1/9. Successful replantation following an accidental forearm amputation. Case report and review of the literature.We report a patient who suffered an accidental complete amputation of the right forearm followed by a successful replantation and comment on the indications and management of macro-replantations of the upper limbs. This is the first time that a successful surgical procedure of this nature has been performed in bolivia, with no post-operative complications and excellent long-term functional recovery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. skin grafts for the salvage of degloved below-knee amputation stumps.We present a series of six patients in whom a traumatic below-knee amputation was associated with significant degloving, such that there was inadequate local skin to achieve primary stump closure. In each case, skin grafts were used to cover the stump muscle flaps. The patients ranged in age from 21 years to 73 years; the mean hospital stay was 72 days and the mean follow-up was 48 months. Despite an average of five procedures to achieve stump healing and an average of 118 days to first limb fitting, all patients have achieved independent mobility with their prosthesis. All have had minor stump problems necessitating periods of time off their prosthesis. Three patients have required minor stump-revision surgery. The advantages of a below-knee amputation over an above-knee amputation compensate for these problems. The forgiving nature of modern prostheses has contributed to acceptable results in these patients, who had what may previously have been considered insufficiently durable stump cover.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. replantation of a crush amputation of distal tibia followed by lengthening with Ilizarov circular external fixator: two-year follow-up.A 20-year-old male sustained a severe crush injury to his left leg, resulting in amputation of the foot at the level of the distal tibia. Despite 12-h warm ischemia, replantation was attempted after radical debridement, bone shortening, and proximal fasciotomies. The replanted part survived totally. Four months later, a 13-cm shortness of the extremity was managed by 10-cm lengthening with distraction osteogenesis, using Ilizarov's circular external fixator and by means of a special shoe. Two-year follow-up of the patient revealed acceptable functional and sensorial recovery. Success of replantation despite the excessive warm-ischemia time was attributed to the sparse muscle content of the distal tibia and foot. Fasciotomies performed on the proximal segment of the leg ensured the patency of anastomoses by maintaining adequate blood flow distally despite increasing edema after the crush injury. debridement and bone shortening at the proximal stump eliminated the vein and nerve grafts to bridge the gap. In conclusion, considering the functional outcome of our case, replantation of distal parts of a lower extremity should be attempted first, even if the nature of the injury is unfavorable and the ischemia time is longer than the documented ischemia-tolerance.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. Complications of replantation surgery.Potential complications after replantation surgery are numerous and varied in their nature. The average replantation patient can expect somewhere between two to three subsequent operations to maximize function. Many surgical complications and unsatisfactory functional outcomes can be avoided through careful assessment of patients and their injuries.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/9. Understanding and meeting the needs of farmers with amputations.BACKGROUND: Despite the hazardous nature of the occupation, farmers who sustain serious permanently disabling injuries return to the physical labor of production agriculture. It is estimated that amputations account for 11% of all major farm-related injuries. PURPOSE: This report describes the process of reentry to farm work of farmers across the united states who experienced above-the-wrist traumatic amputations. SAMPLE: Interviews with 16 farmers revealed the unique features of the work and world view of these workers who labor in the fields. FINDINGS: The occupational recovery process included questioning, analyzing, and "getting along." Prostheses and formal rehabilitation programs were viewed as minimally helpful. Suggestions and resources that may be helpful for the orthopaedic nurse to assist this high-risk work group are included.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/9. Fetal limb deformities due to amniotic constrictions (a possible consequence of preceding amniocentesis).The nature and origin of circular constrictions and intrauterine amputations can be studied more effectively in the fetus than in the newborn. Two cases of fetal micro- and syndactyly secondary to ring constrictions are discussed with respect to morphological processes. The amniotic membranes display active chorionic proliferation in addition to amniotic rupture and passive string formation. Moreover, association between the origin of amniotic bands and preceding amniocentesis seems to be possible in one case though it is difficult to ascertain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Management of severe forearm injuries.A review of principles and an operative guideline for repair of severely mutilating injuries to the forearm have been set forth. These concepts and their application have been illustrated in a series of clinical cases. The following key concepts have developed from these clinical experiences: 1. The surgeon must evaluate each case based upon the potential for return of sensation and function. One cannot justify the statement that a replanted arm is always superior to a prosthesis, even if its only purpose is cosmetic. 2. Care must be taken in the emergency room to evaluate the entire patient, and not to ignore other injuries while concentrating on a mangled extremity. 3. The crush-avulsion nature of injuries seen in a large referral center necessitates aggressive debridement of damaged soft tissue and bone. Wounds that have avulsion of skin, muscle, and nerve throughout the length of the arm do not lend themselves to repair. Destruction of an elbow joint generally precludes repair. 4. A well stabilized skeleton is essential before definitive soft tissue repairs can be performed. 5. Vascular repairs are meticulously performed using magnification. All vessels are reconstructed in an effort to recreate the original anatomy. 6. Wide destruction of muscle and tendon is frequent necessitating ingenuity in connecting proximal motor units to distal tendon. After repair, early active motion of the extremity is emphasized. 7. Perhaps the strongest contraindication to reconstruction of a severely damaged upper limb is avulsion of the nerves throughout the length of the forearm. Sharply divided nerves can be repaired by group fascicular suture. Crushed, divided nerves do well with accurate epineural approximation. Crushed nerves with epineural continuity ar best treated by observation and secondary grafting as required. 8. Primary coverage of areas denuded of skin is by split graft of local transposition flaps. More sophisticated techniques may be used at a later time (myocutaneous flaps or free flaps) if further reconstruction is contemplated. 9. Dressing must be carefully applied without constricting the extremity. A protective plaster is applied beginning from above the elbow and ending in a bonnet over the hand; this allows the recovery room nurse to monitor the vascular status of the repair. 10. The physiotherapist and occupational therapist are integrated into the perioperative care. Active range of motion exercises are begun as soon as the third day after the operation. Lightweight static and dynamic splints help to restore mobility.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. Patterns of power mower injuries in children compared with adults and the elderly.Power mower trauma remains an alarmingly frequent cause of serious injury in young children. The patterns of mower-related injuries in children < 15 years old (n = 13) were compared with those of adults aged 15-64 (n = 16) and elderly victims > or = 65 years old (n = 6), who were similarly injured over the past 5 years. Children were more likely to be injured in accidents involving high-energy riding mowers. Of those children injured, 69% (9 of 13) were playing in the yard while 31% (4 of 13) were riding on the mower with a guardian when the injury occurred. Amputations in children were more frequent and more extensive than in the adults and included one forearm, two Symes, and three below-knee amputations. The need for transfusion was also significantly increased in children (62% vs. 6% adults, p < 0.005), who were also more likely to require prolonged hospitalization (11.8 days vs. 5 days in adults, p < 0.005). Aggressive efforts to increase public awareness regarding the cause and nature of power mower injuries are warranted to decrease the incidence of this debilitating but preventable trauma in young children.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. omentum as gliding material after extensive forearm tenolysis.Tendon adhesion occurring after major replantation can be severe and extensive due to the nature of the trauma, ischaemia, prolonged oedema and/or infection. Therefore there is a high possibility of re-adhesion after tenolysis. In two cases of tenolysis after forearm replantation omentum was used as gliding material and good results were obtained.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |