1/24. 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 = 1keywords = pressure (Clic here for more details about this article) |
2/24. Comparison of measures of physiologic stress during treadmill exercise in a patient with 20% lower extremity burn injuries and healthy matched and nonmatched individuals.patients with burn injuries are referred for rehabilitation within days after the injuries to encourage early ambulation and functional training. Many of these patients are hypermetabolic at rest. Metabolic demands of activity are added to the already hypermetabolic state and elevate total energy requirements and some physiologic measures. Reports on the physiologic stress imposed by therapeutic activities for patients with burn injuries are limited to low levels of metabolic demand (< or =2 metabolic equivalents [METS]). The degree of stress imposed by functional activities such as ambulation (3 METS) and stair climbing (5 METS) is not known for adults with burn injuries. The purpose of this study was to report the clinical measures of myocardial and physiologic stress in a patient with 20% lower extremity total body surface area burns during an exercise challenge equivalent to stair climbing. Physiologic measures were assessed before and during a treadmill activity (5 METS) for a 40-year-old obese man 3 weeks after he had lower extremity burn injuries. These measures were compared with mean values for 62 healthy counterparts and 6 healthy subjects matched for age, gender, and fitness level. heart rate, systolic blood pressure, rate pressure product, and the rating of perceived exertion for the patient with burn injuries were higher at baseline and during exercise than the mean values for the 62 healthy individuals and the 6 matched subjects. The steady state exercise values for heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion at 6 minutes were 189 beats per minute, 190 mm Hg, 3591, and 17, respectively, for the patient with burn injuries and were 111.3 beats per minute, 149 mm Hg, 1680, and 11.7, respectively, for the 6 matched subjects. ventilation during exercise also increased for the patient with burn injuries more than for the matched subjects (3/4 vs 1/4). pain experienced by the patient with burn injuries decreased with activity (9.8 vs 7.3 on a 15-cm scale). Treadmill walking produced near maximal responses for most physiologic measures for this patient who was hypermetabolic at rest. We provided normative data to assist therapists who work with patients with similar burn injuries.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/24. Osseous overgrowth after post-traumatic amputation of the lower extremity in childhood.Severe accidents in children may cause extreme destruction of the lower extremities. In some cases, there is no possibility to preserve the limbs. Initially, a weight-bearing stump cannot be achieved after amputation due to unstable local and soft tissue conditions. This critical situation is often complicated by one of the leading problems in the limb-deficient child - the development of osseous overgrowth. Bizarre overgrowth of the stump may lead to skin perforation, pressure ulcers, and difficulties with the prosthesis. Since 1993, we have been able to follow five pediatric and adolescent patients (2 years to 17 years old) with six post-traumatic amputations of the lower extremities. Four of these cases developed osseous overgrowth. One child treated with initial autologous stump-capping had excellent soft tissue conditions and no problems with the artificial limb. We also report on a case of bizarre and extensive new bone formation. We conclude that close follow-up visits after post-traumatic amputations in children are essential because of new bone formation which may endanger the soft tissue situation of the stump. Unfortunately, surgical revisions have to be performed quite often. To avoid several surgical corrections, an initial stump-capping with autologous material from the injured limb can be performed. Thus, the number of secondary procedures may be reduced drastically.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/24. Delayed presentation of superficial femoral artery injury: report of a case.We describe herein a patient who developed serious complications following a penetrating injury to the lower limb. There was minimal evidence of vascular injury on the initial presentation at the hospital; in particular the ankle systolic pressure was normal. Fourteen days following the initial injury, he was found to have a pseudoaneurysm of the superficial femoral artery associated with the arteriovenous fistula in his left thigh. The findings of this case suggest that a high index of suspicion and a careful clinical review is essential if vascular injuries and their complications are not to be missed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/24. Compartmental syndrome and its relation to the crush syndrome: A spectrum of disease. A review of 11 cases of prolonged limb compression.A review of 11 cases of prolonged limb compression usually following drug overdose, revealed a spectrum of disease from isolated compartmental syndromes to full crush syndromes with renal failure. Residual limb contractures were moderate or severe in 80 per cent of the extremities involved. Five of the 11 patients demonstrated significant, systematic manifestations, Stage II or Stage III crush syndrome by our definition. The severity of the systemic manifestations is related to the amount of muscle tissue being subjected to elevated pressure and the length of time this pressure is maintained. Delay in hospitalization, delay in diagnosis, and delay in treatment prolong this period. The diagnosis should be made on the basis of the histroy of prolonged immobilization and the finding of a swollen extremity. Fasciotomy should be performed immediately, both to minimize residual limb contracture and to prevent the crush syndrome from developing secondary to myonecrosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/24. Cross-limb vascular shunting as an auxiliary to major limb revascularisation.A 40-year-old male motorcyclist suffered a near-total amputation of his right foot. His limb was successfully salvaged with the aid of a cross-leg vascular shunt. Temporary arterial flow from the contralateral limb was transmitted via a pressure monitor tube to perfuse the avulsed part. This allowed the surgeon to carry out unhurried wound debridement, dissection of vital structures and skeletal fixation. The cannulation port was placed well distal to the proposed definitive anas<$>tomosis, to reduce damage to the endothelium. This procedure could be a valuable adjunct in major limb replantation, particularly in cases of prolonged ischaemia.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/24. Versatility of the distally based superficial sural flap for reconstruction of lower leg and foot in children.Twenty children are presented after undergoing a distally based superficial sural flap for coverage of defects at the lower leg and foot. The age of the patients was between 1 and 12 years. Fifteen patients had trauma to the lower leg, with eight of them having associated injuries. Three had postburn contracture and two had pressure sore. In 14 cases, the flap was used as a fasciocutaneous flap, whereas in six cases it was used as a fascial flap covered with a skin graft. The flaps were used to cover the defects from the dorsum of the foot distally up to the mid third of tibia proximally. The mean follow-up was for a period of 2 years. Even though free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children, the distally based superficial sural flap has the advantage of being easy to perform, with short operating time, minimal donor side morbidity, and preservation of major arteries of the leg.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/24. Endoscopic evacuation of a hematoma resulting from strain injury of the medial head of the gastrocnemius muscle.Strain of the medial head of the gastrocnemius muscle (GM) is a common injury that can be confirmed by ultrasound (US) or magnetic resonance imaging. We report a case of strain injury of the medial head of the GM, with a hematoma between the soleus muscle and the GM. US revealed an enlarged hypoechoic area between the soleus and the GM. By US-guided puncture, only a small amount of old blood was evacuated. Hence we undertook a surgical approach. It was performed under general endotracheal anesthesia, in the prone position. The most superficial area of hematoma was shown by US. A sharp 4-mm trocar was inserted in the posteromedial side of the calf and the hematoma was partially evacuated by suction. The cavity was washed out with saline solution. The arthroscope was then inserted. A second portal was made laterally and a shaver was inserted under optic control. The inflow pressure was not allowed to exceed 45 mm Hg. The shaver was used to remove blood coagula and fibrin septa that divided the cavity. The fibrous cavity membrane was debrided. By the end of the procedure, the circumference of the leg was reduced by 3 cm and the skin was softer on palpation. The patient was discharged the next day. One week after surgery, US examination revealed only a thin hypoechoic area in place of the previous collection. Two weeks after surgery, he was able to walk painlessly, and at 6 weeks he had regained normal walking activity.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/24. Effect of limb tourniquet on cerebral perfusion pressure in a head-injured patient.Thirty percent of patients with severe head injury also have significant extracranial injuries. Treatment for these injuries should not be allowed to jeopardise the brain which is more susceptible to damage in these circumstances. A case is presented in which significant decrease in cerebral perfusion pressure occurred consequent upon use of a lower limb tourniquet.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
10/24. High-pressure water injury: case report.High-pressure water jets are commonly used for complex industrial cleaning jobs, yet we found few reports of injuries attributed to these potentially dangerous devices. We present a case of severe laceration to the lower extremity caused by a high-pressure water jet with concomitant major vascular injury, apparently the first reported. Principles of evaluation and treatment are reviewed and documented.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
| | Next -> |