Cases reported "Soft Tissue Injuries"

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1/44. Reconstruction of soft-tissue defects using serratus anterior adipofascial free flap.

    The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. The adipofascial layer overlying the serratus anterior muscle is the anatomic layer, which is supplied by the same branch of thoracodorsal artery. Even though great progress has occurred in the prevention of postoperative adhesion of extremity injuries, the problem has not been completely solved and is still of special importance in complex injuries. Between March of 1995 and February of 1996, seven patients underwent reconstructive operation as a result of soft-tissue defects of the upper or lower extremities or the scalp. We transferred free adipofascial tissue overlying the serratus anterior muscle in three patients and both serratus anterior muscle and adipofascial tissue in four patients. A free adipofascial flap overlying serratus anterior muscle was transferred when a gliding surface was required, owing to the exposure of tendons and neurovascular structures. The average duration from operation to follow-up examination was 8 months (from 4 to 16 months). The results of the operations were satisfactory in functional and cosmetic aspects. This kind of flap was very effective in reconstruction of soft-tissue defects and gliding surfaces for these reasons: easy dissection, the capability of obtaining a long vascular pedicle, large-sized flap, composite flap including muscle or rib, and the fact that there was no serious functional or cosmetic deficit at the donor site.
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ranking = 1
keywords = operative
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2/44. Treatment and stabilization of complex wounds involving the pelvic bone, groin, and femur with the inferiorly based rectus abdominis musculocutaneous flap and the use of power color Doppler imaging in preoperative evaluation.

    The authors present case reports demonstrating the trilevel utility of the inferiorly based rectus abdominis musculocutaneous flap in the closure of complex wounds involving the pelvis, groin, and femur that had failed previously or were not amenable to traditional closure techniques. The use of the rectus abdominis flap was especially advantageous for achieving infection eradication and large dead space closure. Additionally they present the emerging technique of power color Doppler imaging as a valuable tool in preoperative flap planning. This technique is particularly useful in evaluating the candidacy for rectus abdominis musculocutaneous flap placement of patients with a prior history of abdominal surgeries, trauma, infection, irradiation, or other conditions that might compromise the patency of the deep inferior epigastric vessels.
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ranking = 5
keywords = operative
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3/44. Experience with regional flaps in the comprehensive treatment of maxillofacial soft-tissue injuries in war victims.

    This article presents our experience with regional flaps in the treatment of facial soft-tissue defects and deformities in 33 patients with various facial injuries from warfare during the period from 1986 to 1999. Thirty-two males and 1 female aged between 8 and 53 years (mean 24.18 years) were treated with facial soft-tissue injuries from high velocity projectiles and varying degrees of associated hard-tissue injuries. Bullets were the most common cause (70%), followed by injuries from shrapnel (21%), land mines (6%), and breech blocks (3%). The perioral region was involved in 15 cases (45%), the midface and cheeks were involved in 13 cases (39%), and the periorbital area was involved in 5 cases (15%). All soft-tissue injuries were treated primarily by debridement and primary closure and by combining, modifying, and tailoring standard regional flap techniques to fit the location of the injury and compensate for the extent of tissue loss. These procedures consisted basically of local-advancement or rotation-advancement flaps, used in conjunction with pedicled fat or subcutaneous supporting flaps, nasolabial, cheek, cervical, Dieffenbach, and Abbe-type flaps. Scar revision, tissue repositioning, and lengthening procedures, such as W, V-Y, Z, or multiple Z-plasty techniques were also used both primarily and secondarily. Revisions and secondary operations were done in 48% of the patients. Initial healing of the flaps was favourable in 76% of the patients. Postoperative discharge from the suture sites was seen in 24% of the patients, but this usually resolved within several weeks using daily irrigation, and these cases underwent scar revision subsequently. None of the soft-tissue flaps sloughed or developed necrosis. Form and function of the soft-tissue reconstructed regions usually recovered within one year postoperatively. The aesthetic results obtained were favourable. None required facial nerve grafting as only the terminal branches were injured in our cases and functional recovery was acceptable. Application of local tissue transfer procedures in our series of facial warfare injuries yielded acceptable tissue form, texture, and colour match, especially when these procedures were used in combination, and tailored to surgically fit the individual case. Moreover, application of these procedures is relatively easy and postoperative morbidity is limited, provided the general condition of the patient is stable, and the surgical techniques used have good indications and flap principles.
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ranking = 3
keywords = operative
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4/44. Temporoparietal fascial flap in orbital reconstruction.

    OBJECTIVE: To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. DESIGN: Retrospective analysis. SETTING: Tertiary medical center. patients: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. INTERVENTIONS: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. MAIN OUTCOME MEASURES: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. RESULTS: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. CONCLUSIONS: The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.
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ranking = 2
keywords = operative
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5/44. Clinical applications of the posterior rectus sheath-peritoneal free flap.

    Soft-tissue injuries involving the dorsum of the hand and foot continue to pose complex reconstructive challenges in terms of function and contour. Requirements for coverage include thin, vascularized tissue that supports skin grafts and at the same time provides a gliding surface for tendon excursion. This article reports the authors' clinical experience with the free posterior rectus sheath-peritoneal flap foil dorsal coverage in three patients. Two patients required dorsal hand coverage; one following acute trauma and another for delayed reconstruction 1 year after near hand replantation. A third patient required dorsal foot coverage for exposed tendons resulting from skin loss secondary to vasculitis. In all three patients, the flap was harvested through a paramedian incision at the lateral border of the anterior rectus sheath. After opening the anterior rectus sheath, the rectus muscle was elevated off of the posterior rectus sheath and peritoneum. When elevating the muscle, the attachments of the inferior epigastric vessels to the posterior rectus sheath and peritoneum were preserved while ligating any branches of these vessels to the muscle. Segmental intercostal innervation to the muscle was preserved. The deep inferior epigastric vessels were then dissected to their origin to maximize pedicle length and diameter. The maximum dimension of the flaps harvested for the selected cases was 16 X 8 cm. The anterior rectus sheath was closed primarily with non-absorbable suture. Mean follow-up was 1 year, and all flaps survived with excellent contour and good function in all three patients. Complications included a postoperative ileus in one patient, which resolved after 5 days with nasogastric tube decompression.
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ranking = 1
keywords = operative
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6/44. Subpectoral post-traumatic lipoma.

    Although post-traumatic lipomas have been reported in various sites, a subpectoral location has, to the best of our knowledge, not previously been described. We report on the clinicopathological, radiological, intraoperative and postoperative details of a post-traumatic subpectoral lipoma in a 35-year-old black African female.
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ranking = 2
keywords = operative
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7/44. Flap transfers for the treatment of perichondrial ring injuries with soft tissue defects.

    Seven cases (six fresh) of perichondrial ring injury with skin defects were treated using flap transfers. The study included four boys and three girls ranging in age from 2 to 9 years (average 6). They were followed up for an average of 8 years and 10 months. The period from injury to flap coverage was 8-12 days, with an average of 10 days in the fresh cases. Fracture was noted in four cases, with one an epiphyseal fracture. Peroneal flaps were transferred in four cases, latissimus dorsi myocutaneous flaps in two, and gastrocnemius muscle flap in one. Six flaps survived perfectly, and one failed due to venous thrombosis. This latter case was treated with a cross leg flap. Postoperative radiographic assessments confirmed partial growth plate arrest in the chronic case, but all the fresh cases had no postoperative growth disturbance. Flap coverage, for perichondrial ring injuries with wide skin defects, is a useful method not only for skin coverage, but for the prevention of growth disturbances as well.
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ranking = 2
keywords = operative
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8/44. Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis.

    The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.
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ranking = 5
keywords = operative
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9/44. Dorsalis pedis tendocutaneous delayed arterialized venous flap in hand reconstruction.

    We report two patients whose acute soft-tissue and tendon defects in the hand were treated with a dorsalis pedis tendocutaneous delayed arterialized venous flap between 1994 and 1997. The surviving surface area was 100 percent in both patients. The flap sizes were 10 x 10 cm and 6 x 6 cm. At 2 weeks postoperatively, active flexion and passive extension commenced, and progressive resistance exercises were performed for an additional 5 weeks. Flaps showed a similar color match and skin texture compared with the normal skin of the hand. Advantages of the tendocutaneous delayed arterialized venous flap are that a larger flap can be obtained than when using a pure venous flap or arterialized venous flap; the survival rate of the arterialized venous flap increases, which permits the use of a composite flap; the main artery of the donor site is preserved; thin, nonbulky tissue is used; and elevation is easy, without deep dissection. The disadvantages are the two-stage operation, donor-site scarring, and weak extension of the toes.
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ranking = 1
keywords = operative
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10/44. Combined ingestion and subcutaneous injection of elemental mercury.

    A 40-year-old man with a history of schizophrenia and inflammatory soft tissue lesions after self-injection of elemental mercury presented to the Emergency Department. Multiple skin abscesses associated with fever required operative debridement. An incidental finding of oral mercury ingestion was followed clinically and did not result in complications. Exposure to elemental mercury through injection or ingestion is an uncommon event, but one the Emergency Physician may encounter. Subcutaneous mercury injection should be managed with local wound debridement, whereas ingestions are rarely of clinical significance.
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ranking = 1
keywords = operative
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