Cases reported "Wounds, Penetrating"

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1/9. Use of a venous flap from an amputated part for salvage of an upper extremity injury.

    The authors describe a patient in whom a large arterialized venous flap was harvested from a nonreplantable part after partial hand amputation. A 9 x 6-cm segment of dorsal hand skin was transplanted acutely in an artery-vein-vein fashion to cover exposed bone, joints, and reconstructed tendons. The flap provided durable coverage, and at 1 year the patient regained 94% total active motion at the index finger and 99% total active motion at the long finger. Salvage of component parts such as a venous flap and extensor tendons avoided additional procedures for coverage and staged tendon reconstructions.
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2/9. Delayed hemopericardium following penetrating foreign body into the aorta.

    A four and a half year old girl with delayed appearance of traumatic hemopericardium, detected radiologically despite misleading clinical manifestations, is presented. The presence of cardiomegaly and a needle in the right upper mediastinum on the chest roentgenogram and its partial motion together with diminished cardiac pulsations at fluoroscopy led to angiocardiography. The radiological demonstration of hemopericardium due to the needle penetrating the aortic root, enabled successful surgical intervention.
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3/9. Aeromonas hydrophilia infections after penetrating foot trauma.

    The bacterium aeromonas hydrophila is an anaerobic gram-negative bacillus commonly found in natural bodies of water and can cause infection in patients who suffer water-associated trauma or in immunocompromised hosts. The authors present 5 cases of penetrating wound trauma that did not involve any aquatic environment and developed rapidly forming infections. All patients presented with severe pain, cellulitis, ascending lymphangitis, fever, and pain on range of motion of the joint near the traumatic site. Presentation of clinical symptoms mimicked that of a septic joint or of severe streptococcal infection. All patients required surgical incision and drainage, intravenous and oral antibiotics using levofloxacin or bactrim, and local wound care. Results from cultures taken intraoperatively showed only A hydrophilia in every case. Resolution of symptoms occurred rapidly after surgery, and clinical resolution was seen within 72 hours. Each patient healed uneventfully and returned to preinjury status.
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4/9. Plant thorn synovitis: an uncommon cause of monoarthritis.

    Plant thorn synovitis (PTS) is an uncommon cause of monoarthritis. Seven cases of PTS were identified at our institution from January 1979 to July 1990, six of whom were men. Mean age was 27 years (range, 7 to 56 years). Symptoms included pain, swelling, and stiffness. synovitis was present on examination along with decreased range of motion of affected joints in all patients. Roentgenograms were unremarkable in five patients, but disclosed demineralization in two others. Initial conservative treatment with nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics, or splinting was usually unsuccessful; surgery was necessary in six patients. Findings included marked inflammatory synovial reactions with evidence of retained thorn in all patients. One patient had a positive operative wound culture (enterobacter agglomerans) without evidence of osteomyelitis. All patients improved after surgery without sequelae. Despite a history suggesting thorn injury in many cases, diagnosis was often delayed; mean time to diagnosis was 10 weeks (range, 2 weeks to 9 months). PTS must be included in the differential diagnosis of monoarthritis. Histologically, PTS can mimic sarcoidosis, tuberculosis, or fungal infection. Optimal treatment of PTS is arthrotomy, foreign body removal, and extensive synovectomy.
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5/9. epikeratophakia in children with traumatic cataracts.

    epikeratophakia provides a permanent optical correction for aphakia in children with congenital or traumatic cataracts; suturing the epikeratophakia graft onto the cornea eliminates the problems of contact lens or spectacle non-compliance in these young and generally uncooperative patients and provides tectonic support to scarred and irregular corneas. Eighteen children under the age of six years underwent epikeratophakia for the correction of aphakia after the removal of trauma-induced cataracts. Graft success rate was 88%; the average change in keratometry in the patients with successful grafts was 14.82 /- 2.0 diopters. In the 13 patients eligible for visual acuity tabulation, preoperative acuities ranged from light perception to 20/200, and postoperative acuities ranged from hand motions to 20/30. Ten (77%) had acuities of 20/80 or better. Poor results in three patients with less than 20/200 acuities were likely the results of non-compliance with amblyopia therapy. Present work indicates that in cases of traumatic cataract, the epikeratophakia procedure facilitates amblyopia therapy and decreases the astigmatism in scarred and irregular corneas.
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6/9. Late reconstruction of patellar ligament ruptures using Ilizarov external fixation.

    Chronic patellar ligament ruptures, on which failed reconstruction attempts have been made, cause structural changes in the quadriceps mechanisms with marked fixed proximal migration of the patella. Before reconstruction, the position of the patella must be normalized. When using Ilizarov principles and an Ilizarov external fixator to treat these ruptures, full weightbearing and range of motion can be maintained throughout the pre- and postreconstruction period. This previously unreported technique has been used in 2 patients with chronic patellar ligament ruptures in whom reconstruction attempts had failed. Successful results obtained with this procedure warrant its consideration for this rare but disabling problem.
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7/9. Management of a patient with lacerations of the tendons of the extensor digitorum and extensor indicis muscles to the index finger.

    The purpose of this report is to describe the management of a 30-year-old male truck driver following a zone-VI (metacarpal level) laceration of the tendons of the extensor digitorum and extensor indicis muscles to the index finger. Surgical repair was performed 6 days after the injury and was followed by a 32-day period of short-arm cast immobilization. Physical therapy was begun immediately following cast removal. At about 8 to 10 days into the rehabilitation process, we became concerned about an increasing extensor lag (active extension less than passive extension), which affected the treatment program. We hypothesized that the scar at the tendon repair site had become excessively lengthened, and we therefore discontinued all flexion stretching and emphasized active extension. Additionally, we rested the joint in extension using a static splint except during exercise. As the patient's extensor lag improved, we increased the vigor of active extension exercise to promote tendon gliding and elongate restricting adhesions. The patient regained full range of motion and was able to return to work at full duty. The immobilization period implemented postoperatively in this case represents a traditional, conservative approach. The case emphasizes the need for careful monitoring and interpretation of both active and passive range of motion following tendon repair.
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8/9. Severe penetrating eye trauma caused by fish pick accidents.

    PURPOSE AND methods: The authors describe three cases in which commercial fishermen presented with penetrating ocular injuries from fish picks, which are hand-held, fish-sorting tools with relatively blunt tips designed to partially penetrate fish and expedite handling. Ocular injuries from this tool have not been reported previously. RESULTS: Presenting visual acuity was light perception in two cases and hand motions in one case. Corneal laceration and vitreous hemorrhage were seen in all cases. Initial ultrasound showed no retinal detachment, and all patients underwent primary repair of the corneal laceration. However, within the first 2 months, follow-up ultrasound was suggestive of retinal detachment in all cases, and pars plana vitrectomy was performed. One patient who was found to have a retinal hole but no retinal detachment did well, with a visual acuity of 20/80. Two patients with retinal detachment did poorly, one with a dense epiretinal membrane and the other with a chronic irreparable retinal detachment and extensive subretinal fibrosis. CONCLUSIONS: These injuries differ from fish hook injuries because the instrument is much larger and is blunt in nature, imparting significant energy into the eye. Consequently, patients with these injuries have a much less favorable outcome.
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9/9. Post-traumatic corneal mucormycosis caused by absidia corymbifera.

    OBJECTIVE: The purpose of the study was to report a case of mycotic keratitis caused by the organism absidia corymbifera (class Zygomycetes, order mucorales, family Mucoraceae). DESIGN: Case report. PARTICIPANT: A healthy 37-year-old farmer scratched his left cornea on a galvanized nail while working in his barn. Within 24 hours, an infiltrate in the interior cornea developed that advanced superiorly, reducing the vision to hand motion by the following day. He was treated with topical and systemic antibiotics and antifungal medications, but the infiltrate spread to the adjacent nasal limbus. INTERVENTION: An 11-mm penetrating keratoplasty was performed with an adjacent nasal 7-mm superficial lamellar sclerectomy. MAIN OUTCOME MEASURES: Pathologic examination of the keratoplasty specimen. RESULTS: Corneal cultures grew A. corymbifera. The organisms were identified in tissue sections by light, fluorescent, electron, and immunoelectron microscopy. CONCLUSIONS: The authors believe that this is the first reported case of keratitis caused by an absidia species and, as such, represents an unusual form of mucormycosis in an otherwise healthy individual.
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