1/21. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/21. Vascular surgery of the upper limb: the first year of a new vascular service.Upper limb vascular reconstruction represents a small part of the vascular surgical workload (5%). The aim of this study was to assess the incidence of upper limb vascular reconstruction in a Regional Hospital. During the first year of a new vascular surgical service in Waterford Regional Hospital, upper limb vascular problems were prospectively analysed. Upper limb vascular reconstruction comprised seven of the total 92 major vascular procedures performed. Three cases were emergencies and four elective. There was one case of penetrating injury, two injuries due to blunt trauma, three patients with thoracic outlet syndrome (TOS) and one chronic ischaemia. The male:female ratio was 4:3 and the mean age was 42 years. Six of the cases were arterial in nature only, and one was both venous and arterial. Two of the cases were associated with upper limb fractures and multiple trauma. Three patients had interposition reversed cephalic vein grafting. One patient had an embolectomy and endarterectomy. Procedures for TOS included excision of a cervical rib in two patients (one bilateral) and scalenectomy alone in one patient. Of these, one patient also had thrombolysis and thrombectomy of the axillary and brachial artery. All of the patients made a good functional recovery and all arteries remained patent but the patient with the brachial plexus injury is awaiting repair abroad. Upper limb vascular problems form a small but significant part (8%) of the workload. Many cases present as emergencies and maybe associated with multiple trauma. This emphasises the need for an emergency vascular surgery service in all trauma units.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
3/21. brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap.Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter. Common complications recorded in literatures are hematoma and muscle atrophy due to a compartment syndrome. We treated a patient with soft tissue avulsion at forearm using free latissimus dorsi muscle transfer for soft tissue coverage in our hospital. Unfortunately during the transfer the patient's brachial plexus was injured. After timely treatment, he recovered completely.- - - - - - - - - - ranking = 6keywords = plexus (Clic here for more details about this article) |
4/21. The random fasciocutaneous flap for upper extremity coverage.Rapid and appropriate healing of any upper extremity wound is essential for preservation of normal hand function. If vascularized tissue must be used, local cutaneous flaps nourished by the multiple perforators to the fasciocutaneous plexus avoid the complexity of microsurgical tissue transfers or prolonged immobilization required for distant pedicled flaps. For small or moderate-sized defects, assuming that adequate adjacent deep fascia has remained intact, these simple, rapidly elevated, so-called random fasciocutaneous flaps deserve initial consideration, as demonstrated in all 11 cases in this reported series.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
5/21. Burn of the elbow: the role of the radial forearm island flap.The coverage of posterior elbow defects after debridement of burns is usually done by skin flaps from adjacent chest or abdomen in a two-stage operation. Other possibilities are local flaps and free-tissue transfer. A proximally based radial forearm flap for the cover of a 5-day-old burn is presented. It is considered to be indicated in large defects of the posterior surface of the elbow, including several centimetres of the triceps tendon.- - - - - - - - - - ranking = 0.0059391946522672keywords = chest (Clic here for more details about this article) |
6/21. Coverage of traumatic chest-wall defect using a fasciocutaneous forearm flap: case report.Complete, stable chest-wall reconstruction was accomplished in a single operative procedure, using a fasciocutaneous free forearm flap based on the brachial artery. This allowed coverage of an extensive chest-wall defect.- - - - - - - - - - ranking = 0.035635167913603keywords = chest (Clic here for more details about this article) |
7/21. Sharp force fatalities: suicide, homicide or accident? A series of 21 cases.Cases at study comprise 21 sharp force fatalities (9 suicides--7 m and 2 f; 8 homicides--5 m and 3 f; 2 accidental deaths--1 m and 1 f; 2 uncertain cases--2 m), examined from 1993 to 2002. suicide age range was 17-75 years, mean 42.4; in seven cases the age was upper 40. Scene of death was at home in six cases, at open place in two, during hospitalisation in one. Incised wounds were pre-eminent in suicides. Homicides showed multiple stab wounds. The two accidents were caused by "glassing". Uncertain cases were a small stab wound to the chest and an eviration.- - - - - - - - - - ranking = 0.0059391946522672keywords = chest (Clic here for more details about this article) |
8/21. Vascularized ulnar nerve graft.ABSTRACT: The purpose of this article is to describe the indications, anatomy, and harvesting technique of vascularized ulnar nerve graft based on the superior ulnar collateral artery (SUCA) for reconstruction of upper extremity function. The ulnar nerve has an extrinsic blood supply consisting of multiple dominant systems: the SUCA, the inferior ulnar collateral artery, the posterior ulnar recurrent artery, and the ulnar artery. The entire length of the ulnar nerve can survive based on the SUCA and its venae comitantes. The vascularized ulnar nerve graft is used when there is a hopeless prognosis for ulnar nerve repair. This technique may be selected if there is a definite evidence of preganglionic injuries of the C8 and T1 roots in brachial plexus injuries. This technique can be recommended for reconstruction of a large defect of the median or radial nerves in selected cases, such as upper arm replantation.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
9/21. amputation stump salvage using a "banked" free-tissue transfer.A free radical forearm flap was salvaged from a nonreplantable amputated extremity and banked on the ipsilateral chest wall. Later, the flap was simply rotated to provide coverage of the proximal humeral stump, eliminating the need for a second microvascular procedure.- - - - - - - - - - ranking = 0.0059391946522672keywords = chest (Clic here for more details about this article) |
10/21. Traumatic scapulothoracic dissociation: case report.A 23-year-old man suffered traumatic scapulothoracic dissociation (TSD) in a car-vs.-bicyclist accident. TSD is a devastating forequarter injury characterized by brachial plexus damage, major upper extremity musculoskeletal disruption, and exsanguinating hemorrhage: our patient survived a hematocrit of 7. Prompt recognition and aggressive management of TSD's multiple injuries are crucial.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
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