1/5. 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) |
2/5. 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) |
3/5. 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) |
4/5. Crush injuries to the hand and forearm.Crush injuries to the hand and forearm from mechanical devices and heavy equipment are a frequently seen injury in heavily industrialized areas. These injuries are particularly difficult due to their unpredictability, individualized nature and often devastating results. To optimize the outcome for these patients, it is essential to educate the nursing staff on emergent as well as ongoing care, form a systemized plan of care, and recruit patient and family support. A multiskilled group effort will be required to allow the patient with crushed tissue to realize optimal potential and return to a functional position in society.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/5. Two open forearm fractures after airbag deployment during low speed accidents.Automotive airbags effectively mitigate the impact of vehicular collision by absorbing and distributing a force that otherwise would be sustained by the occupants. To be effective, inflation must be instantaneous and sufficient to provide restraint to a moving body. Deployment of automotive airbags is a violent event that may cause injury to the occupants of the vehicle. This report describes two patients with severe, open radius and ulna fractures that were caused by airbag inflation during low velocity motor vehicle accidents. The degree of soft tissue injury and bone comminution in these patients was not fully appreciated until surgery. Orthopaedic surgeons should be aware of the explosive nature of airbag deployment and realize that the injury may be far greater than expected from a low energy motor vehicle accident.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |