J Trauma
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Myelographic evidence of traumatic meningocele in brachial plexus injuries has been considered to be pathognomonic of root avulsion. Two such cases with myelographic evidence of root avulsion with excellent recovery at those levels are presented. Various diagnostic procedures in brachial plexus injuries are critically reviewed. The sequence in which these tests are of diagnostic value are: 1) clinical evaluation, motor and sensory, from the time of admission; 2) electroneuromyography at 2-3 weeks following injury; 3) axon reflex response at 2-3 weeks; 4) myelography; 5) very rarely, surgical exploration.
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The frequent application of split thickness porcine skin grafts to cover an exposed vascular repair is a reasonable alternative to amputation in patients with severe extremity injury. It is essential that soft-tissue debridement be complete and at least one wall of the exposed vascular repair be supported by healthy, viable muscle. Limb salvage was achieved in seven of nine patients in whom this technique was used, including two patients with exposed Dacron grafts.