1/5. Local muscle flap in a venous hypertensive environment.Local rotation muscle flaps are useful for soft tissue reconstruction in open grade III fractures of the lower extremity. Gastrocnemius or soleus muscle flaps provide early bone coverage and avoid a more demanding free tissue transfer. Deep vein thrombosis is common in injured limbs and venous hypertension may result in acute muscle flap necrosis. Loss of bone coverage and an increased risk of osteomyelitis follow. We present a successful soleus rotation flap for tibial coverage in a lower extremity with a documented major venous thrombosis.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/5. Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. Secondary orbital and facial reconstruction used available bone fragments and iliac bone graft in one patient and vascularized free tissue transfer in the other. In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
3/5. Global reconstruction of type IIIA open comminuted femoral shaft fracture with segmental bone loss in an 11-year-old girl.An 11-year-old girl with type IIIA open fracture of the femoral shaft and 4.5 cm bone loss, was treated by global reconstruction using a reamed, interlocking, intramedullary titanium nail, following meticulous primary debridement with pulsed lavage irrigation. The nail entry was carefully chosen at the lateral transtrochanteric point in order to avoid any vascular damage to the head of femur. The osteophilic nature of the titanium nail, in addition to the thick periosteum of the paediatric bone, helped satisfactory union despite a hostile environment. The child had 0-90 degrees flexion of the knee without any extensor lag at the last follow-up. To our knowledge, this is the first case described in the literature that proves the efficacy of nailing for such a fracture.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
4/5. Importunate fractures.The treatment of compound fractures has been discussed extensively in the literature. Little has been written, however, about the closed fracture that compounds in the hospital environment. This paper discusses three cases of importunate fracture, with skin breakdown and exposed fracture fragments, and their treatment with tobramycin beads (and in two cases, external fixateurs).- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
5/5. Antibiotic impregnated beads in open fractures. A report on the technique and possible applications in military surgery.The use of antibiotic impregnated beads has been shown to be a valuable adjunct in the prevention of infection in open fractures. The bead pouch technique employs these beads within the wound, producing high local levels of antibiotic in a moist environment. This effectively inhibits bacterial colonisation and wound infection whilst preventing desiccation of structures such as bone and tendons. This technique can be used to manage wounds until soft tissue cover is obtained, whether by delayed primary suture or by plastic surgical means. The potential use in acute military surgery includes the management of wounds associated with fractures, damage to tendons or neuro-vascular injury. In such cases delay in soft tissue cover may be clinically necessary or dictated by casualty evacuation to rearward surgical facilities. The bead pouch technique offers a means of managing the wound between initial wound surgery and soft tissue cover.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |