovery of both extremities and sufficient residual function for unassisted ambulation six months postoperatively.
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ranking = 2
keywords = tibia
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13/19. Severe peripheral burn polyneuropathy: a case report.

    This report describes a 30-year-old man with a 45 per cent mixed deep partial and full thickness flame burn, who--following sepsis and multisystem failure--developed a severe polyneuropathy affecting the left median and both ulnar nerves, and both peroneal and posterior tibial nerves. The neurological alterations were significantly reversible, early reinnervation in all limbs was demonstrated by electromyography at 8 months, with subsequent progressive reinnervation at 1 year. The most likely cause of this polyneuropathy was the acute development of uraemia, at day 33 post-burn.
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ranking = 1
keywords = tibia
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14/19. Salvage of an arm by means of a free cutaneous flap based on the posterior tibial artery.

    A case involving medial calf, free cutaneous flap based on the posterior tibial artery for one-stage reconstruction of soft tissue and main vessel damage is presented. Flap anatomy is outlined, and operative techniques for transfer are detailed, in a case of deep contact burn of an arm.
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ranking = 5
keywords = tibia
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15/19. The successful treatment of a patient with extensive deep burns and an open comminuted fracture of a lower extremity.

    A patient with 95 per cent of the body surface area burned (51 per cent third degree burn) who also sustained an open comminuted fracture of the upper third of the tibia and fibula has been treated successfully.
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ranking = 1
keywords = tibia
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16/19. Marked bone spur formation in a burn amputee patient.

    This report presents an unusual case of a lower extremity burn amputee with a marked degree of bone spur formation. A 17-year-old man suffered 56% body surface area mixed-depth electrical and flame burns, necessitating left below knee amputation. He was admitted to a rehabilitation center 3 months postinjury for pylon fitting and gait training. Difficulty was encountered with poor skin tolerance to weight bearing because of the prominent distal bony margins in the stump. x-rays of the stump revealed a marked degree of linear bone spur formation, extending longitudinally from the distal tibia and fibula with multiple cross-bridges. The spur formation was considered an extensive bony exostosis of unclear etiology. Surgical revision was elected to obtain a stump more suitable for prosthetic tolerance, and to avoid a bulky "bypass" prosthesis. This stump revision enabled the patient to attain independent functional prosthetic ambulation. Although there is evidence of some recurrence of bone spur formation, this remains limited and asymptomatic.
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ranking = 1
keywords = tibia
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17/19. Tibialis anterior turnover flap coverage of exposed tibia in a severely burned patient.

    A case report of a longitudinally split tibialis anterior turnover flap reconstruction of an exposed tibia in a burn patient is presented here. The patient had sustained deep partial- and full-thickness burns to 70 per cent of his total body surface area (TBSA), resulting in an exposed left patella and upper two-thirds of the left tibia. Although full thickness loss of skin occurred on the left lower leg, no muscle trauma was sustained. Reconstruction was therefore deemed possible using local muscle tissue to provide transposed flap coverage. A gastrocnemius muscle flap was used to cover the exposed patella and superior aspect of the tibia. A portion of the tibialis anterior muscle was split longitudinally and turned over medially to cover the remaining exposed tibia. The advantages offered by this infrequently used flap include technical simplicity, reliability, minimal donor site dysfunction and the allowance of future use of the soleus flap. The tibialis anterior turnover flap may therefore have wide applicability for reconstruction of the severely burned lower extremity.
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ranking = 11
keywords = tibia
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18/19. Reconstruction of posttraumatic defects of the foot by flow-through anterolateral or anteromedial thigh flaps with preservation of posterior tibial vessels.

    Massive posttraumatic defects of the foot in 4 patients and a tibial malunion in another were repaired by flow-through anterior (anterolateral and anteromedial) thigh flaps. Posterior tibial vessels were used as the recipient vessel just below the level of the medial malleolus. Soft-tissue defects in foot-injured patients were covered with flow-through anterior thigh flaps interposing the descending branch of the lateral circumflex femoral system between the transected posterior tibial vessels. In another patient, a combined anteromedial thigh flap and vascularized iliac bone cross-leg "chimeric" flap were successfully transferred for the reconstruction of a malunion of a tibial fracture, which had been accompanied by severe vascular damage to the thigh. The utilization of derivative branches from the lateral circumflex femoral system facilitates revascularization of ischemic areas and simultaneous transplantation of multiple components, as well as preserves recipient vessels. Owing to the stable blood supply, these flaps can be readily processed into both deepithelialized and thin flaps.
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ranking = 8
keywords = tibia
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19/19. Multiple, synchronous ipsilateral soleus muscle flaps, including the Achilles' "wraparound" flap.

    Versatility of the soleus muscle beyond its traditional role for the middle third of the leg is often overlooked. Substantial muscle bulk frequently extends even to the calcaneus, although this is quite variable. Its distal reach as a muscle flap then may potentially include encircling the Achilles' tendon itself as a local "wraparound" flap in an area otherwise notorious for requiring the complexity of a free tissue transfer. Since this maneuver only envelops the Achilles' tendon by stretching its own inserting soleus muscle, no muscle dissection per se is required, and nutrition from minor pedicles is sustained. Therefore, concomitant proximally based hemisoleus flaps can be utilized simultaneously and safely for more conventional coverage of midtibial defects. In this fashion, multiple, independent local flaps from a single soleus muscle can achieve coverage of disparate leg wounds, while sacrificing a minimum of donor site function.
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ranking = 1
keywords = tibia
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