RESUMO
The article is dedicated to one of the currently important problems of present-day traumatology and angiosurgery, i. e. possibility of performing primary reconstructive operations in children with complete and incomplete amputations, open and closed bone fractures in the conditions of circulatory impairment. The authors share their experience in treatment of 92 patients presenting with such injuries, describing the main indications for carrying out repair operations, and drawing appropriate conclusions. The main stages of reconstructions are demonstrated by a series of clinical examples.
Assuntos
Amputação Traumática , Fixação Interna de Fraturas/métodos , Salvamento de Membro/métodos , Procedimentos Neurocirúrgicos/métodos , Reimplante/métodos , Extremidade Superior , Procedimentos Cirúrgicos Vasculares/métodos , Amputação Traumática/diagnóstico , Amputação Traumática/fisiopatologia , Amputação Traumática/cirurgia , Angiografia/métodos , Criança , Feminino , Humanos , Masculino , Índices de Gravidade do Trauma , Resultado do Tratamento , Extremidade Superior/lesões , Extremidade Superior/cirurgiaRESUMO
The paper deals with the principles of management of combined mechanical injuries to the upper extremities with special reference to amputation of their segments based on the 3-year experience with the treatment of 1488 patients including 405 ones with traumatic amputations. Replantation of large and small segments was undertaken in 24 and 76% of the cases respectively. 43% of the patients underwent one-step traumatic amputation of two and more segments. Skin and soft tissue defects occurred in 111 patients including 27 with extensive lesions. 82.4% of the surgical interventions had the desired outcome. An example of successful replantation is described. The results are compared with the literature data.
Assuntos
Amputação Traumática/cirurgia , Artéria Braquial , Traumatismo Múltiplo/cirurgia , Meios de Transporte , Extremidade Superior/irrigação sanguínea , Extremidade Superior/lesões , Extremidade Superior/cirurgia , Adolescente , Adulto , Amputação Traumática/diagnóstico por imagem , Amputação Traumática/etiologia , Amputação Traumática/fisiopatologia , Artéria Braquial/lesões , Artéria Braquial/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/fisiopatologia , Necrose/etiologia , Guias de Prática Clínica como Assunto , Radiografia , Reimplante/efeitos adversos , Reimplante/métodos , Meios de Transporte/métodos , Meios de Transporte/normas , Resultado do Tratamento , Extremidade Superior/diagnóstico por imagemRESUMO
The article deals with one of the currently important problems encountered in modern microsurgery, i. e., a possibility of performing restorative operations in complete and incomplete traumatic amputations of hand fragments. Our experience gained in managing a total of one hundred and fifty-one patients has confirmed the necessity of performing primary reconstructive operations on vessels, which in the majority of cases makes it possible to save the damaged segments. Also given herein are the main indications for carrying out restorative operations, with the appropriate conclusions drawn.
Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Dedos/irrigação sanguínea , Traumatismo Múltiplo/cirurgia , Reimplante/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Traumatismos do Punho/cirurgia , Adulto , Feminino , Dedos/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The article deals with certain aspects of managing patients presenting with extremital bone-and-vascular injuries known for utter severity and a high incidence rate of postoperative complications. Suggested herein, as the authors believe, is an optimal for both the patient and surgeon policy of emergency reconstruction. Emphasis is placed on the necessity to follow a certain sequence while restoring the anatomical structures destroyed. The conclusions drawn include compulsorily considering a possibility to spare the damaged segment, followed by restoring adequate blood circulation and prevention of wound infection, carrying out osteosynthesis with obligatory shortening of the bones, and postponing orthopaedic measures for the remote postoperative period. Also presented in the article is a photograph-illustrated clinical case report of a successful brachial replantation.