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.
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A case of traumatic hemipelvectomy with survival is presented, apparently the sixth reported case in the literature. Following complete left hemipelvectomy and fracture of the right acetabulum, the patient recovered, demonstrated voluntary bowel and urinary control, was full weight bearing on crutches (against advice), and refused a bucket seat or prosthesis, as well as neurosurgical consultation. The patient was then unfortunately lost to followup.
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The 14th myelographically demonstrated case of lumbosacral nerve root avulsion is presented with a summary of the previously reported cases. In most cases lumbosacral nerve root avulsion is associated with pelvic fractures and sacroiliac dislocation, which cause a stretching force to be applied to the nerves of the lumbar and sacral plexuses, and in turn to the nerve roots intradurally. ⋯ The myelographic defect is a pseudomeningocele or diverticulum-like outpouching created by the tearing of the arachnoid covering of the nerve roots. Myelography clearly indicates nerve root avulsion and surgical exploration is not indicated.