1/135. upper extremity salvage using the tensor fascia lata flap: report of two cases.The tensor fascia lata pedicled flap was successfully used to salvage 3 severely injured upper extremities in 2 patients. Both patients had undergone 3 prior free tissue transfers without complete closure of their wounds. All 3 tensor fascia lata flaps (2 myocutaneous, 1 myofascial) survived entirely. We believe this flap offers a distinct advantage compared with the groin flap when pedicled flap coverage of the upper extremity is required.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/135. Post-traumatic distal nerve entrapment syndrome.Eleven patients with paralysis of muscle groups in the upper or lower extremity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. patients were seen within an average of 8 months after trauma (minimum 3 months and maximum 2 years after). Nerve lesions were caused either by gunshot, motor-vehicle accident, and other direct trauma or, in one case, after tumor excision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on testing over the "classic" (distal) anatomic nerve entrapment sites only. After surgical release through decompression of the nerve compression site distal to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor function (M4/M5) was achieved in 63 percent of all cases. Twenty-five percent had no or only poor improvement in motor function, despite a good sensory recovery. Those patients in whom nerve compression sites were surgically released before 6 months after trauma had an improvement in almost all neural functions, compared to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with subsequent distal nerve compressions is provided, using the "double crush syndrome" hypothesis.- - - - - - - - - - ranking = 0.5292857313964keywords = upper, pain (Clic here for more details about this article) |
3/135. Management of farm-related injuries to the upper extremity.This article familiarizes physicians with common farm equipment that can cause devastating hand injuries. The focus is on farm-related injuries to the hand and stresses the degree of soft tissue injuries, discusses avulsion injuries, and acute management principles. Types of injuries, their pathophysiology, case reports, and treatments also are reviewed. This article also stresses how these injuries differ from the urban trauma patient.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
4/135. 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 = 2.5keywords = upper (Clic here for more details about this article) |
5/135. 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 = 0.5keywords = upper (Clic here for more details about this article) |
6/135. Treatment of painful neuromas: a case report.The authors report a 15-year history of management of multiple recurrent neuromas in a patient with an amputated arm. Various surgical modalities were employed, including burying the nerve ends in muscle and bone. In addition, they also treated successfully one of the neuromas in this patient by capping the transected nerve with an extended autologous vein graft. This application of the extended autologous venous nerve conduit may be a novel alternative in the treatment of this challenging problem.- - - - - - - - - - ranking = 0.11714292558559keywords = pain (Clic here for more details about this article) |
7/135. The voluntary control of motor imagery. Imagined movements in individuals with feigned motor impairment and conversion disorder.The ability to volitionally control motor imagery was investigated by comparing the chronometry of real and imagined movements in a patient (AB) with conversion disorder who presented with paralysis of the left arm and hand and in a patient (MM) with an actual injury to the left arm. Control experiments investigated voluntary control of motor imagery in a group of healthy individuals who feigned a motor impairment with one limb and in one group who were instructed to move carefully and slowly. The visually guided pointing task was used to investigate the speed for accuracy trade-offs that occur as target size is varied for both real and imagined performance. In the healthy individuals, the speed for accuracy trade-off for both real and imagined performance on the motor task conformed to Fitts' law provided both the speed and accuracy of movements was emphasised. In MM, real and imagined performance was also within normal limits despite considerable pain and discomfort. In AB and in subjects feigning a motor impairment, motor task performance with the affected limb was slow and did not conform to Fitts' law. However, although imagined performance with the affected limb was generally slower than with the unaffected limb, it did conform to Fitts' law. These results suggest subjects cannot anticipate the effects of an actual limb injury. Furthermore, while they are able to control the general duration of imagined movements they have little voluntary control over their relative timing.- - - - - - - - - - ranking = 0.029285731396398keywords = pain (Clic here for more details about this article) |
8/135. Combined latissimus dorsi musculocutaneous flap and free superior gluteal artery skin flap.We used a combined superior gluteal artery skin flap and latissimus dorsi musculocutaneous flap to repair a massive tissue defect of the upper limb. This combined flap has several advantages in that the length can be more than 60 cm, it can be used as an auxilliary muscle (latissimus dorsi) and it can also be used as a sensory flap. This combined flap is useful for covering massive skin defects.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
9/135. The platform transfer splint: 2 case reports of a mobility aide for persons with arm injuries or conditions.Limited or impaired mobility is a major obstacle to maximizing length of stay efficiency for inpatient rehabilitation. Trauma patients and others with multiple limb impairments present a mobility challenge to all rehabilitation centers. Of particular concern are patients with forearm fractures who are nonambulatory. With shorter inpatient stays, patients are being discharged home or to other settings with continued weight-bearing restrictions. These patients put great demands on their caregivers as a result of their limited mobility. The Platform Transfer Splint (PTS) has been developed to overcome limitations seen in this patient population. It is an upper extremity splint that allows weight bearing through the humerus for patients with impairments of the forearm or hand. With use of the PTS, patients can become independent in transfers and wheelchair propulsion. Two case studies are presented to show the impact of the PTS on patient mobility and discharge disposition. Fabrication of the splint is also discussed.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
10/135. Clinical outcome following nerve allograft transplantation.The clinical outcome of seven patients who underwent reconstruction of long upper- and lower-extremity peripheral nerve gaps with interposition peripheral nerve allografts is reported. patients were selected for transplantation when the nerve gaps exceeded the length that could be reconstructed with available autograft tissue. Before transplantation, cadaveric allografts were harvested and preserved for 7 days in University of wisconsin Cold Storage Solution at 5 degrees C. In the interim, patients were started on an immunosuppressive regimen consisting of either cyclosporin A or tacrolimus (FK506), azathioprine, and prednisone. immunosuppression was discontinued 6 months after regeneration across the allograft(s) was evident. Six patients demonstrated return of motor function and sensation in the affected limb, and one patient experienced rejection of the allograft secondary to subtherapeutic immunosuppression. In addition to providing the ability to restore nerve continuity in severe extremity injuries, successful nerve allografting protocols have direct applicability to composite tissue transplantation.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
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