Annals of plastic surgery
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Annals of plastic surgery · Mar 1999
Case ReportsFlexor tenosynovitis in the hand caused by Mycobacterium terrae.
The authors describe an uncommon case of flexor tenosynovitis caused by Mycobacterium terrae, an atypical mycobacterium generally considered nonpathogenic in humans. A prolonged delay in diagnosis and various ineffective therapies led to synovial biopsy and culture. After confirming the diagnosis of M. terrae, appropriate antimycobacterial chemotherapy resolved the synovitis. For chronic tenosynovitis without a clear etiology, limited synovectomy and culture are essential in establishing a diagnosis and in initiating treatment for this atypical mycobacterial infection.
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Annals of plastic surgery · Nov 1998
Case ReportsParamedian sternal bone plate reinforcement and wiring for difficult sternotomy wounds.
Longitudinally oriented bone plates of stainless steel adapted to each sternal half after midline sternotomy provide a reinforced construct for transverse wiring. A method for placement of these 3.5-mm screw diameter plates in a supraperiosteal position is described. Clinical indications for use have included sternal osteoporosis, previous pull through of conventional wires, segmental sternal fractures, and obese body habitus. This technique is presented as a method to avoid sternal instability and potential wound infection for those patients at risk for sternal separation with standard wiring techniques.
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Digital block anesthesia with epinephrine, ring technique, and digital tourniquet have been implicated in causing finger gangrene. An extensive review of the literature provided no case of finger gangrene attributed solely to the adjunctive use of epinephrine with lidocaine for digital block. By causing vasoconstriction, epinephrine complements the local analgesic by prolonging the duration of action and providing a temporary hemostatic effect. Epinephrine augmentation of digital block anesthesia was used in the treatment of 23 finger injuries without a complication.
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A retrospective review of 22 patients who sustained snowblower injuries to the hand was performed. There were 17 men and 5 women, ranging in age from 20 to 68 years (average age, 39.7 years). Fifty percent were manual laborers, 25% were unemployed, 15% were office workers, and 10% were not categorized. ⋯ The middle and ring fingers are most commonly involved, with relative sparing of the thumb. Fractures are the most frequent injury, followed by nail bed injuries and amputations. Snowblower injuries are often managed as open fractures with intravenous antibiotics; irrigation and debridement; and repair of bone, soft tissue, and nail bed structures.
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Annals of plastic surgery · Sep 1998
Prefabrication of a high-density porous polyethylene implant using a vascular induction technique.
Three-dimensional defects have been reconstructed with carved and remodeled frameworks wrapped within vascular carriers and have wide use in ear and nose reconstruction. The main problem with thick coverings is masking of the fine details in the frameworks. Other problems are insufficient blood supply, infection, and exposure of the implant. ⋯ Twenty implants were prefabricated in this procedure, and they were evaluated via histological examination and perfusion scintigraphy. Results revealed that the implants were invaded by fibroneovascular tissue. Blood supply coming from the vascular pedicle was sufficient to maintain the implant as a prefabricated composite flap, which could be transferred as a pedicled flap or a free flap.