1/26. Central dislocation of the hip with complications.A case of severe central fracture-dislocation of the acetabulum is described. This lesion was complicated by a small-bowel rupture and occlusion of the iliac vessels. In order to reduce the dislocation, iliopubic osteotomy and excision of the hip joint capsule was necessary.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/26. The posterior interosseous flap: a review of 81 clinical cases and 100 anatomical dissections--assessment of its indications in reconstruction of hand defects.Based on our experience of 100 cadaveric dissections and a series of 81 clinical cases, we have assessed the indications for the posterior interosseous flap in reconstruction of the hand. Large fasciocutaneous island flaps can be harvested, even when the radial or ulnar pedicles are damaged, sacrificing only vessels of secondary importance to the perfusion of the hand. Compound flaps can be dissected based on muscular, musculoperiosteal and fascioperiosteal branches. The primary indications for using this flap are dorsal hand defects up to the metacarpal joints, reconstruction of the first web space up to the interphalangeal joint of the thumb and extensive lesions on the ulnar border of the hand.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/26. Periarterial sympathectomy salvage of the acutely ischemic hand.A 40-year-old woman involved in a motor vehicle accident presented to the emergency room with signs and symptoms of acute left hand ischemia. The mechanism of injury consisted of a severe crushing component limited to a linear zone across the left hand metacarpals. After patient management, and compartment decompressions and stabilization of fractures, an ischemic state persisted that failed to improve after extensive vessel exploration and bathing in vasodilating solutions. Only after extensive peripheral sympathectomy was appropriate flow re-established to the hand. The need to employ periarterial sympathectomy in the acute trauma setting will occur infrequently, but is a valuable tool to have in mind when flow is not re-established after appropriate less invasive measures have failed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/26. femoral artery thrombosis after open reduction of an acetabular fracture.The increasingly popular ilioinguinal anterior approach for select fractures of the acetabulum provides excellent exposure with minimal soft tissue dissection. Vascular complications reported with this procedure, although infrequent, are usually quite pronounced in their presentation. The authors encountered a more subtle case of femoral artery thrombosis secondary to vessel retraction while using this approach. The susceptibility of major vessels to thrombus formation is noteworthy. The precautions, and the close postoperative monitoring necessary to detect such vascular lesions, are emphasized.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/26. Open reduction and internal fixation of an acetabular fracture during pregnancy.Fractures of the pelvis and acetabulum are common injuries in a mechanized society and frequently occur in the younger age groups. Commonly associated injuries such as hemorrhage, urethral tears, gastrointestinal injuries, and major vessel damage are well reported and well known to orthopaedic surgeons. Another less frequently reported complication of pelvic fractures is the potential association with pregnancy and subsequent childbirth. This problem was first described by Malgaigne in 1857 in his classic article on double vertical fractures of the pelvis, in which he described a 34-year-old woman with a pelvic fracture who subsequently died during childbirth. A review of the literature reveals numerous articles addressing potential problems with parturition subsequent to a pelvic fracture and several articles dealing with pelvic fractures occurring during pregnancy. The current literature on pelvic fractures during pregnancy, however, recommends only nonoperative treatment and, to our knowledge, there have been no reports of operative fixation during pregnancy. The purpose of this article is to report a case of an acetabular fracture in a pregnant woman treated with open reduction and internal fixation, who went on to carry a full-term baby and have a normal delivery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/26. Intrapelvic intrusion of the lumbosacral spine.A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/26. Sonographic intraperitoneal fluid in patients with pelvic fracture: two cases of traumatic intraperitoneal bladder rupture.Two patients who presented to the Emergency Department (ED) in shock with severe pelvic fractures were evaluated for intra-abdominal injury with a focused assessment with sonography in trauma (FAST) examination. Free intraperitoneal fluid was identified in the hepato-renal recess of both patients. At laparotomy both patients were found to have extensive uroperitoneum resulting from intraperitoneal bladder rupture and no other intra-abdominal injuries. The source of shock in both cases was ultimately determined to be arterial hemorrhage from pelvic vessels. The utility of FAST examinations in the setting of major pelvic injury is relatively unstudied. Coincident injuries make the evaluation for source of hemorrhage in this subset of patients challenging. This is a report of sonographic intraperitoneal fluid in the setting of major pelvic injury and hemodynamic instability found to be uroperitoneum and not hemoperitoneum.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/26. Use of an inferiorly based rectus muscle flap in flank wound coverage.An inferiorly based rectus island flap was used to repair a large infected hip wound resulting from treatment of a posteriorly dislocated-comminuted acetabular fracture. The muscle island flap (based on the inferior epigastric vessels) allowed an extended arc of rotation to cover this laterally located wound.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/26. Extended trapezius myocutaneous free flap for the reconstruction of a foot defect lacking adjacent recipient vessels.foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved.- - - - - - - - - - ranking = 8keywords = vessel (Clic here for more details about this article) |
10/26. Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels.Functional and esthetic reconstruction of the bony and tendinous structures with a stable, sensate soft tissue integument after complex posttraumatic defects of the heel is demanding. Cases are rare in the literature and hardly comparable due to their heterogeneity. The reconstructive approach has to consider both patient profile and the reconstructive tree, with free microvascular flaps playing a primary role. The goals are the reconstruction of both osteotendinous structures and slender soft tissue lining for proper shoe fitting for ambulation and mechanical and thermal protection. The flap should be sensate in weightbearing areas to optimize gait and to prevent long-term complications by ulcers. The osteofasciocutaneous deep inferior circumflex artery (DCIA) flap is especially suitable for complex heel defects with subtotal or total loss of the calcaneal bone as all components (iliac bone, groin skin, and fascia lata) can have a wide range of size and shape. We operated on 2 cases with this variable composite flap. One patient had a complete heel defect by war shrapnel. The complete calcaneus, soft heel, and achilles tendon were reconstructed. The second patient had an empty os calcis after a comminuted fracture and a lateral crush-induced soft tissue defect. In both patients, a stable wound closure, osseous integration, and weightbearing ambulation could be achieved.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
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