Closure of the large bilateral soft-tissue defects on the anterior knees surfaces with the use of an island muscle flaps from the gastrocnemius. Case report.
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A case is described of gangrene of the foot and lower leg due to cold injury following exposure to liquid nitrogen. The severe damage to the entire microcirculation was followed by irreversible ischemia finally requiring amputation of the lower leg. Histology revealed conspicuous lesions of the small vessels within the entire soft tissues, with subsequent thrombotic occlusion and circulatory blockade. Some recommendations concerning occupational exposure to liquid nitrogen are added.
A randomized, double-blind study was carried out to assess the prophylactic value of ultraviolet irradiation in the autumn as a means of preventing the development of chilblains on the toes and fingers during the course of the winter. Placebo irradiation was achieved by means of an optical filter which absorbed all ultraviolet radiation from the lamps but allowed the visible light component to be transmitted, thus giving patients the impression that both limbs were being treated. Patients were reviewed at monthly intervals during the winter. The response between patients was variable; some patients developed chilblains whilst others remained symptom free. However, in no patient did the ultraviolet treated limb differ from the untreated limb. We conclude that the ultraviolet phototherapy is of no value in the prophylaxis of chilblains.
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Skin conditions caused by cold temperatures are not uncommon. Recognition is generally easy at a clinical level, but awareness of the much less common underlying disorders is important. Treatment, both physical and pharmacological, is aimed at keeping the body warm and maintaining vasodilation.
Creation of tissue flaps on the basis of retrograde circulation enables mobilization of the tissues which have acquired the possibility of a wide range of peripheral rotation. The course and result of the treatment of extensive ulceration within the region of the tuber calcanei by such a soleus muscle flap have been presented. A good late result was obtained.
A case of chilblains on the face of a man is described. An acute episode of chilblains occurred after a long period of exposure to cold. The unusual site and unusual clinical aspect raised problems of differential clinical diagnosis. Moreover histological diagnosis is easy to perform only after a correct clinical diagnosis has been carried out. For these reasons the literature on chilblains needs to be updated, even though, thanks to impaired living and working conditions, this disease is becoming uncommon.
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Until recently, military personnel have had the greatest risk for cold injuries. During the past two decades, however, destitute persons without adequate clothing or shelter, and sports enthusiasts participating in snowmobiling, mountain climbing, and skiing have been responsible for the increased incidence of cold exposure seen in a large civilian population. Consequently, cold injury remains a crippling problem. Although research is opening new avenues of accurate diagnosis and expeditious treatment, the standard against which these methods must be measured continues to be a rational treatment plan that often prevents the sequelae of cold injuries.
A total of 847 cases of cold injury occurred within the short space of 2 weeks during the Indo-Pakistan conflict in Kashmir in December 1971. The management of these cases and their end results are described. A combination of drugs consisting of low-molecular-weight dextran, an anti-inflammatory agent, and a vasodilator was tried with encouraging results. A conservative attitude towards ablation of necrosed tissues paid good dividends.
Trauma induced soft tissue defects of the heel are likely to develop recurrent ulcerations along with osteitis of the calcaneus even after years of conservative treatment. Biomechanical as well as plastic surgical, traumatological and orthopedical shoe device problems which must be taken into consideration to manage the functional demands, are discussed.
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The free forearm flap is ideal for vascularized tissue transfer because of its large vessels and multiple nerve supply. In the case presented a distally based forearm flap on a long vascular pedicle was employed relying on a reversed blood flow. Unfortunately the reversed venous flow did not develop and therefore in order to provide a venous drainage an autologous vein graft was used.
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