Der Unfallchirurg
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Replantation using microsurgical techniques is a fairly new procedure in Vietnam. We reviewed and evaluated our 7-year results of thumb replantation in Vietnamese patients following traumatic thumb amputation. ⋯ Vascular thrombosis was the cause of all failures. Proper debridement, standardized microvascular techniques, timely detection of thrombosis formation, and reoperation using vein grafts play a decisive role in the final success.
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Subtalar dislocations represent uncommon injuries of the foot. Leitner [7] described the relationship between medial and lateral dislocations as 6:1. The mechanism is a trauma in plantar flexion/supination of the forefoot with a fixed hindfoot. ⋯ Subsequently, x-rays and CT scans should be performed in two planes in order to rule out concomitant injuries at the processus posterior tali and the talar head, as bony fragments can necessitate an operative intervention in the case of an interposition of the articulation. In terms of aftercare an immobilization of 6 weeks with a lower leg cast is suggested in the literature. In the presented case an early functional therapy with 2 weeks cast and 4 weeks with a therapy boot could achieve good clinical results.
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Case Reports
[Embolization of life-threatening intercostal hemorrhaging in a severely injured patient: a rarity in trauma care].
Transarterial embolization of ruptured intercostal arteries due to massive bleeding represents an infrequent indication in severely injured patients. The current literature shows isolated case descriptions but no clinical trials exist. ⋯ The vital signs returned to normal immediately after the procedure and surgical intervention could be avoided. The course of the disease represented in the following shows the effectiveness of this type of treatment not only for bleeding due to pelvic fractures and abdominal injuries, but also for isolated arterial bleeding in other body regions.
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A questionnaire study was conducted to ask trauma surgery centers about thrombosis prophylaxis methods and strategies for the diagnosis and therapy of heparin-induced thrombocytopenia (HIT). ⋯ While pharmacological thrombosis prophylaxis following trauma surgery seems to be generally performed according to guidelines, diagnosis and treatment of HIT need to be systematized.
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Multiple trauma patients frequently demonstrate a hypothermic core temperature, defined as a temperature below 35 degrees C, already at admission in the emergency room. As a drop of the core temperature below 34 degrees C has been shown to be associated with a significant increase in post-traumatic complications, this limit is considered to be critical in these patients. ⋯ Therefore effective rewarming measures are essential for adequate bleeding control and successful resuscitation. If and to what extent the induction of controlled hypothermia in the early phase of treatment on the intensive care unit after resuscitation and operative bleeding control can contribute to an improved post-traumatic outcome, has to be clarified in further experimental and clinical studies.