1/204. Myofasciocutaneous expansion in the tegumentary rehabilitation of the amputation stump.In post-traumatic amputations, in particular in leg amputations, the presence of an unstable scar or of ulcerous areas that are difficult to heal in the site of the amputation stump constitutes a repair problem that is not easily solved. In this specific field of reconstruction skin expansion has earned significant agreement, and is even considered to be a safe and reliable method for the surgical rehabilitation of the amputation stump, allowing us to obtain high-quality tegumentary covering, with no excessive thickness, that adapts well to the prosthesis and to the underlying skeleton, and that is characterized by good sensitivity of protection. Tegumentary amplification may, in some cases, also become myocutaneous, allowing us to obtain more tissue thickness for protection in patients submitted to chronic loading that lasts longer and in those with thin teguments, in which traditional expansion could determine excessive narrowing of the tegumentary covering, following atrophy caused by compression of the subcutaneous adipose tissue.- - - - - - - - - - ranking = 1keywords = leg, ulcer (Clic here for more details about this article) |
2/204. Chronic compartment syndrome of the lower leg: a new diagnostic method using near-infrared spectroscopy and a new technique of endoscopic fasciotomy.A 19-year-old female basketball player had chronic compartment syndrome. During basketball playing, she complained of bilateral lower leg pain that disappeared after several minutes of rest. The intracompartmental pressure in the anterior compartment was 41 mm Hg on the right side and 29 mm Hg on the left side immediately after playing. Prolonged ischemia of the anterior compartment was observed in comparison with four normal controls using near-infrared spectroscopy. magnetic resonance imaging also revealed that the anterior compartment was mainly affected. Endoscopic fasciotomy was performed using an arthroscope, a transparent outer tube, and a retrograde blade. After the operation, her symptoms disappeared. Three months postoperatively, the anterior compartment pressure decreased and prolonged tissue ischemia improved. Endoscopic fasciotomy allowed us to cut the fascia safely and less invasively. We concluded that this technique is useful in treating chronic compartment syndrome in the anterior compartment of the lower leg.- - - - - - - - - - ranking = 5.995247428516keywords = leg (Clic here for more details about this article) |
3/204. Muscle hernias of the lower leg: MRI findings.Muscle hernias of the lower leg involving the tibialis anterior, peroneus brevis, and lateral head of the gastrocnemius were found in three different patients. MRI findings allowed recognition of herniated muscle in all cases and identification of fascial defect in two of them. MR imaging findings and the value of dynamic MR imaging is emphasized.- - - - - - - - - - ranking = 4.9960395237633keywords = leg (Clic here for more details about this article) |
4/204. Basosquamous carcinoma after ultraviolet therapy with artificial sunlight.We report a 63-year-old Japanese man with basosquamous carcinoma developing after ultraviolet therapy with artificial sunlight. Because he had had an eczematous lesion on the right leg five years previously, he had received ultraviolet therapy with artificial sunlight from a mercury-quartz lamp for a total of 30 sessions over a 3-year period. physical examination revealed an irregular erythematous plaque measuring 5 x 6 cm, with slight eruptions and erosions, on the right leg. A brownish plaque, measuring 9 x 12 cm, surrounded the erythematous plaque. Histopathologically, in the nests of atypical cells in the dermis, nuclear palisading was present at the edge of each tumor cluster. Adjacent clusters exhibited transitions to squamous cells and contained horn pearls. Most of the cells of the epidermis and adnexa were atypical, but cells of the normal adnexal epithelium extended over the atypical cells of the epidermis in an umbrella-like fashion in other lesions. We believe that, in the present case, artificial sunlight therapy caused solar keratosis and that this developed into basosquamous carcinoma. To our knowledge, skin cancer developing after ultraviolet therapy with artificial sunlight without PUVA has not previously been reported in the English literature.- - - - - - - - - - ranking = 1.9984158095053keywords = leg (Clic here for more details about this article) |
5/204. Amputated lower limbs as a bank of organs for other organ salvage.Aggressive modern technologies have made it possible to attempt limb salvage in even the most extreme cases. However, it is imperative to remember that prolonged salvage attempts may lead to devastating complications. The decision-making is more problematic in patients with bilateral severely injured mangled lower limbs. In such a case, protocols like the MESS are no longer valid because of the implications of bilateral amputation. In these rare cases, we use a multi-team approach and modern micro-surgical reconstructive techniques in attempting to salvage at least one of the lower limbs. We present here our experience in six patients with bilateral mangled lower limbs where an amputated limb was the source of "spare parts" for the salvage of the contralateral limb. In each of the cases, after evaluation and planning, the harvesting of the required tissues (including skin, muscle, bone, nerve and blood vessels) from the amputated leg was performed and simultaneously, a reconstruction of the contralateral severely injured limb was done. These cases emphasize the importance of modern trauma care, not only the ability to treat multiply traumatized patients, but also the capability to execute sophisticated techniques during the acute phase of treatment with maximal cooperation between teams from different disciplines.- - - - - - - - - - ranking = 0.99920790475267keywords = leg (Clic here for more details about this article) |
6/204. Free flap to the arteria peronea magna for lower limb salvage.A 36-year-old woman sustained an amputation of her right leg at the thigh level and a degloving injury of her left foot and ankle region in an accident during a suicide attempt. Primarily, her left foot was covered with a split skin graft, resulting in a soft-tissue defect at the medial malleolus and at the calcaneus bone. Reconstruction was planned with a free latissimus dorsi muscle flap. Preoperative examinations revealed an arteria peronea magna with a hyperplastic peroneal artery solely providing arterial blood supply to the foot. The arteria peronea magna divided into two branches proximal to the upper ankle joint, replacing the dorsal pedis artery and the medial plantar artery. Tibial posterior and tibial anterior arteries were hypoplastic-aplastic. Microvascular end-to-end anastomoses of the flap vessels to the medial branch ("medial plantar artery") of the arteria peronea magna and its concomitant vein at the medial malleolar bone level were successfully performed. The postoperative course was uneventful. Four weeks postoperatively, the patient started walking assisted by a prosthesis on her right thigh stump. This experience demonstrates that even in a case of arteria peronea magna, free flap surgery for lower limb salvage is a reliable and worthwhile method.- - - - - - - - - - ranking = 0.99920790475267keywords = leg (Clic here for more details about this article) |
7/204. Widely split latissimus dorsi muscle flaps for reconstruction of long soft-tissue defects in lower extremities.Although the latissimus dorsi is one of the largest and longest muscles in the human body, it is still sometimes inadequate for reconstruction of a soft-tissue defect of extensive length and dimension. Eight patients with such lower limb defects were treated with latissimus dorsi muscles split into two hemiflaps sequentially linked, one after the other like a chain. Six transfers were completely successful, one required reexploration for arterial occlusion, and two hemiflaps had a partial loss that could be managed by touching up the skin graft. The average split sequential-link muscle was 42 cm in length. Although two patients had a partial loss, we consider that the widely split single latissimus dorsi muscle can still be used reliably to reconstruct a long slender defect, or two separate, longitudinally located, medium-sized defects in the same leg.- - - - - - - - - - ranking = 0.99920790475267keywords = leg (Clic here for more details about this article) |
8/204. Field hospital treatment of blast wounds of the musculoskeletal system during the Yugoslav civil war.The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former yugoslavia was reviewed. patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.- - - - - - - - - - ranking = 0.99920790475267keywords = leg (Clic here for more details about this article) |
9/204. The use of the photoplethysmograph to monitor the training of a cross-leg free flap prior to division.The cross-leg free flap is an important, although rarely used, option in the reconstruction of lower limb trauma. We report the use of photoplethysmography in the assessment of such a flap's training and the time of pedicle division.- - - - - - - - - - ranking = 4.9960395237633keywords = leg (Clic here for more details about this article) |
10/204. Free transfer of expanded parascapular, latissimus dorsi, and expander "capsule" flap for coverage of large lower-extremity soft-tissue defect.The coverage of large soft-tissue defects usually requires a large flap transfer, especially in a combination and expanded form. However, some large soft-tissue defects still cannot be covered by such flaps. In this article, we present a case of a civil war injury in a patient from afghanistan who had severe trauma to the right knee, lower thigh, and upper leg and a marked soft-tissue defect. This large soft-tissue defect was covered with a large combined free flap of the expanded parascapular and latissimus dorsi muscle, including a large retrograde hinge flap of the tissue expander capsule and a complementary skin graft. The defect was covered completely, and the final result was excellent.- - - - - - - - - - ranking = 0.99920790475267keywords = leg (Clic here for more details about this article) |
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