Microsurgery
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Aneurysms of the digital artery are rare. Since 1980, we have treated three traumatic aneurysms of the digital artery. There were two lesions of the common palmar digital artery and one of the ulnar pollicis artery. ⋯ On histologic examination, there were two true aneurysms and one false aneurysm. Two cases were treated by excision only, and one case was treated by excision and reanastomosis. The operating microscope was useful during neurolysis, excision of the aneurysm, and vascular anastomosis.
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Management of major penetrating glass injuries to the upper extremities in children and adolescents.
Penetrating glass injuries are a common cause of severe neurovascular damage, both in adults and in children. Frequently, an innocent skin wound disguises the extensive nature of the injuries beneath. Nineteen children and adolescents (ages 3-16 years) with a mean age of 9 years who sustained upper extremity penetrating glass wounds were evaluated retrospectively in order (1) to determine the incidence of unappreciated significant neurologic, musculotendonous, or vascular injury; (2) to provide indications for intraoperative evaluation under anesthesia; and (3) to further define the role of microneurorrhaphy in this population. ⋯ A detailed follow-up evaluation to assess the results of these repairs was carried out from 4 to 9 years postsurgery. There were no clinical problems related to the vascular reconstructions. The results of the nerve repairs in this small series of children and adolescents were remarkably good.(ABSTRACT TRUNCATED AT 250 WORDS)
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Epigastic flaps measuring approximately 6 x 4 cm with borders related to well-defined anatomical structures were isografted (Dark Agouty to Dark Agouty inbred rats) with or without anastomosing their epigastric pedicle, after various periods of ischaemia, ranging from 0 to 120 h. During the ischaemic insult the flaps were stored at 0 degrees C in a hypertonic citrate solution. The non-revascularized flaps exhibited survival percentages varying from 2 to 34% (mean, 16%) of the original flap,. independent of the storage interval. ⋯ It is concluded that the model described in this study is suitable for free flap research, because of its delineated borders. However, when the area of flap survival is lower than 30% in revascularized flaps there is a distinct likelihood that the flaps have survived regardless of the pedicle as simple Wolfe or composite grafts. Results must therefore be interpreted with great care.
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Twenty patients with sympathetic maintained pain (SMP) underwent surgery to treat an associated nerve injury. In each patient, an axillary catheter technique was used to maintain anesthesia and sympatholysis for up to 4 days following surgery. In no instance was the SMP exacerbated by the operation. The use of prolonged sympathetic blockade as an adjunct increases the margin of safety in surgery for these patients when nonoperative measures cannot relieve the pain or restore function.