Cases reported "Forearm Injuries"

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1/23. forearm pseudarthrosis--neurofibromatosis: case report.

    A 3 1/2-year-old white girl with neurofibromatosis sustained left radius and ulna fractures. The radius was sclerotic with no medullary canal at the fracture site, and the ulna was hypoplastic distal to the fracture. The fractures failed to unite when immobilized in a long arm plaster cast for 5 months and pseudarthrosis developed. Three subsequent operative attempts to obtain union of the pseudarthrosis by means of internal fixation and bone grafting over the next 30 months were also unsuccessful, and the pseudarthrosis persisted. The forearm was supported in a custom molded leather brace until the child was 13 1/2 years old and had reached skeletal maturity. Osseous union was then operatively obtained using dual onlay tibial cortical and cancellous bone grafts. There has been no recurrence of the pseudarthrosis 3 years and 2 months after bone grafting. The author recommends postponing surgical attempts to achieve union of the forearm bone pseudarthrosis associated with neurofibromatosis until the patient reaches skeletal maturity.
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keywords = operative
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2/23. Successful replantation following an accidental forearm amputation. Case report and review of the literature.

    We report a patient who suffered an accidental complete amputation of the right forearm followed by a successful replantation and comment on the indications and management of macro-replantations of the upper limbs. This is the first time that a successful surgical procedure of this nature has been performed in bolivia, with no post-operative complications and excellent long-term functional recovery.
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ranking = 0.5
keywords = operative
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3/23. Flow-through use of the osteomusculocutaneous free fibular flap.

    A case of a forearm defect resulting from a high-velocity firearm injury was reconstructed by flow-through free transfer of the osteomusculocutaneous fibular flap harvested from the remaining stump of the patient's left leg that was amputated below the knee. The dimensions of the bone defect and damage to anatomic structures of more than one type (including ulnar artery, ulnar bone, and overlying soft tissue) were the reasons for the treatment approach with a composite tissue transfer including vascularized bone. Preoperative radiographic and angiographic examination revealed that the amputation stump offered a fibular shaft with adequate length and a peroneal artery patent up to the most distal point of the bone. Instead of the usual osteocutaneous fibular harvest, flap harvest was performed in an osteomusculocutaneous manner with incorporation of a segment of soleus muscle with an overlying skin paddle. In addition to the replacement of the bone defect, transfer of the flap in a flow-through manner reestablished the dual blood supply of the hand by replacing the ulnar artery gap, whereas the muscle and skin of the flap allowed three-dimensional reconstruction of the complex defect. In severe injuries of the upper extremity, flow-through free transfer of the fibular flap provides not only replacement of the resulting composite defect but also may offer salvage, or at least revascularization, of the extremity when complicated by arterial damage.
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keywords = operative
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4/23. Split flexor carpi ulnaris transfer: a new functioning free muscle transfer with independent dual function.

    BACKGROUND: A functioning free muscle transfer is a well-established modality of restoring upper limb function in patients with significant functional deficits. Splitting the neuromuscular compartments of the free muscle based on its intramuscular neural anatomy and using each compartment for a different function would allow for restoration of two functions instead of one at the new distant site. methods: The authors previously reported on the clinical use of a pedicled split flexor carpi ulnaris muscle transfer. They now report the use of this muscle as a functioning free split muscle transfer to restore independent thumb and finger extension in a patient with total extensor compartment muscle loss in the forearm and a concomitant high radial nerve avulsion injury. RESULTS: Nine months postoperatively, the patient was able to extend his thumb and fingers independent of each other. CONCLUSION: This is the first report of a functioning free split muscle transfer demonstrating two independent functions in the upper limb.
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ranking = 0.5
keywords = operative
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5/23. Treatment of infected wounds with maggot therapy after replantation.

    Postoperative wound infection is a rare, but major, complication of replantation. Failure to control infection can lead directly to vascular thrombosis and, in turn, to loss of the replanted extremity. The use of maggots for wound debridement has a long history and has been lately re-introduced for treatment of intractable wounds. In this report, the authors present the experience of successful debridement of a severely infected wound after forearm replantation, using maggot therapy. The results and mechanism of maggot therapy are discussed.
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ranking = 0.5
keywords = operative
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6/23. Free flap choice for soft tissue reconstruction of the severely damaged upper extremity.

    Reconstruction of complex wounds of the hand associated with severe bone, tendon, nerve and soft-tissue injuries has been a major problem in hand surgery. Early definitive soft-tissue coverage of this kind of extensive wound with well-vascularized tissue is one of the most important stages of reconstruction for salvage of the extremity and restoration of function. Although multiple free flap donor sites have been described for complex upper extremity wounds, the authors think that anterolateral thigh (ALT) and lateral arm (LA) flaps are good choices for soft-tissue reconstruction in the upper extremity because of their reconstructive characteristics. These flaps can be used as flow-through and also sensate flaps. There is no need for position change intraoperatively and two teams may work simultaneously. Donor sites can be hidden and there is no required sacrifice of major artery or muscle.
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ranking = 0.5
keywords = operative
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7/23. Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm.

    A free combined vascularized fibula and peroneal composite flap was transferred to the forearm in a patient with a severely damaged forearm following a heat-press injury. The operative technique, postoperative management, and subsequent clinical course are described, and the advantages of this method are outlined. Not only can the fibula now be used as a free vascularized bone graft in simple bone defects, but further applications, such as a combined fibula and peroneal composite flap, can be employed in the treatment of severely damaged forearms.
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ranking = 1
keywords = operative
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8/23. Simultaneous bilateral forearm revascularization.

    A successful simultaneous bilateral forearm revascularization was performed on a 17-year-old boy. Functional recovery of both forearms was evaluated 42 months after injury. The patient can use both hands for the activities of daily living. So far, he has been employed and has no significant psychological problems. Temporary intraluminal silicone shunts are extremely helpful for reducing ischemic damage to the injured limb. The sufficient skeletal shortening of the upper limb replantation is crucially important. The wounds must be managed by aggressive and repeated debridement. Accurate primary nerve repair is essential, and the early postoperative rehabilitation is also important to achieve a satisfactory functional return. The functional replanted or revascularized upper extremity is superior to an amputation or prosthesis, especially in the cases of bilateral upper extremity amputation or devascularization.
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ranking = 0.5
keywords = operative
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9/23. Treatment of open fracture of the forearm in osteogenesis imperfecta.

    An open fracture of the forearm in a patient with osteogenesis imperfecta is reported. Immediate operative debridement and open reduction, combined with rigid external fixation, provided the patient with an excellent functional result.
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ranking = 0.5
keywords = operative
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10/23. Tendon transfers in muscle and tendon loss.

    Tendon transfers in muscle and tendon loss offer some of the most gratifying results to both patient and surgeon. Poor results do occur at times in tendon transfer. When patients whose results were found to be less than expected were studied, the following problems were identified: 1. Acceptance of less than full passive range of motion before transfer. In some instances, this will be unavoidable. The use of pretransfer hand therapy techniques may improve the situation; or, if possible, pretransfer capsulotomies may better prepare the patient for the tendon transfer. 2. Adhesions along the course of the transfer. At times the transfer route can be better prepared by the use of skin grafts adding subcutaneous tissue to the transfer bed. The use of a staged technique in which a silicone rubber tendon implant is installed along the transfer route, to prepare for a later transfer, is occasionally indicated. 3. Technical failures: a. juncture breakdown, b. transfer put in under too little tension. 4. Patient noncompliance. A recent experience in which a patient removed his postoperative cast and came in 2 weeks later with his transfer disrupted is an extreme example. Many other patients are not prepared to undertake what may be a rigorous and time-consuming postoperative transfer program. Adequate preoperative evaluation, including patient selection as well as careful attention to the details of the procedure during surgery, along with attentive postoperative care, should eliminate most of these problems.
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ranking = 2
keywords = operative
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