1/11. Burn due to misuse of an acetylene gas burner: a case report.A rare case of deep penetrating burn injury caused by misuse of a high-pressure acetylene burner is reported. A 35 year old man was admitted with second and third degree burns involving the right arm cubital area and a subcutaneous burn on his right arm caused by a high-pressure acetylene gas flame. Early surgical debridement and secondary skin grafting using a preserved subcutaneous vascular network skin graft (PSVNSG) proved effective in this patient. skin contracture was prevented and function was recovered. The basis of PSVNSG is that the vascular system existing in the graft is used as a permanent vascular system without degeneration. This case shows that, in this kind of burn injury, subcutaneous tissue damage should be suspected and that it is important to perform surgical debridement early after admission.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/11. Dorsal compartment syndrome of the upper arm. A case report.A rare case of posttraumatic dorsal compartment syndrome of the upper arm is reported. This case was diagnosed by measuring the intracompartmental pressure. The patient was administered local anesthesia and immediately underwent surgery. The result was successful.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/11. Volkmann's ischemia. A volar compartment syndrome of the forearm.In a series of 19 patients with Volkmann's iscemia, 63 per cent had suffered skeletal trauma, whereas 38 per cent had received non-skeletal trauma. Non-specific trauma may trigger an ischemia-edema cycle, producing increased intracompartmental pressure. This cycle, if unrelieved, can involve all of the muscles in the compartment, via cyclic propagation and reinforcement of arterial spasm. The volar compartmental syndrome is not an all or none phenomenon. Localized ischemia may trigger a gradually spreading arterial spasm which results in slowly progressive clinical changes as late as 3-4 months after onset. decompression not only of the compartment but of each individual muscle which shows evidence of vascular compromise, may reverse this destructive cycle even as late as 3-4 months but it should be performed promptly with the onset of symptoms, when its effect is rapid and dramatic. Induration of the compartment is pathognomonic of the compartmental syndrome. As long as it is present, benefit can be expected from decompression procedures. regeneration of necrotic ischemic muscle is possible following restoration of circulation.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/11. Acute compartment syndrome of the upper arm: a report of 2 cases.compartment syndromes of the upper arm are rare clinical entities but can be a serious problem, especially in unconscious patients or those presenting with altered mental status. A high index of suspicion is needed to make an accurate diagnosis. Measuring compartment pressures is helpful, but the role of pressure measurement in the diagnosis and treatment may be secondary to the clinical examination. In patients presenting without histories of trauma, who have sustained long periods of immobilization, a suspicion of a crush syndrome should also be included during the workup of a compartment syndrome. Fasciotomy and debridement of necrotic and nonviable tissue are the treatments of choice for a patient with a compartment syndrome, but initiating medical management and providing medical stability for systemic complications resulting from a crush syndrome may be necessary prior to surgical intervention to prevent organ failure and death. overall, prognosis is improved by early diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/11. Parascapular fasciocutaneous flap for covering an above-elbow amputation stump.The successful use of a parascapular fasciocutaneous flap to cover an above-elbow amputation stump with exposed bone is described. Better stability of the stump to pressure (or manipulations), a relatively early one-stage surgical procedure and diminished possibility of later contracture leads to a better long-term outcome.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/11. Pedicled and "flow-through" venous flaps: clinical applications.Recently, the pedicled venous flap and "flow-through" venous flap have been the focus of increasing attention for skin defects of the fingers and hands. For successful venous flap use, the following approaches have been suggested: (1) a pedicled venous flap with preservation of the draining veins alone; (2) a "flow-through" flap with preservation of a flow-through vein in the flap; and (3) an arterialized "flow-through" venous flap which ensures arterial blood flow into the flap. Based on findings that venous blood is helpful in flap survival, the authors made use of the first two flap types, the pedicled venous flap and the "flow-through" venous flap and attempted to establish and clarify reasonable conditions for flap survival. venous pressure of the finger and elbow was measured and venographies of the finger and hand were also carried out. The following conditions are regarded as essential in successful venous flap procedures: (a) use of a venous flap with a rich venous network; (b) preservation of many "flow-through" veins; (c) harvesting a pedicled venous flap where the veins have afferent (reversed) venous pressure; and (d) anastomosing veins of the "flow-through" flap with recipient veins where high efferent venous pressure exists and differential pressure is observed. Clinical cases are presented and the authors attempt to explain flap failure from previously unknown causes. Conditions for flap harvesting are also discussed.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/11. Arteriovenous shunts in free vascularized tissue transfer for extremity reconstruction.Local vessels are occasionally unsatisfactory donor choices for vascularized tissue transfer in extremity reconstruction. Construction of a temporary arteriovenous loop facilitates not only tension-free anastomoses outside the zone of injury but also affords vascular distention at physiological pressures, an opportunity to verify vein graft patency before tissue transfer, and presumably a decrease in the ischemia time of the vein graft itself. We reviewed the cases of 25 consecutive patients who underwent upper and lower extremity reconstruction facilitated by temporary arteriovenous shunts. In single-stage procedures, greater or lesser saphenous veins were used; the venous end was left in situ in its bed in 17 patients and the entire vein harvested freely in 8. The most common destination was the leg (11), followed by the thigh (7), foot (2), sacrum (2), knee (1), arm (1), and forearm (1). There were three (12%) failures. We conclude that construction of temporary arteriovenous shunts using vein grafts is a productive adjunctive technique in vascularized tissue transfer where additional pedicle length is needed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/11. Pneumatic tourniquet paralysis following intravenous regional analgesia.A case of pneumatic tourniquet paralysis with permanent damage is presented. The importance of relating the cuff pressure to the cuff used, the arterial blood pressure and the shape of the arm is emphasised.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/11. Principles of treatment and indications for surgery in severe multiple trauma.Despite major advances, pitfalls in diagnosis and emergency treatment influence the survival chances of multitraumatized patients considerably. Diagnosis of traumatic shock cannot be made by blood pressure, pulse rate and shock index. Immediate shock therapy is indicated in all cases with severe trauma of two body regions, combined injury of one body cavity and long bone fractures and in all cases with one major thoracic or pelvic injury. In a consecutive series of 418 multitrauma patients, extremity injuries were present in 90%, severe head injuries in 65%, major thoracic trauma in 50% and abdominal or pelvic injuries in 40%. The most frequent pattern of multitrauma was long bone fractures with associated head trauma and one thoracic, abdominal or pelvic injury. Priorities of treatment are based on a 4-stage-schedule: Stage 1 includes intubation and hyperventilation for cerebral trauma, volume replacement by central venous catheter, emergency x-ray of cervical spine, chest, abdomen, pelvis and diagnostic peritoneal lavage. In 25% of admitted cases, diagnosis of abdominal hemorrhage was missed by the referring surgeon despite hemorrhagic shock, falsely attributed to cerebral trauma. At Stage 2, emergency surgery of internal and external bleeding is indicated. Wide open fractures are stabilized by external fixation. Stage 3 is concerned with stabilization of vital systems and further diagnostic evaluation, its duration varying from 2 hours to 2 days. At Stage 4, internal fixation of fractures and other non-emergency-operations are indicated. Operating time can be reduced considerably by 2 surgical teams operating simultaneously or overlapping. Early shock diagnosis, immediate intubation, ventilator treatment and the "4-stages-schedule" are considered the most successful steps in the management of multitrauma, as well as volume replacement with Fox' hypertonic saline solution and blood constituents instead of colloids. This has reduced mortality due to respiratory failure from 31% to 20%.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/11. Elevated compartmental pressures after closure of a forearm burn wound with a skin-stretching device.A case of successful delayed primary closure of an upper extremity electrical blow-out injury is described using an alternative technique. The Sure-Closure skin-stretching device was used for permanent wound closure following serial debridement to protect the radial artery which was exposed over a distance of 21 cm. This method increases the options possible to achieve wound closure. However, the potential risks of this method include potentially high compartment pressures over a prolonged time in the postoperative period which requires close monitoring of limb perfusion.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
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