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1.
Isr Med Assoc J ; 23(2): 71-75, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33595209

RESUMO

BACKGROUND: The coronavirus disease-2019 (COVID-19) crisis has affected how hospitals work and has had an effect on orthopedic surgery. OBJECTIVES: To compare patient management and low-energy and high-energy trauma treatment at two orthopedic trauma units during the COVID-19 crisis and to clarify resource demands and preparedness in orthopedic clinics during the state of emergency caused by the COVID-19 pandemic. METHODS: This retrospective study was conducted at two orthopedic trauma units from 14 March 2019 to 14 April 2019 and from 14 March 2020 to 14 April 2020. RESULTS: The proportion of patients admitted in the multi-trauma orthopedic unit decreased by one-third, the mean time interval from admission to surgery significantly decreased, and the number of surgeries and mean length of stay in hospital decreased in 2020 compared to the same test period in 2019. In the orthopedic trauma unit, the number of patients and surgeries also decreased. CONCLUSIONS: Our study highlights changes in orthopedic injury characteristics in two orthopedic units during the COVID-19 crisis in Latvia and compares these changes to data from the same time period one year earlier.


Assuntos
Hospitalização/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Letônia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Sistema Musculoesquelético/lesões , Sistema Musculoesquelético/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
2.
Ann R Coll Surg Engl ; 103(2): 114-119, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559558

RESUMO

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.


Assuntos
Fraturas Ósseas/epidemiologia , Hospitalização/tendências , Transtornos Mentais/epidemiologia , Encaminhamento e Consulta/tendências , Tentativa de Suicídio/tendências , Adulto , Alcoolismo/epidemiologia , Transtornos de Ansiedade/epidemiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Corpos Estranhos/cirurgia , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/epidemiologia , Luxações Articulares/cirurgia , Londres/epidemiologia , Masculino , Transtornos Mentais/tratamento farmacológico , Procedimentos Ortopédicos , Psicotrópicos/uso terapêutico , Estudos Retrospectivos , Lesões dos Tecidos Moles/epidemiologia , Lesões dos Tecidos Moles/cirurgia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/cirurgia
3.
Medicine (Baltimore) ; 100(5): e24357, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592883

RESUMO

ABSTRACT: Although it is well recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I trauma center.This study included patients who presented to a single, regional, level I trauma center between March 1, 2016 and February 28, 2018. Patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Cases requiring consultation for the correction of posttraumatic deformity or secondary deformity and trauma sequelae, such as scars, were excluded. Data on patients' demographics and detailed surgical procedures were acquired from electronic medical records. The reviewed cases were categorized by the primary anatomical region requiring surgery and the primary procedure performed.A total of 1544 patients underwent surgery, and 2217 procedures were recorded during the 2-year study period. In 2016, 1062 procedures on 690 patients, and, in 2017, 1155 procedures on 787 patients were registered. The average age of the patients who underwent plastic surgical procedure due to a trauma-related cause was 38.4 years (range, 2 days to 91 years), and 1148 patients (77.7%) were male. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. The most commonly elevated free flap was the ALT flap (n = 69).Plastic surgeons play various roles in level I trauma centers, such as in the management of facial injury, performing limb-saving free tissue transfers, and complex wound reconstruction with flaps or skin grafts. Thus, plastic surgeons are an essential part of trauma centers.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , República da Coreia , Estudos Retrospectivos , Adulto Jovem
4.
Rev Infirm ; 70(267): 24-25, 2021 Jan.
Artigo em Francês | MEDLINE | ID: mdl-33455675

RESUMO

In the postoperative monitoring of a patient with severe limb trauma, the nurse's objectives are multiple: prevention and screening of complications, follow-up care, compliance with postoperative instructions. Presentation of the key elements of this monitoring, which must be systematised and personalised.


Assuntos
Extremidades , Monitorização Fisiológica , Ferimentos e Lesões , Extremidades/lesões , Humanos , Monitorização Fisiológica/enfermagem , Período Pós-Operatório , Índices de Gravidade do Trauma , Ferimentos e Lesões/enfermagem , Ferimentos e Lesões/cirurgia
5.
Rev Infirm ; 70(267): 31-33, 2021 Jan.
Artigo em Francês | MEDLINE | ID: mdl-33455678

RESUMO

The occurrence of severe limb trauma is a brutal event for all patients in any context. Many questions quickly arise, with a very broad scope - from the course of the intervention to family and social reintegration. The nurse has an essential role in listening, educating and supporting the patient before and after the operation. In addition to reassurance, she plays a central role in organising the return home and helping the patient to resume socio-professional activities.


Assuntos
Extremidades , Retorno ao Trabalho , Participação Social , Ferimentos e Lesões , Extremidades/lesões , Humanos , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Índices de Gravidade do Trauma , Ferimentos e Lesões/enfermagem , Ferimentos e Lesões/cirurgia
6.
Medicine (Baltimore) ; 100(1): e24142, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429789

RESUMO

ABSTRACT: To identify the natural changes of traumatic vertebral compression fractures during the first six months in patients visiting for disability certificates after conservative treatment.Data of patients who visited the rehabilitation medicine department of a university hospital for disability certificates concerning traumatic vertebral compression fractures from 2015 to 2018 were reviewed. Those who visited 180 to 210 days after injuries were included, and those who received invasive procedures for compression fractures were excluded. The anterior and posterior heights, local kyphotic angle of compression fractures, and upper and lower vertebrae on initial and follow-up images were measured and compared. Compression ratio was calculated by vertebral body compression ratio and anterior vertebral body compression percentage. Thoracic and lumbar traumatic fractures were also compared.Among 110 patients, 61 patients met the criteria. After six months, the anterior height of compression fractures decreased more than 4 mm, which implies the development of new compression fractures. The compression ratio and local kyphotic angle increased significantly without affecting the upper and lower vertebrae. Thoracic and lumbar compression fractures showed similar changes.Traumatic vertebral compression fractures change significantly during the first six months. This study could warrant 6 months of waiting for issuance of disability certificates for patients with traumatic vertebral compression fractures.


Assuntos
Avaliação da Deficiência , Fraturas por Compressão/complicações , Fatores de Tempo , Adulto , Idoso , Feminino , Fraturas por Compressão/reabilitação , Humanos , Cifoplastia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coluna Vertebral/fisiopatologia , Vertebroplastia/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/reabilitação , Ferimentos e Lesões/cirurgia
7.
Can J Surg ; 63(5): E418-E421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009901

RESUMO

SUMMARY: The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.


Assuntos
Congressos como Assunto/organização & administração , Infecções por Coronavirus/prevenção & controle , Currículo , Cirurgia Geral/educação , Cooperação Internacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Canadá/epidemiologia , Congressos como Assunto/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Cirurgia Geral/métodos , Guiana/epidemiologia , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Quênia/epidemiologia , Nigéria/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Suíça/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia , Estados Unidos/epidemiologia , Comunicação por Videoconferência/organização & administração , Comunicação por Videoconferência/normas , Ferimentos e Lesões/cirurgia
8.
Cir. Esp. (Ed. impr.) ; 98(8): 433-441, oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194164

RESUMO

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients


La infección por el nuevo coronavirus SARS-COV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Cirurgia Torácica/normas , Sociedades Médicas , Procedimentos Cirúrgicos Operatórios/normas , Serviço Hospitalar de Emergência/normas , Ferimentos e Lesões/cirurgia , Espanha/epidemiologia
9.
Khirurgiia (Mosk) ; (8): 17-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869610

RESUMO

OBJECTIVE: To evaluate the effectiveness of surgical treatment of post-burn defects of face and cranial vault. MATERIAL AND METHODS: There were 65 patients with post-burn defects of face and cranial vault. Mean age of patients was 38.5 years (min 17 years, max 67 years). Soft tissue reconstruction was performed by using of local tissues, combined plasty, balloon dermotension aand free flaps on microvascular anastomoses. Osteoectomy and sequestrectomy were carried out if it was necessary. Implants were used to eliminate through skull defects. RESULTS: Balloon dermotension with expanders and plasty with local tissues ensure skull reconstruction in the vast majority of patients. Through bone defects required reconstruction of the cranial vault with various implants. CONCLUSION: The proposed surgical approach ensures correction of severe functional and cosmetic disorders caused by post-burn skull defects, elimination of bone damage, restoration of normal skin of the face and cranial vault.


Assuntos
Queimaduras/cirurgia , Traumatismos Craniocerebrais/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Queimaduras/complicações , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Humanos , Microcirurgia , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Crânio/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
10.
S Afr Med J ; 110(7): 667-670, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880345

RESUMO

BACKGROUND: Trauma in pregnancy poses a unique challenge to clinicians. Literature on this topic is limited in South Africa (SA). OBJECTIVES: To review our institution's experience with the management of trauma in pregnancy in a developing-world setting. METHODS: This study was based at Grey's Hospital, Pietermaritzburg, SA. All pregnant patients who were admitted to our institution following trauma between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS: During the 6-year study period, 2 990 female patients were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS), of whom 89 were pregnant. The mean age of these patients was 25.64 (range 17 - 43) years. The mechanism of injury was road traffic crash (RTC) in 39, stab wounds (SW) in 19, assault other than SW or gunshot wounds (GSW) in 19, GSW in 8, snake bite in 5, impalement in 1, dog bite in 1, hanging in 1, sexual assault in 1 and a single case of a patient being hit by a falling object. A subset of patients sustained >1 mechanism of injury. Thirty patients were managed operatively. The mean time of gestation was 19.16 (5 - 36) weeks. Three patients died, and there were 16 fetal deaths (including 3 lost after the mother's death). Forty-five fetuses were recorded as surviving at discharge, while 25 fetal outcomes were not specifically recorded. There were 2 threatened miscarriages and/or patients with vaginal bleeding, 1 positive pregnancy test with no recorded outcome and no premature births as a result of trauma. CONCLUSIONS: Trauma in pregnancy is relatively uncommon and mostly due to a RTC or deliberately inflicted trauma. Fetal outcome is largely dependent on the severity of the maternal injury, with injuries requiring laparotomy leading to a high fetal mortality rate.


Assuntos
Complicações na Gravidez/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Morte Fetal , Humanos , Gravidez , Complicações na Gravidez/cirurgia , África do Sul/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Traumatologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
12.
Rev Col Bras Cir ; 47: e20202533, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844914

RESUMO

PURPOSE: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient's' treatment. METHODS: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS<9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours from extubation; (F4) Admission-laparotomy time greater than 60 min. in hemodynamically uinstable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours from admission; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time greater than 6 hours; (F10) Surgery after 24 from admission. The indicators, treatments, adverse effects and deaths were analyzed, using the SPSS software, and the chi-squared and Fisher tests were used to calculate the statistical relevance. RESULTS: from the 92 cases, 36 (39,1%) had complications and 15 (16,3%) died. The adequate use of quality indicator's were substantially different among those who survived (was of 12%) compared to those who died (55,6%). The incidence of complications was of 77,8% (7/9) in patients with compromised indicators and 34,9% (28/83) in those without (p=0.017). CONCLUSIONS: trauma quality indicators are directly related with the occurrence of complications and deaths, in elderly trauma patients.


Assuntos
Extubação , Hematoma Subdural Agudo/cirurgia , Laparotomia , Centros de Traumatologia/normas , Ferimentos e Lesões/cirurgia , Idoso , Atenção , Feminino , Cirurgia Geral , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
13.
Eur J Trauma Emerg Surg ; 46(4): 737-741, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32712775

RESUMO

PURPOSE: In the absence of effective treatment options, the recent SARS-CoV2 pandemic poses a great challenge to the health and social sectors worldwide. Hereby, we would like to share our proposals in the hope that it will prove helpful for our colleagues in this difficult time. METHODS: The present recommendations are based on the opinion of experts as well as the experience of a group of traumatologists directly involved in the organization of traumatology wards. The reassignment of the healthcare personnel, the separation of the potentially infected patients and the different levels of restriction on the trauma care are all key elements of our protocol. RESULTS: Since the first SARS-CoV2-positive case was confirmed in Hungary, our trauma surgeons were able to avoid contamination with the help of the new guidelines, without reducing the quality of trauma care. CONCLUSION: Reasonably adjusted patient care protocols in every medical field are key to contain the spread of infection and to avoid public health crisis. Sharing experience can be an important element of a successful fight against the recent pandemic.


Assuntos
Protocolos Clínicos , Infecções por Coronavirus , Controle de Infecções , Pandemias , Pneumonia Viral , Centros de Traumatologia/organização & administração , Ferimentos e Lesões , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Procedimentos Clínicos , Humanos , Hungria/epidemiologia , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/cirurgia
14.
Chin J Traumatol ; 23(4): 207-210, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32653358

RESUMO

Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Ferimentos e Lesões/cirurgia , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Humanos , Malásia/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
18.
Korean J Radiol ; 21(8): 935-945, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677378

RESUMO

We retrospectively reviewed the cases in which complications occurred during below-the-knee (BTK) endovascular treatments that were performed at our hospital from 2005 to 2014. Several interesting cases have been described herein. All the patients had diabetes and non-healing wounds on their feet and/or rest pain in their foot or leg, and therefore, endovascular treatment was performed for the BTK arteries of the affected lower extremity. The complications that occurred during the procedure were classified into six categories-vascular spasm, flow limiting dissection, perforation, broken guidewire, distal thromboembolism, and unusual puncture site bleeding. Each complication has its own solutions and management. We discuss these different classes of complications and describe how cases of each type were managed.


Assuntos
Angioplastia/efeitos adversos , Isquemia/cirurgia , Joelho/irrigação sanguínea , Joelho/cirurgia , Idoso , Artérias/fisiologia , Complicações do Diabetes/patologia , Diabetes Mellitus/patologia , Feminino , Pé/irrigação sanguínea , Humanos , Isquemia/etiologia , Articulação do Joelho/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos e Lesões/patologia , Ferimentos e Lesões/cirurgia
19.
Surg Clin North Am ; 100(4): 707-725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681871

RESUMO

Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.


Assuntos
Articulação do Tornozelo/cirurgia , Pé/cirurgia , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Braquetes , Doença Crônica , Desbridamento , Desenho de Equipamento , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Humanos , Aparelhos Ortopédicos , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tendinopatia/fisiopatologia , Tendinopatia/cirurgia , Ferimentos e Lesões/fisiopatologia
20.
Surg Clin North Am ; 100(4): 733-740, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681873

RESUMO

This article reviews techniques for wound coverage that are not amenable to simple linear closure. The relevant anatomy and classification of flaps is discussed, as well as specific techniques for successful flap design.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Ferimentos e Lesões/cirurgia , Humanos , Manejo de Espécimes , Técnicas de Fechamento de Ferimentos
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