[Soft tissue injuries and soft tissue defect in the region of the forehead].
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Child↗
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Acute treatment of penetrating popliteal artery trauma: the importance of soft tissue injury.
During a 20-year period from 1973 to 1992, 109 patients underwent early operation for acute popliteal artery trauma. Clinical variables were analyzed for their association with amputation. Gunshot wounds accounted for the majority of injuries (73%), followed by shotgun wounds (18%), stab wounds (6%), iatrogenic injuries (2%), and lacerations (1%). Fasciotomies were performed selectively in 41% of patients. Seven patients (6%) lost the injured extremity despite arterial repair. The mean time from injury to arterial repair was not significantly different for patients with or without subsequent amputation (8.6 +/- 3.6 and 9.7 +/- 7.4 hours, respectively; p = 0.69). Delay in diagnosis longer than 6 or 12 hours after the injury did not increase the risk of amputation. Other factors not associated with limb loss were preoperative ischemic neurologic deficit or compartmental hypertension, concomitant fracture, and popliteal vein injury. Severe soft tissue injury (p < 0.0001) or postoperative wound sepsis (p < 0.0001) substantially increased the risk of amputation. Delayed fasciotomies were uncommon (4%) but were associated with a significantly increased risk of amputation (p < 0.0001). Vein grafting for arterial repair (p = 0.0017) and shotgun injuries (p < 0.0001) were associated with amputation to the extent that they were related to severe soft tissue injury. The degree of soft tissue trauma and subsequent infection of devitalized tissue limits the success of popliteal arterial repair. Changes in the mechanism of trauma, liberal use of four-compartment fasciotomies, and aggressive management of soft tissue injury resulted in a significant decline in the amputation rate from 21% (4/19) in the first 5 years to 0% (0/39) in the last 5 years of the study.
Adolescent↗
[Fractures. 10. Injuries of soft tissues and combined bone-soft tissue injuries].
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Fracture Fixation, Internal↗
Soft-tissue injury as an indication of child abuse.
We reviewed the hospital records of 371 children who were suspected of having been physically abused. Our purpose was to determine specific features that might be used to distinguish injuries resulting from abuse from accidental injuries. Soft-tissue injuries were found in 341 (92 per cent) of these children. Ecchymoses were most common, accounting for 555 (62 per cent) of 892 soft-tissue injuries, and very few had a suspicious pattern. Only thirty-four (9 per cent) of the children had a radiographically documented fracture, but radiography was performed for only thirty-seven (10 per cent) of the patients and it rarely was done unless a fracture was clinically obvious. The patterns of injury were age-specific. The forty-four children who were nine months old or less had an average of only one soft-tissue injury; thirty soft-tissue injuries involved the head or face, and seven (16 per cent) of the children had a burn. These children were the most severely injured: two (5 per cent) died and twenty (45 per cent) had a fracture. The sixty-one children who were ten months to two years and eleven months old had an average of two soft-tissue injuries; fifty-four soft-tissue injuries involved the head or face, and nine (15 per cent) of the children had a burn. A fracture was found in eight (13 per cent) of these children.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
Management of associated soft-tissue injury.
Initially, soft-tissue injuries associated with vascular trauma require management according to the general surgical principles of wound care. Antimicrobial prophylaxis should be instituted. The mechanism and extent of injury must be determined, and debridement and irrigation should be completed in the operating room with the intent to preserve vital structures, decrease bacterial contamination, and render the wound free of devitalized tissue. Prompt coverage of exposed vascular repairs is vital in order to minimize the chance for infection and to protect the repair from desiccation and subsequent trauma. Early primary closure of heavily contaminated wounds can have disastrous results. Therefore, questionable wounds should be managed by delayed primary closure after repeated irrigation and debridements, with the definitive decision as to the timing of wound closure being based on quantitative cultures. The plastic and reconstructive surgeon can aid the vascular surgeon in the primary or secondary closure of such wounds by bringing healthy, vascularized muscle to cover the vascular repair. Vascularized muscle has proved superior in the coverage and healing of contaminated wounds. If conditions permit, this can be most readily accomplished by transfer of local muscle. Musculocutaneous flaps are of special value in cases that require increased durability or where extended coverage is necessary. With either of these flap techniques, the surgeon must be thoroughly familiar with the anatomy, blood supply, and function of the local muscles. Free-tissue transfer is to be utilized when local tissue is severely damaged in a way that precludes the use of adjacent muscle or myocutaneous flaps. Strict adherence to the principles and techniques of microsurgery, thorough evaluation of the zone of injury and recipient blood vessels, and understanding of the principles governing local muscle transfer are essential for a successful outcome.
Bacterial Infections↗
The radial forearm flap in the management of soft tissue injuries of the hand.
Soft tissue injuries of the hand frequently require flap cover either to preserve structures damaged at the time of injury or to facilitate later reconstruction. Techniques such as the groin flap, the abdominal flap and the cross arm flap require staged procedures and until now, surgeons have had to resort to the more complicated microsurgical techniques required in free flap transfer to obtain soft tissue cover in a single-stage. The radial forearm flap makes local tissue readily available and offers a simple and effective one-stage method of soft tissue reconstruction. Surgery is confined to a single limb permitting early mobilisation and rehabilitation. The vascular anatomy of the radial forearm flap will be described and three cases presented to illustrate this technique in the management of differing soft tissue injuries of the hand.
Adolescent↗
Soft tissue injuries of the neck.
Soft tissue injuries of the neck are a frequent and important cause of disability and as such deserve close attention and concern. Patient management following this injury should not be left to the therapist but instead should be controlled closely by the physician to promote rapid recovery and avoid psychosomatic problems. Despite all methods of treatment there are patients who continue to complain of neck symptoms and others who develop degenerative disk changes in the years after injury.
Accidents, Traffic↗
Managing soft tissue injuries.
The management of soft tissue injuries of the face is best approached in an organized manner. The goal is early functional and cosmetic rehabilitation. The steps to be undertaken should be: initial evaluation, planning, repair and follow-up. Thorough cleansing with minimal debridement, use of fine suture material and early suture removal are some of the important principles.
Dermatologic Surgical Procedures↗
Treatment of mild to moderate pain of acute soft tissue injury: diflunisal vs acetaminophen with codeine.
Acute soft tissue injuries create pain and limitation of function. Treatment requires analgesia and time for full recovery. Acetaminophen with codeine (650 mg plus 60 mg, respectively, every 4 to 6 hours) is used frequently as the analgesic of choice. Diflunisal (1,000 mg initially then 500 mg twice a day) vs acetaminophen with codeine was prospectively studied in the treatment of acute mild to moderate pain from soft tissue injuries. Thirty-five patients with acute strains, sprains, or low back pain were randomized to treatment (17 acetaminophen with codeine vs 18 diflunisal). Both groups were similar in the amount of pain and type of injury at initiation of therapy. Patient pain rating went from 3.3 +/- 0.6 to 1.6 +/- 1.5 for acetaminophen with codeine and from 3.3 +/- 0.6 to 1.3 +/- 1.1 for diflunisal. However, 65 percent of acetaminophen with codeine patients experienced side effects, with 35 percent of these patients stopping the medication because of intolerable side effects. In the diflunisal group, 28 percent of the patients experienced side effects and 5 percent had to stop the medication early. Diflunisal was found to be an effective analgesic in mild to moderate pain of acute soft tissue injuries, and caused fewer and more tolerable side effects than did acetaminophen with codeine.
Acetaminophen↗
[Soft tissue injuries in the area of the hand].
Soft tissue injuries to the hand are always a problem to the surgeon. A thorough examination and a precise preoperative diagnosis are the most important factors regarding forming a treatment concept. Blood supply, sensitivity and additional injuries are especially important parameters. The modern methods of plastic and reconstructive surgery involving tissue transfer and microvascular and even combined reconstruction methods, all offer multiple possibilities for reconstruction--even for problematic soft tissue injuries. The method of determining the urgency (Urgence différée) permits as even to offer patients methods that are normally only useful or successful in the hands of a specialist. Primary treatment can even take place in the first 48-72 h. If adequate operative treatment is performed by a plastic and reconstructive surgeon, the further corrective procedures that are often necessary can often also be avoided.
Amputation, Traumatic↗
Acute soft-tissue injuries in the young athlete.
Although the incidence of soft-tissue injury is high in the young athlete, one must be constantly aware of the tendency toward epiphyseal and apophyseal injuries in individuals with open growth plates. After the diagnosis of a soft-tissue injury (sprain, strain, or contusion) has been made, treatment must include an initial 24- to 48-hour period of RICE. Appropriate splinting may be required. Rehabilitation then proceeds aggressively, with early restoration of strength, flexibility, and joint range of motion. Prior to return to full athletic activity, the athlete should meet the criteria outlined in this article. Protective taping or bracing may be necessary upon return to full activity. The treatment of soft-tissue injuries should start with prophylaxis. All predisposing factors to the development of injury should be sought on preparticipation physical examinations and corrected prior to allowing the young athlete to compete. Using the program described as a guide to treating the injured athlete should result in early return to function with low recurrence rates of injury.
Adolescent↗
Thumb length preservation following soft tissue injuries.
Six cases of major soft-tissue injuries to the mid or base of thumb are presented. In each case, pedicle reconstruction of the soft tissues was necessary in order to preserve thumb length. A variety of techniques was used, including distant tissues and local tissues. We have illustrated the superiority of local pedicles and cross-finger pedicles in thumb reconstruction and have emphasized the following points: 1) Preservation of thumb length is an important goal. 2) Conservation of the soft tissues in the initial management plays a key role in thumb reconstruction. 3) Local pedicles and cross-finger flaps have given better results than distant flaps, as evidenced by: a. better sensory capacity in the pedicle skin; b. more stable skin on the reconstructed thumb; c. less bulkiness of the pedicle skin; d. reconstruction is less time consuming.
Adult↗
A double-blind comparison of mefenamic acid and piroxicam in acute soft tissue injuries.
Thirty patients suffering from strains, sprains or direct soft tissue injuries were entered into a double-blind trial comparing mefenamic acid and piroxicam. Mefenamic acid was given at a dosage of 500 mg 3-times daily and piroxicam as a single daily dose of 20 mg, for a maximum of 10 days. Both drugs were effective in treating the symptoms associated with acute soft tissue injuries. There were statistically significant improvements in all parameters monitored (pain, functional capacity, sleep disturbance, local swelling and tenderness) by Day 2, except for local swelling in the mefenamic acid group and sleep disturbance in the piroxicam group. By Day 5 all parameters showed improvement. Almost all (90%) of the patients had recovered from their injury in less than 1 week. Both drugs were well tolerated, only 5 patients reporting adverse events (3 on mefenamic acid and 2 on piroxicam).
Acute Disease↗
Results of nerve grafting in severe soft tissue injuries.
Nerve grafting was performed in a series of patients, 81% of whom had associated severe soft tissue injuries in the area in which nerve grafting was done. Other factors that have been shown to have an adverse effect on nerve grafting results were analyzed and were not thought to be major factors influencing results. Results were worse than those of previous reports in which the initial injury was less severe. The initial soft tissue injury is very important in predicting how well a nerve graft will function. Nerve grafting is a valuable procedure even in the face of severe soft tissue injuries, since it alone can restore protective sensation.
Acute Disease↗
The pattern and management of traumatic soft tissue injuries of the lower limb.
38 cases of soft tissue injuries of the lower limb seen in the Department of Plastic Surgery, Singapore General Hospital are reviewed. The pattern of soft tissue trauma reveals that the incidence is highest in the young male population between the ages of 20-30 years. Road traffic accidents are the commonest cause of trauma and the pedestrian is the most frequent victim. The commonest site of lower limb involvement is the leg and the majority of the cases of bone exposure following trauma are due to degloving injuries. The reconstructive procedures used include split-skin grafts, cross-leg flap, local transposition flap, muscle transposition flap, dorsalis pedis island flap and free groin flap. Split-skin graft and cross-leg flap procedures accounted for the management of 75% of the cases in this series.
Accidents, Traffic↗
Death due to superficial soft tissue injuries.
A series of deaths due to multiple superficial injuries is reported. These cases represented 5% of a consecutive homicide series in the Northern Territory of Australia. All cases were characterized by extensive superficial injuries, particularly involving soft tissue, which were present over much of the body including the face, head, arms, legs, and trunk. Upper-limb fractures were present in some cases, as were fractured ribs. The internal organs and tissues were pale, but there was either little or no organ damage. No significant volume of free blood was found in any of the body cavities. In one case, fat emboli were identified in moderate numbers in the lung and kidney. Death due to multiple superficial soft tissue injuries has not previously been characterized in the literature.
Adult↗
Complement activation and hematologic, hemodynamic, and respiratory reactions early after soft-tissue injury.
The effect of soft-tissue trauma was studied in dogs. Following injuries to the hind leg an aggregation of thrombocytes in blood and trapping in the lung was noted. Injury was initially followed by leukopenia and later by leukocytosis. Early hemolysis of red cells was observed. The injury was accompanied by complement activation. Its possible relation to hemolysis, leukopenia, thrombocytopenia, and increased insufflation pressure is discussed.
Animals↗
Outcome of tibial shaft fractures with severe soft tissue injury treated by unreamed nailing versus external fixation.
MATERIALS: Between 1987 and 1991, 114 fresh tibial shaft fractures with severe soft tissue injury, which met the inclusion criteria, were treated and retrospectively reviewed. There were 48 cases in the unreamed nail (unreamed tibial nail (UTN)) group and 66 cases in the external fixation (EF) group. METHODS: Soft tissue injury was classified by the Gustilo and Tscherne methods. There were 18 AO type A, 56 type B, and 40 type C fractures. There were no significant difference in fracture type, soft tissue injury, age, and additional injury between the groups. Outcome was assessed using the Karlström score after 28 months. RESULTS: There were a significantly higher number of reoperations in the EF group. Mean time to bony healing was 25.8 weeks. In the EF group, there was a 26% rate of pin tract infection, whereas 19% of cases had bolt breakages in the UTN group. In the UTN group, 40% had good results, compared with 27% in the EF group. In the UTN group, there were significantly fewer ante- and recurvatum deformities of more than five degrees. CONCLUSIONS: Treatment of tibial fractures by UTN, compared with EF, gave a lower reoperation rate and better functional outcome.
External Fixators↗