Economic use of damaged tissue in severe trauma lower limb.
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Biomedical subjects
Publications and source records attributed to O N Mehrotra.
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Traumatic below-knee amputations do not always leave enough soft tissue of bone with which to fashion a stump of sufficient length and durability to support a prosthesis. Composite free flaps can often be harvested from the amputated limb to provide immediate one-stage stump salvage and to preserve knee function. We report a new technique to increase stump length by incorporating the calcaneus into a foot fillet flap as a vascularized bone transfer. The calcaneal fillet flap is a useful addition to the inventory of available composite flaps. It is recommended for knee joint salvage when there is less than 11 cm of tibial remnant length.
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It is uncommon to be able to use the same flap to resurface a defect of the hand and another extremity of the body. Two cases are presented. In one, the hand and neck and in the other, the hand and foot were resurfaced from the same flap. In the former a tubed pedicle flap was used and in the latter, part of a groin flap was transferred as a free flap.
Bleeding after serious facial fractures may be of such life-threatening proportions that it is sometimes impossible to control it by traditional methods. Super-selective arteriography allows accurate localisation of the bleeding site and immediate embolisation of the offending vessel is a highly effective manoeuvre. Two clinical cases are reported.
In a severely burnt hand one of the most difficult problems in reconstructive surgery is the prevention of contractures. Early skin grafting, and the reduction of oedema and joint stiffness by early mobilization, will minimize contraction, but will not altogether prevent it. When the dominant hand has also suffered damage, the need for a reconstructive procedure is absolutely essential, and by far the best functional and cosmetic results are achieved with the use of local tissue from the damaged digits. This paper describes various reconstructive salvage procedures for severely deformed hands.
This is a review of six patients presenting with severe injuries of the dorsum of the hand following motor vehicle accidents. In each case the injury was sustained by the hand being trapped between the road and the overturning vehicle. The injured hands were either outside the window or passed through the open window at the time of the accident. These injuries were all sustained during the summer months.
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Contour defects resulting from trauma, from the excision of a neoplasm, or present at birth, may be restored in a number of ways, and the material used may be autogenous, homogenous, heterogenous, or synthetic in nature. The use of Silastic implants is currently fashionable, but despite the manufacturer's claims, there is no foreign material which the body will accept permanently as its own. Implants are easy to procure and to shape, and their use can sometimes simplify a surgical procedure, but there is no doubt that where autogenous material is available, it will almost always give the best and most permanent result. This paper illustrates the versatility of simple de-epithelialization and over-flapping procedures in restoring contour defects, and is also a plea for the use of living tissue where it is readily available.
Improvement in the function and appearance of hand brought about by using tissue from a damaged index finger is presented. The damaged index finger could have been retained as a stiff digit or thrown away in the bucket.
Management of compression injuries of the hand. Primary treatment of extreme conversatism is recommended. Repair by local tissues is superior in every way as regards function, sensation and appearance of the hand. Where local tissues cannot be used free skin grafting and distant flaps should be considered.
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A method is presented for the repair of full-thickness defects of the eyelid. The lining and tarsal plate are replaced by a free chondromucosal graft from the nasal septum, in which the cartilage is thinned and perforated. Cover is provided by a compound, bipedicled flap of skin and muscle from the opposite lid.