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At least 847 records · Page 47Linked to original sources
PubMed2004

[Salvage of exposed alloplastic materials in irradiated wounds - a case report].

BACKGROUND: Modern multimodal concepts of complex reconstructions and advanced wound management enlarge strategies for surgical oncological therapies. One of the mainstays of classical surgical therapy in case of exposed alloplastic materials in irradiated wounds was to remove the foreign body due to the risk of infection. This loss of integrity and function of the contaminated host bed was to allow wound healing and closure. METHOD: We report the management of a 56-year-old female patient who developed a lyomyosarcoma at her left shoulder girdle 8 years after radiation of the left thorax because of breast cancer. After radical tumor resection and exarticulation of her left arm in the shoulder joint a necrosis of the soft tissue envelope developed, leading to an exposed alloplastic mesh. Staged debridement and continuous application of negative pressure was performed three times. Ultimate plastic coverage was performed by means of a pectoralis myocutaneous island flap from the other breast. RESULTS: After staged debridement and repeated vacuum application excellent wound cleaning, neovascularisation, wound contraction and formation of granulation tissue within the previously irradiated tissue zone was observed. Until fourteen months postoperative wound coverage remained stable and no signs of infection were observed. DISCUSSION: By means of negative pressure therapy even in radiated wounds excellent wound cleaning and sufficient formation of granulation tissue can be achieved. In some cases negative pressure therapy together with staged debridement allows reintegration of exposed and therefore potentially contaminated alloplastic meshes into new formed granulation tissue in radiated wounds respectively radiation ulcers. Thus leading to the possibility of ultimate plastic coverage.

Breast Neoplasms↗
PubMed2006

Design and preliminary evaluation of a portable device for the measurement of bioimpedance spectroscopy.

Portable bioimpedance spectroscopy (BIS) devices are of great value for monitoring the pathological status of biological tissues in clinical and home environments. The two traditional techniques for measuring complex bioimpedance, the bridge method and quadrature demodulation method, are either time-consuming or often associated with high cost, high power consumption, and large board space, and therefore are not ideally suitable for designing a portable device for BIS measurement. This paper describes a novel design of a portable BIS device based on the magnitude-ratio and phase-difference detection method and its implementation using the newest generation of analog electronic products which greatly decrease the complexity of both hardware and software. In order to improve the accuracy of the device, a three-reference calibration algorithm was applied. Experimental sweep-frequency measurements on RC circuits were carried out to preliminarily evaluate the performances of the device. The results obtained by the device were found to be in good agreement with the results measured by a commercial impedance analyzer HP4194, with an overall mean error of 0.014% in magnitude and 0.136 degrees in phase over a frequency range of 20 kHz to 1 MHz.

Adult↗
PubMed1985

Regeneration of upper femur after subperiosteal resection.

A 16-year-old patient had total thigh fillet for decubitus ulcer with an infected hip joint. The patient had extraosseous calcification and infection and was hospitalized again one year later for operation. Approximately four years after the initial operation the patient regenerated a femoral head, neck, and approximately 20 cm of the femoral shaft. This was resected. How often does this occur and should we take steps to obliterate the periosteum when doing a subperiosteal thigh fillet procedure?

Adolescent↗
PubMed2002

Treatment outcome of nonclostridial gas gangrene at a Level 1 trauma center.

OBJECTIVE: To evaluate the results of treatment of nonclostridial gas gangrene at a Level 1 trauma center. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS: Seven patients with nonclostridial gas gangrene were studied. The average age of all patients at the time of admission was 40.3 years (range 14 to 67 years). RESULTS: Three of seven patients had posttraumatic infection, and the remaining four were strongly associated with underlying diseases: diabetes mellitus in three and paraplegia as the result of a spinal cord injury in two. The time of symptom onset was clearly defined in four cases, and the average interval between symptom onset and transfer to our hospitals was six days (range 2 to 10 days). Surgical debridement was performed immediately on admission in six patients (86 percent). A triple antibiotic regimen consisting of penicillin, gentamicin, and clindamycin was used initially in all patients. In three patients, hyperbaric oxygen therapy was also used. The overall mortality rate was 42.9 percent (three of seven patients). In these patients, the interval from onset of symptom to transfer to our hospital was ten days in one patient, which was longer than average, and was not accurately known in the other two patients. CONCLUSION: Nonclostridial gas gangrene is extremely rare but life-threatening. The greatest pitfall for the emergency department physician is failure to suspect it clinically. Aggressive treatment, including surgical debridement and intravenous antibiotics with or without hyperbaric oxygen therapy, must be initiated immediately to minimize morbidity and mortality.

Adolescent↗
PubMed1998

Wound coverage using modified tissue expansion.

We describe the use of a "lacing apparatus" across large and complex wounds to accomplish wound closure. This technique utilizes the principles of tissue expansion (exploiting inherent extensibility of the skin, mechanical creep, and biologic creep) but is able to employ them in situations in which traditional tissue expansion (utilizing implantable expanders) is not practical. After preparation, the wounds are laced with large nylon suture, which is tightened on a daily basis, typically allowing closure of even massive wounds within 8 to 10 days. In this report, we describe the technical details of wound preparation, application of the lacing apparatus, and postoperative execution of the expansion leading to final wound closure. This technique is particularly valuable in the upper arm, trunk, and lower extremity but has limited application in the distal forearm and the distal third of the lower extremity.

Adult↗
PubMedDate not supplied

Massive osteolysis of the femur (Gorham's disease): a case report and review of the literature.

A case of Gorham's disease involving the proximal femur of a 12-year-old girl is presented. Although Gorham's disease is rare and has benign histologic characteristics, in this patient it took an aggressive clinical course that resulted in severe morbidity. Diagnosis is difficult to establish; almost all investigative approaches provide only indirect evidence of the pathology. A high index of suspicion and open biopsy performed soon after presentation will establish diagnosis. Treatment modalities may be more effective if applied earlier in the disease process, especially as the osteolytic process appears to escalate after pathologic fractures, which occur frequently in this disorder.

Child↗
PubMed1991

Syme's two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot.

Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.

Adult↗
PubMed1956

Syme's amputation.

Explore the source record for details and available documents.

Amputation, Surgical↗
PubMed1990

Hindquarter amputation for tumours of the musculoskeletal system.

We reviewed 34 hindquarter amputations performed for malignant tumours around the hip from 1971 to 1988, classifying them as palliative or curative according to the resection margins or the presence of disseminated disease at the time of surgery. There were three peri-operative deaths, 12 palliative and 19 curative procedures. Ten patients died of disseminated disease within a year of surgery, eight of whom had had a palliative operation. Three patients died between one and five years after palliative surgery. One died of unrelated disease at nine years. Seventeen patients are disease free an average of 31 months from surgery, 16 after curative procedures. The median survival after palliative amputations was six months and the 5-year survival rate for curative cases was 83%.

Adolescent↗