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

Bipedicle flaps: simple solutions for difficult problems in the extremities.

Bipedicle flaps have been used to provide good quality soft tissue cover for defects in many anatomical sites. The indications for the use of this flap have not been well defined and with the advent of more complex modes of tissue transfer this simple technique is often overlooked. We have found it to be a safe and expedient method of providing cover for difficult defects on the extremities. We present a series of 9 flaps raised on 7 patients over a 12-month period and discuss the indications and refinements in flap design.

Adult↗
PubMed1997

Revascularization of degloving injuries of the limbs.

Between 1990 and 1994 a study was carried out of 32 patients who had degloving injuries of the limbs. There were three types of injuries: type I, nine patients with severely damaged skin and subcutaneous tissue; type II, 13 patients whose skin and subcutaneous tissue were moderately damaged, but subcutaneous veins were still identifiable; and type III, 10 patients whose skin and subcutaneous tissue were moderately damaged and venous back flow was observed. The patients in type I were treated by extensive debridement and the flaps were used for free full and split thickness skin grafting. In type II, arterialization of the venous system of the flaps was performed and successful perfusion was observed in nine patients. In type III, venous anastomoses were performed and all had good results. Revascularization of the flaps in types II and III degloving injuries of the limbs gave good results. The raw surface which needed skin grafting was minimized and the course of treatment and morbidity were decreased.

Adolescent↗
PubMed2002

Lower extremity injuries in youth sports.

The lower extremity is the most commonly injured anatomic area in sports. An appropriate history and physical examination is sufficient to diagnose most injuries. By knowing the position where a joint has the greatest and least bony stability, one can predict the likelihood of bony and ligament injury. Such information is helpful in determining which structures are most susceptible to injury as well as identifying when radiographs or other diagnostic studies are indicated. An accurate diagnosis is crucial for planning effective therapy and in determining the need for surgical referral. An understanding of common injury patterns is also helpful in differentiating sources of musculoskeletal pain that are not injury related.

Adolescent↗
PubMed1977

The prevention and treatment of amputation neuromata by silicone capping.

A technique of silicone capping of amputated sciatic or tibial nerves was evaluated in a single litter of ten New Zealand white rabbits (eight experimental, two control). All nerves and caps were evaluated 12 and 4 weeks after operation. Neuroma formation was prevented when a lengh:diameter ratio of 5:1 (minimum) to 10:1 (maximum) of the cap was observed and a smooth, filmy, nonreactive capsule around all nerve ends and caps was noted. Eighteen patients with 38 traumatic neuromata in the upper extremity were treated by silicone capping and were evaluated an average of 41 months after operation. Of these 18 patients, 17 underwent revision surgery for the specific purpose of relieving disabling neuroma pain. Two patients developed a causalgic state. One patient had recurrence of symptoms in one of four nerves capped and was relieved by reoperation and recapping. The remaining 15 patients were relieved of their preoperative complaints.

Adult↗
PubMedDate not supplied

Death and injury caused by land mines in Burma.

One hundred and eighty-eight Burmese refugees in Thailand were interviewed. One hundred and five of those interviewed had knowledge of a total of 313 persons who had been exposed to land mine explosions. Twenty-three of the interviewed were land mine survivors. They were all male, aged between eight and 68 years, and all except one had been injured between 1986 and 1997. Fifteen of the 23 were civilians, eight were guerilla soldiers who were injured either in battle or while deploying or disarming land mines. Those who had stepped on land mines were all crus or femur amputated and had several scars on the lower limbs, abdomen and some also on the forearms. Those who had handled a land mine had lost either fingers or hands and one also lost both eyes. This study shows that the frequency of land mine accidents in Burma has been underestimated and that the mortality is high. The study also supports the general impression that many victims are civilians.

Adolescent↗
PubMed2003

Soft tissue infections of the extremities in an orthopaedic centre in the UK.

OBJECTIVES: To determine the spectrum, and clinical impact of acute extremity soft tissue infections, encountered in the Orthopaedic service of an inner city hospital in UK. METHODS: Patients requiring admission for an acute limb soft tissue infection to the Orthopaedic unit of the Manchester Royal Infirmary, UK, between July 1996 and 2001 were identified from our database. Infections involving the groin and axilla, those developing within 30 days of a surgical procedure, and patients with chronic soft tissue ulcers or infections were not considered. RESULTS: Of 142 infections the majority were cellulitis (50%) and superficial abscesses (34.5%). Most were secondary to trauma (31.6%), human or animal bites (20%) and intravenous drug abuse (17.6%). Although most patients were young and otherwise healthy, ten developed significant complications: myonecrosis requiring below knee amputation (1), acute carpal tunnel syndrome (1), osteomyelitis (6), extensive skin loss requiring reconstruction (1), deep vein thrombosis (1). Seven hundred and eighty four hospital inpatient days and 143 operative interventions were devoted to these patients. The estimated cost for each episode of soft tissue infection was pound 1011. In 25% of cases earlier referral to a surgical service would have been more appropriate. CONCLUSIONS: Soft tissue infections of the extremities confer significant morbidity and impose an important burden on medical resources.

Adolescent↗
PubMed2001

[A new classification for standardizing nomenclature in wound closure by microvascular flap-plasty].

The profusion of terms currently used to describe microvascular flap wound closure according to the time of reconstruction makes reliable comparisons of outcomes between institutions difficult if not impossible. To address the issue, a consistent terminology applicable to microvascular flap wound closure in general was formulated with respect to our experience with a total of 197 microvascular tissue transplantations. The nomenclature presented divides microvascular flap closure into three categories: "primary microvascular flap closure" (within 24 hours). "delayed primary microvascular flap closure" (two to seven days), and "secondary microvascular flap closure" (after seven days). This is consistent with known biological, microbiological, and surgical principles of wound closure in general and should provide a simple basis for classifying microvascular flap wound closure. Sample cases are selected to illustrate the categories within this new classification scheme.

Adolescent↗
PubMed2005

[Plasma concentration of endothelin-1 after myocutaneous latissimus dorsi-transplantation -- role in reperfusion injury].

The success of a free flap transplantation is based on a sufficient microanastomosis which meets the following requirements: a pedicle placed without kinking or twisting, a good drainage, a well defined recipient vessel and integrity of the endothelium. The aim of this study was to determine whether operation-related ischaemia through flap transplantation and tourniquet induces an increase of Endothelin-1 plasma levels as one cause of vasospasm during microvascular procedures. We focused our attention in particular on the reperfusion period which is often limited to an irreversible perfusion failure of microcirculation due to free radicals, interleukin and Endothelin-1. Twenty-one patients with tissue injury of the lower leg were included in our study, fourteen underwent a latissimus dorsi muscle transplantation with a combined ischaemia, seven patients had a tourniquet ischaemia for tumour resection, debridement and local flap transfer. The duration of ischaemia varied due to the course of operation. The withdrawal of venous blood via central vein catheter, flap vein and wound bed followed a fixed time table pre- and post-reperfusion (T1: preoperative day via cubital vein, T2: 6th postoperative day, T3: 5 min, T4: 10 min, T5: 15 min, T6: 1 h post-declamping and after tourniquet ischaemia via central vein catheter and T7: within 5 min from the flap vein immediate after recharging the flap). The vessel anastomosis determined the withdrawal from the local wound bed. ET-1 in venous blood samples were measured with ELISA. The duration of ischaemia in the tourniquet group ranged from 22 min up to 210 min with a mean of 76.58 min and in the latissimus group from 87 min up to 203 min with a mean of 139.21 min. The mean ET-1 plasma concentration measured systemically before operation in the 21 patients was 0.51 +/- 0.08 pg/ml (Mean +/- SD). This result corresponds with data published in literature. The locally measured plasma levels of ET-1 after tourniquet and flap ischaemia were increased with 0.34 up to 3.90 pg/ml (0.95 +/- 0.79 pg/ml [Mean +/- SD]) for the tourniquet group and with 0.34 up to 14.87 pg/ml (1.85 +/- 3.64 pg/ml [Mean +/- SD]) for the latissimus group. This is an increase compared to systemically measured values as 0.75 +/- 0.06 pg/ml (Mean +/- SD) for the tourniquet group and 0.58 +/- 0.21 pg/ml (Mean +/- SD) for the latissimus group. We conclude that Endothelin-1 is increased locally in the early reperfusion period after free latissimus dorsi-transplantation.

Adult↗
PubMed2005

Golf and racquet sports injuries.

There are specific injuries that are common in golf and racquet sports. These abnormalities have a predilection for specific structures as well and can be divided into two categories on the basis of etiology as either chronic repetitive injury or acute trauma. With golf injuries, upper extremity abnormalities prevail and include rotator cuff disease, epicondylitis, wrist tenosynovitis, and hamate hook fracture. Thoracolumbar spine pain can also occur. The order of frequency of these ailments is different for professional and recreational athletes. With racquet injuries, as in tennis, lower extremity injuries are more common and include medial gastrocnemius and Achilles tendon abnormalities, although shoulder, elbow, and wrist abnormalities may also occur. Knowledge of the biomechanics behind each sport is also helpful in understanding the pathophysiology of injury and in part explains the findings seen at imaging.

Athletic Injuries↗
PubMed1993

Direct muscle neurotization.

The results of experimental research, as well as of a large clinical series (n = 51) of direct muscle neurotization, have been encouraging enough to warrant extending the indications for the procedure to patients in whom traditional repair by direct nerve suture or nerve graft is impossible, because of the lack of a distal nerve segment, or because of destruction of the neural portion of one or more muscle groups. Prerequisites include a satisfactory volume of muscle with sufficient vascularity and adequate postoperative joint and muscle immobilization.

Animals↗
PubMed1990

Restoration of lymph drainage after extremity replantation.

A clinical analysis of 171 major extremity replantations was carried out. From one month to 2.5 years after surgery, direct lymphographic studies of replanted limbs were done in 17 patients (16 upper limbs and one lower limb). Despite a complete disruption of lymphatic drainage, replanted limbs underwent adaptive and compensatory structural changes of the lymphatic system in the post-replantation period; first, with regeneration of cutaneous vessels and then (after six to eight weeks postoperatively) with regeneration of lymphatic collecting vessels. Such changes led to improvement as early as four to six weeks postoperatively and subsequently to restoration of lymphatic drainage in the replanted limb. The rate and extent of lymphatic recovery depends largely on the surgical techniques used in replantation.

Adolescent↗
PubMed1993

[Orthopedic and biomechanical concepts of sports shoe construction].

Based on anatomical, orthopaedic and epidemiological considerations two sets of concepts relevant for sport shoe construction have been proposed and discussed, one for the reduction of excessive load and one for the improvement of performance. The concepts for excessive load reduction are cushioning, support and guidance. These can be achieved by altering the material properties or the construction of the shoe. The concepts for improving performance are, first, that energy should be returned at the right location, at the right time, with the right frequency, and second, that reduction of loss of energy is more important than return of energy.

Athletic Injuries↗