Microsurgery
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The effect of hyperbaric oxygen (HBO) on ischemia-reperfusion injury of skeletal muscle, applied during different periods, was studied in 56 male rats. Animals were subjected to 6-h ischemia by a tourniquet over the major femoral trocanter and 4 (A) or 24 (B) h of reperfusion. HBO was carried out during 1 h in an acrylic chamber at a pressure of 2.0 ATA (100% oxygen): in the last 60 min of ischemia (II), after ischemia, during 1-h reperfusion time (III), and during the last hour of ischemia plus 1-h reperfusion (IV). ⋯ No interstitial hemorrhage, neutrophil infiltrate, or cellular necrosis were induced by HBO. The apoptosis index did not differ among the groups. HBO reduced morphologic alterations and promoted better results when administered in the ischemia plus reperfusion period (GIV).
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The purpose of this report is to introduce the cross-leg anterolateral thigh perforator flap for closure of a defect on the dorsum of the foot, and to show that the anterolateral thigh perforator flap is a safe option for a cross-bridge microvascular anastomosis in defects of the extremity. The free anterolateral thigh perforator flap was used for a patient with an unhealed wound on the dorsum of the foot. ⋯ After a 4-week neovascularization period, the pedicle was cut. To the best of our knowledge, this is the first report of the use of a free anterolateral thigh perforator flap for a cross-bridge microvascular anastomosis.
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The varying degrees of spontaneous reinnervation that occur in untreated obstetrical brachial plexus palsy leave characteristic deformities of the shoulder, elbow, forearm, wrist, and hand. Common sequelae are internal rotation and adduction deformity of the shoulder, elbow flexion contractures, forearm supination deformity, and lack of wrist extension and finger flexion. ⋯ Secondary procedures of the shoulder, elbow, forearm, and hand will improve the appearance and function of the upper extremity in late cases of obstetrical brachial plexus. Careful preoperative planning is mandatory and a multistage approach should be applied, depending on the type of palsy and the age of the patient.
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Review Case Reports
Concepts of nerve regeneration and repair applied to brachial plexus reconstruction.
Brachial plexus injury is a serious condition that usually affects young adults. Progress in brachial plexus repair is intimately related to peripheral nerve surgery, and depends on clinical and experimental studies. We review the rat brachial plexus as an experimental model, together with its behavioral evaluation. ⋯ Surgical planning in root rupture or avulsion is proposed. In total avulsion, the authors are in favor of the reconstruction of thoraco-brachial and abdomino-antebrachial grasping, and on the transfer of the brachialis muscle to the wrist extensors if it is reinnervated. Surgical treatment of painful conditions and new drugs are also discussed.
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Case Reports
Reliable option for reconstruction of amputation stumps: the free anterolateral thigh flap.
The increased use of microsurgery has enabled reconstructive surgeons to deal with tissue defects of various sizes and compositions. The limited amount of qualified tissue for covering is the primary problem in stump reconstruction. Free flaps offer the ideal solution by providing the optimal cover, and by preserving the length of the amputation site. ⋯ All underwent previous stump reconstruction with local flaps in other clinics. Anterolateral thigh flaps avoided further shortening of the extremities, and provided stable tissue for prosthesis use. The flap offers reliable soft-tissue reconstruction of amputation stumps.