Cases reported "Forearm Injuries"

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1/43. Acute carpal tunnel syndrome from thrombosed persistent median artery.

    We report a case of acute carpal tunnel syndrome from thrombosis of a persistent median artery caused by blunt trauma. The sudden onset of numbness in the median nerve distribution with pain in the fingers in a young adult may provide clues to the diagnosis.
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2/43. Vascular injuries of the upper extremity.

    Vascular injuries of the upper extremity represent approximately 30% to 50% of all peripheral vascular injuries. The majority of injuries are to the brachial artery, and 90% of injuries are due to penetrating trauma. Return of function is often related to concomitant injury to peripheral nerves. However, timely restoration of blood flow is essential to optimize outcome. The diagnosis is made by physical examination and limited Doppler ultrasonography. Arteriography may be helpful if there are multiple sites of injury. Anticoagulation with heparin should be given if not otherwise contraindicated. Revascularization should be completed within the critical ischemic time: 4 hours for proximate injuries and 12 hours for distal injuries. Revascularization methods include resection and primary repair or resection with an interposition graft. The sequence of repair of multiple injuries to the extremity begins with arterial revascularization followed by skeletal stabilization and nerve and tendon repair.
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3/43. The farmer's wife and the salmon fork: a near miss for the median nerve.

    This case history illustrates how a farmer's wife accidentally impaled her forearm on a salmon fork with barbs. Despite the fact that the barbs were not obvious to the rescuing firemen, they had the good sense to transfer the patient with the fork in situ and well supported to prevent traction injury. Any effort to remove the fork at the time of injury would have resulted in complete division of the median nerve.
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ranking = 5
keywords = nerve
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4/43. Twenty-five-year follow-up evaluation of an active silicone/Dacron tendon interposition prosthesis: A case report.

    A 19-year-old man sustained a severe avulsion wound of the dominant distal forearm, dividing the radial and ulnar arteries, median and ulnar nerves, and all flexor tendons. Initial treatment consisted of revascularization. Shortly thereafter he had sural nerve grafting of the median and ulnar nerves. This was followed by insertion of a silicone/Dacron tendon interposition prosthesis to reconstruct a 4-cm deficit in the flexor profundus tendons and the flexor pollicis longus tendon. Six weeks thereafter an opposition transfer using the extensor indicis proprius and a Brand type 2 intrinsic transfer using the extensor carpi radialis longus and a plantaris tendon graft were performed. Several months later an attempt was made to remove the prosthesis. It was encased in scar tissue, however, and left in place. Evaluation 25 years later revealed that the flexor tendons and prosthesis were functioning well.
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ranking = 3
keywords = nerve
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5/43. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.

    A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.
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ranking = 16
keywords = nerve
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6/43. Free temporoparietal fascial flap for coverage of a large palmar forearm wound after hand replantation.

    A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.
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ranking = 1
keywords = nerve
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7/43. Penetrating injury to the terminal branches of the posterior interosseous nerve with nerve grafting.

    We report two cases of penetrating injuries to the terminal branches of the posterior interosseous nerve in the forearm. Repair using nerve grafts in both cases were followed by complete recovery.
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ranking = 10
keywords = nerve
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8/43. An uncommon peripheral nerve injury after penetrating injury of the forearm: the importance of clinical examination.

    A 22 year old woman presented to the accident and emergency department with a self inflicted stab wound to the radial side of the volar aspect of the left forearm caused by a pen knife. Her wounds were sutured on the day of injury. Over the course of next three weeks her wounds healed well but she noticed difficulty in using the hand. She therefore attended her general practitioner who suspected a possible nerve injury and referred the patient back to the A&E department. On follow up examination, she was noticed to have a loss of finger and thumb extension and weakness of thumb abduction. Active extension of the wrist (with radial deviation) was intact. There was no sensory deficit. Posterior interosseous nerve (PIN) palsy was diagnosed and the patient was referred to the regional hand surgery unit where she underwent exploration of the wound. A complete transection of the PIN in the supinator canal was found and repaired with good functional outcome. This case reflects the importance of clinical examination in uncommon peripheral nerve injuries and appropriate referral to a specialist department in case of doubtful penetrating wound that pose a threat to an underlying important structure.
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ranking = 7
keywords = nerve
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9/43. Follow-up study after replantation of the forearm and nerves resuture.

    OBJECTIVE: Clinical and electrophysiological evolution after total section of the forearm and nerves resuture. MATERIAL AND methods: A young boy aged 14 years with accidental amputation of the right forearm. The forearm was replanted within the first 6 hours after accident. electromyography, nerve conduction, estimated number of the motor units, single fiber EMG and motor complex reflex responses were studied until 4 years after surgery. RESULTS: Functional recovery was reached in muscles innervated by median and ulnar nerves. After 4 years of evolution EMG showed signs of chronic neuropathy. Nerve conduction did not reach normal values. Single fiber EMG showed increased fiber density and jitter, and intermittent impulse blocking The estimated number of the motor units was severely reduced with high mean amplitude. Motor reflex responses were elicited by cutaneous stimulation consistent with axon reflexes or ephatic responses. CONCLUSIONS: Replanted limbs in selected cases and nerve's resuture may reach a functional recovery for daily activities.
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ranking = 8
keywords = nerve
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10/43. Temporary innervation of a primary coverage muscle: a new technique to optimize function in a subsequent functional microvascular muscle transplant.

    The author describes the simple technique of innervating the coverage muscle in the staged reconstruction of an upper-extremity crush-avulsion injury with a functional microvascular muscle transplant (FMMT). The thoracodorsal nerve was repaired to the mixed motor-sensory radial nerve above the elbow. Contraction of the latissimus muscle at 8 months after nerve repair signaled the adequacy of the 10-cm thoracodorsal nerve graft as a target motor nerve for the eventual FMMT. Excursion of the latissimus muscle created a septo-alveolar plane similar to the plane between two healthy muscles into which the FMMT could be placed. The author also discusses the potential advantages of early thoracodorsal nerve repair for successful nerve regeneration. This simple technique helped overcome the potential limitations to functional muscle transplantation in the severely traumatized upper extremity, and deserves applied study.
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ranking = 7
keywords = nerve
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