RESUMEN
PURPOSE: To demonstrate the utility of computed tomography angiographic planning of a single-stage, complete release of syndactyly in Apert syndrome. METHODS: Computed tomography angiograms were performed as a preoperative planning tool in 6 patients. Five came to surgery. All had a single-stage operation for complete release of their syndactyly. RESULTS: Five patients, ranging from Upton type 1 to type 3 Apert hand deformities, have had preoperative computed tomography angiography that delineated the vascular anatomy. This allowed planning and execution of a single-stage syndactyly release in all patients. The preoperative imaging identified noteworthy abnormalities in vascular anatomy that were incorporated into surgical planning. CONCLUSIONS: The protocol presented allows preoperative planning and single-stage operation for complete release of syndactyly in patients with Apert syndrome.
Asunto(s)
Angiografía/métodos , Dedos/anomalías , Procedimientos Ortopédicos/métodos , Sindactilia/diagnóstico por imagen , Sindactilia/cirugía , Acrocefalosindactilia/diagnóstico por imagen , Acrocefalosindactilia/cirugía , Niño , Preescolar , Femenino , Dedos/cirugía , Estudios de Seguimiento , Deformidades Congénitas de la Mano/diagnóstico por imagen , Deformidades Congénitas de la Mano/cirugía , Humanos , Lactante , Masculino , Estudios Retrospectivos , Medición de Riesgo , Muestreo , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe a successful case of sural nerve cable grafting to the leg following a gunshot injury. CLINICAL PRESENTATION AND INTERVENTION: A 28-year-old man was shot at close range, sustaining extensive damage to the left popliteal fossa. Initial exploratory operation revealed a pierced sciatic nerve proximal to its bifurcation into the tibial and common peroneal branches. The 60% division 3.5-cm common peroneal deficit and the complete transection of the tibial division were repaired using an ipsilateral sural cable nerve graft that was not reversed. Initial re-assessment in the clinic setting revealed a denervation atrophy of all 3 leg compartments and paraesthesia below the left knee sparing the sural nerve. After 3 months, the patient had a significant improvement in both power and sensation which was felt to be due to a resolution of a neuropraxic component to the nerve injury. Re-assessment at 9 months and later at 14 months revealed an almost full recovery, suggestive of the success of the nerve grafting procedure. CONCLUSION: This report shows that, given favourable conditions, a good result is possible following use of cable nerve grafting to treat nerve damage from gunshot.