Eur J Trauma Emerg S
-
Upper extremity composite tissue defects may result from trauma, tumor resection, infection, or congenital malformations. When reconstructing these defects the ultimate objectives are to provide adequate soft tissue protection of vital structures, and to provide optimal functional and esthetic outcomes. The development of clinical microsurgery has added a large number of treatment options to the trauma surgeon's armamentarium - primarily replantation of amputated tissues and transplantation of vascularized tissues from distant donor sites. Since the early 1970s, considerable refinement in microsurgical tools and techniques together with a better understanding of the anatomy and physiology of microcirculatory tissue perfusion led to the introduction of a variety of thin, pliable and versatile-free flap designs. ⋯ Where possible, the best results may be achieved by reattaching the amputated original tissues (microsurgical replantation). In noninfected, uncontaminated traumatic injuries resulting in composite soft tissue defects, Early free flap reconstruction of the upper extremities has important advantages over delayed (72 h-3 months) or late wound closure (3 months-2 years). In recent years, thin, pliable, and versatile fasciocutaneous flaps such as the anterolateral thigh (ALT) and lateral arm (LA) free flaps have been increasingly used with great success to reconstruct the upper extremity. The use of "spare parts" and functional reconstructions using osteomyocutaneous free flaps or toe to thumb transfers complete the armamentarium of the upper limb reconstructive microsurgeon.
-
Eur J Trauma Emerg S · Feb 2007
Magnet Resonance Angiography versus Conventional Angiography for the Planning of Reconstructive Surgeries.
Assessing the vascular status and anatomy of the lower extremity is of crucial importance when planning the coverage of a tissue defect with a free flap. The standard techniques comprise the clinical examination, Doppler ultrasound and Doppler sonography for healthy patients without suspected direct trauma to the vascular system, and conventional digital subtraction angiography (DSA), respectively, in case of traumatized vessels or patients with peripheral arterial obstructive disease. ⋯ Taking into account the advantages for the assessment of vessels using MRA, in particular when considering the impact of the frequently varying vascular anatomy of the lower leg on reconstructive surgery, as well as the significantly lower morbidity rate of the examination itself, then the MRA must be regarded as a safe alternative to the DSA.
-
Eur J Trauma Emerg S · Feb 2007
Function Versus Position: A Randomized Controlled Trial of Interfocal Kirschner Wiring of Unstable Distal Radial Fractures.
A randomized, prospective study has been carried out to determine if immobilisation in dorsiflexion following K-wire fixation of unstable distal radial fractures improves functional outcome. ⋯ Immobilisation in dorsi-flexion following K-wiring for unstable distal radial fractures does not improve functional outcome. The overall functional results were excellent and we believe that Kwiring still as a place in the treatment of distal radial fractures in the previously defined population.
-
Eur J Trauma Emerg S · Feb 2007
An in Vivo Experimental Comparison of Stainless Steel and Titanium Schanz Screws for External Fixation.
To compare the clinical benefits of stainless steel (SS) to titanium (Ti) on reducing pin track irritation/infection and pin loosening during external fracture fixation. ⋯ There is no clinically relevant substantial advantage in using either SS or Ti pins on reducing pin loosening or pin track irritation/infection.
-
Today, vacuum therapy can be regarded as established in routine clinical use. Many hundreds of reports on the subject of vacuum therapy have appeared in medical literature. This review intends to give an overview of the peer-reviewed literature published to date and its quality considering criteria of evidence-based medicine (EbM). ⋯ The clinical significance of this therapy is underlined by an obviously continuously marked extension of the range of indications in all surgical fields, and even in extreme ages of the patients. There is a considerable deficit of basic pathophysiological research and well-designed studies. This "deficiency," however, when judged against the quality of the general medical literature, does not point to the poor efficacy or low benefit of vacuum therapy but should rather be seen as a symptom of the clinical practitioner's problems in dealing with modern aspects of the theoretical background of EbM.