Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expec...Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.展开更多
Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran ...Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.展开更多
Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of...Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001);while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.展开更多
Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper lim...Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper limb disabilities respond differently to the same rehabilitation protocol. Apart from each patient’s unique characteristics, there are specific brain reorganizing patterns that affect the post-rehabilitation response rate. Functional magnetic resonance imaging (fMRI) determines brain activation area and connectivity patterns and has been utilized in the neurorehabilitation field. Material and Methods: Six stroke patients who suffered from moderate to severe upper extremity dysfunction were enrolled in this pilot study. Upper extremity function tests including the Fugl-Meyer assessment test for upper extremity (FMA-UE), and Wolf Motor Function Test (WMFT) were utilized before and after completing an intensive rehabilitation. The intensive rehabilitation program was conducted one hour a day for five days per week for four weeks. Moreover, fMRI was applied before initiating rehabilitation. The regions of interest were those associated with movement, including Brodmann areas (BA) BA1-BA6. Results: Six stroke patients in the sub-acute to chronic phase and ages ranging between 33 - 75 years were enrolled. All patients showed an improvement in upper limb function after four weeks of rehabilitation. Patient number one (Pt1) had the most improvement in FMA-UE, while patient number four (Pt4) recovered the most measured by WMFT. Pt1 demonstrated increased activity in all contralesional regions, whereas Pt4 had only increased activity in ipsilesional areas. Furthermore, patients with greater activation in the ipsilesional BA6 (Pt1, Pt4, Pt5, and Pt6) had better responses to the rehabilitation therapy. Conclusion: Patients with greater activation in the baseline fMRI, particularly ipsilesional BA6, had a better response to the intensive rehabilitation therapy. However, the patients with the most severe hand dysfunction showed lesser improvement despite the same brain activity as others in the initial fMRI.展开更多
Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the...Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the change of peripheral diameter of the affected limb.Methods:National Knowledge Internet(CNKI),Wan Fang Digital Journals(Wan Fang),VIP Chinese periodical service platform(VIP),Chinese biomedical literature service system(CBM),PubMed and EMBASE were searched on computer.And clinical randomized controlled trials(RCT)of the treatment of upper extremity edema after breast cancer surgery with integration of Chinese and western treatment were selected.The time was from January 2011 to May 2020.Upper extremity edema after breast cancer surgery was the first key word and the second was traditional Chinese combined with western therapy.Note Express was used to screen and extract literature.Bias risks of all the literature included in the study were evaluated and analyzed by RevMan5.3 software.Results:10 randomized controlled clinical tests,644 patients in conformity to the inclusion criteria,9 for the observation of curative effectiveness,5 of changes in limb circumference.322 cases were included in the observation group and the same number of cases in the control group,all of which were in Chinese.The results expressed that the curative effect in the observation group was 91.1%,and it was higher than the curative effect in the control group treated by single western treatment obviously,and it was only 68.9%[95%CI(1.22,1.44),Z=6.55,P<0.00001].The peripheral diameter shrinking degree of the affected limb in the observation group was also clearly higher than that in the control group which was healed by simple western treatment[95%CI(-0.98,-0.64),Z=9.40,P<0.00001].Conclusion:Traditional Chinese combined with western therapy treating upper extremity edema after the surgery of breast cancer had a notable clinical effect,which treated the disease and effectively lessened the peripheral diameter of the affected limb.The method was worthy of clinical application.However,owing to the low quality of the included documents,further discussion and learning were still needed.展开更多
Objective To discuss the etiology,course of diseases and prognosis of symmetry peripheral entrapment enuropathies of upper extremity. Methods The etiology, clinical scale and resluts of 14 cases were analyzed betwen 1...Objective To discuss the etiology,course of diseases and prognosis of symmetry peripheral entrapment enuropathies of upper extremity. Methods The etiology, clinical scale and resluts of 14 cases were analyzed betwen 1999 and April 2002. Results In the bilateral tunnel syndrome, the excellent and good rate was 60% at the original side and 80% at the contralateral side occurred later. In the bilateral carpal tunnel syndrome, the excellent and good rate was 67% at the original side and 89% at the contralateral side occurred later. Conclusion The main etiological factor of the bilateral cubital tunnel syndrome was the elbow eversion deformity. The lesions of synovium contributed mainly to the symmetry carpal tunnel syndrome. The symmetry peripheral entrapment neuropathies of upper extremity should be operated on as soon as possible when diagnosis had been made for enhancement of treatment outcome. 5 refs,2 tabs.展开更多
Objective To investigate the clinical features and magnetic resonance imaging (MRI) findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy. Methods Three patients with H...Objective To investigate the clinical features and magnetic resonance imaging (MRI) findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy. Methods Three patients with Hirayama disease simply展开更多
Background Little is known regarding risk factors specific to pedialric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk popul...Background Little is known regarding risk factors specific to pedialric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.Methods A 20-year retrospective review was conducted.Patients 17 years of age and younger,with upper extremity injuries related to a firearm,were included.Analysis involved Fisher's exact and Chi-square tests.Results One hundred and eighty patients were included.The mean age was 12.04±4.3 years.Most included patients were male(85%).Interestingly,females were more frequently victims of assault(P=0.03),and males were more frequently injured due to accidental discharge(P<0.001).The most affected race/ethnicity was White-not Hispanic or Latino(48%).The hand was the most frequent location injured(31%)and was more likely to be accidental than proximal injuries(P=0.003).Air rifes were the most common firearm type used(56%).Pistols were implicated in 47(26%)cases,rifles in 17(9%),and.shotguns in 10(6%).Ninety-nine(55%)patients had procedures in the operating room.The most frequent procedure was foreign body removal(55%).Conclusions Risk factors such as male sex,W hite-not Hispanic or Latino race/ethnicity,and adolescent age were attributed to increased risk for injury.Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault.Air rifles were the most common firearm type overall,although female sex was associated with increased risk for injury by powder weapon.展开更多
Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial n...Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial nerve branch reinnervation are still being explored.This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.展开更多
Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the re...Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the reports in the literature are mostly case reports for upper extremity. Case Series: 7 patients, who were treated between 1999 and 2015 in our clinic with the diagnosis of cutaneous anthrax in their upper extremity, were included to our study. 3 patients applied directly to plastic surgery, others were consulted from the infectious disease clinics. Reconstructions were done with skin grafts or secondarily. Discussion: Anthrax causes cutaneous, gastrointestinal and inhalation forms of the disease. Despite being very rare in Europe and US, in Turkey there are many reported anthrax cases. However, cutaneous anthrax of upper extremity is reported rarely in the literature. Painless papule and vesicles are well defined as clinical findings. In anthrax, the excision of skin lesions or biopsies is contraindicated because of the risk of systemic spread. Conclusion: Despite cutaneous anthrax of the hand and upper extremity is very rare, the diagnosis is easy because of the typical presentation and history. Once the definitive diagnosis is set, the treatment is effortless with the antibiotherapy and first steps of the reconstruction ladder.展开更多
Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients fro...Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients from October 2017 to December 2020 were selected,all patients underwent surgical intervention,retrospectively analyzed the basic clinical data of patients,and statistically analyzed the influencing factors of upper limb lymphedema.All patients with upper extremity lymphedema received high-quality nursing intervention,and the specific nursing effect was analyzed.Results:Logistic regression analysis showed that the risk factors of upper limb lymphedema after breast cancer surgery included hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and so on.After nursing intervention,the patients*12*5 elbow 10cm,elbow 10cm,wrist size value and VAS score were better than those before nursing(P<0.05).The quality of life score of patients after nursing intervention was significantly better than that before nursing(P<0.05).Conclusion:Hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and other factors can induce upper limb lymphedema after breast cancer surgery.Effective nursing intervention can alleviate the condition of patients with upper limb lymphedema and improve their quality of life,which is worthy of comprehensive promotion.展开更多
BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is ver...BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.展开更多
Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Ob...Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572);also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.展开更多
Objective: To investigate the main risk factors of peripherally inserted central catheter(PICC) related upper extremity deep venous thrombosis and establish the risk predictive model of PICC-related upper extremity de...Objective: To investigate the main risk factors of peripherally inserted central catheter(PICC) related upper extremity deep venous thrombosis and establish the risk predictive model of PICC-related upper extremity deep venous thrombosis.Methods: Patients with PICC who were hospitalized between January 2014 and July 2015 were studied retrospectively; they were divided into a thrombosis group(n ? 52), with patients who had a venous thrombosis complication after PICC, and a no-thrombosis group(n ? 144), with patients without venous thrombosis. To compare between the two groups, significantly different variables were selected to perform multivariate logistic regression to establish the risk-predictive model.Results: The PICC catheter history, catheter tip position, and diameter of blood vessel were the key factors for thrombosis. The logistic regression predictive model was as follows: Y ? 3.338 t 2.040 PICC catheter history t1.964 catheter tip position 1.572 diameter of vessel. The area under the receiver operating characteristic curve for the model was 0.872, 95%CI(0.817e0.927). The cut-off point was 0.801,the sensitivity of the model was 0.832, and the specificity was 0.745.Conclusions: The PICC catheterization history, catheter tip position, the diameter of blood vessel were the key factors for thrombosis. The logistic regression risk model based on these factors is reliable for predicting PICC-related upper extremity deep venous thrombosis.展开更多
Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Pati...Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.展开更多
Acute upper limb ischemia caused by a gunshot penetrating vascular injury and subsequent arterial embolization by foreign body is uncommon in everyday practice and is associated with high morbidity/mortality rates, es...Acute upper limb ischemia caused by a gunshot penetrating vascular injury and subsequent arterial embolization by foreign body is uncommon in everyday practice and is associated with high morbidity/mortality rates, especially with emergency surgery. We present the case of a 72-year old male who attempted suicide using a gun. A gunshot entry wound was evident in the right upper chest region with no pellet exit wound. Radial pulses were palpable bilaterally. Angiography revealed right subclavian artery direct injury and pellet embolization to the brachial artery. The patient underwent open surgery, with reversed saphenous vein interposition graft to replace subclavian artery defect. A pellet was removed by a separate arteriotomy in the brachial artery. Associated injuries were clavicle-comminuted fracture and subclavian vein injury. The patient remained well 5 months later with no reported complications. In conclusions, the presence of radial pulses alone on clinical exam cannot rule out the presence of a significant vascular injury.展开更多
The large finite element global stiffness matrix is an algebraic, discreet, even-order, differential operator of zero row sums. Direct application of the, practically convenient, readily applied, Gershgorin’s eigenva...The large finite element global stiffness matrix is an algebraic, discreet, even-order, differential operator of zero row sums. Direct application of the, practically convenient, readily applied, Gershgorin’s eigenvalue bounding theorem to this matrix inherently fails to foresee its positive definiteness, predictably, and routinely failing to produce a nontrivial lower bound on the least eigenvalue of this, theoretically assured to be positive definite, matrix. Considered here are practical methods for producing an optimal similarity transformation for the finite-elements global stiffness matrix, following which non trivial, realistic, lower bounds on the least eigenvalue can be located, then further improved. The technique is restricted here to the common case of a global stiffness matrix having only non-positive off-diagonal entries. For such a matrix application of the Gershgorin bounding method may be carried out by a mere matrix vector multiplication.展开更多
Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further...Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further a discussion on upper and lower limb reconstruction following MCIs.Methods: Review of the literature, including our institute's experience with the 2013 Boston Marathon Bombings, the 2015-2016 Terror Attacks in Ankara, and the 2010 earthquake in Haiti, pertaining to extremity reconstruction following MCIs.Results: The three aforementioned case profiles highlight extremity wounds associated with MCIs and the subsequent reconstructive role of plastic surgeons. Surgical intervention or temporization of extremity wounds is a critical responsibility of plastic surgeons in this setting. Limb salvage is possible and often the preferred option following disasters.Conclusion: Intentional or naturally occurring MCIs are a grim reality. Successful response to these events requires prompt mobilization of emergency medical staff and hospital activation. Plastic surgeons play a paramount role in multidisciplinary management of trauma with a particularly important involvement in limb reconstruction.展开更多
Subcutaneous emphysema is commonly associated with infection caused by gas-producing organisms.In this case report,we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a pu...Subcutaneous emphysema is commonly associated with infection caused by gas-producing organisms.In this case report,we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a puncture injury to the first web space of the hand.Our objective is to increase awareness of the potential for seemingly minor trauma to cause entrapment of significant air in subcutaneous tissues,thereby decreasing the likelihood that a clinically benign-appearing patient will be started down an unnecessarily aggressive treatment pathway.A 16-year-old,otherwise healthy white female,presented to the pediatric emergency room with an impressive amount of subcutaneous emphysema that developed over a 12-h period after sustaining an accidental laceration to the first web space of her right hand.She appeared nontoxic and had a clinically benign presentation.A comprehensive work-up was performed.She was splinted by the orthopedic surgery resident on call,and was admitted to the Pediatric Intensive Care Unit for overnight monitoring.She received tetanus vaccination and broad-spectrum antibiotics.The patient was discharged 2 days after admittance,with a splint applied to her right hand and forearm.She undertook home-based physical and occupational therapy.She had a pain-free range-of-motion in the right wrist,elbow and shoulder.The swelling in the right hand subsided completely.Although initially alarming,traumatic subcutaneous emphysema in an otherwise healthy patient from minor wounds(as featured in this case)does not necessarily mean one ought to proceed down an aggressive treatment algorithm.Careful evaluation of the patient's history,clinical examination findings,and determination of the Laboratory Risk Indicator for Necrotizing Fasciitis score can help guide physicians in the management of traumatic subcutaneous emphysema and potentially avoid unnecessary and costly interventions.展开更多
Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartmen...Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.展开更多
文摘Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.
基金the Veterans and Martyrs Affair Foundation (VMAF)Janbazan Medical and Engineering Research Center (JMERC)
文摘Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
文摘Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001);while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.
文摘Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper limb disabilities respond differently to the same rehabilitation protocol. Apart from each patient’s unique characteristics, there are specific brain reorganizing patterns that affect the post-rehabilitation response rate. Functional magnetic resonance imaging (fMRI) determines brain activation area and connectivity patterns and has been utilized in the neurorehabilitation field. Material and Methods: Six stroke patients who suffered from moderate to severe upper extremity dysfunction were enrolled in this pilot study. Upper extremity function tests including the Fugl-Meyer assessment test for upper extremity (FMA-UE), and Wolf Motor Function Test (WMFT) were utilized before and after completing an intensive rehabilitation. The intensive rehabilitation program was conducted one hour a day for five days per week for four weeks. Moreover, fMRI was applied before initiating rehabilitation. The regions of interest were those associated with movement, including Brodmann areas (BA) BA1-BA6. Results: Six stroke patients in the sub-acute to chronic phase and ages ranging between 33 - 75 years were enrolled. All patients showed an improvement in upper limb function after four weeks of rehabilitation. Patient number one (Pt1) had the most improvement in FMA-UE, while patient number four (Pt4) recovered the most measured by WMFT. Pt1 demonstrated increased activity in all contralesional regions, whereas Pt4 had only increased activity in ipsilesional areas. Furthermore, patients with greater activation in the ipsilesional BA6 (Pt1, Pt4, Pt5, and Pt6) had better responses to the rehabilitation therapy. Conclusion: Patients with greater activation in the baseline fMRI, particularly ipsilesional BA6, had a better response to the intensive rehabilitation therapy. However, the patients with the most severe hand dysfunction showed lesser improvement despite the same brain activity as others in the initial fMRI.
基金General project of national natural science foundation(No.81573989,81403408)Project for national talent inheritors of traditional Chinese medicine[No.(2019)36]Project for leading talent of hygiene and health of Shandong province[No.(2020)3]。
文摘Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the change of peripheral diameter of the affected limb.Methods:National Knowledge Internet(CNKI),Wan Fang Digital Journals(Wan Fang),VIP Chinese periodical service platform(VIP),Chinese biomedical literature service system(CBM),PubMed and EMBASE were searched on computer.And clinical randomized controlled trials(RCT)of the treatment of upper extremity edema after breast cancer surgery with integration of Chinese and western treatment were selected.The time was from January 2011 to May 2020.Upper extremity edema after breast cancer surgery was the first key word and the second was traditional Chinese combined with western therapy.Note Express was used to screen and extract literature.Bias risks of all the literature included in the study were evaluated and analyzed by RevMan5.3 software.Results:10 randomized controlled clinical tests,644 patients in conformity to the inclusion criteria,9 for the observation of curative effectiveness,5 of changes in limb circumference.322 cases were included in the observation group and the same number of cases in the control group,all of which were in Chinese.The results expressed that the curative effect in the observation group was 91.1%,and it was higher than the curative effect in the control group treated by single western treatment obviously,and it was only 68.9%[95%CI(1.22,1.44),Z=6.55,P<0.00001].The peripheral diameter shrinking degree of the affected limb in the observation group was also clearly higher than that in the control group which was healed by simple western treatment[95%CI(-0.98,-0.64),Z=9.40,P<0.00001].Conclusion:Traditional Chinese combined with western therapy treating upper extremity edema after the surgery of breast cancer had a notable clinical effect,which treated the disease and effectively lessened the peripheral diameter of the affected limb.The method was worthy of clinical application.However,owing to the low quality of the included documents,further discussion and learning were still needed.
文摘Objective To discuss the etiology,course of diseases and prognosis of symmetry peripheral entrapment enuropathies of upper extremity. Methods The etiology, clinical scale and resluts of 14 cases were analyzed betwen 1999 and April 2002. Results In the bilateral tunnel syndrome, the excellent and good rate was 60% at the original side and 80% at the contralateral side occurred later. In the bilateral carpal tunnel syndrome, the excellent and good rate was 67% at the original side and 89% at the contralateral side occurred later. Conclusion The main etiological factor of the bilateral cubital tunnel syndrome was the elbow eversion deformity. The lesions of synovium contributed mainly to the symmetry carpal tunnel syndrome. The symmetry peripheral entrapment neuropathies of upper extremity should be operated on as soon as possible when diagnosis had been made for enhancement of treatment outcome. 5 refs,2 tabs.
文摘Objective To investigate the clinical features and magnetic resonance imaging (MRI) findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy. Methods Three patients with Hirayama disease simply
文摘Background Little is known regarding risk factors specific to pedialric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.Methods A 20-year retrospective review was conducted.Patients 17 years of age and younger,with upper extremity injuries related to a firearm,were included.Analysis involved Fisher's exact and Chi-square tests.Results One hundred and eighty patients were included.The mean age was 12.04±4.3 years.Most included patients were male(85%).Interestingly,females were more frequently victims of assault(P=0.03),and males were more frequently injured due to accidental discharge(P<0.001).The most affected race/ethnicity was White-not Hispanic or Latino(48%).The hand was the most frequent location injured(31%)and was more likely to be accidental than proximal injuries(P=0.003).Air rifes were the most common firearm type used(56%).Pistols were implicated in 47(26%)cases,rifles in 17(9%),and.shotguns in 10(6%).Ninety-nine(55%)patients had procedures in the operating room.The most frequent procedure was foreign body removal(55%).Conclusions Risk factors such as male sex,W hite-not Hispanic or Latino race/ethnicity,and adolescent age were attributed to increased risk for injury.Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault.Air rifles were the most common firearm type overall,although female sex was associated with increased risk for injury by powder weapon.
文摘Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial nerve branch reinnervation are still being explored.This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.
文摘Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the reports in the literature are mostly case reports for upper extremity. Case Series: 7 patients, who were treated between 1999 and 2015 in our clinic with the diagnosis of cutaneous anthrax in their upper extremity, were included to our study. 3 patients applied directly to plastic surgery, others were consulted from the infectious disease clinics. Reconstructions were done with skin grafts or secondarily. Discussion: Anthrax causes cutaneous, gastrointestinal and inhalation forms of the disease. Despite being very rare in Europe and US, in Turkey there are many reported anthrax cases. However, cutaneous anthrax of upper extremity is reported rarely in the literature. Painless papule and vesicles are well defined as clinical findings. In anthrax, the excision of skin lesions or biopsies is contraindicated because of the risk of systemic spread. Conclusion: Despite cutaneous anthrax of the hand and upper extremity is very rare, the diagnosis is easy because of the typical presentation and history. Once the definitive diagnosis is set, the treatment is effortless with the antibiotherapy and first steps of the reconstruction ladder.
文摘Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients from October 2017 to December 2020 were selected,all patients underwent surgical intervention,retrospectively analyzed the basic clinical data of patients,and statistically analyzed the influencing factors of upper limb lymphedema.All patients with upper extremity lymphedema received high-quality nursing intervention,and the specific nursing effect was analyzed.Results:Logistic regression analysis showed that the risk factors of upper limb lymphedema after breast cancer surgery included hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and so on.After nursing intervention,the patients*12*5 elbow 10cm,elbow 10cm,wrist size value and VAS score were better than those before nursing(P<0.05).The quality of life score of patients after nursing intervention was significantly better than that before nursing(P<0.05).Conclusion:Hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and other factors can induce upper limb lymphedema after breast cancer surgery.Effective nursing intervention can alleviate the condition of patients with upper limb lymphedema and improve their quality of life,which is worthy of comprehensive promotion.
文摘BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.
文摘Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572);also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.
文摘Objective: To investigate the main risk factors of peripherally inserted central catheter(PICC) related upper extremity deep venous thrombosis and establish the risk predictive model of PICC-related upper extremity deep venous thrombosis.Methods: Patients with PICC who were hospitalized between January 2014 and July 2015 were studied retrospectively; they were divided into a thrombosis group(n ? 52), with patients who had a venous thrombosis complication after PICC, and a no-thrombosis group(n ? 144), with patients without venous thrombosis. To compare between the two groups, significantly different variables were selected to perform multivariate logistic regression to establish the risk-predictive model.Results: The PICC catheter history, catheter tip position, and diameter of blood vessel were the key factors for thrombosis. The logistic regression predictive model was as follows: Y ? 3.338 t 2.040 PICC catheter history t1.964 catheter tip position 1.572 diameter of vessel. The area under the receiver operating characteristic curve for the model was 0.872, 95%CI(0.817e0.927). The cut-off point was 0.801,the sensitivity of the model was 0.832, and the specificity was 0.745.Conclusions: The PICC catheterization history, catheter tip position, the diameter of blood vessel were the key factors for thrombosis. The logistic regression risk model based on these factors is reliable for predicting PICC-related upper extremity deep venous thrombosis.
文摘Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.
文摘Acute upper limb ischemia caused by a gunshot penetrating vascular injury and subsequent arterial embolization by foreign body is uncommon in everyday practice and is associated with high morbidity/mortality rates, especially with emergency surgery. We present the case of a 72-year old male who attempted suicide using a gun. A gunshot entry wound was evident in the right upper chest region with no pellet exit wound. Radial pulses were palpable bilaterally. Angiography revealed right subclavian artery direct injury and pellet embolization to the brachial artery. The patient underwent open surgery, with reversed saphenous vein interposition graft to replace subclavian artery defect. A pellet was removed by a separate arteriotomy in the brachial artery. Associated injuries were clavicle-comminuted fracture and subclavian vein injury. The patient remained well 5 months later with no reported complications. In conclusions, the presence of radial pulses alone on clinical exam cannot rule out the presence of a significant vascular injury.
文摘The large finite element global stiffness matrix is an algebraic, discreet, even-order, differential operator of zero row sums. Direct application of the, practically convenient, readily applied, Gershgorin’s eigenvalue bounding theorem to this matrix inherently fails to foresee its positive definiteness, predictably, and routinely failing to produce a nontrivial lower bound on the least eigenvalue of this, theoretically assured to be positive definite, matrix. Considered here are practical methods for producing an optimal similarity transformation for the finite-elements global stiffness matrix, following which non trivial, realistic, lower bounds on the least eigenvalue can be located, then further improved. The technique is restricted here to the common case of a global stiffness matrix having only non-positive off-diagonal entries. For such a matrix application of the Gershgorin bounding method may be carried out by a mere matrix vector multiplication.
文摘Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further a discussion on upper and lower limb reconstruction following MCIs.Methods: Review of the literature, including our institute's experience with the 2013 Boston Marathon Bombings, the 2015-2016 Terror Attacks in Ankara, and the 2010 earthquake in Haiti, pertaining to extremity reconstruction following MCIs.Results: The three aforementioned case profiles highlight extremity wounds associated with MCIs and the subsequent reconstructive role of plastic surgeons. Surgical intervention or temporization of extremity wounds is a critical responsibility of plastic surgeons in this setting. Limb salvage is possible and often the preferred option following disasters.Conclusion: Intentional or naturally occurring MCIs are a grim reality. Successful response to these events requires prompt mobilization of emergency medical staff and hospital activation. Plastic surgeons play a paramount role in multidisciplinary management of trauma with a particularly important involvement in limb reconstruction.
文摘Subcutaneous emphysema is commonly associated with infection caused by gas-producing organisms.In this case report,we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a puncture injury to the first web space of the hand.Our objective is to increase awareness of the potential for seemingly minor trauma to cause entrapment of significant air in subcutaneous tissues,thereby decreasing the likelihood that a clinically benign-appearing patient will be started down an unnecessarily aggressive treatment pathway.A 16-year-old,otherwise healthy white female,presented to the pediatric emergency room with an impressive amount of subcutaneous emphysema that developed over a 12-h period after sustaining an accidental laceration to the first web space of her right hand.She appeared nontoxic and had a clinically benign presentation.A comprehensive work-up was performed.She was splinted by the orthopedic surgery resident on call,and was admitted to the Pediatric Intensive Care Unit for overnight monitoring.She received tetanus vaccination and broad-spectrum antibiotics.The patient was discharged 2 days after admittance,with a splint applied to her right hand and forearm.She undertook home-based physical and occupational therapy.She had a pain-free range-of-motion in the right wrist,elbow and shoulder.The swelling in the right hand subsided completely.Although initially alarming,traumatic subcutaneous emphysema in an otherwise healthy patient from minor wounds(as featured in this case)does not necessarily mean one ought to proceed down an aggressive treatment algorithm.Careful evaluation of the patient's history,clinical examination findings,and determination of the Laboratory Risk Indicator for Necrotizing Fasciitis score can help guide physicians in the management of traumatic subcutaneous emphysema and potentially avoid unnecessary and costly interventions.
文摘Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.
