RESUMO
We treated 37 patients with chronic osteomyelitis of the tibia (25), femur (9), radius (2) and humerus (1) by a two-stage technique, comprising radical debridement of all infected bone and soft tissue with the provision of soft-tissue cover, and delayed autogenous bone grafting when necessary. All patients were reviewed at an average of 49 months (12 to 121). Infection-free bone union was achieved in 34. No patient required amputation. Wide excision of all compromised tissue and the closure of bone within a healthy vascularised soft-tissue envelope are essential if infection is to be eradicated. The combined assessment and management of such patients by an orthopaedic surgeon and a plastic surgeon are advocated.
Assuntos
Transplante Ósseo , Desbridamento , Osteomielite/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Transplante Ósseo/métodos , Quimioterapia Adjuvante , Doença Crônica , Desbridamento/métodos , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Recidiva , Retalhos Cirúrgicos/métodosRESUMO
There is good evidence of the benefit of transferring vascularized muscle into wounds that are contaminated or have been infected previously. This benefit particularly applies in cavities around bones and joints. We present two patients in whom the inclusion of a portion of muscle in the lateral arm and radial forearm flaps allowed the effective combination of good-quality skin cover with the properties of vascularized muscle.
Assuntos
Músculos/transplante , Retalhos Cirúrgicos/métodos , Adulto , Idoso , Braço/cirurgia , Antebraço/cirurgia , Humanos , Masculino , Músculos/irrigação sanguíneaRESUMO
A first dorsal metacarpal artery island flap from the index finger was used in 20 cases for reconstruction of defects in the hand. In six cases it was used as a neurovascular flap for sensory resurfacing of the thumb and in five cases for release of a contracted first web. One flap underwent necrosis and there was a complication in one donor site.
Assuntos
Traumatismos da Mão/cirurgia , Retalhos Cirúrgicos , Polegar/cirurgia , Adulto , Idoso , Dedos , Dermatoses da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Cutânea/cirurgia , Polegar/lesõesRESUMO
Four methods of exsanguination of the upper limb during hand surgery were compared by a randomised blind trial in one hundred patients. Exsanguination by a method of hand-over-hand compression proved ideal in 92% of cases. The advantages of this technique are discussed.
Assuntos
Braço/irrigação sanguínea , Mãos/cirurgia , Torniquetes , Hemostasia Cirúrgica , Humanos , Cuidados Intraoperatórios , Pressão , Distribuição Aleatória , Fluxo Sanguíneo RegionalRESUMO
We describe a V-Y palmar flap that allows both skin advancement and scar lengthening, and which has proved useful in the treatment of Dupuytren's disease.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Contratura de Dupuytren/cirurgia , Mãos/cirurgia , Retalhos Cirúrgicos , Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/cirurgia , Cicatriz/prevenção & controle , Mãos/irrigação sanguínea , Humanos , Pele/irrigação sanguínea , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/patologia , Infecção da Ferida Cirúrgica/etiologiaRESUMO
In a prospective study, 114 patients with 138 zone 2 flexor tendon injuries were treated over a three-year period. Early active mobilisation of the injured fingers was commenced within 48 hours of surgery. 98 patients (86%) were reviewed at least six months after operation. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion recovered was graded excellent or good in 77% of digits, fair in 14% and poor in 9%. Dehisence of the repair occurred in 11 digits (9.4%) and in these an immediate re-repair followed by a similar programme of early active mobilisation resulted in an excellent or good outcome in seven digits.
Assuntos
Deambulação Precoce , Traumatismos dos Dedos/reabilitação , Traumatismos da Mão/reabilitação , Traumatismos dos Tendões/reabilitação , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Traumatismos dos Dedos/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traumatismos dos Tendões/cirurgiaRESUMO
We present the results of fresh cadaver hand dissections and dye injection studies to help in raising a vascularized bone graft from the index or middle metacarpals based on the second dorsal metacarpal artery. This vascularized bone graft could be used for treating nonunion of the scaphoid and other carpal bones.
Assuntos
Transplante Ósseo , Metacarpo/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Cadáver , HumanosRESUMO
We reviewed 34 patients with 65 zone 2 flexor tendon injuries in 39 digits whose outcome had been prospectively studied in an earlier investigation at a mean of 10.6 years after repair. Grip strength was assessed using a Jamar dynamometer. Outcome of grip strength in relation to normal data indicated an excellent or good outcome in 94% of patients, fair in 3% and poor in 3%. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion was graded as excellent or good in 75% of digits, fair in 15% and poor in 10%. These results compare favourably with those of the original study with 5/39 of digits showing an improvement from good to excellent. Sixteen of the 34 of patients continued to suffer from cold sensitivity.
Assuntos
Terapia por Exercício , Traumatismos dos Dedos/reabilitação , Traumatismos dos Tendões , Traumatismos dos Tendões/reabilitação , Adolescente , Adulto , Idoso , Temperatura Baixa , Feminino , Traumatismos dos Dedos/fisiopatologia , Articulações dos Dedos/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Traumatismos dos Tendões/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
A case of florid reactive periostitis of the thumb is presented. This is a rare pseudosarcomatous lesion which generally has a benign radiographic appearance, but on histology it may be mistaken for a malignant process. The clinical behaviour may simulate a malignant tumour but after local excision there is very little propensity for recurrence. Local resection is the recommended treatment. Surgeons and pathologists should consider the possibility of florid reactive periostitis before making a diagnosis of sarcoma in the hand.
Assuntos
Periostite , Polegar , Humanos , Masculino , Pessoa de Meia-Idade , Periostite/diagnóstico por imagem , Periostite/patologia , Radiografia , Polegar/diagnóstico por imagem , Polegar/patologiaRESUMO
A case is presented in which a scalp island flap in an elderly bald male was used for intraoral reconstruction following tumour excision. The flap was based on the posterior branch of the superficial temporal vessels as its arteriovenous system. This flap when available has advantages over other flaps described for intra-oral reconstruction.
Assuntos
Boca/cirurgia , Couro Cabeludo/transplante , Retalhos Cirúrgicos , Artérias Temporais/transplante , Idoso , Humanos , Masculino , Neoplasias Bucais/cirurgiaRESUMO
The radial forearm flap derives its blood supply from the radial artery. Anatomical variations of this vessel are uncommon. This report describes an anomaly which has relevance for the radial forearm flap.
Assuntos
Artérias/anormalidades , Antebraço/irrigação sanguínea , Retalhos Cirúrgicos , Adolescente , Pé/cirurgia , Humanos , Masculino , MétodosRESUMO
Three clinical cases are presented to illustrate the usefulness of the radial artery forearm flap in the repair of defects over the elbow joint. Incorporation of a segment of vascularized muscle may be indicated where intra-articular infection is present. The secondary defect in the distal forearm was covered by split skin graft and was free of problems in each case.
Assuntos
Articulação do Cotovelo/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Antebraço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões no CotoveloRESUMO
During the period December, 1983 to August, 1984, 14 patients were treated for alopecia of the scalp using tissue expansion in the Northern Ireland Plastic and Maxillo-Facial Service. Nine of the defects were due to burns. Representative case reports are presented and the planning of advancement and rotation flaps described. The management and prevention of complications are discussed, and the conclusion drawn that tissue expansion is a valuable technique in the treatment of alopecia, allowing reconstruction of defects previously beyond adequate surgical repair.
Assuntos
Alopecia/cirurgia , Couro Cabeludo/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Alopecia/etiologia , Queimaduras/complicações , Criança , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Próteses e Implantes , Couro Cabeludo/transplanteRESUMO
The clinical applications of the second dorsal metacarpal artery island flap are illustrated by selective case reports from a series of 12 consecutive cases carried out in this Unit. In five cases the flap was transferred as a neurovascular island flap for sensory resurfacing of the thumb. There were no failures and no donor site complications. The anatomy and clinical dissection of the flap are described.
Assuntos
Mãos/cirurgia , Retalhos Cirúrgicos/métodos , Adolescente , Adulto , Artérias/anatomia & histologia , Feminino , Mãos/anatomia & histologia , Mãos/irrigação sanguínea , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tecido Nervoso/transplanteRESUMO
This paper reviews the treatment of 168 open tibial fractures referred to the Northern Ireland Plastic Surgery Service over a 15-year period. Flap reconstruction was carried out in 133 (79%) and split skin graft cover in 22 (13%). There were 18 amputations (11%). There was a high incidence of complications among early post-injury fasciocutaneous flaps and late free flaps. Twenty-five primary free flaps were transferred without complication. The current management of open tibial fractures in this Unit is described.
Assuntos
Fraturas Expostas/cirurgia , Cirurgia Plástica/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vasos Sanguíneos/lesões , Transplante Ósseo/métodos , Criança , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Transplante de Pele , Retalhos Cirúrgicos/métodos , Nervo Tibial/lesõesRESUMO
A sliding fasciocutaneous flap on the medial side of the lower third of the leg is described. Its application in the management of skin defects in this area is illustrated.
Assuntos
Transplante de Pele/métodos , Retalhos Cirúrgicos/métodos , Fraturas da Tíbia/cirurgia , Adulto , Idoso , Fixação de Fratura/métodos , Humanos , MasculinoRESUMO
A series of 23 type III fractures of the tibia in 20 elderly patients (over 60 years of age) presenting for combined plastic and orthopaedic surgical management over a period of 15 years are reviewed. Overall limb salvage was 53 per cent, with an average inpatient duration not significantly different from that for amputation, suggesting that an age of over 60 years is not necessarily a contraindication to attempts at limb salvage in type III injuries.
Assuntos
Fraturas Expostas/cirurgia , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica , Feminino , Fixação de Fratura/métodos , Fraturas Expostas/patologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fraturas da Tíbia/classificação , Fraturas da Tíbia/patologiaRESUMO
The rabbit hind limb has been used extensively as an orthopaedic model in the investigation of fracture pathology and healing and the effects of vascular abnormalities. However, a detailed description of the normal arterial supply appears to be absent from the literature. A study of the entire arterial vasculature has been undertaken using a lead oxide injection technique developed for this and other orthopaedic studies. This technique has proved reliable and inexpensive, giving high-quality arteriography, which is easily interpreted. Accurate description of the arterial anatomy is possible without the need for repeated dissection. The rabbit lower limb shows some interesting variations in blood supply, particularly below the knee. The foot has three distinct patterns of blood supply, depending on the presence or absence of the peroneal artery and the degree of dominance of the dorsalis pedis artery. This arrangement has not previously been described and differs from the situation in other mammals. The arteriographic technique and the anatomical description have allowed the interpretation of changes occurring in the vasculature after injury in a fracture model.
Assuntos
Membro Posterior/irrigação sanguínea , Coelhos/anatomia & histologia , Angiografia , Animais , Artéria Femoral/anatomia & histologia , Membro Posterior/diagnóstico por imagem , Artéria Ilíaca/anatomia & histologia , Artéria Poplítea/anatomia & histologia , Artérias da Tíbia/anatomia & histologiaRESUMO
Seventeen consecutive patients with Grade IIIB open tibial fractures had definitive treatment of both the fracture and soft tissues performed within 72 h of injury. Free tissue transfer was used for cover in each case. There were no cases of deep infection. Flap survival was 100 per cent. The mean time to fracture healing was 10 months, and mean time to walking unaided was 12 months. The average length of stay in hospital was 82 days. The findings suggest that immediate radical debridement followed by adequate soft tissue cover is a safe and effective method for treating these severe injuries.