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[Tears of the distal tendon of the biceps muscle].

The author describes a relatively rare injury, disruption of the distal attachment of biceps in two sportsmen, body-builders. In comparison with literature the author presents diagnosis, possible ways of therapy and evaluates late consequences. Early operation revision and reinsertion of the disrupted tendon into the position of original attachment on tuberositas radii is recommended as a therapeutic procedure. This is the only way to secure the full strength of flexion and supination of forearm and to renew the original muscular relief of the arm.

Adult↗

Prefabricated flaps for the head and neck: a preliminary report.

The authors present some clinical applications of the concept of flap prefabrication. Three cases are described where reconstructions around the head and neck were accomplished. The radial vascular territory of the forearm was selected for prefabrication of structures which were then transferred by microsurgical techniques. In two cases, a sensate flap was used, with nerve repair in the neck.

Adolescent↗

Salvage of proximal humeral amputations with a remnant forearm flap.

Spare-part surgery of upper extremity avulsions may facilitate primary soft-tissue healing and prosthetic rehabilitation. This procedure also may be applicable to the management of analogous proximal lower extremity avulsions where a short femoral stump and a shortage of soft tissue exist.

Arm Injuries↗

Rotational stability of the carpus relative to the forearm.

To perform rotational tasks adequately, the rotational laxity between the radius and the carpus must be constrained within a certain limit. The contribution of nine individual capsuloligamentous structures to the rotational stability of the radiocarpal joint was studied using 14 fresh-frozen human cadaveric specimens. Torque-rotation curves, with sequential section of the soft-tissue structures, were used to calculate the percentage contribution of each individual structure. The primary pronation constraint was the palmar radioscaphocapitate ligament. The contributions to supination constraint were more complex; the dorsal radiotriquetral ligament was dominant, assisted by the palmar ulnolunate ligament. Structures originating from the ulna changed their major constraint contribution with forearm orientation, whereas those with a radial origin had a constant contribution independent of forearm rotation. Injury of these structures may lead to rotational instability at the radiocarpal level and should be considered when treating carpal instabilities.

Adult↗

Complications of Colles' fractures.

Patients with Colles' fractures have serious complications more frequently than is generally appreciated. A study of 565 fractures revealed 177 (31 per cent) with such complications as persistent neuropathies of the median, ulnar, or radial nerves (forty-five cases), radiocarpal or radio-ulnar arthrosis (thirty-seven cases), and malposition-malunion (thirty cases). Other complications included tendon ruptures (seven), unrecognized associated injuries (twelve), Volkmann's ischemia (four cases), finger stiffness (nine cases), and shoulder-hand syndrome (twenty cases). In many patients, incomplete restoration of radial length or secondary loss of the reduction position caused the complications.

Arthritis↗

Vinylpyridine: an unusual cause of a chemical burn.

A case of a chemical burn following cutaneous exposure to vinylpyridine is presented. This unusual injury was distinguished by the delay in onset of pain and erythema, followed by gradual resolution leaving patchy skin discolouration. The properties of vinylpyridine are outlined. This case illustrates the dangers of long-term chemical storage and the importance of proper disposal.

Adult↗

Complete plantar foot coverage with the free neurosensory radial forearm flap.

Resurfacing the sole of the foot is a unique and challenging problem. Many methods have been advocated in search of an ideal solution. When the entire surface requires reconstruction, alternatives have been limited, and their results have often been less than satisfactory. Free-flap transfer allows a single-stage reconstruction from a variety of donor sites. This report of a free neurosensory radial forearm flap to cover a complete plantar weight-bearing surface is an additional choice for reconstruction. This flap has the potential for sensory reinnervation by the medial antebrachial cutaneous nerve and when elevated without its fascia can provide improved adherency.

Accidents, Occupational↗

Complications and failures of the ESIN technique.

Only knowledge of the possible failures and complications of a method allows its correct application. This also applies to ESIN (Elastic Stable Intramedullary Nailing), which has been promoted as a simple procedure. Most failures occur through neglect of the important biomechanical principles, and by obvious technical errors. The combination of both causes of failure can lead to serious complications in this method, which is generally regarded as "benign". These complications include serious rotational deformity, leg shortening, and growth disorders from growth plate injuries. A fundamental distinction must be made between intraoperative and postoperative problems and true complications. The present paper is intended to contribute towards avoiding such errors and detecting errors as early as possible during surgery in order to correct them.

Adult↗

Penile reconstruction for a victim of electrical injury with bilateral below-elbow amputations.

We report on a young man who had complete loss of the penis and bilateral below-elbow amputations following severe electrical injury. Reconstruction of the penis was completed by using a deliberately tailored dorsalis pedis flap to solve the problems encountered by a migrated skin tube. Construction of a neourethra with release of the contracture was done simultaneously and brought about successful results.

Adult↗

Dog and cat bites to the hand: treatment and cost assessment.

PURPOSE: To assess the demographic patterns, clinical morbidity, and treatment costs associated with domestic animal bites to the hand. METHODS: A retrospective review was performed on 111 patients who suffered either a dog or cat bite to the hand. Demographic data were collected for both the patient and the animal involved. RESULTS: The patient population had suffered 71 dog bites and 40 cat bites. Two scenarios were identified that increased the likelihood of a bite: (1) attempting to separate fighting animals and (2) attempting to aid an injured animal. More than half of the victims (61 of 111) were bitten by an animal with which they were familiar. Bite injuries ranged from relatively minor wounds to major injuries that included open fractures, persistent deep infection including osteomyelitis, nerve laceration, tendon laceration, or tissue loss. Approximately two thirds of patients required hospital admission at least for intravenous antibiotics. Approximately one third of animal bite victims required at least 1 surgical procedure. Thirteen patients required long-term intravenous antibiotics and/or multiple surgeries and incurred medical expenses in excess of dollar 77,000. CONCLUSIONS: Domestic animal bites to the hand are common injuries that can produce considerable morbidity. Stray animals did not account for the majority of incidents. Bite prevention strategies should focus on careful handling of animals that are fighting or injured. Animal bite wounds often require intravenous antibiotics and hospitalization and the cost of care for deep infections can be enormous. Our patient population was selected from a small geographic area over a relatively short collection period, suggesting that domestic animal bite injuries may represent a major public health issue. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level IV.

Adolescent↗

An EFE model on skin-sleeve interactions during arm rotation.

Skin and garment constitute a dynamic contact system for human body comfort and protection. Although dermatological injuries due to fabric actions during human body movement are common, there is still no general guidance or standard for measuring or evaluating skin/garment contact interactions, especially, during intense sports. A three-dimensional explicit finite element (EFE) model combined with Augmented Lagrange algorithm (ALA) is developed to simulate interactions between skin and fabric during rotation of the arm. Normalized effective shear stresses at the interface between skin and the sleeve during the arm rotation are provided to reflect the severity of the interactions. The effects due to changes in fabric properties, fabric-skin gap, and arm rotation rate are also illustrated. It has been demonstrated from our predictions that factors such as elastic modulus, friction coefficients, density of fabric, and the initial gap between skin and fabric influence significantly the shear stress and thus the discomfort and even injury potential to skin during intensive body movement such as sports and military. Thus this study for the first time confirms quantitatively that poorly chosen fabric with inappropriate garment design renders adverse actions on human skin.

Clothing↗

The pronator quadratus muscle flap: coverage of the osteotomized radius following elevation of the radial forearm flap.

Skin-graft take following elevation of the osteocutaneous radial forearm flap has been shown to be difficult. The pronator quadratus muscle flap can be elevated to cover the exposed osteotomized radius and flexor carpi radialis and brachioradialis tendons. This technique is technically easy to perform and may significantly reduce donor-site wound-healing problems.

Adult↗

Osteocutaneous grafting from the forearm to the foot. Case report.

A vascularised osteocutaneous flap from the forearm was transferred to a crushed forefoot after a motorbike accident. Rapid bone formation and good coverage of the wound led to normal walking within nine months. This method can overcome the difficult problem of metatarsal bone and soft tissue loss and confers considerable benefit on the patient.

Adolescent↗

A histological analysis of a high voltage electric current injury to an upper limb.

The mechanisms and patterns of high voltage electric current injury to living tissues are not fully understood. Most available data is derived from animal experimentation using voltages that are considerably lower that those encountered by human victims during electrocution accidents. This work aims to contribute human tissue histological data by analyzing the pattern of tissue damage after a real life unfortunate high voltage electrocution accident.

Amputation, Surgical↗

[Pedicle ilio-inguinal axial flaps: clinical analysis of 140 cases].

Pedicle ilio-inguinal axial flaps were carried out in 140 cases with hand injury. The success rate of the operation was 97.85%. The authors consider that the high success rate was due to rare occurrence of vascular variation of the flap and more simplicity of the technique with less complications. This kind of flap could be used in cases of replacement of scar, acute injury and infective wound of hand. The donor area of ilio-inguinal flap is quite concealment. It is much better in cosmetic consideration. But still some disadvantages were existed such as fixation of the arm making discomfort to the patient, and bulky of the hand because of the subcutaneous fat in some cases.

Adolescent↗

Restoration of the foot using the radial forearm flap.

Large foot defects unsuitable for reconstruction by local foot flaps are most expediently salvaged with distant free-tissue transfers. Although muscle flaps are preferred for infected wounds, coverage of the clean or acute foot deformity may be better achieved with the innervated radial forearm fasciocutaneous flap. This almost ideal donor site has been used by us for all traumatic foot defects requiring free flaps during the previous year. Our results document that in the 5 available clinical examples, restoration of normal foot contour, durability during ambulation, and an excellent aesthetic appearance were achieved.

Adolescent↗

Simultaneous bilateral foot reconstruction using a single radial forearm flap.

The radial forearm septocutaneous flap is an excellent source of thin tissue with an anatomically consistent network of large vessels that simplify microsurgical transfer. It may be divided into multiple flaps leaving a single donor-site defect. The clinical usefulness of this concept is demonstrated in a single case in which simultaneous coverage of electrical burns of both feet was required.

Burns, Electric↗

[Cubital nerve injury].

One of the more frequently accomplished treatment job in the nursing profession is blood extraction. The preferred location is the elbow flection, in the cephalic or basilic veins. Puncture in one of those veins may produce a series of complications as described in every procedure handbook in print. One of them, very rare, is the punction of cubital nerve that may lead to serious consequences for the patient.

Catheterization, Peripheral↗