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At least 127 records · Page 7Linked to original sources
PubMed1999

Management of the radial composite donor site: an orthopaedic opinion.

Maxillofacial and plastic surgeons have reported on the management of radial composite flap donor sites, but little reference is made to orthopaedic advice. Orthopaedic surgeons manage forearm injuries more often than other specialties and we thought that an orthopaedic consensus was long overdue. The composite radial donor site subsequently fractures in up to 43% of cases. There is no agreement on the optimal management of these difficult injuries and the patient is often referred for orthopaedic advice. Options include plaster-cast immobilization, internal fixation with either a plate or intramedullary nail, and external fixation. Bone grafting may also be required. A postal questionnaire, using two case histories including radiographs, was sent to 100 consultant orthopaedic surgeons in the UK asking how they would manage the donor site primarily and how they would manage a fracture at this site. Fifty-nine adequate replies were received. Generally, six weeks of immobilization in a plaster of Paris (POP) cast was considered sufficient for the initial management of the donor site. In the event of a fracture, internal fixation with a dynamic compression plate with or without a cancellous bone graft was the most common choice.

Bone Transplantation↗
PubMed1983

Wringer washer injuries in children.

Injuries resulting from wringer washers are still fairly common around the world. Manufacturers' data regarding wringer washers are reported. The literature is reviewed, and 104 new pediatric cases seen between 1970 and 1980 at one pediatric institution are presented. These patients suffered a wide variety of injuries ranging from simple skin abrasions to loss of limbs. Skeletal, nerve, and tendon injuries were encountered. The recommended management stresses the importance of elevation and close observation with no emphasis on compression dressing.

Accidents, Home↗
PubMed2006

Free fibula and corticocancellous bone grafting for salvage of a war-injured forearm.

The treatment of a complex forearm injury inflicted by a wartime mine explosion is presented in this study. Apart from the soft tissue damage, a 4-part fracture of the radius and loss of 19 cm of the ulnar diaphysis were present along with lesions of the median and ulnar nerves. The radial pulse was intact. The first formal treatment of the wounding consisted of extensive soft tissue and bone debridement and external fixation of radius with an additional intramedullary K-wire. After wound closure was obtained, a free vascular fibula grafting of the ulna and corticocancellous bone grafting of the radius were performed. Bone union of both the radius and ulna was subsequently achieved and 9 years after the injury, the patient has full flexion and extension of the elbow, full pronation and 70% of supination. Motion of the wrist is limited because of an ulnar plus variant of the distal radioulnar joint. Hand function is still limited by chronic low-moderate median nerve palsy, but the ulnar nerve has recovered completely. The patient is able to pinch, has full finger extension and can make a fist. He is satisfied that he made the correct decision in not having an initial amputation for his injury.

Adult↗
PubMed1981

Woodsplitter injuries of the hand.

The hydraulic woodsplitter is a new labor-saving tool for woodstove users. A new spectrum of hand injury has been observed in association with its use. Twenty-three such injuries are reviewed. Among these were nine digit amputations, four of which were successfully replanted. There was a surprising preponderance of central digit injury, with border digit sparing due to the dominant role of the central digits in power grip of the log. Both human carelessness and faulty design features were instrumental in the production of injury.

Adolescent↗
PubMed1995

One rectus abdominis muscle for two separated soft-tissue reconstructions.

One rectus abdominis muscle flap, when based on superior and inferior pedicles, can be transferred simultaneously as two free-muscle flaps in two different configurations during the same operation. The two free flaps based on either pedicle are safe, reliable, and extremely well vascularized. Excellent functional and cosmetic results have been achieved in five patients with minimal donor-site morbidity. It has been our flap of choice for reconstructing the moderate- to large-sized defects at two separate sites of the upper and lower extremities.

Abdominal Muscles↗
PubMed1997

Comparison of free and reversed pedicled posterior interosseous cutaneous flaps.

The posterior interosseous cutaneous flap is characterized by its thinness and the adjustable length of its vascular pedicle. This flap can be used both as a free and reversed vascular pedicled flap. We applied the free flap mostly for reconstruction of the digits, and the reversed vascular pedicled flap for soft-tissue defects of the proximal hand. Of 17 free flaps, 16 survived completely, and 1 developed partial necrosis. Eleven flaps were elevated as reversed vascular pedicled flaps, three of which were combined with the lateral arm flap to cover large defects. In these three combined flaps, the posterior radial collateral artery was anastomosed to an artery in the recipient site to enhance circulation; all three flaps survived completely. Operative time was 30 to 40 minutes shorter for the reversed vascular pedicled flaps. Two of the remaining eight reversed vascular pedicled flaps developed partial necrosis. The flap success rate was thus higher in the free flaps than in the reversed vascular pedicled flaps.

Adult↗
PubMed2005

Biceps femoris perforator free flap for upper extremity reconstruction: anatomical study and clinical series.

BACKGROUND: Perforator flaps are an important development in reconstructive surgery. The description of new perforator flaps is an open field in anatomical and surgical research. METHODS: The anatomy of the musculocutaneous perforating vessels of the short head of the biceps femoris muscle was investigated as a possible source for free tissue transfer in 10 fresh specimens. A series of 10 free biceps femoris perforator flaps for upper extremity reconstruction is described. RESULTS: There were three constant sizable perforators, located at 6 cm (range, 5 to 6.5 cm), 11.6 cm (range, 10 to 14 cm), and 15.3 cm (range, 14 to 17 cm), respectively, from the knee joint line. The distalmost perforator was a branch off the superior lateral genicular artery in all anatomical specimens. The middle perforator was a direct branch off the popliteal artery in 60 percent of the cases and off the profunda femoris in the remaining 40 percent. The uppermost perforator was usually a branch off the middle perforator. The flaps of the clinical series were based on the middle perforator (11.6 cm). All 10 free flaps were used for upper extremity trauma coverage, with a 100 percent success rate, although one flap required pedicle revision because of arterial thrombosis and developed partial necrosis. Donor-site delayed wound healing occurred in two patients. CONCLUSIONS: The vascular anatomy is relatively constant. Flap dissection is straightforward under tourniquet control, donor morbidity is low provided a primary closure is possible, and pedicle size is appropriate for repair. When a moderate-size free flap with moderate thickness and a medium-sized pedicle is needed, the biceps femoris perforator flap should be considered in the first-choice group of donor areas.

Adolescent↗
PubMed1993

[Occupational diseases caused by exposure to sensitizing metals].

Diseases caused by occupational exposure to sensitizing metals including platinum (Pt), rhodium (Rh), nickel (Ni), chromium (Cr), cobalt (Co), gold (Au), mercury (Hg), zirconium (Zr) and beryllium (Be) are reviewed. Allergic reactions induced by the metals are described according to the classification by Coombs and Gell. Metals with unproven sensitizing potential are not discussed if reports on these are either very rare or devoid of convincing evidence for allergic involvement. The sensitizing metals are haptens which are not themselves able to act as antigens. There is evidence that combination of the metals with circulating or tissue protein gives rise to new antigens. An alternative hypothesis is that these metals interfere with the antigen recognition step of the immune response. Immunomodulatory effects or immunotoxicity of the metals may be also involved in metal-induced hypersensitivity. Occupational exposure to Pt, Rh, Ni, Cr, and Co causes allergic asthma via type I allergic reaction in which serum from affected individuals shows specific IgE antibodies against mental-human serum albumin conjugates. Some rheumatoid arthritis patients treated with gold salt therapy develop glomerulonephritis, thrombocytopenia, or agranulocytosis, which arise from type II and/or type III allergic reactions. Occupational exposure to mercury causes glomerulonephritis in which involvement of type III reaction is suggested. Type IV hypersensitivity reaction of the skin also takes place following exposure to the metals: allergic contact dermatitis is evoked by exposure to Ni, Cr, Co, Rh, and Hg; cutaneous granuloma is formed by contact with Zr and Be. Be is also a sensitizer of the lungs, resulting in granulomatous disease. Diagnosis of metal-induced allergic diseases is made on the basis of allergological tests with metal antigens including skin tests, radioallergosorbent test for specific antibody, lymphocyte transformation test, macrophage migration inhibition test, and provocation test. Atopy is a predisposing factor and smoking is a risk factor for developing metal-induced asthma. Evidence for genetic factors in the development of metal contact dermatitis is conflicting, although animal models implicate genetic factors in skin sensitization with some metals and respiratory sensitization with Be. Skin irritation, forearm injury, complication with atopic dermatitis and concomitant sensitization to other agents are determinants for prognosis of the dermatitis. Epidemiological reports of occupational diseases from allergic reactions to metals in industries are reviewed with respect to prevalence and allergic manifestations. There is a report on a clinical trial of hyposensitization with Pt in a platinum asthma patient. Predictive methods for evaluating sensitization potential of metals have been developed and new methods, which quantify potential more objectively, are sought.

Allergens↗
PubMed1997

Rock climbing injuries.

Three-quarters of elite and recreational sport climbers will suffer upper extremity injuries. Approximately 60% of these injuries will involve the hand and wrist, the other 40% will be equally divided between the elbow and the shoulder. Most injuries will be tendonopathies secondary to strains, microtrauma or flexor retinacular irritation. However, up to 30% of these injuries in up to 50% of elite climbers will involve the proximal interphalangeal (PIP) region. These injuries are more serious and consist of varying degrees of flexor digitorum sublimis insertional strains, digital fibro-osseous sheath ruptures and PIP joint collateral ligament strains. Early changes in climbing schedules, stretching and exercise habits, and protective digital taping are necessary to protect and rehabilitate these athletes.

Finger Injuries↗