Injury
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Comparative Study
Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases.
The aim of this report is to compare free perforator flaps and propeller flaps in the coverage of lower limb soft tissue defects. ⋯ Our results do not demonstrate significant differences between the two groups about correlation of risk factors or flap size with complication or failure. The surgical option choice should be taken only after accurate evaluation of the soft tissue surrounding the defect. Propeller flaps should be preferred in case of small/medium size defects in otherwise healthy extremities. Free perforator flaps should be the choice in large defects due to trauma or vascular diseases. The economic analysis suggests that propeller flap should be considered when possible.
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Violence is a leading cause of death worldwide for youth age 15-29. A growing body of literature has described assault-injured youth in United States emergency centres, identifying risk factors for re-injury and mortality, and developing targeted interventions. Despite the fact that low- and middle-income countries are disproportionately affected by violence, little research on assault-injured youth exists in these settings. ⋯ Violence is a chronic and recurring disease, suggesting opportunities for interventions during health care contacts. Our population of assault-injured youth demonstrated significant rates of alcohol use and binge drinking, as well as alcohol use prior to the assault. Future secondary violence prevention initiatives should consider targeting alcohol use and abuse.
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To investigate demographics and outcomes of Vancouver type C periprosthetic femoral fractures (PPFF) treated with open reduction and internal fixation. ⋯ The lowest reoperation rate was observed using locking plates in Vancouver type C fractures when compared with conventional plates or intramedullary nailing. The presence of an ipsilateral knee prosthesis did not influence the outcome of the surgical treatment.
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Portal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. ⋯ Despite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.
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Multicenter Study Comparative Study
The medial femoral condyle free corticoperiosteal flap versus traditional bone graft for treatment of nonunions of long bones: a retrospective comparative cohort study.
Fracture healing is a complex process and many factors change the local biology of the fracture and reduce the physiologic repair process. Since 1991 the free vascularised corticoperiosteal graft has been proposed to treat nonunions. In this study we compare the healing rate and the healing time of the free vascularised corticoperiosteal graft harvested from medial femoral condyle versus the traditional cancellous bone graft from the iliac crest combined with other biologic or pharmacologic factors. ⋯ Some studies describe a high healing rate of recalcitrant nonunions with treatments different from vascularized bone flaps: it is difficult to compare the results of vascularized bone transfers with the results of other case series. Our groups are very homogeneous even if it is difficult to define correct inclusion criteria because there is still no agreement about what is defined a recalcitrant or difficult nonunion, and the number of trials of previous surgery before to perform a vascularized free flap. Even if our study cohort is small, we have demonstrated that the MFCCF generally seems to give a better healing chance with a shorter healing time compared to other treatments.