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At least 649 records · Page 36Linked to original sources
PubMed1997

Are antibiotics necessary in the surgical management of upper limb lacerations?

Previous research has shown that antibiotic usage in patients with superficial sharp lacerations has no influence over infection rate. This study is a prospective controlled trial, using systematic allocation, of 250 patients of which 113 received co-amoxiclav (Augmentin) and 137 did not. Special emphasis was placed on wound debridement and irrigation. All sharp soft tissue lacerations including those with nerve, tendon and muscle damage were entered into the trial. The results show a low overall infection rate of 4%. The infection rate in the group treated with antibiotics was 5% and 3.2% in the group who received no antibiotics. Lacerations operated on up to 48 h from the injury were included and there was no correlation between the length of time waited and the infection rate. We conclude that antibiotics are an unnecessary adjunct in the treatment of sharp lacerations of the hand and upper limb, provided meticulous surgical debridement is performed.

Adolescent↗
PubMed1998

Analysis of the distribution of cutaneous perforators in cutaneous flaps.

An anatomic and statistical analysis was performed on the distribution of cutaneous perforators that perfuse the scapular, radial forearm, and lateral arm cutaneous flaps. Perforators were categorized as direct, terminal, and intransitive, depending upon perforator origin and termination site relative to the source artery. Statistical cluster analysis of perforator distributions was performed to determine the regions in which cutaneous perforators are consistently found. The scapular and radial forearm flaps could be divided into up to three well-perfused segments. The analysis predicted the possibility of dividing the lateral arm flap into as many as seven segments while maintaining perfusion. Clinical applications of this method for preoperative flap design and elevation as well as final results are shown.

Arm↗
PubMed1998

[Restoration of supination of forearm by flexor carpi radialis transfer].

The dysfunction of supination of forearm following injury of brachial plexus or poliomyelitis always affects the function of hand. To find the dynamic muscle for restoration of the supination, the flexor carpi radialis was investigated on fifty male cadavers. The blood supply of the muscle was polygenic, mainly derived from the humoral and radial arteries. The movement of the muscle was innervated by median nerve. If the proximal 1/3 belly of the muscle was reserved, the blood supply and innervation of the complete muscle was reserved. According to the anatomic data, the operative procedure was designed as following: transfer the distal 2/3 of flexor carpi radialis over the ulnar aspect of the forearm to the dorsal-radial side, the tendon was fixed on the radius shaft 6 to 10 cm proximal to the styloid process with forearm in full supination. Four patients were treated and after followed up for 3.2 years average, the supination restored. It was discussed that in case of paralysis of the flexor carpi ulnaris and pronator teres, the optimal choice to restore the supination would be flexor carpi radialis.

Adult↗
PubMed2005

Management of high voltage electrical injury in children.

High voltage electrical injuries in children are rare. They produce severe internal damage to limbs resulting in a high incidence of amputation. Early, aggressive serial debridement ensures adequate removal of dead tissue. Flap coverage to defects is necessary. Secondary surgery is common, and delayed sequelae such as tendon rupture should be expected.

Abdomen↗
PubMed1975

[Radiologic diagnosis and surgical treatment of closed injuries to the distal biceps tendon (author's transl)].

A technique for the recognition of closed injuries of the distal biceps tendon by introducing CO2 gas contrast into the soft tissues has been devised. The gas is injected into the fascial cover of biceps with a special apparatus. This produces direct and indirect signs of rupture of the tendon in radiographs. The repair of the distal biceps tendon is achieved by an original method using a homoplastic sling around the radius. Good results were obtained in 13 patients.

Adult↗
PubMed1986

Fracture treatment for the multiply injured patient.

Multiply injured patients are benefited by an intradisciplinary approach to treatment. Consultants provide expertise in the treatment of particular injured systems. Resuscitation and diagnostic evaluation are life-saving priorities of treatment in the emergency room. Definitive surgical treatment of body cavity injury is combined with careful monitoring while the patient is under anesthesia. The orthopaedic surgeon's responsibility then is to stabilize the fractures, thus minimizing the risk of infection, lung failure, and debilitation so that the patient may be gotten out of bed and rehabilitation started. Prolonged recumbency is probably the worst thing that can happen to a traumatized patient. The goal of fracture treatment is bone union without infection and with stable soft tissue coverage and normal motion of associated joints. It is important to realize that in these multiply injured people, fractures of the femoral or tibial shafts and unstable pelvic fractures threaten survival and should be surgically treated as soon as feasible. The operative treatment of fractures of the humerus, forearm, knee, and ankle can be addressed on an emergent basis. The condition of the skin around the ankle and knee influences the timing of surgery; a 24-hour delay may preclude surgery for weeks because of swelling and blisters. Orthopaedic surgeons now are beginning to understand the concepts of spine instability and have devices to stabilize the fractures. We think that unstable fractures should be given the same priority that fractures of major long bones receive. Free vascularized tissue provides excellent coverage when skin loss occurs over the distal two-thirds of tibial fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1989

[Donor tissue source in plastic surgery of the hand].

From topographic and anatomical examination of 32 upper limbs the authors proved that an island skin-fascia graft supplied with blood by the septocutaneous branches of the posterior interosseous vascular bundle can be formed on the posterior aspect of the forearm. Such a graft on a peripheral vascular pedicle was transplanted in 6 patients with defects in the integumentary tissues of the hand; it healed completely in 4 cases, peripheral necrosis occurred in 2 cases but did not affect the end result. The use of means of optic magnification and prevention of compression of the vascular pedicle in the postoperative period ensure successful transplantation of the graft.

Adult↗
PubMed1976

Electrical injuries of the upper extremity.

Although electrical burns of the upper extremity comprise a small percentage of all thermal injuries, they present formidable clinical problems. The physician must not be lulled into a false sense of security because the visible cutaneous burn is not great. Sound surgical principles, such as the control of bacterial proliferation with topical chemotherapy, débridement of dead tissue, and timely wound closure, in conjunction with the expertise necessary in caring for thermally injured patients, are necessary for a maximally rehabilitated patient.

Adolescent↗
PubMed1991

[Pregnancy and traffic accident. A case report].

The authors report the case of patient (second pregnancy, first birth) who had been involved in a traffic accident which occurred on October 5, 1989 after 7 months of pregnancy. The trauma was scored 2 on the international Overall Abbreviated Injury Scale. The impact was frontal and the patient driving and wearing her seatbelt. After being admitted to hospital on several occasions with metrorrhagia and uterine contractions, it was decided to carry out a cesarian and a baby was successfully removed. The child presented with angulation of the left fore-arm and skeletal X-ray, particularly of the arms, revealed a fracture line with a callous already formed.

Accidents, Traffic↗
PubMed1982

Free microneurovascular muscle transfer in limbs to provide motor power.

The experience gained in a series of 7 free microneurovascular muscle transfers to the limbs over a seven-year period has led us to conclude that: free gracilis microneurovascular flaps can be safely transferred and can aid restoration of movement following severe injuries of the limbs, including post-replantation cases; inclusion of a cutaneous island with the muscle is safe, improves cover, and simplifies closure following muscle transfer; tendon adhesions and joint stiffness are the greatest obstacles to transferred muscle function, and early passive extension is recommended; additional procedures are usually required after muscle transfer, to improve the level of function; and additional experimental work is required to determine methods of establishing the correct resting tension in transferred muscles.

Adolescent↗
PubMed1996

[Functional radial tendon replacement surgery at the Accident Hospital of the occupational association in Hamburg. Indications--technique--results].

Tendon transpositions serve to restore functions which were lost through an injury of nerves or muscles. At the Department of Hand Surgery and Plastic Surgery at the Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, 116 tendon transpositions were carried out for radial paralysis between 1960 and 1989. The follow-up for 85 patients is presented and the evaluation scheme developed by Haas (1991) further modified and our scoring system compared to others such as Zachary (1946) modified by Neumann and Partecke (1980). The results were good, also when evaluated according to Riordan (1959) and Merle d'Aubigné (1953).

Adolescent↗
PubMed1997

No sense; no sensibility--a tale of two adult hairdrier burns.

Hot air burns resulting from hairdriers held against the skin are rare. The largest published clinical series relates to burns in children injured by the use of hairdriers at home. Adults are assumed not to be at risk because the pain associated with thermal injury would normally stimulate acute action to prevent further skin damage. We present two adult patients in whom the normal protective mechanisms were inactive. There was loss of consciousness resulting from an epileptic fit in one case, and the local absence of sensation in a flap used to reconstruct a breast after mastectomy, in the other. The temperatures generated by hairdriers were experimentally assessed and the results are reviewed. We emphasize that hairdriers are a potentially dangerous source of hot air and can cause burns.

Adult↗
PubMed1998

Combined use of axillary block and lateral femoral cutaneous nerve block in upper-extremity injuries requiring large skin grafts.

An axillary block and lateral femoral cutaneous nerve block combination was used in 11 patients with upper-extremity injuries requiring large skin grafts. In our experience, this block combination was highly successful. All but one of the patients obtained excellent pain relief (mean visual analog pain scores, 0.2) that required no narcotic analgesics or sedatives. There were no systemic or neurologic side effects attributed to the local anesthetic drugs. We believe that combining an axillary block and a lateral femoral cutaneous nerve block is a clinically useful and effective technique and an excellent anesthetic alternative for procedures requiring large grafts for the upper extremity.

Adult↗
PubMed2004

Bone loss in the contralateral asymptomatic hand in patients with complex regional pain syndrome type 1.

Regional osteoporosis was seen radiographically in clinically affected areas in patients with complex regional pain syndrome type 1 (CRPS1). The aim of the this study was to investigate whether bone loss developed in the contralateral hand in patients with unilateral CRPS1 of the hand. Thirty-two patients with CRPS1 of the hand were included in this study. Bone mineral density was measured in the left proximal femur and both ultradistal radiuses, using dual-energy X-ray absorptiometry. The subjects were classified as grades 1 to 3 according to the T-score of both ultradistal radiuses (densitometric grades): grade 1, both radiuses were normal; grade 2, bone loss was determined only in the affected radius; and grade 3, there was bone loss in both radiuses. Twenty (62.5%) patients had bone loss in the affected hand; 11 patients (34.4%) had bone loss only on the affected side and 9 patients (28.1%) had bone loss on both sides. The mean duration of the period between the diagnosis of the injury and the measurement of bone density was 1.9 +/- 0.6 months in patients with grade 1, 3.1 +/- 1.0 months in patients with grade 2, and 5.5 +/- 2.2 months in patients with grade 3. The Spearman test showed a significant correlation between the period of injury and the densitometric grade ( R = 0.774; P = 0.0001). In conclusion, the current study of patients with CRPS1, showed that the bone loss in the asymptomatic contralateral hand developed at a later stage than that in the affected hand. This bone loss was less frequent and of a lower degree in the asymptomatic contralateral hand than in the affected hand. The bone loss in the asymptomatic contralateral hand could be explained by the loss of sympathetic tone in CRPS1 and contralateral sympathetic innervation.

Absorptiometry, Photon↗
PubMed1989

Sural nerve grafts for delayed repair of divided posterior interosseos nerves.

Sural nerve grafts were used in three patients to bridge gaps measuring 2 1/2 to 4 1/2 cm in previously transected but not repaired posterior interosseous nerves. The grafts were done at 4, 5, and 7 months after injury. Extension was weaker in all three than on the uninjured side, but the range of motion was complete, with the exception of a slight lag of index finger extension and partial return of extension of the extensor carpi ulnaris in the same patient. All three patients recovered full function of the involved hand 1 year after grafting. The properties of the posterior interosseous nerve (pure motor and short distance to the muscle) contribute to good results with nerve grafts in delayed nerve repairs. We believe that these results are better than tendon transfers, at least in young patients.

Adolescent↗
PubMedDate not supplied

The use of tensor fascia lata interposition grafts for the treatment of posttraumatic radioulnar synostosis.

PURPOSE: There is no agreement on the ideal treatment of traumatic radioulnar synostosis, especially the type of interposition material to be used. The purpose of this study is to report our experience with synostosis resection and interposition of tensor fascia lata grafts. METHODS: A chart review was conducted for all patients treated for posttraumatic radioulnar synostosis between 2000 and 2004. Demographic data, mechanism of injury, length of time to synostosis resection, range-of-motion, patient satisfaction, and postoperative complications were analyzed. RESULTS: Thirteen patients were identified for this study. The mean preoperative pronation was 14 degrees and the mean postoperative pronation was 62 degrees. The mean preoperative supination was 4 degrees and the mean postoperative supination was 62 degrees. The mean follow-up time was 30 months. CONCLUSIONS: These results indicate that synostosis resection with tensor fascia lata graft interposition is an effective technique for the treatment of posttraumatic radioulnar synostosis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed1994

Compartment syndrome associated with infection of the upper extremity.

Compartment syndrome is a potentially devastating entity associated with a great variety of injuries, but to the authors' knowledge there are no known reports of infection documented as a cause. A retrospective review of 263 patients with upper extremity infections admitted to the orthopaedic infection ward during 1992 was conducted to identify patients with compartment syndrome directly associated with infection. Four patients' clinical presentations fulfilled the criteria: two presented with infection and compartment syndrome, and two developed compartment syndrome 2-12 hours after admission. All four had beta-hemolytic streptococci on initial culture; three of four grew Group A streptococcus. Fasciotomies and serial debridements were necessary. One patient ultimately underwent amputation through the elbow.

Adult↗
PubMed1991

A composite neuro-teno-cutaneous forearm flap in the one-stage reconstruction of a large defect of the soft tissue around the ankle.

The vascular anatomy of the radial forearm flap, incorporating the brachioradialis and palmaris tendons together with the superficial radial nerve in 20 fresh cadavers, is described. The radial artery in the cadaveric forearm was irrigated and injected with blue latex. The number and distribution of the cutaneous branches supplying the skin, brachioradialis tendon, palmaris tendon, and superficial radial nerve, were then documented in relation to the distance from the radiocarpal joint. The radial artery was found to provide adequate blood supply to the above structures. This flap has been used as a composite neuro-teno-cutaneous flap to resurface a large defect involving tendon, nerve, and skin loss in the ankle and the foot as a one-stage procedure. This technique avoids multiple-staged operations and thus shortens the convalescent period in rehabilitation of severely traumatized limbs.

Adult↗