摘要:

In this article, we emphasize that knowledge of terminal ballistics is essential for understanding the pathophysiology of war wounds. We present our own experiences in treatment of high-energy war wounds in 75 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. Patients were divided into three groups with regard to the time of definite reconstruction, using local or free microvascular flaps. About 12% of patients underwent flap reconstruction in the acute phase, associated with low complication rate and the shortest hospital stay. Group II was comprised by 18%of the patients and, considering the number of complications, presented the most unfavorable time for reconstruction. Flap reconstruction in the chronic phase resulted in a substantial prolongation of the hospital stay in 82% of patients. Therefore, we advocate proper primary treatment of wounds aimed at early flap closure. This type of management results in a significantly shorter hospitalization and leads to more effective rehabilitation and recovery of patients.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Venous congestion in the intraoperative and postoperative period can be a problem with some transverse rectus abdominis musculocutaneous flaps. We evolved a technique to allow us the ability to bleed the congested flap in a controlled manner both intra- and postoperatively. Arteriotomy cannulae are placed within the lumens of the deep inferior epigastric artery (DIEA) and vein (DIEV) and they are brought out on the lateral aspect of the reconstructed breast. We believe that intermittent venous bleeding from the DIEV allows a congested flap time to improve venous outflow and adapt to the new reversed blood circulation. When laser Doppler flow meter is simultaneously used as a monitor, bleeding from the DIEV or DIEA can improve balance between arterial and venous pressure in the flap.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although the fibula osteocutaneous free flap has many advantages when used in mandibular reconstruction, many investigators have found the skin island is not always reliable. We present a technique that enhances skin island reliability by including a maximal number of skin perforators. This method has been used in 10 consecutive osteocutaneous free flaps without any skin loss. This technique also expands the usefulness of the fibula free flap, allowing it to be used for shorter bone defects or in cases when skin coverage is needed at a distance from the bone. In addition, this method provides additional vascularized soft tissue for neck contour restoration and coverage of fixation plates.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Avulsion injury of the leg may result in exposure of the anterior surface of the tibia in addition to skin loss. This exposed bone should be covered by a soft tissue flap to facilitate healing and provide durability. The split anterior tibial muscle flap is ideal in this situation because of its adjacent location, reliability, and simplicity. A cadaveric study demonstrated rich intramuscle vascular anastomoses between the segmental branches from the anterior tibial artery that provide safety in partial transfer. The technique of split anterior tibial muscle flap was applied successfully in 4 patients with leg avulsion injury associated with tibial bone exposure. The cosmetic result was good and the function of the muscle was preserved.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A method for reconstruction of soft tissue defects of the distal foot, web spaces, and toes using the reverse first dorsal metatarsal artery flap is presented. This flap is supplied by minute cutaneous branches of the first dorsal metatarsal artery and can be extended to the territory of the dorsalis pedis artery. We have applied this flap to 11 patients since 1987. Superficial tip necrosis occurred in 3 flaps among 8 extended ones, however, they healed spontaneously and satisfactory results were obtained in all patients. Two other reverse flow flaps based on the second, and the third and fourth dorsal metatarsal arteries, respectively, have also been applied. The versatility and pitfalls of reverse dorsal metatarsal artery flaps are discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The free transverse rectus abdominis musculocutaneous (TRAM) flap is a recognized, reliable method of breast reconstruction after mastectomy. However, blood supply to the contralateral side of both the free and pedicled TRAM flap, especially in zone four, is often precarious. In patients with previous midline abdominal scars or with significant rectus divarication, both zones three and four are at risk of necrosis. Various techniques have been described to improve the reliability of the blood supply to the contralateral tissue in the pedicled TRAM flap, including prior delay and microvascular supplementation. We describe a new technique for augmentation of the blood supply of the contralateral side by microvascular anastomosis of the distal end of the ipsilateral deep inferior epigastric vessels to a contralateral periumbilical perforator of the opposite side. This technique produces reliable survival of contralateral tissue in zones three and four, even in the presence of midline scars, with minimal damage to the contralateral rectus muscle. The technique is also beneficial where large bulk of tissue is needed, such as in radical mastectomy patients, or when abdominal tissue is thin but the normal breast is large. Five patients in a series of 50 free TRAM flaps have been treated with the technique and the results are compared with other techniques.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

One of the most popular methods of mandible fragment fixation is the precontoured reconstruction plate technique. Unfortunately, this method is not a reliable option when tumor distorts the mandibular contour or extends through the buccal cortex of the mandible. An alternative to the precontoured reconstruction plate is the splint-and-plate technique of mandible fragment fixation. An application of this appliance and method in 10 patients revealed the technique's advantages. The splint can be applied quickly and does not obstruct the ablative or reconstructive procedure. Further, the splint accurately keys the dentition and reliably maintains temporomandibular joint relationships. Finally, this technique provides a reference point to the exact position of the symphysis and angle when these landmarks have been resected.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although tissue expansion has many advantages over other reconstructive options, potential complications require consideration. The purpose of this study was to evaluate the experience of tissue expansion in the infant and child. During the 6-year period from 1985 to 1990, a total of 147 expanders were placed in 76 patients. Age of the patients at the time of insertion of the expanders ranged from 1 to 18 years (median, 8 yr). Twenty of the 76 patients studied suffered from complications, a rate of 26%. Despite the high complication rate, complications did not compromise the final result because they occurred near the end of the expansion period and usually involved one of the many implanted expanders. With the appropriate selection of patients, tissue expansion has proved extremely valuable as a reconstructive option in the pediatric patient.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Poisonous snakebites cause a severe envenomation syndrome in children, yet treatment remains controversial. Sixty-seven patients were treated for poisonous snakebites at our institution between 1975 and 1990; 18 were children≤12 years old. There were 13 rattlesnake bites, 4 copperhead bites, and 1 unidentified bite. Initial management included intravenous fluids and antibiotic administration, laboratory studies, tetanus prophylaxis, affected limb elevation, and a limited excision of the bite site in the emergency room. Antivenin was administered only if signs of systemic involvement such as shock, coagulopathy, gastrointestinal cramping, or neurological involvement were present. Children developed systemic involvement 72% of the time, 9 children (50%) developed coagulopathy. Consequently, 11 (61%) children received antivenin. The dose of antivenin they received was 3.2 ml/kg and the children tolerated it well with only 36% of them demonstrating adverse reactions to the antivenin. Clinically, the pediatrics patients demonstrated signs and symptoms of a fulminant envenomation syndrome (8 days, average hospital stay), yet, they had a good eventual outcome. Only 11% of children reported long-term morbidity. No deaths occurred and 100% of patients were able to return to full preinjury activities. We conclude thatCrotalidaeenvenomation in children is a serious disease and warrants hospitalization, early surgical involvement, and frequent use of antivenin.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Deep and narrow mediastinal defect after sternal debridement can be effectively obliterated by deepithelialized vertical rectus abdominis musculocutaneous flaps, based on the superior epigastric vessels. This composite flap has sufficient mass to obviate the need for additional vascularized tissue and is, therefore, offered as an alternative to multiple flap procedures. It offers a superior cosmetic appearance and better chest stability than a traditional island myocutaneous flap. Eleven patients had their mediastinal wounds repaired by this method with a low complication rate and good final results.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID