Cases reported "Forearm Injuries"

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1/194. 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. ( info)

2/194. The role of emergency free flaps for hand trauma.

    Primary closure of a wound with free flap requires minimizing the risk of infection in an effort to cover vital exposed structures. Careful patient selection, radical debridement of the wound, and an experienced microsurgical team are important for the routine application of this technique. Primary reconstruction of all injured structures is an extension of this technique that enables efficient management of severe upper extremity problems in a single setting. ( info)

3/194. Symptomatic forearm muscle hernia: repair by autologous fascia lata inlay.

    Eleven cases of symptomatic muscle hernias of the forearm requiring surgical intervention have been described previously. pain on extremity exertion and an unaesthetic bulge of the forearm were the primary indications for surgery. Advocated treatment modalities range from forearm fasciotomy to anatomic repair of the fascial defect. Although fasciotomy relieves the narrow fascial constriction around the herniated muscle reliably, it often yields an unappealing forearm deformity and incomplete resolution of pain on extremity exertion. Anatomic repair provides the theoretical advantage of restoring normal muscle fascia relationships while concomitantly improving the aesthetic appearance of the extremity. The authors report a case of symptomatic forearm muscle herniation treated successfully with an autologous fascia lata inlay graft. ( info)

4/194. Independent function in a tendon transfer of the split flexor carpi ulnaris.

    This case demonstrates the efficacy of the split flexor carpi ulnaris transfer to restore thumb and finger extension. The humeral and ulnar compartments retained their viability and their function. In addition, they were able to work independently, and the patient has secured two separate functions from one muscle. The versatility and simplicity of this technique give it advantages over more complex reconstructive procedures. ( info)

5/194. Stigmata: part I. shame, guilt, and anger.

    The aesthetic surgeon may occasionally be consulted by a patient who wishes to discuss what can be done for the scars of self-inflicted wounds on the forearms. These scars are popularly referred to as "hesitation marks" or "suicide gestures." Unlike patients suffering from factitial ulcers or Munchhausen syndrome, these patients will admit to the physician that the scars are the result of self-inflicted wounds. These scars often consist of multiple, parallel, white lines extending up and down the forearms (usually volar surface), with more on the nondominant side. Although the pattern of these scars is apparently what drives these patients to the aesthetic surgeon for relief (because even lay people identify these scars as self-inflicted suicide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany that prompted this report. Once the symbolic meaning of these scars was broached, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflicted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own stories and propose guidelines and warnings for the aesthetic surgeon. ( info)

6/194. Fascial flaps based on perforators for reconstruction of defects in the distal forearm.

    Twenty fascial flaps were used in the reconstruction of defects in the distal forearm, wrist and hand in 18 patients over a 2-year period. In 16 patients the fascial flaps were based on a single fascial feeding vessel or 'perforator' arising from the anterior interosseous artery and/or ulnar artery when the radial artery had been used as the donor vessel in free flap reconstruction elsewhere in the body. There was no loss of any fascial flap in the study. The use of fascial flaps based on fascial feeders of the anterior interosseous and ulnar arteries extends the range of fascial flaps that can be raised in the forearm for reconstruction of defects in the distal forearm, wrist and hand. ( info)

7/194. Ultrasound guided reduction of pediatric forearm fractures in the ED.

    Reducing badly displaced or angulated pediatric forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved. We have recently found that bedside ultrasound by emergency physicians is very helpful in guiding the reduction of difficult forearm fractures, allowing the physician to assess the adequacy of the reduction at the patient's bedside. In this report, we describe the technique we have developed for ultrasound-guided fracture reduction and present three case histories showing the usefulness of this technique. ( info)

8/194. Early surgical suction and washout for treatment of cytotoxic drug extravasations.

    This case report is presented to assess safety and efficiency of early suction and saline washout of extravasated cytotoxic drugs. Through multiple small skin incisions, the area of extravasation is first suctioned and subsequently extensively washed out with saline. Incisions are left open and the arm is elevated for 24 hours. A complete healing was obtained in five days without any skin or soft tissue loss. No additional treatment was needed. Early referral and surgical treatment by suction and washout is a safe and reliable treatment protocol for major cytotoxic drug extravasation injuries. ( info)

9/194. 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. ( info)

10/194. 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. ( info)
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