1/7. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. Use of an arterialized venous flap for resurfacing a circumferential soft tissue defect of a digit.Circumferential defects of digit are uncommon but present a challenging problem to the clinician. The use of simple skin grafts tends to cause tendon adhesions and can limit digital range of motion. The use of local skin flaps, such as a cross-finger flap, is limited by the considerable skin loss in a defect that is circumferential in nature. Other options have included the use of reversed forearm flap or some free tissue transfer. We report a case in which the circumferential defect of an index finger, measuring 6 cm around the digit and 3 cm long, is resurfaced by the use of a free arterialized venous flap raised from the volar forearm skin.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/7. Late bullet migration into the knee joint.A 25-year-old active-duty police officer was found to have an intra-articular foreign body on radiographic study of his left knee joint. He had a gunshot wound to the midthigh 54 months prior to the presentation of symptoms. The bullet was lodged in the soft tissue without involving neurovascular structures. The patient complained of limited range of motion of the joint and a "rattle" sensation of the knee. Arthroscopically, a deformed metallic foreign body was found and retrieved. There was no injury inside the joint related to the loose body. These findings were consistent with a migrating bullet from the midthigh to the knee joint. The patient recovered uneventfully and returned to work.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. Reverse first dorsal metatarsal artery flap for reconstruction of traumatic defects of dorsal great toe.BACKGROUND: Soft-tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. This study investigates the feasibility and reliability of reverse first dorsal metatarsal artery flap (FDMA) for reconstruction of the dorsal great toe soft-tissue defects. methods: Six male patients with dorsal great toe defects (mean 2.2 x 4.7 cm) underwent reconstruction using the reverse FDMA flap. Preoperative angiography was performed to confirm the existence and patency of the distal communicating artery between the FDMA and plantar metatarsal artery. The flap was raised by dividing the dorsalis pedis artery and proximal communicating arteries and rotated 180 degrees to cover the defect. RESULTS: All flaps survived completely. Mean follow-up time was 3.3 months. Painless full range of motion was recovered and the contour of the flap was satisfactory. All patients returned to their normal walking and running activities and none necessitated special footwear. No donor-site morbidity was encountered. CONCLUSION: Reverse FDMA flap presents a viable alternative for reconstruction of soft-tissue defects of dorsal great toe when local flap coverage is required. Because of anatomic variations, preoperative angiography is necessary for successful reconstruction, especially in patients with comorbidities affecting patency of their vasculature.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/7. Primary arthrodesis of the injured knee: still a solution in 1995? A case report.After major trauma of the knee joint, conservation and reconstruction of the different bony, ligamentary and soft tissue structures is usually attempted. The end results of these reconstructive procedures are not always gratifying, and in many cases significant instability remains, combined with severe restriction in motion, pain or infectious problems, leading to severe functional impairment. Many patients need secondary corrective procedures, such as arthrodesis. We present a case of an unusual injury to the knee with massive destruction, loss, and contamination of bony, ligamentary, and soft tissue structures. Because attempts at reconstruction would have led to the above-mentioned problems, including possible life-threatening septic complications necessitating amputation, a primary arthrodesis was performed, followed by simple reconstruction of the soft tissue envelope. Two years after the accident, the patient is doing very well. To our knowledge, no such cases have previously been described. We therefore want to communicate our experience with this procedure, which led to an early, pain free, and good functional recovery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. Early salvage reconstruction of severe distal radius fractures.During an 8-year period from 1980 through 1988, 9 distal radius fractures could not be restored because of bone loss or extensive comminution and were, therefore, salvaged by early arthrodesis in 7 patients and Swanson silicone wrist arthroplasty in 2. At a mean of 3.7 years, 4 patients rated good, 2 satisfactory, and 3 poor according to a 100-point scoring system based on residual pain, motion, grip strength, and occupational recovery. Irreparable distal radial fractures with damage largely confined to the skeleton achieved satisfactory or good results. Poor results occurred when there was severe soft tissue damage, especially neurovascular injury, despite a successful skeletal reconstruction. When articular restoration could not be accomplished, early arthrodesis or arthroplasty resulted in wrist alignment, stability, and pain control, and optimized the opportunity for digital and upper extremity functional recovery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/7. Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report.This clinical case report demonstrates the clinical effectiveness of a new form of soft tissue mobilization in the treatment of excessive connective tissue fibrosis (scar tissue) around an athlete's injured ankle. The scar tissue was causing the athlete to have pain with activity, pain on palpation of the ankle, decreased range of motion, and loss of function. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, augmented soft tissue mobilization (ASTM) was administered. ASTM is an alternative nonsurgical treatment modality that is being researched at Performance Dynamics (Muncip, IN). ASTM is a process that uses ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis. This is followed by a stretching and strengthening program. Upon the completion of 6 wk of ASTM therapy, the athlete had no pain and had regained full range of motion and function. This case report is an example of how a noninvasive augmented form of soft tissue mobilization (ASTM) demonstrated impressive clinical results in treating a condition caused by connective tissue fibrosis.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |