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We reviewed 43 patients who had sustained soft-tissue injuries of the neck after a mean 10.8 years. Of these, only 12% had recovered completely. Residual symptoms were intrusive in 28% and severe in 12%. Pain in the neck and lower back was the commonest complaint and older patients had a worse prognosis. After two years, symptoms did not alter with further passage of time.
In consequence of "run-over" road accidents of children there has been a marked increase in severe soft tissue injuries. --The prophylaxis of bacterial contamination, the immediate reduction of compound fractures as well as the consequent debridement of devitalized soft tissue are shown to be essential components of the acute traumatic wound care. Primary closure of the wound must not be forced. The definite procedure includes reconstruction of vessels, nerves and last but not least osteosynthesis of fractures. Special attention is given to the fixateur externe, which is getting increasingly important in childhood injuries. The follow-up results of 17 multiple injured children with 3rd-degree open fractures and/or severe soft tissue injuries demonstrate that in childhood the results are generally better than in grown-up patients with corresponding injuries. 80% of the children showed very good results. No osteomyelitis was observed.
While a full understanding of continuing symptoms following a soft tissue hyperextension injury of the cervical spine remains elusive, recent research has shown that the explanation may lie with occult lesions beyond the musculoskeletal structures of the neck. The balance of the roles of injury, psychological factors, and the effects of litigation has shifted towards the former. However this injury would be unique if the latter two played only a minor role in determining recovery. It seems likely that among the large numbers of patients presenting with symptoms after hyperextension soft tissue injuries, a proportion will have occult bone, joint, or intervertebral disc lesions. Improvements in medical imaging techniques may allow better definition of these specific injuries and the development of more appropriate treatment. The search for a central nervous system lesion in humans continues and until this is demonstrated, many will dispute the existence of an organic brain syndrome. Evidence for significant injury to the temporomandibular joints, ear, and ophthalmic system has been found and this may be amenable to specialist intervention. While there is little evidence for effective treatments of the established injury, reduction in related disability appears most likely to be achieved by prevention. Improvements in automobile design, with particular reference to head restraints, could limit the cost to society of this common and disabling injury.
OBJECTIVE: To evaluate the results of a vacuum-assisted closure device in patients presenting with open high-energy soft tissue injuries. DESIGN: Consecutive nonrandomized clinical study. SETTING/PARTICIPANTS: From August 1999 through October 2000, 21 patients, with 21 high-energy soft tissue wounds (6 tibial, 10 ankle, and 5 with wounds of the forearm, elbow, femur, pelvis, and a below-knee stump) were treated with a vacuum-assisted closure device at a Level 1 trauma center. INTERVENTION: A negative atmospheric pressure device used for the management of complex open injuries. Infected wounds had dressings changed every 48 hours, whereas all others had dressings changed every 72 to 96 hours. MAIN OUTCOME MEASUREMENTS: The duration of vacuum-assisted closure use, final wound closure outcome, costs versus standard dressing changes or free flaps, and a list of all complications were recorded. All patients were followed for 6 months postcoverage. RESULTS: Patients averaged 4.1 sponge changes, 77% performed at bedside, with the device used an average of 19.3 days. Twelve wounds (57%) required either no further treatment or a split-thickness skin graft, and 9 (43%) required a free tissue transfer. CONCLUSIONS: The vacuum-assisted closure appears to be a viable adjunct for the treatment of open high-energy injuries. Application can be performed as a bedside procedure but additional soft tissue reconstruction may be needed for definitive coverage. This device does not replace the need for formal debridement of necrotic tissue, but it may avoid the need for a free tissue transfer in some patients with large traumatic wounds.
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To evaluate the release and possible role of N-terminal end of atrial natriuretic factor (ANF) prohormone (proANF-1-30) and C-terminal end of ANF prohormone (aANP-1-28) in patients with soft tissue and bone injuries, 20 patients with soft tissue injuries, 18 bone-fractured patients, and 21 healthy controls were examined. Samples were collected from patients within 24 h after injury. Plasma level of proANF-1-30 and aANP-1-28 were higher in orthopedic patients than the soft tissue injury patients compared to controls (P < 0.005, P<0.05, respectively). proANF-1-30 was over 15-fold greater than aANP-1-28 in the healthy control samples. These data hypothesized that the concentration of proANF-1-30 may be related to tissue damages in man.
A functional rotatory computed tomography (CT) study of 423 whiplash patients with cervical spine soft-tissue injury was undertaken to determine its diagnostic value. The results are correlated with previous CT studies on normal subjects, and an evaluation of paradox motion, in which the lower vertebra rotates more than the vertebra immediately superior to it, is given. Asymmetrical left/right rotation reached the pathological value in 36% of the patient population at the level of C0-1. Twice as many patients had hypermobile rotation to the left as compared with the right, perhaps indicating that the right alar ligament is more often damaged in injuries involving the whiplash mechanism. A higher percentage of pathological values for hypermobile rotation was found at the level of C0-1 than at C1-2. Patients exhibiting paradox rotation had a significantly higher amount of rotation to the contralateral side than did those who exhibited no paradox rotation. These findings validate the use of functional rotatory CT in the evaluation of soft-tissue damage of the upper cervical spine resulting from whiplash injury.
PURPOSE: To compare magnetic resonance imaging (MRI) and X-ray tomography in assessing the type of fracture, degree of comminution and amount of articular surface depression in acute tibial condylar fractures and to describe the associated soft tissue injuries diagnosed with MRI. METHOD: 27 patients with acute tibial plateau fractures were investigated using linear X-ray tomography and MRI employing T1-weighted and proton density turbo spin echo, STIR, and T2-weighted gradient echo images. Fractures were classified according to the AO classification system. The degrees of depression and comminution were measured and soft tissue injuries were recorded. RESULTS: Fractures were classified as type B1 in 7, as B2 in 6, and as B3 in 6 cases by MRI. More complex C-type fractures were diagnosed in 8 cases. MR and X-ray grading were consistent with the exception of two B3 fractures, which were graded as B1 by X-ray tomography. X-ray tomography under-estimated the degree of comminution 63% of the patients had either meniscal tears or complete ruptures of their cruciate or collateral ligaments. Ten meniscal tears were diagnosed in 9 of 27 patients. Complete tears of the anterior cruciate ligament were seen in 4, and avulsions of the posterior cruciate ligament in 2 patients. CONCLUSION: MRI allows a detailed assessment of acute tibial plateau fractures and can replace conventional X-ray tomography. The high rate of fracture-associated soft tissue lesions makes MRI an especially valuable tool.
The management of high-energy extremity trauma has evolved over the past several decades, and appropriate treatment of associated soft-tissue injuries has proved to be an important factor in achieving a satisfactory outcome. Early evaluation of the severely injured extremity is crucial. Severe closed injuries require serial observation of the soft tissues and early skeletal stabilization. Open injuries require early aggressive debridement of the soft tissues followed by skeletal stabilization. Temporary wound dressings should remain in place until definitive soft-tissue coverage has been obtained. Definitive soft-tissue closure will be expedited by serial debridements performed every 48 to 72 hours in a sterile environment. Skeletal union is facilitated by early bone grafting and/or modification of the stabilizing device. Aggressive rehabilitation, includ-ing early social reintegration, are crucial for a good functional outcome. Adherence to protocols is especially beneficial in the management of salvageable severely injured extremities.
The efficacy, tolerability, and acceptability of topical applications of ketoprofen gel (2.5% w/w), piroxicam gel (0.5% w/w), and diclofenac gel (1% w/w), when administered three times daily for 5 days, in the treatment of acute (within 48 hours) soft-tissue injury, were compared in an open-label, randomized, multicenter, general practice study. Of 1575 patients recruited, 1048 received ketoprofen gel (525 used the gel with a dose-measuring device), 263 received piroxicam gel, and 264 received diclofenac gel. Ketoprofen gel was significantly superior to piroxicam gel in terms of global assessment of treatment response (improvement in 74% vs 65% of patients) and the severity of the injury (38% vs 26% "greatly improved") and in improvements in stiffness (71% vs 64%), restriction of mobility (34% vs 22%), and pain on pressure (81% vs 78%) and movement (83% vs 77%). Ketoprofen gel also compared favorably with diclofenac gel, with a larger proportion of patients assessing a great improvement in the injury (38% vs 30%). Patient acceptability of ketoprofen gel was significantly better than piroxicam gel. More patients noted a significant cooling effect with ketoprofen gel (71%) than with either piroxicam gel (49%) or diclofenac gel (60%). Ketoprofen gel also showed excellent tolerability. In conclusion, ketoprofen gel may offer benefits over established therapies for the treatment of acute soft-tissue injury.
Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation than with unreamed nailing. Further advantages of unreamed nailing are the internal treatment of the fracture and the patient's greater comfort. Therefore, unreamed nailing can be recommended for the primary treatment of tibial fractures with severe open or closed soft tissue trauma.
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A double-blind, controlled clinical study with benzydamine hydrochloride 3% cream was conducted in an Occupational Health Centre on fifty patients with soft tissue injuries (two mild, ten moderate and thirteen severe cases in the placebo group and one mild, thirteen moderate and twelve severe cases in the active group). The trial demonstrated the significant therapeutic superiority of 3% benzydamine cream over inactive placebo in all six qualitative parameters for traumatic inflammatory changes at the end of a six-day assessment and a marked improvement of symptoms event two days after the onset of therapy. In addition, tbe incidental use of ultrasound therapy together with the standard treatment revealed the value of the active drug as an effective couplant. Neither group suffered any side-effects. Although the size of population studied was small, it was apparent that active treatment with benzydamine was a distinct aid to healing of soft tissue injuries and this should be confirmed with further large-scale clinical trials.
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Special X-ray pictures taken of soft tissues for the treatment of closed soft tissue injuries on the extremities, give valuable diagnostic advises. Rupture on the surface of muscles, the lesion to the tendon Achilles and the lig. patellae proprium, tumours, muscle waisting following plexus or periferial nerve lesions etc. by X-ray investigation can be exactly delineated and the site, extension and type of damage defined.
Primary treatment of soft tissue hand injuries is most important for further management and progress. It ensures best protection of lower structures. Soft tissue lesions that can not be closed without resulting tensions need instant plastic-surgical therapy. Various possibilities that range from split skin flaps to distant flaps with microvascular anastomosis can be chosen to cover primary as well as secondary soft tissue defects.
This article presents our experience with regional flaps in the treatment of facial soft-tissue defects and deformities in 33 patients with various facial injuries from warfare during the period from 1986 to 1999. Thirty-two males and 1 female aged between 8 and 53 years (mean 24.18 years) were treated with facial soft-tissue injuries from high velocity projectiles and varying degrees of associated hard-tissue injuries. Bullets were the most common cause (70%), followed by injuries from shrapnel (21%), land mines (6%), and breech blocks (3%). The perioral region was involved in 15 cases (45%), the midface and cheeks were involved in 13 cases (39%), and the periorbital area was involved in 5 cases (15%). All soft-tissue injuries were treated primarily by debridement and primary closure and by combining, modifying, and tailoring standard regional flap techniques to fit the location of the injury and compensate for the extent of tissue loss. These procedures consisted basically of local-advancement or rotation-advancement flaps, used in conjunction with pedicled fat or subcutaneous supporting flaps, nasolabial, cheek, cervical, Dieffenbach, and Abbe-type flaps. Scar revision, tissue repositioning, and lengthening procedures, such as W, V-Y, Z, or multiple Z-plasty techniques were also used both primarily and secondarily. Revisions and secondary operations were done in 48% of the patients. Initial healing of the flaps was favourable in 76% of the patients. Postoperative discharge from the suture sites was seen in 24% of the patients, but this usually resolved within several weeks using daily irrigation, and these cases underwent scar revision subsequently. None of the soft-tissue flaps sloughed or developed necrosis. Form and function of the soft-tissue reconstructed regions usually recovered within one year postoperatively. The aesthetic results obtained were favourable. None required facial nerve grafting as only the terminal branches were injured in our cases and functional recovery was acceptable. Application of local tissue transfer procedures in our series of facial warfare injuries yielded acceptable tissue form, texture, and colour match, especially when these procedures were used in combination, and tailored to surgically fit the individual case. Moreover, application of these procedures is relatively easy and postoperative morbidity is limited, provided the general condition of the patient is stable, and the surgical techniques used have good indications and flap principles.