Successful replantation of a hand amputated through the metacarpus. (1/117)

A successful replantation is reported of a hand completely severed by a circular saw through all five metacarpals. The sequence of primary reconstruction of all important structures beginning three hours after the injury and the functional results eighteen months later are presented.  (+info)

Use of a platysma myocutaneous flap for the reimplantation of a severed ear: experience with five cases. (2/117)

CONTEXT: The traumatic loss of an ear greatly affects the patient because of the severe aesthetic deformity it entails. The characteristic format of the ear, with a fine skin covering a thin and elastic cartilage, is not found anywhere else in the human body. Thus, to reconstruct an ear, the surgeon may try to imitate it by sculpting cartilage and covering it with skin. OBJECTIVE: To use a platysma myocutaneous flap for the reimplantation of a severed ear in humans. DESIGN: Case report. SETTING: Emergency unit of the university hospital, Faculty of Medicine, Ribeirao Preto - USP. CASE REPORT: Five cases are reported, with whole ear reimplantation in 3 of them and only segments in 2 cases. The surgical technique used was original and was based on the principle of auricular cartilage revascularization using the platysma muscle. We implanted traumatically severed auricular cartilage into the platysma muscle. The prefabricated ear was later transferred to its original site in the form of a myocutaneous-cartilaginous flap. Of the 5 cases treated using this technique, 4 were successful. In these 4 cases the reimplanted ears showed no short- or long-term problems, with an aesthetic result quite close to natural appearance. In one case there was necrosis of the entire flap, with total loss of the ear. The surgical technique described is simple and utilizes the severed ear of the patient. Its application is excellent for skin losses in the auricular region or for the ear itself, thus obviating the need for microsurgery or the use of protheses or grafts.  (+info)

Lengthening of congenital below-elbow amputation stumps by the Ilizarov technique. (3/117)

Patients with short congenital amputations below the elbow often function as if they have had a disarticulation of the elbow. We have reviewed the results in six patients who had lengthening of such stumps by the Ilizarov technique to improve the fitting of prostheses. The mean lengthening was 5.6 cm (3.4 to 8.4), and in two patients flexion contractures of the elbows were corrected simultaneously. Additional lateral distraction was used in one patient to provide a better surface on the stump. There were no major complications. All six patients were able to use their prosthesis at the latest follow-up after 39 to 78 months.  (+info)

Experimental and clinical application of microvascular surgery. (4/117)

The object of these studies was the development of a technique whereby a vessel of 1 mm or smaller could be easily anastomosed. In total replantation of rabbit ears, only 3 ears survived replantation in 80 attempts in the first series. In the second series of 80, 35 ears survived completely, 3 ears partially survived and 8 additional ears survived the postoperative period, but the rabbits died within 2 weeks due to diarrhea. Thirty-five ears failed and venous obstruction was the primary cause. Free transplantation of a great toe and a second toe to recreate a thumb is also described. The operative procedure of the great toe to thumb transplantation does not appear to be difficult. Six months after operation, the function of the newly created thumb was good. The second toe to thumb transfer was more difficult technically compared to the great toe to thumb transfer due to the much smaller size of the digital vessels of the second toe. However, removal of the second toe causes less disadvantage than the removal of the great toe. Nine months postoperatively, the function of the newly created thumb was satisfactory. Digital replantation is described with 36 cases with 65 complete finger amputations. Thirty-two with 45 fingers survived the reattachment. Repair of one artery per digit is sufficient, although two probably are better. A minimum of 2 veins per digit must be repaired. Prompt re-exploration is imperative if postoperative circulatory impairment occurs. In this group, arterial obstruction was more frequent than venous obstruction as the cause of replantation failure. The function of the replanted fingers is satisfactory in the majority of the cases.  (+info)

Autoamputation of the tongue. (5/117)

Autoamputation is an uncommon phenomenon that has been reported for the fingers, toes, appendix, ovary, spleen, etc. Autoamputation of the tongue has never been reported. An elderly man with carcinoma of lateral pharyngeal wall and tonsil presented with an autoamputated tongue that was attached to the oral cavity with a thin band. The patient required detachment of the tongue and tracheostomy followed by radiotherapy for the primary tumour.  (+info)

Battle casualities. (6/117)

Eighty casualities, mainly due to explosive devices, sustained over a period of 3 1/2 months by the armed forces of the Sultan of Oman in counterinsurgency operations are analysed and their management by a British field surgical team is described. Of the 73 who reached the surgical centre alive, 56 per cent had suffered major injuries, yet all but 2 survived, giving an overall survival rate of 88.75 per cent (71/80). The effects of first aid and rapid evacuation on survival and their influence on the surgical work load and on the facilities required for treatment are assessed, together with their relevance to the planning of military and civilian accident services.  (+info)

The V-Y plasty in the treatment of fingertip amputations. (7/117)

Fingertip amputations are injuries commonly seen by family physicians. The classification of fingertip injuries corresponds with the normal anatomy of the tip of the digit. There are three zones of injury; the V-Y plasty technique is used to repair zone II injuries. The plane of the injury can be described as dorsal, transverse or volar. The dorsal and transverse planes lend themselves to the use of the V-Y plasty technique. In carefully selected injuries, the family physician can use this technique to repair the injured digit. The use of a single V-Y plasty has replaced the original technique that repaired the digit and restored the contour of the fingertip. Good cosmetic and functional results can be obtained. Complications may include flap sloughing, infection and sensory changes.  (+info)

The Soho nail bomb: the UCH experience. University College Hospital. (8/117)

This paper documents the clinical course of the casualties treated at University College Hospital, following the detonation of a terrorist nail bomb in a public house in Soho, London. The need for adequate primary debridement is paramount, including consideration of definitive primary limb amputation.  (+info)

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