Cases reported "Soft Tissue Injuries"

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11/60. Heroic procedures in vascular injury management: the role of extra-anatomic bypasses.

    The insertion of an extra-anatomic bypass graft is an accepted operative technique in highly selected patients with atherosclerotic occlusive disease and contraindications to in situ grafting. In similar fashion, the technique should be considered in injured or septic patients with large soft tissue defects or wound infections overlying arterial repairs or involving native arteries. The combination of vigorous debridement of injured or infected soft tissue and insertion of an extra-anatomic bypass graft allows for appropriate care of the wound without concern for further injury to the now-displaced arterial repair.
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ranking = 1
keywords = wound
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12/60. Posttraumatic scar revision: a review and case presentation.

    Scar revision is a well-established procedure, but the achievement of satisfying long-term results may present a challenge. An appropriate initial management of wounds is of importance, since it has a role in determining the degree of revision required postoperatively. In addition to the conventional treatment and maturation of the scar tissue, a combination of procedures are now available which may alter the appearance of the final scar. Scar revision, followed by wound care that consists of silastic sheeting, steroid injection, and laser skin resurfacing with carbon dioxide laser (CO2), may be used as adjuncts to achieve camouflage of facial scars. Two case reports are presented to document the procedure, followed by treatment evaluation and protocol.
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ranking = 1
keywords = wound
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13/60. Traumatic avulsion and reconstruction of the midface.

    Traumatic loss of midface soft tissue and supporting structures may result in communication between the oral and nasal cavities. Reconstruction requires both oral and nasal lining, as well as supporting structures. The need for multilaminar tissue, as well as the paucity of local tissue, creates a reconstructive challenge. This case report describes the reconstruction of a traumatic defect of the alveolus, hard palate, inferior orbits, and local soft tissues. An intraoperative alginate mold facilitated a three-dimensional understanding of the wound, and allowed translation of an osseomyocutaneous groin flap to reconstruct the defect in one stage.
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ranking = 0.5
keywords = wound
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14/60. Reverse sural artery flap: caveats for success.

    Complex open wounds of the distal third of the leg and ankle remain a reconstructive challenge for the plastic surgeon. In many cases, these wounds are best addressed with a free tissue transfer. Although this group has performed more than 400 free flaps to the leg during the past 6 years, free tissue transfer can be an arduous operation that requires a team approach and substantial donor site morbidity for the patient. In recent years, the authors have favored the reverse sural artery fasciocutaneous flap in 11 patients for its ease of dissection, limited morbidity, and preservation of major vessels to the limb. Caveats for successful performance of the reverse sural artery flap include Doppler evidence of patent peroneal perforators, placement of a lazy T-shape skin paddle over the distal gastrocnemius muscle bellies, inclusion of the lesser saphenous vein to augment venous drainage, and, lastly, careful dissection to provide a wide adipofascial pedicle.
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ranking = 1
keywords = wound
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15/60. Pedicled groin flaps for upper-extremity reconstruction in the elderly: a report of 4 cases.

    The pedicled groin flap is a useful, versatile flap for coverage of wounds of the hand and distal forearm. It produces predictable results with a procedure that is much less difficult to perform and takes less time than a free-tissue transfer. Contrary to the general belief that the groin flap should not be used in the elderly because of the risk of shoulder stiffness, we found satisfactory results with this procedure in 4 elderly patients (age range, 59-75 y) when immediate shoulder mobilization was instituted and physical therapy was continued during flap maturation and pedicle division.
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ranking = 0.5
keywords = wound
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16/60. Reconstruction of soft tissue defects following total knee arthroplasty.

    Soft tissue defects following total knee arthroplasty can represent serious problems for the patient and the surgeon. Perioperative soft tissue complications can result in loss of the prosthesis or limb. In this study, we present 17 cases with complex wounds following total knee arthroplasty who had surgery between May-1994 and July-2001. Patient-related factors, wound factors, surgical operation, secondary procedures, and duration of follow-up have been analysed for each patient. After local wound care and debridement, soft tissue defects have been covered with either a fasciocutaneous or gastrocnemius myocutaneous flap. All the knees (100%) have been salvaged although in 1 patient (6%) replacement of the prosthesis was necessary. In 5 patients (30%) secondary surgical procedures have been performed. Even though there is no consensus in the management of soft tissue defects following total knee arthroplasty, adequate wound care, including identification of infection, debridement, and early appropriate defect coverage should be the main points to consider.
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ranking = 2
keywords = wound
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17/60. Use of tissue-engineered skin in the dermal atrophy patient with traumatic avulsion injuries.

    Tissue-engineered skin has been approved by the food and Drug Administration for use in certain chronic ulcers (venous stasis ulcers and diabetic foot ulcers). Its use has also been reported in acute (surgical) excisional wounds. The authors report the use of tissue-engineered skin in traumatic avulsion wounds in a series of 10 patients with dermal atrophy. All patients were older than 60 years of age and clinically had thin, atrophic skin. Most were older than 70 years of age and were steroid users. Tissue-engineered skin (Apligraf or Living skin Equivalent; organogenesis, Inc. [corrected], Canton, MA) was used for subacute and acute wound coverage. All wounds healed 100%. Average healing time overall was 9.2 weeks. No wound has recurred with an average follow-up of 14 months. There were no wound infections. The authors conclude that tissue-engineered skin provides a safe, efficacious, and convenient solution for acute avulsion wounds in the patient with age- and/or steroid-related dermal atrophy.
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ranking = 3.5
keywords = wound
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18/60. Facial reconstruction using a combined flap of the subscapular axis simultaneously including separate medial and lateral scapular vascularized bone grafts.

    With the better understanding of the blood supply to the scapula, combined flaps of the lateral scapula along with the latissimus dorsi and/or serratus anterior are well known. The medial border of the scapula, in this respect, has been underused. The authors present a case report in which a conjoined combined free flap consisting of four free tissue transfers based on the subscapular axis was used in simultaneous reconstruction of a gunshot wound to the face. This included a medial scapular osteofasciocutaneous flap for the mandible, a lateral scapular osseous flap for the anterior maxilla, a serratus anterior muscle flap for the cheek, and a separate latissimus dorsi musculocutaneous flap for the forehead. This flap was successful and provides another alternative to the resolution of complex problems needing multiple areas of both soft-tissue coverage and vascularized bone graft.
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ranking = 0.5
keywords = wound
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19/60. Late bullet migration into the knee joint.

    A 25-year-old active-duty police officer was found to have an intra-articular foreign body on radiographic study of his left knee joint. He had a gunshot wound to the midthigh 54 months prior to the presentation of symptoms. The bullet was lodged in the soft tissue without involving neurovascular structures. The patient complained of limited range of motion of the joint and a "rattle" sensation of the knee. Arthroscopically, a deformed metallic foreign body was found and retrieved. There was no injury inside the joint related to the loose body. These findings were consistent with a migrating bullet from the midthigh to the knee joint. The patient recovered uneventfully and returned to work.
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ranking = 0.5
keywords = wound
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20/60. Therapeutic management of problematic superficial wounds: a patient-centred approach.

    Wounds involving surface tissue loss often present in clinical practice. These case studies describe how a treatment regimen that allowed practitioners to change from one dressing to another facilitated healing in problem wounds of this type.
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ranking = 2.5
keywords = wound
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