1/112. erectile dysfunction caused by sacral gun-shot injury.A 22-year-old man suffering from isolated erectile dysfunction associated with damage to the right spinal nerve S2 caused by sacral gun-shot injury. He has no loss of bladder innervation. Treatment has been implantation of a penile prosthesis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/112. Neurotologic evaluation of facial nerve paralysis caused by gunshot wounds.facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck. We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis--including direct injury, compression, fracture, and concussion of the temporal bone--were demonstrated by audiologic, radiologic, and surgical findings. hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.- - - - - - - - - - ranking = 11keywords = nerve (Clic here for more details about this article) |
3/112. Digital nerve repair by autogenous vein graft in high-velocity gunshot wounds.Gunshot wounds to the hands are high-energy injuries that cause widespread tissue damage, including to the nerves. Great difficulty is encountered in later reconstruction with nerve grafting of gaps in these destructive and scarred wounds. We present our experience with three patients with digital nerve repair by autogenous vein graft performed at an early stage in this type of injury. Based on our experience and that of others, this simple and rapid technique suggests a high rate of satisfactory results. It also avoids extensive and destructive late dissection and the morbidity associated with other late reconstructive procedures.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
4/112. Experience with regional flaps in the comprehensive treatment of maxillofacial soft-tissue injuries in war victims.This article presents our experience with regional flaps in the treatment of facial soft-tissue defects and deformities in 33 patients with various facial injuries from warfare during the period from 1986 to 1999. Thirty-two males and 1 female aged between 8 and 53 years (mean 24.18 years) were treated with facial soft-tissue injuries from high velocity projectiles and varying degrees of associated hard-tissue injuries. Bullets were the most common cause (70%), followed by injuries from shrapnel (21%), land mines (6%), and breech blocks (3%). The perioral region was involved in 15 cases (45%), the midface and cheeks were involved in 13 cases (39%), and the periorbital area was involved in 5 cases (15%). All soft-tissue injuries were treated primarily by debridement and primary closure and by combining, modifying, and tailoring standard regional flap techniques to fit the location of the injury and compensate for the extent of tissue loss. These procedures consisted basically of local-advancement or rotation-advancement flaps, used in conjunction with pedicled fat or subcutaneous supporting flaps, nasolabial, cheek, cervical, Dieffenbach, and Abbe-type flaps. Scar revision, tissue repositioning, and lengthening procedures, such as W, V-Y, Z, or multiple Z-plasty techniques were also used both primarily and secondarily. Revisions and secondary operations were done in 48% of the patients. Initial healing of the flaps was favourable in 76% of the patients. Postoperative discharge from the suture sites was seen in 24% of the patients, but this usually resolved within several weeks using daily irrigation, and these cases underwent scar revision subsequently. None of the soft-tissue flaps sloughed or developed necrosis. Form and function of the soft-tissue reconstructed regions usually recovered within one year postoperatively. The aesthetic results obtained were favourable. None required facial nerve grafting as only the terminal branches were injured in our cases and functional recovery was acceptable. Application of local tissue transfer procedures in our series of facial warfare injuries yielded acceptable tissue form, texture, and colour match, especially when these procedures were used in combination, and tailored to surgically fit the individual case. Moreover, application of these procedures is relatively easy and postoperative morbidity is limited, provided the general condition of the patient is stable, and the surgical techniques used have good indications and flap principles.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/112. brachial plexus gunshot injury in an infant.We present the case of an infant with a gunshot lesion in the brachial plexus. Intraoperative nerve action potential recordings suggested posterior cord neurolysis and medial and lateral cord grafting. After 3 years' follow-up complete recovery of motor and sensory function was seen as a result of immense nerve regeneration capability and brain plasticity. According to our knowledge this is the first reported case of such a mechanism of injury in an infant.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
6/112. Penetrating missile injuries of the brachial plexus.We studied a consecutive series of 58 patients with penetrating missile injuries of the brachial plexus to establish the indications for exploration and review the results of operation. At a mean of 17 weeks after the initial injury, 51 patients were operated on for known or suspected vascular injury (16), severe persistent pain (35) or complete loss of function in the distribution of one or more elements of the brachial plexus (51). Repair of the nerve and vascular lesions abolished, or significantly relieved, severe pain in 33 patients (94%). Of the 36 patients who underwent nerve graft of one or more elements of the plexus, good or useful results were obtained in 26 (72%). Poor results were observed after repairs of the medial cord and ulnar nerve, and in patients with associated injury of the spinal cord. Neurolysis of lesions in continuity produced good or useful results in 21 of 23 patients (91%). We consider that a vigorous approach is justified in the treatment of penetrating missile injury of the brachial plexus. Primary intervention is mandatory when there is evidence of a vascular lesion. Worthwhile results can be achieved with early secondary intervention in patients with debilitating pain, failure to progress and progression of the lesion while under observation. There is cause for optimism in nerve repair, particularly of the roots C5, C6 and C7 and of the lateral and posterior cords, but the prognosis for complete lesions of the plexus associated with damage to the cervical spinal cord is particularly poor.- - - - - - - - - - ranking = 4keywords = nerve (Clic here for more details about this article) |
7/112. A large bullet in the bladder.All manner of foreign bodies have been extracted from the bladder. Introduction into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Extraction should be tailored according to the nature of the foreign body and should minimise bladder and urethral trauma. We report a case of a bullet injury to the bladder, which finally presented as a gross hematuria after remaining asymptomatic for four years. We present here an alternative to suprapubic cystostomy with a large bladder foreign body treated via a combined transurethral unroofing followed by removal using a grasper passed through a suprapubic laparoscopic port.- - - - - - - - - - ranking = 0.13605059516519keywords = organ (Clic here for more details about this article) |
8/112. Sensory and motor function impairment after brachial plexuscord compression by a pedicled latissimus dorsi flap.A case of neuropraxia of the sensory and motor nerve fibres of the brachial plexus is reported after successful transfer of an ipsilateral pedicled myocutaneous latissimus dorsi flap to reconstruct a large-volume tissue defect in the neck resulting from a shotgun injury.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/112. Primary and secondary microvascular reconstruction of the upper extremity.Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
10/112. Primary one-stage reconstruction of cheek defect after a shotgun blast to the face: use of the latissimus dorsi musculocutaneous free flap for soft-tissue repair and facial reanimation.The authors describe a case of a shotgun blast injury to the face in which early definitive repair of both facial soft tissues and facial reanimation was accomplished in one stage using a free flap. The trauma occurred 2 days before presentation via a hunting rifle fired at a short range. On examination, a 8 x 5-cm cheek defect was evident, involving the full thickness of the perioral facial mimetic muscles as well. A free latissimus dorsi musculocutaneous flap was transferred to the defect, with the thoracodorsal nerve coapted to an ipsilateral, severed buccal branch of the facial nerve. Postoperatively, the flap survived completely, with its skin paddle excised subsequently in two stages. Good muscle movement was obtained, providing resting symmetry and a pleasant smile. Other than soft-tissue and bony defects resulting from shotgun injuries, ablation of the facial nerve or facial mimetic muscles may be an important component of the defect that needs further consideration. The authors conclude that the current technique of one-stage, early definitive repair of soft tissues and facial reanimation in such cases of facial shotgun blast injury offers the advantages of achieving both goals with one flap and accomplishing the procedure primarily in one stage.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
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