Clinical orthopaedics and related research
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Wound coverage after a complete degloving injury of the hand and fingers is 1 of the most difficult problems in hand surgery. Important structures such as tendons, nerves, and bones are exposed and will necrose if not covered adequately. The goal of treatment should be coverage with a pliable, sensitive, and cosmetically similar tissue that will allow early mobilization. ⋯ In 6 patients with degloving injuries of the thumb in whom replantation was not possible, the thumb was reconstructed using a free wraparound flap from the big toe. In 3 patients with degloving injuries of the fingers, coverage was obtained as an emergency measure using an island radial forearm flap. In conclusion, replantation should be attempted when the degloved skin is available and the vessels are not damaged; secondary reconstruction should be done as early as possible to limit the time of tendon, bone, and joint exposure.
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Advances in microsurgical techniques have permitted replantation and reconstructive procedures to restore amputated or injured parts with a high degree of success in children. Despite this progress, some technical concerns remain. During a 15-year period, replantations were done in 53 children with major limb (18), hand (10), or digit (25) amputations. ⋯ The microsurgical success rate was 86.8% for replantation procedures and 96% for reconstructive procedures. Although the technical aspects and outcome of replantation attempts still differ between adults and children, there appears to be little difference in free tissue transfer. Thus, most replantation and reconstructive procedures can be attempted with a high possibility of success in children.
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Clin. Orthop. Relat. Res. · May 1995
Repair of complete acromioclavicular separations using the acromioclavicular-hook plate.
Complete Tossy III acromioclavicular separations in 21 male patients (according to the Rockwood classification: 7 Type III and 14 Type V lesions) with a mean age of 31 years were treated by surgical repair with the acromicroclavicular-hook plate within a period of 6 years. The population consisted of 18 patients with acute injuries and 3 with old injuries. Six patients experienced infections and delayed wound healing; osteitis did not occur. ⋯ A secondary widening of the hook hole in the acromion was seen in 13 patients; this was related to the large range of motion of the acromioclavicular joint. Calcifications and ossifications in the coracoclavicular ligaments, diastases in the acromioclavicular joint, and redislocations were not significantly different when this method was compared with other surgical techniques as reported in the literature. Use of the acromioclavicular-hook plate permits retention in the transverse plane without impairing the joint itself, but the technique is challenging.