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Soft tissue injuries

John T Stranix, William J Rifkin, Z-Hye Lee, Lavinia Anzai, Adam Jacoby, Daniel J Ceradini, Vishal Thanik, Pierre B Saadeh, Jamie P Levine
BACKGROUND:  Microvascular reconstruction of the lower extremity has the highest reported complication and flap failure rates of any anatomical region. Despite widespread adoption of the mechanical anastomotic venous coupler and encouraging results in other anatomical regions, there are limited reports examining its use in the lower extremity. This study compares outcomes between coupled and hand-sewn venous anastomoses in traumatic lower extremity reconstruction. METHODS:  Retrospective review of our institutional flap registry from 1979 to 2016 identified soft tissue free flaps performed for the reconstruction of Gustilo type IIIB/IIIC open tibial fractures...
June 15, 2018: Journal of Reconstructive Microsurgery
Ujjwal Kanti Debnath, Dipak Kumar Jha, Prasanta Kumar Pujari
Background: High-energy fractures of proximal tibia (Schatzker VI) are associated with severe articular depression, separation of both condyles, diaphyseal comminution & dissociation with loss of integrity of the soft-tissue envelope. Complications of plating are well known since last 50years in these difficult fractures. An alternative method was proposed by Ilizarov (ring fixator) and was adopted for the treatment of these complex injuries. Aim of study: To analyse the results of patients who had ring fixator for the management of high-energy fractures (Schatzker VI) of the proximal tibia...
April 2018: Journal of Clinical Orthopaedics and Trauma
Yongqiang Zhao, X Ma, Y Li, Q Fu
OBJECTIVES: As part of the UN peacekeeping mission in Mali, the People's Republic of China have deployed a level 2 medical treatment facility (CHN L2). The aim of this study was to review the cases managed by the otolaryngology service within this facility. METHODS: The medical records of all patients treated by the otolaryngology service at the CHN L2 from 1 March 2015 to 1 March 2018 were retrospectively assessed. RESULTS: 614/10189 (6%) of all cases seen in the hospital during this period were referred to the otolaryngology service...
June 11, 2018: Journal of the Royal Army Medical Corps
Disha Kumar, Nicolás W Cortés-Penfield, Hanine El-Haddad, Daniel M Musher
BACKGROUND: Fournier's gangrene is a necrotizing soft-tissue infection (NSTI) that often originates from a break in bowel integrity and affects the perineum, anus, or genitalia. Although the pathogenesis is similar, NSTI caused by a break in bowel integrity less commonly presents as infection of other sites. OBJECTIVE: To characterize NSTIs originating from bowel perforation and presenting as infection of the abdominal wall, flank, or thigh but that largely spare the perineum, anus, and genitalia...
June 12, 2018: Surgical Infections
Min Liu, Liangle Liu, Xiaosai Zhou, Lifen Wu, Juncheng Wang, Li Qi, Chunyuan Cai
Morel-Lavallée lesions are rare, closed degloving soft tissue injuries in which the skin and subcutaneous tissues are traumatic separated from the underlying fascia. There is lack of consensus regarding optimal management of these lesions. After failure of conservative management, operative intervention is imperative. The purpose of this manuscript is to describe a minimally invasive endoscopic method for treatment of Morel-Lavallée Lesions, which achieves the goal of an open surgical debridement.
June 4, 2018: Injury
P Sarat Chandra, Pankaj Singh, Rajender K, Deepak Agarwal, Vivek Tandon, S S Kale, Chitra Sarkar
BACKGROUND: Vertebral body (VH) hemangiomas with myelopathy are difficult to manage. OBJECTIVE: To evaluate the role of intra-operative ethanol embolization, surgical decompression and instrumented short segment fusion in VH with myelopathy and long-term outcome (>24 months). METHODS: Prospective study: Symptomatic VH with cord compression with myelopathy. Excluded: pathological fractures, and/or deformity or multi-level pathologies. Surgery consisted of intra-operative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy and cord decompression at the level of pathology followed by a short segment instrumented fusion using pedicle screws...
June 8, 2018: Spine Journal: Official Journal of the North American Spine Society
K O Opara, I C Nwagbara
Background: : Complex soft tissue defects around the knee are not common. They pose significant reconstructive challenges; hence, several methods have been tried. In this study, the use of proximally based sural island fasciocutaneous flap is evaluated. Aim: : The aim of this study is to report our experience with the use of proximally based sural island fasciocutaneous flap in the reconstruction of complex soft tissue defects around the knee. Patients and Methods: This was a prospective study...
June 2018: Nigerian Journal of Clinical Practice
K O Opara, I C Nwagbara
Background: : The management of soft-tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects. Aim: : This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia. Materials and Methods: : Consecutive patients with osteomyelitis of the tibia requiring soft-tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed...
June 2018: Nigerian Journal of Clinical Practice
Benedikt Schliemann, Lukas F Heilmann, Michael J Raschke, Helmut Lill, J Christoph Katthagen, Alexander Ellwein
Background: This study analyzed the indications for conservative management of isolated greater tuberosity (GT) fractures. The rate of secondary interventions for failed conservative treatment was also assessed. Methods: A retrospective data evaluation of isolated GT fractures was performed from the clinical database of two level-I trauma centers from January 2010 to June 2017. Conservatively treated GT fractures were identified and subdivided according to etiology, morphology, and amount of initial displacement...
2018: Obere Extremität
S R Sundararajan, Abdul Azeem Badurudeen, R Ramakanth, Shanmuganathan Rajasekaran
Fractures of talar body are uncommon injuries often associated with fractures of other long bones and in polytraumatized patients. The integrity of the talus is essential for the normal function of the ankle, subtalar, and midtarsal joints. The relative infrequency of this injury limits the number of studies available to guide treatment. They occur as a result of high-velocity trauma and are therefore associated with considerable soft tissue damage. Axial compression with supination or pronation is the common mechanism of injury...
May 2018: Indian Journal of Orthopaedics
Stefan Rammelt, Bruce J Sangeorzan, Michael P Swords
The best treatment for displaced, intraarticular fractures of the calcaneum remains controversial. Surgical treatment of these injuries is challenging and have a considerable learning curve. Studies comparing operative with nonoperative treatment including randomized trials and meta-analyses are fraught with a considerable number of confounders including highly variable fracture patterns, soft-tissue conditions, patient characteristics, surgeon experience, limited sensitivity of outcome measures, and rehabilitation protocols...
May 2018: Indian Journal of Orthopaedics
Yang Zhu, Yasumoto Matsumura, Murugesan Velayutham, Lesley M Foley, T Kevin Hitchens, William R Wagner
Tissue damage and the impairment of regenerative processes by excessive reactive oxygen species (ROS) contributes to the pathogenesis of various diseases in soft tissues including diabetes, atherosclerosis, Parkinson's disease and myocardial ischemic/reperfusion injury. In this study, a thermally responsive injectable hydrogel poly(NIPAAm-co-VP-co-MAPLA-co-MATEMPO) (pNVMT, NIPAAm: N-isopropylacrylamide, VP: vinylpyrrolidone, MAPLA: methacrylate-polylactide, MATEMPO: methacrylate-TEMPO, TEMPO: 4-amino-TEMPO or 4-Amino-2,2,6,6-tetramethylpiperidine-1-oxyl) incorporating recyclable ROS scavenging nitroxide radicals on the polymer backbone was developed to locally control adverse tissue effects from free radical generation...
May 31, 2018: Biomaterials
Mahesh Suresh Kulkarni, Monappa Naik Aroor, Sandeep Vijayan, Saurabh Shetty, Sujit Kumar Tripathy, Sharath K Rao
BACKGROUND: The surgical outcome of floating knee injuries is difficult to predict. The high-velocity nature of the injury, complex fracture pattern and associated soft tissue/visceral injuries may have some impact on the functional outcome. The present study evaluates the variables affecting the clinical and radiological outcomes of floating knee injuries. MATERIALS AND METHODS: The clinical, radiological and functional outcome (Karlstrom and Olegrud criteria) of 89 patients with 90 floating knee injuries were evaluated at the end of one year who were managed in our level 1 trauma center between January 2013 and December 2016...
June 1, 2018: Injury
G T Capolupo, G Mascianà, F Carannante, M Caricato
INTRODUCTION: Laparoscopic cholecystectomy (LC) has become the "gold standard" for the treatment of symptomatic gallstones. However, this surgical technique increases the risk of bile duct injury and lost gallstones. Since over 90% of split gallstones never become symptomatic, they often present as incidental findings on CT-scans. Careful removal of as many stones as possible, intense irrigation and suction are recommended. It has been reported that 8.5% of lost gallstones will lead to a complication, most common are abscesses...
May 4, 2018: International Journal of Surgery Case Reports
Eirik Aunan, Stephan M Röhrl
Background and purpose - In the classical mechanical alignment technique, ligament balancing is considered a prerequisite for good function and endurance in total knee arthroplasty (TKA). However, it has been argued that ligament balancing may have a negative effect on knee function, and some authors advocate anatomic or kinematic alignment in order to reduce the extent of ligament releases. The effect of the trauma induced by ligament balancing on functional outcome is unknown; therefore, the aim of this study was to investigate this effect...
June 8, 2018: Acta Orthopaedica
Roberto Negrín, Nicolás O Reyes, Magaly Iñiguez, Juan José Pellegrini, Mauricio Wainer, Jaime Duboy
Posteromedial meniscotibial ligament lesions, known as meniscal ramp lesions, are typically associated with ACL injuries, but frequently underdiagnosed. When correctly diagnosed, repair is mandatory in most cases. Retraction of the soft tissues makes it difficult to repair and leads to suture failure. Previously described techniques include all-inside and inside-out meniscal sutures, but do not ensure correct meniscotibial closure because of the soft tissue retraction. The purpose of this Technical Note is to describe a meniscal ramp lesion arthroscopic repair with an all-inside technique with the Fast-Fix 360 device, detailing the use of the accessory posteromedial portal, and the addition of an arthroscopic grasper that raises the retracted meniscotibial ligament, to allow correct fixation...
March 2018: Arthroscopy Techniques
Karen M Myrick, Stephen Davis
Morel-Lavallee lesions are post-traumatic, soft-tissue degloving injuries commonly misdiagnosed as hematomas or ruptured bursa. The clinician needs to be aware of this injury, in order to provide appropriate patient care and treatment. If not treated early, risks include superinfection, continued expansion, overlying tissue necrosis, and suboptimal patient outcomes.
June 2018: Clinical Case Reports
Kazuhiro Kai, Ko Ikuta, Keigo Masuda, Takahiro Kitamura, Hideyuki Senba, Satoshi Shidahara
STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the clinical and radiological outcomes of ankylosing spinal disorder (ASD) patients with spinal fractures treated by minimally invasive stabilization (MISt) using percutaneous pedicle screws (PPSs). OVERVIEW OF LITERATURE: ASDs, such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), increase susceptibility to spinal fractures because of extremely decreased spinal flexibility...
June 2018: Asian Spine Journal
Jorge Castizo-Olier, Alfredo Irurtia, Monèm Jemni, Marta Carrasco-Marginet, Raúl Fernández-García, Ferran A Rodríguez
BACKGROUND: Bioelectrical impedance vector analysis (BIVA) is a general concept that includes all methodologies used in the analysis of the bioelectrical vector, whereas the "classic" BIVA is a patented methodology included among these methods of analysis. Once this was clarified, the systematic review of the literature provides a deeper insight into the scope and range of application of BIVA in sport and exercise. OBJECTIVE: The main goal of this work was to systematically review the sources on the applications of BIVA in sport and exercise and to examine its usefulness and suitability as a technique for the evaluation of body composition, hydration status, and other physiological and clinical relevant characteristics, ultimately to trace future perspectives in this growing area, including a proposal for a research agenda...
2018: PloS One
David A Shaye, Travis Tollefson, Irfan Shah, Gopal Krishnan, Damir Matic, Marcelo Figari, Thiam Chye Lim, Sunil Aniruth, Warren Schubert
BACKGROUND: Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education...
June 6, 2018: World Journal of Surgery
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