1/6. Reverse posterior interosseous flap based on an exteriorized pedicle to cover digital skin defects.The posterior interosseous arterial flap is limited by its short vascular pedicle and proximal axis of rotation to the coverage of defects on the dorsal aspect of the hand and the first web space. The authors present the results of three cases in which these limits were surpassed by extending the wrist and exteriorizing the vascular pedicle, thus causing it to bowstring across the angle created by the extended wrist. When flap inset is complete the vascular pedicle is excised under local anaesthesia. This technique is an amalgamation of an island flap and a traditional pedicle flap and, as such, it is a two-stage procedure.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Fulminant hepatic failure following halothane anaesthesia.The forensic pathologist is responsible for determining the cause, manner and approximate time of death and injury. After recording the detailed description of the external and internal appearances, a short summary should be offered of the major positive findings and their relationship to the cause of death. In many cases this will be obvious, however when the findings are less clear-cut, or are multiple, then the alternatives should be discussed detailing the possible sequence of events and interpreting the findings in concluding the cause of death. It is essential to causally connect the autopsy findings to the cause of death. We present a case report wherein a person who sustained avulsion injury to his left hand in an industrial accident, died due to, fulminant hepatitis, hepatic encephalopathy and acute renal failure, having undergone six operations under general anesthesia with halothane during his stay in the hospital.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
3/6. Continuous brachial plexus blockade. A technique that uses an axillary catheter to allow successful skin grafting.An 82-year-old woman sustained a full thickness burn of her hand. A technique for producing anaesthesia of the brachial plexus via an indwelling catheter is described. Confirmation of the catheter position was obtained by X ray. bupivacaine was infused via the catheter after operation to produce immobilisation of the hand to ensure multiple skin grafts would take. Consequent with this goal was excellent postoperative analgesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/6. tendon transfer in partially anaesthetic hands.stereognosis and sensory localisation were studied in hands of patients with partial anaesthesia due to peripheral nerve injury both before and after tendon transfer to impart movement to the anaesthetic part. One patient showed a marked improvement in stereognosis and localisation, but in general little was gained in terms of improved sensation. Function was improved more in the dominant than in the non-dominant hand. Earlier tendon transfer in cases of peripheral nerve injury might decrease cortical exclusion.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/6. hand injuries caused by high pressure injection. Contribution of loco-regional anaesthesia.In a reported case of accidental high pressure injection of white spirit into a finger, the authors emphasise the great contribution of regional anaesthesia maintained from the initial trauma until the lesions are stable. Trauma to the hand caused by injection of paint or grease solvents results in tissue destruction and later necrosis and fibrosis. Secondary amputations are required in many cases. Regional anaesthesia of the stellate ganglion and brachial plexus produces analgesia and vasodilatation of peripheral arteries by inhibition of the sympathetic tone. This vasodilatation limits the necrotic process and promotes the supply of drugs to the injured tissues. Regional anaesthesia is of great benefit for surgical excision and avoids extended amputation.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
6/6. Bilateral first rib fractures associated with driver's air bag inflation: case report and implications for surgery.A case of bilateral fractures of the first rib occurring in an otherwise fit road traffic accident victim is described. The only other injuries sustained were of the peripheral limbs. The driver's air bag was inflated during the crash, leading to speculation as to whether this may have contributed to the mechanism of injury. The patient was well oxygenated and cardiovascularly stable with no evidence of neurovascular damage to the thoracic aorta or its branches. Aortic arch aortography was not performed before internal fixation of the peripheral fractures was undertaken under general anaesthesia. A review of the indications for angiography in such patients follows. The policy that patients with fractures of the upper first ribs do not require angiography unless there is other evidence of neurovascular damage is supported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |