RESUMO
PURPOSE OF THE STUDY: The purpose of this study was to evaluate an alternative procedure for amputations distal to the distal interphalangeal joint: the reposition flap. MATERIALS AND METHODS: The reposition flap was used for 6 patients who underwent fingertip amputations in an emergency setting. Pulp was excised on the amputated segment and the remaining bone and nail bed were reattached to the proximal stump with a Kirschner wire. The pulp was reconstructed with a local advancement and sensitive flap. The patients were aged 18 to 44 years and had been victims of work accidents. All refused finger shortening. RESULTS: The fingers showed good scarring and good trophicity. Two-point discrimination was 6 mm. Bony fusion was constant but all distal interphalangeal joints remained stiff. Cosmetic results were correct except for two cases of claw nail formation. DISCUSSION: Fingertip amputations have been widely reported. Methods have varied from directed scarring to partial toe transfer. These situations present two types of challenge: insensitivity of the volar aspect or an overly sensitive pulp; cosmetic presentation and function of the dorsal aspect due to the complex role of the nail. Distal reimplantation remains the best technique, but the reposition flap offers an interesting alternative in case of failure or for patients who do not accept finger shortening. The advantage of the reposition flap is that it preserves finger length and the nail. Work stoppage and intolerance to cold can be an inconvenience due to the long time required for wound healing.
Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Reimplante/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Amputação Traumática/classificação , Amputação Traumática/diagnóstico por imagem , Amputação Traumática/fisiopatologia , Emergências , Feminino , Traumatismos dos Dedos/classificação , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/fisiopatologia , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Radiografia , Amplitude de Movimento Articular , Reimplante/instrumentação , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
We report two cases of carpometacarpal dislocation of the four long fingers. They were diagnosed in emergency and treated by open reduction and stabilization by intramedullary pinning. They were followed for an average of 30 months. The results were rated good, and the two patients had an excellent grip strength, no deformity, no instability, no disabling or limited prehension. Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction and fixation by pins and immobilisation in a plaster cast. The results was good in the two cases without complications.
Assuntos
Articulações dos Dedos/cirurgia , Fixação de Fratura/métodos , Fraturas Fechadas/cirurgia , Luxações Articulares/cirurgia , Adulto , Ossos do Carpo/patologia , Articulações dos Dedos/patologia , Fraturas Fechadas/diagnóstico , Fraturas Fechadas/patologia , Força da Mão , Humanos , Fixadores Internos , Luxações Articulares/diagnóstico , Luxações Articulares/patologia , Instabilidade Articular , Masculino , Metacarpo/patologia , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A biopsy is needed when a solitary melanonychia striata in a white patient remains unexplained after careful clinical examination in order to rule out the development of a malignant melanoma. The ideal biopsy has to excise entirely the lesion and to provide enough tissue for pathological examination. The authors describe a new method of excisional biopsy based on primarily closure using a longitudinal closing wedge osteotomy of the distal phalanx. The longitudinal elliptical resection extended from the distal interphalangeal joint to the hyponychium with en bloc resection of the entire thickness of the nail complex, including the periosteum. A longitudinal closing wedge osteotomy was then performed in the distal phalanx allowing primarily closure with precise alignment of the nailbed edges. After suture of the nailbed, a tension band nail synthesis was performed. Four consecutive melanonychia striata of 2 to 3 mm were consecutively operated on using this technique. Postoperative cares were uneventful in all the cases. The pathological examination confirmed the diagnosis of melanoma in one case, Bowen's disease in one and junctional nevus in two. Cosmetic and functional assessment at a mean follow-up of 12 months evidenced light nail dystrophy in all the cases. Our method offers to the pathologist enough tissue with preserved architecture for precise pathological examination. The technically simple closing wedge osteotomy never complicated the postoperative course. These preliminary results are encouraging and allow us to recommend this technique for the diagnosis of all suspect melanonychia striata between 2 and 3 mm wide.
Assuntos
Unhas/cirurgia , Osteotomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Adulto , Biópsia/efeitos adversos , Feminino , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Unhas/patologia , Neoplasias Cutâneas/diagnóstico , Técnicas de Sutura , Resultado do TratamentoRESUMO
PURPOSE OF THE STUDY: The purpose of this study was to evaluate early cover of post-traumatic tissue loss in the upper limb. MATERIAL AND METHODS: We report 10 cases of tissue loss in the upper limb treated surgically by fasciocutaneous flaps or muscle flaps. The patients were aged from 14 to 60 years. Six patients underwent surgery as an emergency. Surgery consisted of a thorough debridement, internal fixation if required and soft tissue reconstruction as indicated. This was then followed by immediate flap cover. All had antibiotics during and after surgery. The coverage procedure was selected according to the site and its dimensions. We used 8 fasciocutaneous and 2 muscle flaps in our series. RESULTS: One flap underwent necrosis. The flaps otherwise showed good scaring and trophicity. All the patients were satisfied. DISCUSSION: Early or even immediate coverage of substantial tissue loss following trauma has been made possible because of the development of newer flap techniques. Meyer considers that the improved results can be explained by the fact that early cover prevents bone and tendon desiccation and is achieved before substantial bacterial colonisation can occur. Additionally it is a reliable procedure that brings in vascularised tissue, thereby contributing to reduced scarring of the underlying structures. It also permits immediate osteosynthesis thus avoiding the problems of external fixation. To us the key advantage of emergency skin cover is the fact that the operative field may become colonised but does not become infected. This gives the surgeon the freedom to undertake immediate reconstruction without the prospect of subsequent sepsis.
Assuntos
Traumatismos do Antebraço/cirurgia , Traumatismos da Mão/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Tratamento de Emergência/efeitos adversos , Tratamento de Emergência/métodos , Feminino , Seguimentos , Traumatismos do Antebraço/etiologia , Traumatismos do Antebraço/fisiopatologia , Rejeição de Enxerto , Traumatismos da Mão/etiologia , Traumatismos da Mão/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Amplitude de Movimento Articular , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/fisiopatologia , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/normas , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Scapho-capitate fracture is a rare lesion and its mechanism is controversial. Forced extension seems to be the most frequent cause as this movement of the wrist induces scaphoid fracture by compression. Hyperextension of the wrist as a result of the scaphoid lesion, allows contact between the posterior margin of the radius and the neck of the capitate inducing a capitate fracture. MATERIALS AND METHODS: We report a case of Fenton's Syndrome, the patient was operated as an emergency by pining and immobilization of the carpus and thumb until bone consolidation had occurred. RESULTS: Consolidation was noted at 8 weeks with a good mobility of the wrist. DISCUSSION: Fenton's Syndrome is a rare lesion of the wrist. Analysis of our own case and a review of literature demonstrated extension as a causative mechanism, and the frequency of delayed diagnosis. Because of the presence of instability, scaphoid reduction and osteosynthesis is necessary. Immobilization of the carpus and thumb is essential until bony consolidation is obtained.
Assuntos
Fixação Interna de Fraturas/métodos , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adulto , Pinos Ortopédicos , Feminino , Humanos , Instabilidade Articular , Síndrome , Resultado do Tratamento , Traumatismos do Punho/patologiaRESUMO
This article is based on the retrospective study of 4 cases of necrotic fasciitis of the upper extremity, in adult patients with a mean age of 57 years (range: 36 to 78 years) and with a male predominance (3 M/1 F). Presenting signs were variable: pain, febrile and inflammatory oedema, ecchymoses with inflammatory masses containing clear or haemorrhagic fluid. Treatment with antibiotics and anti-inflammatory drugs did not prevent progression to painless, necrotic ulcers. Rapid medical and surgical treatment constitutes an element essential of the prognosis and must include wide large debridement, antibiotics and intensive care.