1/13. The use of the brachioradialis muscle flap for the coverage of burns of the acute elbow joint.Early coverage of deep burns of the elbow is vital to preserving the range of motion. Although various methods are used for coverage of this site, the brachioradialis muscle flap provides good coverage after debridement, with minimal donor site morbidity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/13. Reconstruction of burn scar of the upper extremities with artificial skin.The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the food and Drug Administration, artificial skin (Integra) has been available in taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skin were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental skin turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/13. Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/13. Surgical treatment of distal triceps ruptures.BACKGROUND: Distal triceps tendon ruptures occur rarely, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of treatment of these injuries. The goal of this report was to present our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon ruptures in twenty-two patients. None of the ruptures followed joint replacement. methods: Twenty-three procedures were performed in twenty-two patients with an average age of forty-seven years. The average duration of follow-up was ninety-three months (range, seven to 264 months). Data were obtained by a retrospective review of records and radiographs before and after surgery. Also, thirteen patients returned for follow-up and were examined clinically. Six additional patients responded to a telephone questionnaire. One patient was lost to follow-up, and two had died. Formal biomechanical evaluation of isokinetic strength and isokinetic work was performed in eight patients, at an average of eighty-eight months after surgery. Isokinetic strength data were available from the charts of two additional patients. RESULTS: Ten of the triceps tendon ruptures were initially misdiagnosed. At the time of diagnosis, triceps weakness with a decreased active range of motion was found in most patients, and a palpable defect in the tendon was noted after sixteen ruptures. Operative findings revealed a complete tendon rupture in eight cases and partial injuries in fifteen. Fourteen primary repairs and nine reconstructions of various types were performed. Three of the primary repairs were followed by rerupture. At the time of follow-up, the range of elbow motion averaged 10 degrees to 136 degrees. All but two elbows had a functional range of motion; however, the lack of a functional range in the two elbows was probably due to posttraumatic arthritis and not to the triceps tendon rupture. Triceps strength was noted to be 4/5 or 5/5 on manual testing in all examined subjects. Isokinetic testing of ten patients showed that peak strength was, on the average, 82% of that of the untreated extremity. Testing showed the average endurance of the involved extremity to be 99% of that of the uninvolved arm. The results after repair and reconstruction were comparable, but the patients' recovery was slower after reconstruction. CONCLUSIONS: The diagnosis of distal triceps tendon rupture is often missed when the injury is acute because of swelling and pain. Primary repair of the ruptured tendon is always possible when it is performed within three weeks after the injury. When the diagnosis is in doubt immediately after an injury, the patient should be followed closely and should be reexamined after the swelling and pain have diminished so that treatment can be instituted before the end of this three-week period. Reconstruction of the tendon is a much more complex, challenging procedure, and the postoperative recovery is slower. Thus, we believe that early surgical repair, within three weeks after the injury, is the treatment of choice for distal triceps tendon ruptures. of evidence.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
5/13. Repair of distal biceps tendon rupture with the Biotenodesis screw.BACKGROUND: Distal biceps tendon ruptures are uncommon injuries with only around 300 cases reported in the literature. Current management tends to favour anatomical reinsertion of the tendon into the radial tuberosity, especially in young and active individuals. These injuries are commonly repaired using either a single anterior incision with suture anchors or the Boyd-Anderson dual incision technique. CASE REPORT: We report the use of a bioabsorbable interference screw for the repair of distal biceps tendon rupture using a minimal incision technique. In this technique the avulsed tendon and a bioabsorbable screw are secured in a drill hole on the radial tuberosity using whip stitch and fibre wire sutures according to Biotenodesis system guidelines. CONCLUSION: The technique described requires minimal volar dissection that is associated with a reduced number of synostosis and posterior interosseous nerve injuries. The bioabsorbable interference screw has all the advantages of being biodegradable and has been shown to have greater pullout strength than suture anchors. It is also a reasonable alternative to titanium screws in terms of primary fixation strength. The strong fixation provided allows early active motion and return to previous activities as seen in our case.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/13. One-stage reconstruction of both the biceps brachii and triceps brachii tendons using a free anterolateral thigh flap with a fascial flap.An avulsed elbow with severe degloving and crush injury was reconstructed in a 66-year-old man. The biceps brachii was completely transected, and the triceps brachii tendon was partly transected. In addition, the skin around the elbow had become totally necrotic. Four weeks after the injury, a free anterolateral thigh flap with a fascial flap was transplanted to reconstruct both the biceps brachii and triceps brachii tendons simultaneously. Six months after the initial injury, the range of elbow motion had recovered to almost the same level as that before injury.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/13. The adipofascial turnover flap for elbow coverage.Closure of soft tissue defects in the vicinity of the elbow with exposed bone or joint remains a difficult problem. Local adipofascial turnover flaps covered by a skin graft were successfully used to reconstruct two elbow defects. The flap's base was placed 1.5 to 2.0 cm from the wound edge. The flap-to-base area ratio, which is an important index of flap survival, in addition to the traditional length-to-width ratio were 3.25 and 3.3, respectively. The undermined skin of the flap donor site was preserved rather than discarded as in the conventional deepithelialized turnover flap. The primary benefits of this flap are that it is an easy and rapid one-stage procedure, it requires limited immobilization of the involved joint, and it leaves an inconspicuous donor site scar. The motion of the elbow joint was not impeded because the adiposal component of the flap faced the exposed vital structures. The padding is not thick, but is sufficient to cover and protect the elbow. The flap is especially indicated for small- to medium-sized, complicated elbow wounds.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/13. Emergency free tissue transfer for reconstruction of acute upper extremity wounds.The accepted method of treatment for acute, contaminated, upper extremity wounds is serial debridement and delayed closure. Emergency free tissue transfer challenges these concepts by advocating radical debridement and early closure of these wounds. The use of emergency free tissue transfer in the upper extremity allows early motion and possibly lowers the rates of infection, nonunion, flap failure, and the length of hospital stay. The decision to carry out emergency free tissue transfer is made after evaluating the patient's systemic condition and the following factors: (1) extent of debridement, (2) bacterial load, (3) fracture type, (4) anatomical location of the wound, and (5) presence of exposed vital structures. When conditions are ideal, emergency free tissue transfer may be the best choice for closure of acute, contaminated, upper extremity wounds.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/13. Traumatic segmental bone defects in the upper extremity. Treatment with exposed grafts of corticocancellous bone.We treated twenty-two consecutive patients for an open fracture and segmental loss of bone in the upper extremity by delayed insertion of a graft of iliac corticocancellous bone. All of the wounds were left open and healed by secondary intention. Sixteen patients (nineteen grafts) had long-term follow-up. Ten injuries were secondary to a gunshot wound. The ten patients (twelve grafts) who had an injury to the hand were followed for an average of 24.1 months. No patient in this group had an infection, and all had primary union after an average of 13.3 weeks. Nine had a satisfactory result. The other six patients (seven grafts) had an injury to the arm or forearm and were followed for an average of 30.2 months. There were four non-unions, one refracture, and no persistent infections. The final result was satisfactory in five and unsatisfactory in one patient. Fourteen of the nineteen grafts were inserted within seventeen days after the initial injury. All nine of the grafts in the hand that were inserted early did well, but three of the other five (in the arm or forearm) became infected. The method that was used in the patients who had an open injury of the hand allowed early active motion and quick rehabilitation. The exposed cortical bone was not prone to infection. The technique has limited application in patients who have an open injury of the arm or forearm because of a high incidence of complications.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/13. Comparison of functional results of replantation versus prosthesis in a patient with bilateral arm amputation.Function was evaluated in a 12-year-old girl who had traumatic, bilateral proximal humeral amputation at seven years of age. Unilateral successful replantation was performed with subsequent nerve grafts and tendon transfers to improve function. The contralateral side was fitted early after amputation with a body-powered prosthesis. Subjectively, the patient preferred the replanted side for activities of daily living. The range of motion and strength was better overall on the replanted side. Sensory return, although poor when compared with a normal hand, allowed the patient when blindfolded to identify objects placed in the hand. The replanted arm offers better function than the prosthesis for most activities.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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