Injury
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Review Case Reports
Clavicular reconstruction with free fibula flap: A report of four cases and review of the literature.
Midclavicular fracture is one of the most common injuries of the skeleton, representing 3-5% of all fractures and 45% of all shoulder injuries. The recurrent failure of clavicular fracture treatment, whether conservative or surgical, could give rise to multiple surgeries, ultimately leading to a painful nonunion. The aim of the article is to address the indications, surgical technique and results of clavicular reconstruction using vascularised fibular flaps based on 4 cases reports.
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The aim of this study was to investigate the intraoperative findings, postoperative complications, donor site morbidity and patients' Quality of Life in order to evaluate the usefulness of the free osteofasciocutaneous fibula flap in the reconstruction or construction of a mandibula, neophallus, lower leg or forearm. ⋯ Advantages of free osteofasciocutaneous fibula flaps were the wide cortical bone and the relative constant anatomy, the long pedicle, flat, uniform and sufficient large and pliable skin island, as well as the good blood circulation also by massive modelling of the skin and bone part. The skin island could be harvested large enough in order to reconstruct extended soft-tissue defects in the face and the extremities as well as to construct neophallus in its normal size without any restrictions. The lower leg donor-site morbidity was moderate and can be readily covered with a sock in patients' everyday life common activities. Finally, in our hands, the utilisation of the free osteofasciocutaneous fibula flap is the best possible therapy for these difficult composite reconstructions.
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Microsurgical techniques are vital for the treatment of many aspects of trauma in the child, both in initial management and later reconstructive surgery. The basic principles of microsurgery pertain to all patients, but there are nuances of technique and of the psycho-social and peri-operative aspects of treatment which are particularly important in the child. It is these distinctions that are examined in this paper.
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Over recent years, hand surgeons in the Middle East and Arabic region have particularly had to deal with an increasing number of war blast injuries to the upper extremity, in the acute, subacute and chronic phases. Many have been referred from War Zone countries such as Iraq and, more recently, Syria, where the resources to treat such complex injuries are scarce. The present article is a comprehensive review of the basic principles of management of blast injuries based on the available literature merged with the authors' personal experience of these injuries. The state of the art in treatment of blast injuries to the hand, from ammunition physics and wound ballistics to radiological investigation and, ultimately, the principles of surgical management are discussed.
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In upper brachial plexus palsy patients, loss of shoulder function and elbow flexion is obvious as the result of paralysed muscles innervated by the suprascapular, axillary and musculocutaneus nerve. Shoulder stabilisation, restoration of abduction and external rotation are important as more distal functions will be affected by the shoulder situation. ⋯ Combined nerve transfer by using the spinal accessory nerve for suprascapular nerve neurotisation and one of the triceps nerve branches for axillary nerve and teres minor branch neurotisation is an excellent choice for shoulder abduction and external rotation restoration.