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1.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
2.
J Craniofac Surg ; 30(7): 2261-2264, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503115

RESUMO

BACKGROUND: Bicanalicular lacerations are relatively rare and more of a surgical challenge in clinical practice. The purpose of this study is to evaluate the clinical characteristics and surgical outcomes of bicanalicular lacerations with a new bicanalicular silicone stent at a tertiary eye care center. METHODS: All patients who underwent bicanalicular lacerations repair from January 2013 and December 2018 were retrospectively reviewed. Data collected for each patient included patient demographics, affected sides, cause of injuries, the timing of management, associated ocular injuries, the timing of stent removal, duration of follow-up and the outcomes of the surgical repair with a new bicanalicular silicone stent. RESULTS: Thirty-six patients with bicanalicular lacerations met the inclusion criteria and were enrolled in the study. The mean age of the patients was 43.8 years old (range: 2-73years). Of the 36 patients, 33 (91.7%) were males and 3 (8.3%) were females. The right eye was injured in 17 patients (47.2%). All patients underwent surgical intervention within 24 hours. The most common cause of bicanalicular lacerations was electric bicycles accidents (7 patients, 19.4%), and followed by motor vehicle accidents (6 patients, 16.7%), blunt objects (6 patients, 16.7%), fights (6 patients, 16.7%), falls (3 patients, 12%), dog bites (2 patients, 5.6%), hook injuries (2 patients, 5.6%), broken glass (2 patients, 5.6%), and sharp objects (2 patients, 5.6%). The most common associated ocular injuries were orbital fracture (61.1%), followed by lid lacerations and open globe injuries. The functional success rate was 86.1%. The average interval between the surgery and the stent removal was 13.8 weeks (range: 8-20 weeks). All the stents were removed successfully without any difficulty in the outpatient department. The follow-up after stent removal ranged from 2 to 12 months (mean: 5.1months). CONCLUSIONS: Bicanalicular lacerations involvement occured in 6.8% of all canalicular lacerations. The most common cause of bicanalicular lacerations was electric bicycles accidents and the most common associated ocular injuries was orbital fracture in North China. The new bicanalicular silicone stent achieved good functional success (86.1%) in the management of bicanalicular lacerations.


Assuntos
Lacerações/cirurgia , Stents , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Traumatismos Oculares/cirurgia , Feminino , Humanos , Doenças do Aparelho Lacrimal/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/cirurgia , Estudos Retrospectivos , Silicones , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
3.
Vet Surg ; 48(7): 1299-1308, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31282055

RESUMO

OBJECTIVE: To describe perioperative management, surgical procedure, and outcome in mares with third-degree perineal lacerations (TDPL) treated with a single-stage repair, the Utrecht repair method (URM). STUDY DESIGN: Retrospective study. ANIMALS: Twenty mares with TDPL. METHODS: Medical records of mares with TDPL reconstructed with a URM were reviewed for perioperative management; surgical outcome; and postoperative fertility, athletic performance, and complications. RESULTS: Mares ranged in age from 3.5 to 11 years. Long-term follow-up was available for 13 mares. Mean duration of follow-up was 9 years (median, 9.5; range, 2-215 months (17.9 years)). Standardized perioperative fasting and postoperative refeeding protocols were used. Only five mares received supportive gastric medication. Reconstruction of the rectovestibular shelf was successful in 18 of 20 mares. Two of 20 mares developed a small rectovestibular fistula after the initial repair, which was successfully repaired with a second surgery. Other postoperative complications were observed in 13 mares and consisted of mild postanesthetic myositis, facial nerve paralysis, esophageal obstruction, rectal obstipation, partial perineal dehiscence, and rectal or vestibular wind-sucking. Six of seven mares that were subsequently bred became pregnant. One mare was successfully used for embryo recovery, and five of six mares foaled without recurrence of a TDPL. Nine of 13 mares were used for riding at various levels. CONCLUSION: The alternative single-stage reconstruction for TDPL was successful in 18 of 20 mares after a single surgery. No major complications related directly to the technique were noted. CLINICAL SIGNIFICANCE: The URM is a valid alternative surgical technique for repairing TDPL in mares.


Assuntos
Doenças dos Cavalos/cirurgia , Cavalos/lesões , Lacerações/veterinária , Períneo/lesões , Anestesia Geral , Animais , Feminino , Lacerações/cirurgia , Períneo/cirurgia , Complicações Pós-Operatórias , Reto , Estudos Retrospectivos
4.
Vet Surg ; 48(7): 1229-1236, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31222767

RESUMO

OBJECTIVE: To evaluate the effect of combining a continuous epitendinous suture with three-loop pulley (3LP) and locking-loop (LL) core patterns for flexor tendon repair. STUDY DESIGN: Ex vivo biomechanical study. SAMPLE POPULATION: Seventy-two cadaveric superficial digital flexor musculotendon (SDFT) units. METHODS: Tendons were divided into four groups (n = 18/group). After sharp transection, SDFT were repaired with 3LP, LL, 3LP + epitendinous (E), or LL + E suture patterns. After preloading, repaired constructs were tested to failure. Video data acquisition allowed evaluation of failure mode and quantitation of gap formation. Yield, peak, and failure force were measured from force-displacement data. Significance was set at P < .05. RESULTS: Mode of failure did not differ between repairs with or without an epitendinous suture (P = .255). Gap formation was best prevented with 3LP compared with LL when used alone (P = .001). Mean yield force for 3LP, LL, 3LP + E, and LL + E were 91.4 N ± 25.4, 61.3 N ± 18.4, 195.2 N ± 66.0, 165.3 N ± 46.8, respectively. Tenorrhaphies combined with an epitendinous suture achieved higher yield (P < .0001), peak (P < .0001), and failure forces (P < .0001), without gapping between tendon ends. CONCLUSION: Addition of an epitendinous suture eliminated gapping between tendon ends until failure and increased resistance to loads tolerated at the repair site. CLINICAL SIGNIFICANCE: The addition of an epitendinous suture may increase the strength of tendon repairs and resistance to gap formation over core suture use alone. The influence of epitendinous suture placement on tendinous healing and blood supply warrants in-vivo testing.


Assuntos
Lacerações/veterinária , Procedimentos Ortopédicos/veterinária , Técnicas de Sutura/veterinária , Suturas/veterinária , Tendões/cirurgia , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Lacerações/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos , Traumatismos dos Tendões/cirurgia , Resistência à Tração
5.
Medicine (Baltimore) ; 98(16): e15294, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008978

RESUMO

RATIONALE: Damage control is a staged surgical approach to manage polytraumatized patients. The damage control approach comprises three steps. First, bleeding is controlled and fractures are stabilized temporarily; second, vital parameters are stabilized and the child is rewarmed in the intensive care unit; and third, the child is reoperated for definitive repair of injuries. We aimed to describe the feasibility of the damage control orthopedic approach in a child. PATIENT CONCERNS: An 8-year-old girl fell from the balcony of the 5th floor onto concrete pavement and was admitted to our accident and emergency ward in a stable cardiorespiratory state, but with gross deformity of the lower limbs, left thigh, and forearm. DIAGNOSES: The child had sustained multiple injuries with severe bilateral lung contusion, pneumothorax, fracture of first rib, liver laceration, stable spine fractures, transforaminal fracture of sacrum, pelvic ring fracture, displaced baso-cervical femoral neck fracture, displaced bilateral multifragmental growth plate fractures of both tibiae, fractures of both fibulae, displaced fracture of left forearm, and displaced supracondylar fracture of the humerus. INTERVENTION: In the initial operation, we performed closed reduction and K-wire fixation of the right tibia, closed reduction and external fixation of the left tibia, open reduction and screw osteosynthesis of the femoral neck fracture, closed reduction and K-wire fixation of the radius, and closed reduction of the supracondylar fracture. Subsequently, we transferred the girl to the pediatric intensive care unit for hemodynamic stabilization, respiratory therapy, rewarming, and treatment of crush syndrome. In a third step, 10 days after the injury, we managed the supracondylar fracture of the humerus by closed reduction and K-wire fixation. OUTCOMES: Growth arrest of the left distal tibial growth plate and osteonecrosis of the femoral head and neck, slipped capital femoris epiphysis (SCFE), and coxa vara of the right femur led to balanced leg length inequality 2 years after the injury. The lesion of the left sciatic nerve improved over time and the girl walked without walking aids and took part in school sports but avoided jumping exercises. LESSONS: We emphasize the importance of damage control principles when managing polytraumatized children.


Assuntos
Traumatismo Múltiplo/cirurgia , Acidentes por Quedas , Criança , Contusões/cirurgia , Feminino , Fraturas do Colo Femoral/cirurgia , Fíbula/lesões , Fraturas Ósseas/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Lacerações/cirurgia , Fígado/lesões , Lesão Pulmonar/cirurgia , Ossos Pélvicos/lesões , Pneumotórax/cirurgia , Costelas/lesões , Sacro/lesões , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Tíbia/cirurgia
6.
World Neurosurg ; 127: 117-120, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30959251

RESUMO

BACKGROUND: Aneurysms of superficial temporal arteries (STAs) are rare. The majority of them are induced by blunt trauma. To our knowledge, a pseudoaneurysm of the STA induced by scalp laceration has never been reported. CASE DESCRIPTION: A 20-year-old man who complained of a pulsatile headache and had a lump on his right temple was admitted to our department. He had a history of frontal scalp laceration 2 weeks before the admission, and physical examination revealed 1 healed scar over the lump. On the basis of the characteristics of the headache and lump, surgical excision was taken and diagnosis was confirmed intraoperatively and by pathologic examination postoperatively. The postoperative course was uneventful. CONCLUSIONS: Despite the rarity of pseudoaneurysm of STA after scalp laceration, this case may warrant the potential complication of a pseudoaneurysm, especially if scalp laceration courses over the branches of the STA.


Assuntos
Falso Aneurisma/diagnóstico , Desbridamento/métodos , Lacerações/diagnóstico , Couro Cabeludo/patologia , Artérias Temporais/patologia , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Humanos , Lacerações/complicações , Lacerações/cirurgia , Masculino , Couro Cabeludo/cirurgia , Artérias Temporais/cirurgia , Adulto Jovem
7.
J Craniofac Surg ; 30(7): 2115-2118, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30950946

RESUMO

BACKGROUND: To evaluate fundus examinations in terms of traumatic retinal tears or dialysis that may be related to canalicular lacerations (CLs). MATERIALS AND METHODS: This retrospective study was conducted on patients with CL repair from June 1, 2009 to May 30, 2018. The authors collected the data from the patients' medical records, including their demographic details, mechanism and setting of injury, associated ocular injuries, type of stent used, setting of repairs, duration of follow-up, complications, pre- or intraoperative findings of biomicroscopic and fundus examinations, refractive errors, postoperative follow-up of fundus examination, and management. RESULTS: Sixty patients (43 males and 17 females) were included in the study. The mean age of all the patients was 27.50 ± 21.72 (min: 1-max: 94) years. Isolated CL was found in 38 patients. Nonisolated CL, which means with some additional pathologies, were found in 22 patients (37%, approximately 1/3). Retinal follow-up records were available in 49 patients with a mean follow-up period of 7.48 ± 9.82 months. Retinal tears were seen in 3 patients (0.05%) with no predisposing risk factors. Two of these tears were found in the follow-up period after the traumas. CONCLUSION: Consequent retinal tears after canalicular lacerations were not strongly addressed in previous works. In this study, the authors aimed to view CL from a different perspective. Canalicular laceration is also an ocular trauma that may threaten vision. The authors emphasized that performing detailed fundus examinations and follow-up in all canalicular traumas is necessary.


Assuntos
Lacerações/cirurgia , Doenças do Aparelho Lacrimal/cirurgia , Perfurações Retinianas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Oculares/cirurgia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Erros de Refração , Estudos Retrospectivos , Fatores de Risco , Lâmpada de Fenda , Stents
8.
South Med J ; 112(3): 185-189, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30830234

RESUMO

OBJECTIVES: Adequate repair is vital to reduce the long-term sequelae of obstetric anal sphincter injuries (OASIS). Sufficient documentation is necessary to reflect the quality of care provided, to guide future management, and to reduce medicolegal liability. With the advent of electronic health records, proper methods of documentation can be more easily disseminated and applied for general use. The objectives of our study were to assess whether documentation of OASIS management is improved by introducing a standardized electronic operative report, determining rates of readmission due to complications, and measuring adherence to practice guidelines. METHODS: A pre- and postintervention study was conducted by auditing electronic charts of patients affected by OASIS at two university-affiliated delivery units throughout the 2016 calendar year. Unit A is a safety-net hospital and unit B is private. A standardized electronic template was created in the electronic health records of both units. The primary outcome was the quality of repair documentation, which was quantified using a scale that included all relevant aspects of the repair. RESULTS: Analyzing both units separately, baseline characteristics including operator training level, episiotomy rate, and operative delivery were similar pre- and postintervention. The quality of documentation measured by the scale score improved significantly postintervention. Proper use of antibiotics and bowel regimen significantly increased after the intervention at both units. CONCLUSIONS: The use of a standardized electronic template for reporting the diagnosis and repair of OASIS improves the thoroughness of documentation and appears to promote the implementation of best practice guidelines.


Assuntos
Canal Anal/lesões , Parto Obstétrico/métodos , Documentação/normas , Lacerações/cirurgia , Complicações do Trabalho de Parto/cirurgia , Melhoria de Qualidade , Adolescente , Adulto , Registros Eletrônicos de Saúde , Feminino , Hospitais Privados , Humanos , Gravidez , Provedores de Redes de Segurança , Técnicas de Sutura , Adulto Jovem
10.
J Hand Surg Asian Pac Vol ; 24(1): 123-126, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760150

RESUMO

We report a case of complete laceration of both flexor tendons in the dominant ring finger of a young male caused by a closed volar fracture fragment of the proximal phalanx. Careful clinical examination, reasonable index of suspicion and ultrasound confirmation play a pivotal role in the diagnosis and surgical planning of this rare yet consequential injury. Good outcomes can be achieved from the surgical management and rehabilitation of both soft tissue and bony injuries when planning of surgical approaches and fixation techniques are facilitated by an accurate pre-operative diagnosis.


Assuntos
Falanges dos Dedos da Mão/lesões , Fraturas Fechadas/complicações , Lacerações/etiologia , Traumatismos dos Tendões/etiologia , Adulto , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas , Fraturas Fechadas/cirurgia , Humanos , Lacerações/diagnóstico por imagem , Lacerações/cirurgia , Masculino , Radiografia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Ultrassonografia
11.
J Hand Surg Asian Pac Vol ; 24(1): 83-88, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760154

RESUMO

BACKGROUND: The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique. METHODS: The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014. Clinical outcome was assessed using the revised Strickland and Glogovac criteria, which categorises repairs based on the total active motion of the repaired digit. RESULTS: Sixty-two patients with 74 digits were included. The overall mean total active motion was 122°. The overall satisfactory outcome of the modified Lim/Tsai technique was 81.1%. The rupture rate of the modified Lim/Tsai technique was 2.7%. Using multivariate linear regression model, we found that outcomes were negatively influenced by subzone 2C and crush/saw injuries, but not by concomitant neurovascular injuries or post-operative follow-up duration. CONCLUSIONS: Based on this retrospective study of patients with zone 2 flexor tendon injuries, the clinical outcomes of modified and original Lim/Tsai techniques are comparable. As such, there is no clinical evidence favouring one over the other.


Assuntos
Traumatismos dos Dedos/cirurgia , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Adulto , Idoso , Lesões por Esmagamento/fisiopatologia , Feminino , Traumatismos dos Dedos/fisiopatologia , Humanos , Lacerações/fisiopatologia , Lacerações/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/fisiopatologia , Adulto Jovem
13.
J Pediatr Orthop ; 39(9): e661-e667, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30628976

RESUMO

BACKGROUND: Prior research has shown decreased accuracy of meniscal injury detection using magnetic resonance imaging (MRI) for anterior cruciate ligament (ACL)-deficient adult patients as well as ACL-deficient pediatric and adolescent patients. The objectives of this study were the following: (1) assess the diagnostic ability of MRI in detecting meniscal injuries for pediatric and adolescent patients undergoing arthroscopic ACL reconstruction and (2) characterize the unrecognized meniscal injuries. METHODS: The sensitivity, specificity, positive predictive value, and negative predictive value of meniscal tears (medial, lateral, or both) on MRI were calculated for the 107 patients in this cohort. Fisher exact tests were used to compare event frequencies between medial meniscal (MM) and lateral meniscal (LM) tears. One-way analysis of variance tests were performed to compare event rates between the location and type of unrecognized meniscal tears. RESULTS: The median age of the cohort was 15 (range: 7 to 18). The sensitivity, specificity, positive predictive value, and negative predictive value of MRI in detecting meniscal tears (medial, lateral, or both) in ACL-deficient pediatric and adolescent patients was 62.3%, 68.4%, 78.2%, and 50.0%, respectively. There were 26 (24.3%) cases in which a meniscal injury was not detected on MRI, but was discovered arthroscopically (MM: 5 knees, LM: 20 knees, both: 1 knee). These unrecognized meniscal injuries were more commonly the LM than the MM (77.8%, P-value=0.100), a vertical/longitudinal tear type (77.8%, P-value <0.001), and located in the posterior horn (74.1%, P-value <0.001). CONCLUSIONS: In this ACL-deficient pediatric and adolescent cohort, there were 26 (24.3%) patients with unrecognized meniscal injuries. A vertical tear in the posterior horn was the most commonly unrecognized meniscal injury, supporting the findings of prior research postulating that the location and configuration of a tear influence the accuracy of MRI in detecting these injuries. More research is needed to investigate strategies to improve the detection of meniscal tears in pediatric and adolescent patients preoperatively. These findings have implications with regard to patient counseling, operative planning, anticipatory guidance with regard to postoperative rehabilitation, recovery expectations, and surgical outcomes. LEVEL OF EVIDENCE: Level IV.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Imagem por Ressonância Magnética , Meniscos Tibiais/diagnóstico por imagem , Lesões do Menisco Tibial/diagnóstico por imagem , Adolescente , Algoritmos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Criança , Estudos de Coortes , Coleta de Dados , Feminino , Humanos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Lacerações/cirurgia , Los Angeles/epidemiologia , Masculino , Meniscos Tibiais/cirurgia , Pacientes , Prevalência , Estudos Retrospectivos , Ruptura , Sensibilidade e Especificidade , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/cirurgia
14.
Medicine (Baltimore) ; 98(1): e13980, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608439

RESUMO

Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015. The average patient age was 41 years (range, 23-59). The time from injury to treatment averaged 4.7 months. The average follow-up period was 9 months (range, 4-18). Functional outcome was evaluated from a comparison between the Quick-disabilities of the arm, shoulder, and hand (DASH) score and the visual analogue scale (VAS) for pain, which were measured at the time of preoperation and final follow up.Four patients showed partial rupture of the flexor digitorum profundus (FDP) tendon and 3 showed partial rupture of the flexor digitorun superficialis (FDS) tendon. Both the FDP and FDS tendons were partially ruptured in 2 patients, and the remaining patient had a partial rupture of the flexor pollicis longus tendon. All patients regained full range of motion, and there has been no recurrence of triggering. The average VAS score decreased from 3.6 (range, 3-5) preoperatively to 0.3 (range, 0-1) at the final follow up. The average Quick-DASH score decreased from 33.6 preoperatively to 5.3 at the final follow up.When we encounter patients with puncture or laceration wounds in flexor zone 2, even when the injury appears to be simple, partial flexor tendon laceration must be taken into consideration and early exploration is recommended.


Assuntos
Ruptura/cirurgia , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/cirurgia , Dedo em Gatilho/etiologia , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Humanos , Lacerações/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/complicações , Amplitude de Movimento Articular , Estudos Retrospectivos , Ruptura/patologia , Prevenção Secundária/métodos , Tendões/fisiopatologia , Escala Visual Analógica
15.
Foot Ankle Surg ; 25(3): 272-277, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29409181

RESUMO

BACKGROUND: Extensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers. METHODS: We present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues. RESULTS: At one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported. CONCLUSIONS: Second EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible. LEVEL OF EVIDENCE: IV (Case Series).


Assuntos
Hallux/lesões , Hallux/cirurgia , Músculo Esquelético/cirurgia , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Adulto , , Humanos , Lacerações/cirurgia , Masculino , Pessoa de Meia-Idade , Dedos do Pé , Transplante Autólogo , Transplante Homólogo , Adulto Jovem
16.
World Neurosurg ; 122: 282-286, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30415047

RESUMO

BACKGROUND: Iatrogenic vertebral artery injury is an uncommon but well recognized complication during cervical spine surgery. Intraoperative surgical repair is extremely challenging, and options for endovascular repair are limited because of the lack of proper equipment in the operating room setting. CASE DESCRIPTION: A 53-year-old woman who presented with myelopathy underwent anterior cervical diskectomy and fusion of C3-7. A significant laceration injury of the left vertebral artery was encountered during surgery, which was salvaged by intraoperative endovascular repair with a covered stent under portable fluoroscopy guidance. The salvage and repair led to the rest of the surgery being finished as planned preoperatively without any consequences. CONCLUSIONS: Vertebral artery injury is an uncommon but severe complication of cervical spine surgery. For uncontrolled bleeding, intraoperative endovascular repair with portable fluoroscopy is warranted and possible. A covered stent can seal the laceration and stop the bleeding completely which enables completion of the surgery.


Assuntos
Perda Sanguínea Cirúrgica , Complicações Intraoperatórias/cirurgia , Stents Metálicos Autoexpansíveis , Artéria Vertebral/lesões , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Doença Iatrogênica , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Lacerações/cirurgia , Pessoa de Meia-Idade , Terapia de Salvação/métodos , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
17.
Female Pelvic Med Reconstr Surg ; 25(4): 271-278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29324570

RESUMO

OBJECTIVE: The aim of this study was to report subjective, long-term outcomes and describe patient demographics, presenting symptoms, perioperative management, and complications after overlapping sphincteroplasty repair for chronic fourth-degree lacerations (cloacal-like deformities). METHODS: In this retrospective study, hospital records were reviewed for women who underwent overlapping anal sphincteroplasty for a cloacal-like deformity of the perineum at a single institution from 1996 to 2013. Details including patient demographics, presenting symptoms, perioperative management, and complications were abstracted from the medical record. As a follow-up, subjects were contacted by telephone and were administered the validated Modified Manchester Health Questionnaire to assess anal continence status and anal incontinence-related quality of life since the time of surgery. RESULTS: Of 57 women who underwent an anal sphincteroplasty within the study period, 29 met inclusion criteria. Median parity was 3 (range, 1-7) and 24.5% reported a history of forceps or vacuum-assisted vaginal delivery. Presenting symptoms included fecal incontinence (58.6%), flatal incontinence (41%), sexual dysfunction (20.7%), and poor body self-image (3.4%). Thirteen (45%) women could be contacted by telephone and all agreed to participate. Overall, 46.2% of the 13 women who completed the Modified Manchester Health Questionnaire reported some form anal of incontinence, whereas 53.8% reported complete continence at a mean follow-up of 7.0 ± 3.6 years. Perioperative morbidity was uncommon, and postoperative antibiotics were used in 75.9% of cases for a median duration of 8.8 ± 3.3 days. CONCLUSIONS: Perioperative morbidity after overlapping sphincteroplasty for cloacal-like deformities after obstetrical injury is rare. Although long-term complete anal continence may be difficult to achieve in all cases, good quality of life measures and low symptom severity were noted at a mean interval of 7 years after surgery.


Assuntos
Canal Anal/cirurgia , Parto Obstétrico/efeitos adversos , Lacerações/cirurgia , Períneo/cirurgia , Adulto , Canal Anal/lesões , Imagem Corporal/psicologia , Incontinência Fecal/etiologia , Feminino , Seguimentos , Humanos , Lacerações/complicações , Pessoa de Meia-Idade , Períneo/lesões , Qualidade de Vida , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/etiologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Pediatr Emerg Care ; 35(7): e124-e126, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27941503

RESUMO

We present the case of a 7-year-old boy with a forehead laceration that required suture repair. The child was anxious and uncooperative, and the initial plan was to administer intranasal midazolam to facilitate the repair. However, a facemask blinder was first implemented as a visual barrier to block the child's view of any anxiety-provoking stimuli and appeared to improve the child's cooperation with the procedure. Intranasal midazolam was not administered, and the laceration was cleaned and repaired successfully. In conjunction with adequate local anesthesia and distraction techniques, the facemask blinder helped to facilitate the completion of the laceration repair without the need for any physical restraint or pharmacologic anxiolysis or sedation.


Assuntos
Ansiedade , Traumatismos Faciais/cirurgia , Lacerações/cirurgia , Máscaras , Criança , Traumatismos Faciais/psicologia , Humanos , Lacerações/psicologia , Masculino
19.
Ann Vasc Surg ; 54: 336.e9-336.e12, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30114500

RESUMO

BACKGROUND: Iliac vein injury associated with pelvic fracture due to blunt trauma is an uncommon and difficult diagnosis but a life-threatening condition which often requires an emergent management. Although open repair has been traditionally used as the treatment of choice in unstable patients, it is controversial, given the difficulty due to injured vessel exposure in patients with significant retroperitoneal hematoma as well as tamponade effect loss associated with laparotomy. We present a challenging case of iliac vein laceration successfully treated by placement of a self-expanding covered stent. METHODS: A 15-year-old male was hemodynamically unstable and was transferred to our emergency department after a severe polytrauma due to a motorcycle accident. Contrast-enhanced computed tomography showed a left external iliac vein laceration with active bleeding and retroperitoneal hematoma as well as complex pelvic and left supracondylar femoral fractures. A 13 × 100 mm self-expanding covered stent was successfully deployed through duplex ultrasound-guided percutaneous approach of both femoral veins. RESULTS: The patient's blood pressure was normalized as soon as the stent graft was placed, and then femoral fracture was reduced and fixed. At 12-month follow-up, the patient remained asymptomatic, and stent-graft patency was confirmed. CONCLUSIONS: Covered stent-graft placement can be an effective and rapid treatment for life-threatening iliac vein injury.


Assuntos
Procedimentos Endovasculares , Fraturas Ósseas/complicações , Veia Ilíaca/lesões , Lacerações/cirurgia , Ossos Pélvicos/lesões , Adolescente , Prótese Vascular , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/cirurgia , Processamento de Imagem Assistida por Computador , Lacerações/complicações , Masculino , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Ossos Pélvicos/diagnóstico por imagem , Flebografia , Stents , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes
20.
Am J Emerg Med ; 37(5): 817-822, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30057072

RESUMO

PURPOSE: The technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training. METHODS: Wound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5-10 days following suturing. RESULTS: Sixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2-4) and 5 (4-5), respectively (p = 0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p < 0.001). CONCLUSIONS: There were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement.


Assuntos
Cicatriz/prevenção & controle , Traumatismos Faciais/cirurgia , Internato e Residência , Lacerações/cirurgia , Técnicas de Sutura/educação , Adulto , Idoso , Competência Clínica , Desbridamento/educação , Medicina de Emergência/educação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Traumatismos Faciais/patologia , Feminino , Humanos , Lacerações/patologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos
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