Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.870
Filtrar
1.
Orthop Clin North Am ; 52(2): 149-155, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752836

RESUMO

The field of hand surgery continues to evolve in new and exciting directions. Advances in diagnosis and management for common complaints and complex injuries allow higher-level care, while still being cognizant of the cost of health care delivery. Indications and protocols for past paradigm shifts, such as volar locked plating for distal radial fractures, continue to be honed, and the outcomes seen for modern flexor tendon repairs are impressive. Open questions remain, but promising results for scaphoid nonunion surgery and peripheral nerve reconstruction with processed allograft will continue to shed light on these unsolved problems.


Assuntos
Traumatismos da Mão/cirurgia , Procedimentos Ortopédicos/métodos , Traumatismos do Punho/cirurgia , Analgésicos Opioides/administração & dosagem , Avaliação da Deficiência , Humanos , Dor Pós-Operatória/tratamento farmacológico
2.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563677

RESUMO

We report the case of an 11-year-old boy brought to our emergency department 2 hours after a viper bite to his right hand. He suffered severe pain and rapidly progressive swelling with signs of haemodynamic compromise in keeping with distributive shock. The oedema progressed from his right wrist upwards to his forearm and upper arm with compartment syndrome ultimately resulting. He underwent fasciotomy of the right upper limb and antivenom serum was given. The patient required vasopressors for 48 hours and a total of nine surgical interventions were necessary. In the event of a snakebite, it is essential to promptly recognise the signs of severity, complications and indications for the administration of antivenom serum. We intend to highlight this rare shock aetiology and the need for emergency management if severe clinical signs are present. Early administration of antivenom serum is essential and it should be available in all emergency departments.


Assuntos
Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Traumatismos da Mão/etiologia , Traumatismos da Mão/cirurgia , Choque/tratamento farmacológico , Choque/etiologia , Mordeduras de Serpentes/complicações , Animais , Antivenenos/uso terapêutico , Criança , Humanos , Masculino , Mordeduras de Serpentes/tratamento farmacológico , Venenos de Víboras/toxicidade , Viperidae
3.
Handchir Mikrochir Plast Chir ; 53(1): 61-66, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33588491

RESUMO

PURPOSE: The objective of this study was to evaluate the outcome of a special interdisciplinary hand therapy program depending on the time interval between trauma and rehabilitation. PATIENTS AND METHODS: With use of self-assessed scores (Disability of the Arm, Shoulder and Hand Score [DASH-Score], European Quality of Life 5 Dimensions [EQ-5D]) and objective functional parameters (TAM = Total Active Motion for finger injuries, ROM = Range of Motion for wrist injuries, grip strength) the outcome of 76 patients with injuries of the fingers, wrist or a complex regional pain syndrome (CRPS) was analysed at the begin and end of an inpatient rehabilitation and at a follow-up examination after 12 to 16 weeks. The patients were divided into groups with an early (< 120 days after trauma) or late beginning of their rehabilitation. RESULTS: At the follow-up examination early beginners had a significant better DASH-Score as well as a ROM. At the end of the rehabilitation program and at the time of the follow-up examination significant more patients with an early as patients with a late start of the rehabilitation were back to work. Especially patients with CRPS and finger injuries benefit from an early start of the rehabilitation. CONCLUSION: Compared to a late start an early start of a rehabilitation program after finger and hand injuries and a CRPS leads to better functional with special benefit for patients with a CRPS.


Assuntos
Traumatismos da Mão , Traumatismos Ocupacionais , Traumatismos do Punho , Mãos , Traumatismos da Mão/cirurgia , Força da Mão , Humanos , Qualidade de Vida , Amplitude de Movimento Articular , Resultado do Tratamento , Articulação do Punho
4.
Cochrane Database Syst Rev ; 1: CD012479, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33434949

RESUMO

BACKGROUND: Various rehabilitation treatments may be offered following surgery for flexor tendon injuries of the hand. Rehabilitation often includes a combination of an exercise regimen and an orthosis, plus other rehabilitation treatments, usually delivered together. The effectiveness of these interventions remains unclear. OBJECTIVES: To assess the effects (benefits and harms) of different rehabilitation interventions after surgery for flexor tendon injuries of the hand. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, MEDLINE, Embase, two additional databases and two international trials registries, unrestricted by language. The last date of searches was 11 August 2020. We checked the reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared any postoperative rehabilitation intervention with no intervention, control, placebo, or another postoperative rehabilitation intervention in individuals who have had surgery for flexor tendon injuries of the hand. Trials comparing different mobilisation regimens either with another mobilisation regimen or with a control were the main comparisons of interest. Our main outcomes of interest were patient-reported function, active range of motion of the fingers, and number of participants experiencing an adverse event. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias and assessed the quality of the body of evidence for primary outcomes using the GRADE approach, according to standard Cochrane methodology. MAIN RESULTS: We included 16 RCTs and one quasi-RCT, with a total of 1108 participants, mainly adults. Overall, the participants were aged between 7 and 72 years, and 74% were male. Studies mainly focused on flexor tendon injuries in zone II. The 17 studies were heterogeneous with respect to the types of rehabilitation treatments provided, intensity, duration of treatment and the treatment setting. Each trial tested one of 14 comparisons, eight of which were of different exercise regimens. The other trials examined the timing of return to unrestricted functional activities after surgery (one study); the use of external devices applied to the participant to facilitate mobilisation, such as an exoskeleton (one study) or continuous passive motion device (one study); modalities such as laser therapy (two studies) or ultrasound therapy (one study); and a motor imagery treatment (one study). No trials tested different types of orthoses; different orthosis wearing regimens, including duration; different timings for commencing mobilisation; different types of scar management; or different timings for commencing strengthening. Trials were generally at high risk of bias for one or more domains, including lack of blinding, incomplete outcome data and selective outcome reporting. Data pooling was limited to tendon rupture data in a three trial comparison. We rated the evidence available for all reported outcomes of all comparisons as very low-certainty evidence, which means that we have very little confidence in the estimates of effect. We present the findings from three exercise regimen comparisons, as these are commonly used in clinical current practice. Early active flexion plus controlled passive exercise regimen versus early controlled passive exercise regimen (modified Kleinert protocol) was compared in one trial of 53 participants with mainly zone II flexor tendon repairs. There is very low-certainty evidence of no clinically important difference between the two groups in patient-rated function or active finger range of motion at 6 or 12 months follow-up. There is very low-certainty evidence of little between-group difference in adverse events: there were 15 overall. All three tendon ruptures underwent secondary surgery. An active exercise regimen versus an immobilisation regimen for three weeks was compared in one trial reporting data for 84 participants with zone II flexor tendon repairs. The trial did not report on self-rated function, on range of movement during three to six months or numbers of participants experiencing adverse events. The very low-certainty evidence for poor (under one-quarter that of normal) range of finger movement at one to three years follow-up means we are uncertain of the finding of zero cases in the active group versus seven cases in the immobilisation regimen. The same uncertainty applies to the finding of little difference between the two groups in adverse events (5 tendon ruptures in the active group versus 10 probable scar adhesion in the immobilisation group) indicated for surgery. Place and hold exercise regimen performed within an orthosis versus a controlled passive regimen using rubber band traction was compared in three heterogeneous trials, which reported data for a maximum of 194 participants, with mainly zone II flexor tendon repairs. The trials did not report on range of movement during three to six months, or numbers of participants experiencing adverse events. There was very low-certainty evidence of no difference in self-rated function using the Disability of the Arm, Shoulder and Hand (DASH) functional assessment between the two groups at six months (one trial) or at 12 months (one trial). There is very low-certainty evidence from one trial of greater active finger range of motion at 12 months after place and hold. Secondary surgery data were not available; however, all seven recorded tendon ruptures would have required surgery. All the evidence for the other five exercise comparisons as well as those of the other six comparisons made by the included studies was incomplete and, where available, of very low-certainty. AUTHORS' CONCLUSIONS: There is a lack of evidence from RCTs on most of the rehabilitation interventions used following surgery for flexor tendon injuries of the hand. The limited and very low-certainty evidence for all 14 comparisons examined in the 17 included studies means that we have very little confidence in the estimates of effect for all outcomes for which data were available for these comparisons. The dearth of evidence identified in this review points to the urgent need for sufficiently powered RCTs that examine key questions relating to the rehabilitation of these injuries. A consensus approach identifying these and establishing minimum study conduct and reporting criteria will be valuable. Our suggestions for future research are detailed in the review.


Assuntos
Traumatismos da Mão/reabilitação , Traumatismos dos Tendões/reabilitação , Adolescente , Adulto , Idoso , Viés , Criança , Terapia por Exercício/efeitos adversos , Terapia por Exercício/métodos , Exoesqueleto Energizado , Feminino , Traumatismos da Mão/cirurgia , Humanos , Imobilização , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Cuidados Pós-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Amplitude de Movimento Articular , Ruptura/reabilitação , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Terapia por Ultrassom , Adulto Jovem
7.
Plast Reconstr Surg ; 146(4): 819-829, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970003

RESUMO

BACKGROUND: Multilevel dysvascular injury of the hand can be treated with replantation or revision amputation. The authors compared both modalities regarding functional outcomes, patient-reported outcomes, and required resources, as relevant studies are scarce. METHODS: In this retrospective review of consecutive case series (replantation, n = 8; revision amputation, n = 11), clinical results and functional outcomes (including grip strength, range of motion, sensory recovery, and grip or pinch ability) were assessed. Patient-reported outcomes, required hospital resources, and treatment cost until 1 year after surgery were compared between both groups. RESULTS: Six patients used passive prostheses, two used body-powered prostheses, and three did not use a prosthesis in the revision amputation group. All patients in the replantation group could grip objects and had restored hands, with protective sensory recovery and substantial wrist motion, whereas six patients in the revision amputation group were unable to grip or pinch objects. Replantation was associated with superior patient-reported outcomes, but required more hospital resources and treatment costs. CONCLUSIONS: This study suggests that in the treatment of multilevel dysvascular injury of the hand, the surgical method should be chosen on a case-by-case basis. For better functional and patient-reported outcomes, replantation is preferred. Revision amputation can be performed in the absence of sufficient hospital resources and to reduce treatment cost. These findings can aid in the preoperative counseling of patients with multilevel dysvascular injury of the hand. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Traumatismos da Mão/cirurgia , Mãos/irrigação sanguínea , Mãos/cirurgia , Reoperação , Reimplante/métodos , Adulto , Idoso , Amputação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Ther Umsch ; 77(5): 199-206, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32870096

RESUMO

Treatment of acute injuries of the hand Abstract. Injuries to the hand are a common presentation in primary care units. When accurately assessed, many open injuries may be handled in the emergency department without referral to a hand surgery specialist. We would like to give some recommendations on how to treat the most frequent injuries like lesions to the nail and nailbed, fingertip amputation as well as burns, infections and bites. But first, we highlight the different methods of local anesthesia and discuss the use of a tourniquet or vasoconstriction with adrenalin - WALANT - instead.


Assuntos
Mordeduras e Picadas , Traumatismos dos Dedos/diagnóstico , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/cirurgia , Traumatismos da Mão/terapia , Anestesia Local , Mãos , Humanos , Unhas/lesões , Torniquetes
9.
Cir. plást. ibero-latinoam ; 46(3): 335-341, jul.-sept. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196923

RESUMO

INTRODUCCIÓN Y OBJETIVO: Los colgajos de perforantes son una técnica de la Cirugía Reconstructiva que utiliza una porción de piel y/o grasa subcutánea vascularizada por uno o varios vasos que perforan un plano profundo (músculo, fascia o tabique), tomada de una zona distante o adyacente, para cerrar y restaurar un área de defecto corporal. Permiten realizar reconstrucciones utilizando estructuras adecuadas sin desvitalizar las áreas donantes. El objetivo de este artículo es describir la experiencia en el cierre y la reconstrucción de heridas traumáticas de antebrazo y mano mediante el uso de colgajos pediculados de vasos perforantes intercostales, específicamente de arterias laterales, dorsolaterales y/o anteriores, como una opción reconstructiva accesible, funcional y estéticamente viable, en países con ingresos medios y bajos en los que se cuenta con un acceso limitado al uso de la Microcirugía en casos de emergencia. MATERIAL Y MÉTODO: Presentamos 3 casos clínicos representativos que ejemplifican el uso de distintos tipos de colgajos de perforantes intercostales como alternativa a la amputación quirúrgica en lesiones extensas de miembro superior, que por su complejidad, comprometen la viabilidad del mismo. Los 3 casos fueron atendidos en uno de los 3 hospitales de referencia de adultos de la Seguridad Social de un país de ingresos medios, Costa Rica, donde no se dispone de acesso habitual a la Microcirugía. RESULTADOS: Los 3 pacientes son varones. Caso 1: de 19 años de edad; fractura expuesta y lesión en antebrazo con compromiso de piel y tejidos blandos a consecuencia de accidente automovilístico; reconstrucción con colgajo LICAP de 32 X 12 cm. Caso 2: de 21 años de edad; trauma importante en codo y mano a consecuencia de accidente de tránsito; reconstrucción con colgajo AICAP izquierdo de 8 X 10 cm y LICAP derecho de 20 X 12 cm. Caso 3: de 32 años de edad; pérdida de la cara anterior del antebrazo derecho por accidente con cristal; intervención vascular y después colgajo LICAP de 30 X 10 cm. En todos los casos se utilizaron colgajos con 2 perforantes y la autonomización se realizó a las 3 semanas de la intervención. Cierre adecuado de las heridas y evolución de los colgajos sin complicaciones con recuperación de funcionalidad. CONCLUSIONES: En realidades donde los recursos sanitarios son limitados y no siempre están disponibles alternativas terapéuticas novedosas, nuestra experiencia, apoyada en los 3 casos descritos, muestra como los colgajos de perforantes intercostales son una alternativa viable en la reconstrucción postraumática de miembros superiores


BACKGROUND AND OBJECTIVE: Perforator flaps are a reconstructive surgery technique that uses a portion of skin and/or subcutaneous fat tissue vascularized by one or more vessels that perforate a deep plane (muscle, fascia or septum), which is removed from a distant or adjacent part to close and restore the excised section. This procedure allows reconstruction using appropriate structures without devitalizing the donor area. The aim of this report is to describe the experience in the closure and reconstruction of traumatic forearm and hand wounds using pedicled flaps of perforating intercostal arteries from lateral, dorsolateral and/or anterior vessels, as an accessible, functional and aesthetically viable option, in low- and middle-income countries where other alternatives such as Microsurgery are not frequently accessible. METHODS: We describe 3 procedures to exemplify reconstruction by using different types of intercostal perforator flaps as an alternative to surgical amputation of extensive traumatic upper limb injuries that, due to complexity, compromise their viability. The selection of cases corresponds to patients attended in one of the 3 referral hospitals of Social Security of a middle-income country, Costa Rica, where Microsurgery is not usually available. RESULTS: All cases corresponded to male patients. Case 1: 19-year-old patient who, after a car accident, presented an exposed fracture and an extensive forearm injury that compromised skin and soft tissue; reconstruction with a 32 X 12 cm LICAP flap. Case 2: 21-year-old patient who, after a traffic accident, presented significant trauma to the elbow and hand; reconstruction with a left 8 X 10 cm AICAP flap and a right 20 X 12 cm LICAP flap. Case 3: 32-year-old patient presenting loss of the anterior aspect of the right forearm after an accident with a glass window; he required prior vascular intervention and was subsequently treated with a 30 X 10 cm LICAP flap. In all cases, flaps with 2 perforators were used and autonomization was performed 3 weeks after the intervention. Likewise, adequate wound closure, flap evolution without complications, and recovery of functionality were recorded. CONCLUSIONS: In scenarios where healthcare resources are limited and the newest therapeutic alternatives are not always available, our experience, supported by the 3 cases described, shows how the use of intercostal perforating flaps constitutes a viable alternative in the reconstruction of upper limbs after trauma, especially in low- and middle-income countries


Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Retalhos Cirúrgicos/cirurgia , Extremidade Superior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/economia , Procedimentos Cirúrgicos Reconstrutivos/economia , Extremidade Superior/lesões , Traumatismos do Braço/cirurgia , Cotovelo/lesões , Cotovelo/cirurgia , Traumatismos da Mão/cirurgia , Traumatismos do Braço/cirurgia
10.
Orthopade ; 49(9): 771-783, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32776276

RESUMO

BACKGROUND: Unrestricted gliding of extensor and flexor tendons is essential for normal functioning of the hand. If tendon gliding is impaired, a restricted range of motion of finger joints and, finally, joint stiffness result. OBJECTIVES: To answer the questions about the causes of tenodesis in the hand, which examinations are most informative, how tenolysis is technically performed, and what results can be expected. METHODS: The reasons, examinations, surgical technique, and results of extensor and flexor tendon tenolysis are presented. RESULTS: Based on the data in the literature tenolysis of flexor tendons leads to range of motion that is only 50-60% of the preoperative range of motion. In about 20% of patients, deterioration as serious as secondary tendon rupture is observed. Meaningful results of extensor tendon tenolysis have not yet been published. CONCLUSIONS: Tenolysis of extensor and flexor tendons in the hand is a demanding surgical procedure, and in addition to detailed knowledge of anatomy and biomechanics, it requires sufficient experience-especially following the primary repair of tendon injuries. The earliest indication for tenolysis can occur at about 3 months, usually after 6 months, if continuous intensive hand therapy and splinting have not been successful. General and individual benefits and risks must be carefully weighed. The key to successful tenolysis is the patient's access to and unrestricted participation in competent postoperative treatment, ideally performed by a specialist in hand therapy, which may last for weeks or months.


Assuntos
Traumatismos da Mão , Traumatismos dos Tendões , Articulações dos Dedos , Mãos , Traumatismos da Mão/cirurgia , Humanos , Amplitude de Movimento Articular , Traumatismos dos Tendões/cirurgia , Tendões , Aderências Teciduais
11.
Hand Surg Rehabil ; 39(5): 459-461, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32777488

RESUMO

The recent coronavirus outbreak has tested the adaptability, cooperation and organizational capabilities of our healthcare systems. Restrictions were implemented in several countries to reduce virus transmission whilst emergency departments (ED) were overwhelmed and there was shortage of healthcare providers. Given this situation and the consequences of hand injuries, we studied the epidemiology of hand injuries in an accredited FESSH emergency center during the lockdown in France (March 17 to May 10, 2020) due to the coronavirus outbreak. During this period, 1947 patients consulted for a hand injury. We found high percentages of men (63%), open wounds (70%), domestic accidents (88%) and surgical treatment being required (76%). There was a significant decrease in admissions and consultations relative to the same period in 2019. This reference data can help healthcare systems prepare for future outbreaks and similar restrictions.


Assuntos
Infecções por Coronavirus/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/cirurgia , Pneumonia Viral/epidemiologia , Quarentena , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
13.
Plast Reconstr Surg ; 146(2): 250e-251e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740632
15.
Medicine (Baltimore) ; 99(34): e21837, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846830

RESUMO

RATIONALE: Repair of soft tissue defects on the dorsum of the hand with accompanying tendon defects is a challenging problem in clinical practice. PATIENT CONCERNS: Here, we describe the case of a 3-year-old boy with a 1-week old soft tissue injury with infection due to a soft tissue defect on the dorsum of his right hand, and further describe its treatment. DIAGNOSIS: A diagnosis of a soft tissue defect of the dorsum with extensor tendon defects in the fore, middle, ring, and little fingers of the right hand was made. INTERVENTIONS: The defects were repaired using a dorsal foot flap combined with the extensor digitorum brevis tendon, under spinal anesthesia, and a small dose of the sedative phenobarbital (Lumina) was administered via pump injection after the surgery. OUTCOMES: The patient was followed-up for 6 months. The shape of the dorsal hand flap recovered satisfactorily and the skin color was almost normal. Protective sensation was restored and the tendon graft functioned well in vivo. Satisfactory outcomes were achieved in the flexion and extension of each finger. LESSONS: This case study provides evidence that for soft tissue defects on the dorsum of the hand with tendon defects, 1-stage transfer of a dorsal foot flap with the extensor digitorum brevis tendon can be effective for recovery of appearance and extensor function. In case of infant patients, postoperative use of low-dose sedation can effectively reduce the risk of vascular crisis, thus promoting survival of the flap graft, and ensuring the success of the operation.


Assuntos
Anormalidades Musculoesqueléticas/cirurgia , Retalhos Cirúrgicos/transplante , Transferência Tendinosa/métodos , Tendões/cirurgia , Assistência ao Convalescente , Pré-Escolar , Traumatismos da Mão/complicações , Traumatismos da Mão/cirurgia , Humanos , Masculino , Anormalidades Musculoesqueléticas/etiologia , Infecções dos Tecidos Moles/microbiologia , Lesões dos Tecidos Moles/complicações , Tendões/anormalidades , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(28): e21216, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664172

RESUMO

INTRODUCTION: The anterolateral thigh (ALT) flap is the most popularly used flap for major soft tissue reconstruction. Although it is widely used, acute compartment syndrome (ACS) in pediatric patients has rarely been reported in the literature. We herein reported a case of ACS in a 6-year-old girl after ALT flap harvest with direct closure of the donor site. PATIENT CONCERNS: A 6-year-old girl was admitted to the Second Hospital of Jilin University with crush injury on the palmar aspect of the right hand and wrist. DIAGNOSIS: Examination showed soft tissue defect of the hand and wrist, damage on the thenar muscles, lightly crushed flexor tendons, crushed median nerve, and ulnar artery thrombosis. INTERVENTIONS: The defect was closed with an ipsilateral ALT flap measuring 9 cm in length by 6 cm in width. OUTCOMES: After debridement was performed 3 times, the majority of the rectus femoris and lateral femoris were removed. Secondary closure by skin grafting was performed 2 weeks later. Three days after the procedure, necrotic tissues were noted on the edges of the wound. The diagnosis of ACS of the right was made. A second exploration was decided, and an extensive anterior compartment fasciotomy was performed. After 6 weeks of vacuum sealing drainage therapy, the defect was closed with a free latissimus dorsi musculocutaneous flap. At 4 months of follow-up, the right thigh wound had healed. At 6 months of follow-up, quadriceps muscle weakness remained. At 1 year of follow-up, the patient's mobility had been significantly improved, but diminished sensation remained on the lateral aspect of the thigh. CONCLUSION: ACS can occur after ALT flap harvesting in pediatric patients and should be recognized as early as possible to avoid devastating complications.


Assuntos
Síndromes Compartimentais/etiologia , Complicações Pós-Operatórias/etiologia , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos , Coxa da Perna/cirurgia , Doença Aguda , Criança , Lesões por Esmagamento/cirurgia , Feminino , Traumatismos da Mão/cirurgia , Humanos , Traumatismos do Punho/cirurgia
17.
Hand Surg Rehabil ; 39(5): 454-458, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32619686

RESUMO

Since the first cases were detected in China in December 2019, the COVID-19 pandemic has spread rapidly, collapsing many healthcare systems, and forcing them to adapt. Hand surgery has been indirectly affected by this scenario. This article aims to provide an overview on how Spanish hand surgeons have modified their daily practice. Based on a survey conducted nationwide, we observed a decrease in the number of emergency cases and cancellation of elective cases, shift to a more conservative treatment approach, use of personal protective equipment, and decrease in the number of outpatient visits and tests. Without definitive evidence at this point, knowing how we have dealt with the situation so far will help us adopt the needed measures to ensure both the patient's and surgeon's safety and manage available resources in future pandemics.


Assuntos
Infecções por Coronavirus/epidemiologia , Traumatismos da Mão/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Pandemias , Espanha/epidemiologia
18.
Chirurg ; 91(10): 895-902, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32699912

RESUMO

Flexor tendon injuries of the hand are relatively rare but pose significant challenges to both physician and patient. A thorough clinical evaluation enables flexor tendon lacerations to be identified and classified. The flexor tendons of the hand are divided into five anatomic zones (from distal to proximal). Diagnostics, treatment and prognosis may differ depending on which zone is affected. Early, careful and proficient management is needed to ensure good functional outcomes. Various factors influence the outcome, including location, mechanism of injury, presence of concomitant injuries, time of surgery, quality of tendon repair and the rehabilitation protocol. It is important to inform the patient about the importance of thorough rehabilitation and possible complications. Postoperative scarring and adhesions, infections and secondary tendon ruptures due to insufficient primary repairs are especially challenging and potentially necessitate a lengthy and strenuous secondary repair and rehabilitation process.


Assuntos
Traumatismos dos Dedos , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/cirurgia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Humanos , Ruptura , Tendões
19.
Postgrad Med J ; 96(1137): 379-383, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32522845

RESUMO

INTRODUCTION: Managing healthcare service during pandemics and outbreaks is a challenging process. The aim is to keep patient safety as the priority, besides, continuing to provide essential healthcare services. METHODS: Situational audit was performed for the services rendered before and during COVID-19 pandemic and the elevation of the disease alert status, and a retrospective analysis of the attendance and procedures performed in the service. RESULTS: We present a methodology for performing a situational audit and generating service modification for hand and reconstructive microsurgery unit in a pandemic. There was no significant difference between the number of patients seen at outpatient clinics. However, there was a reduction in the numbers of total surgeries performed, with a 40% drop in the number of elective surgeries performed. There was also a reduction of cases seen in the emergency department hand clinic. DISCUSSION: COVID-19 pandemic is currently affecting not only the health service but also, other vital services all over the world. The pandemic puts significant challenges to acute surgical services in a hospital system involved in the management of the pandemic. Surgeons need to take proactive and a systematic approach in managing the available resources while maintaining essential surgical services. This paper provides the tools and methodology for doctors to plan their services in a pandemic situation. CONCLUSIONS: It is possible to maintain essential surgical services in a pandemic situation through rapid situational audits and generating localised strategies while considering the constraints imposed during the pandemics while maintaining patient and staff safety.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Traumatismos da Mão/cirurgia , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/métodos , Auditoria Clínica , Humanos , Microcirurgia , Segurança do Paciente , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Singapura/epidemiologia
20.
Int Orthop ; 44(8): 1497-1501, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32488564

RESUMO

PURPOSE: The lockdown imposed in France to cope with the COronaVIrus Disease 2019 (COVID-19) outbreak has led to major changes in the lifestyle of French citizens. The aim of our study was to study its impact on activity related to emergencies in hand and upper limb trauma in comparison to the same reference period in 2019. MATERIAL AND METHODS: All consecutive patients consulting for upper limb injury requiring urgent care at Georges-Pompidou European Hospital (HEGP), France, during the lockdown period (case group) and the equivalent period in 2019 (control group) were included. In each group, the type of accident, the anatomical location of the injury, and the treatment were reported and compared. RESULTS: Two hundred seventy-five patients were included in the case group in comparison to 784 patients in the control group. We observed a two-third decrease in the rate of upper limb emergencies (- 64.9%) in particular a drastic drop in the rate of road, work, and leisure accidents (10.4% vs 14.3%, p = 0.1151; 10.0% vs 22.6%, p < 0.0001; 13.1% vs 30.8%, p < 0.0001, respectively), and a clear increase in domestic accidents (66.5% vs 32.3%, p < 0.0001). The aetiologies were more dominated by lacerations of soft tissues (48.4%, vs 38.3%, p = 0.0034) and infections (8.7% vs 5.1%, p = 0.0299) with an increase in the indications for surgical management (51.2% vs 36.9%, p < 0.0001). Conversely, we observed fewer consultations for joint injuries (20.7% vs 30.7%, p = 0.0015) and fractures (22.2% vs 25.9%, p = 0.2210). CONCLUSION: The lockdown imposed in France has changes the etiologies and the management of hand and upper limb emergencies.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Traumatismos da Mão , Pandemias , Pneumonia Viral , Extremidade Superior/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Emergências , Feminino , França , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Traumatologia , Universidades , Extremidade Superior/cirurgia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...