Hand clinics
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Burns of the upper extremity occur frequently in children. Because of differences in development and anatomy, patterns of burn injury are different in children compared to adults. Immediate goals after these injuries are to prevent compartment syndromes and minimize progressive damage. ⋯ If the injury heals within 2 weeks, then scarring is minimized. If the wound has not healed in that time period, then grafting should be considered. Grafting techniques that optimize function and cosmetic appearance are outlined.
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Case Reports
Double muscle transfer for upper extremity reconstruction following complete avulsion of the brachial plexus.
Recent interest in reconstruction of the upper limb following brachial plexus injuries has focused on the restoration of prehension following complete avulsion of the brachial plexus. The authors use free muscle transfers for reconstruction of the upper limb to resolve the difficult problems in complete avulsion of the brachial plexus. This article describes the authors' updated technique--the double free muscle procedure. ⋯ Based on the long-term result, selection of the patient, donor muscle, and donor motor nerve were indicated. Most patients were able to achieve prehensile functions such as holding a can and lifting a heavy box. This double free muscle transfer has provided prehension for patients with complete avulsion of the brachial plexus and has given them new hope to be able to use their otherwise useless limbs.
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Adult brachial plexus injury (BPI) is a closed injury. It usually involves a plexus of nerves formed by a number of roots, spinal nerves, trunks, cords, and numerous terminal branches, in a complicated fashion. Successful results in the management of adult BPI are based on the knowledge of anatomic arrangement, pathophysiology considerations, preoperative evaluation and diagnosis, surgical technique, postoperative management, rehabilitation and regular patient follow-up, surgical treatment of sequelae deformities, and factors influencing its results. This article deals with traumatic lesions of the brachial plexus in adults, and focuses on controversial questions and philosophy of treatment of adult BPI.
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Restoration of satisfactory function following composite tissue loss in the hand and forearm requires reconstruction of soft tissue defect, nerve and tendon injury, and skeletal fixation when fracture occurs. Microsurgical techniques often are required, but single-donor composite tissue transfers seldom are necessary. Reconstructive strategy requires careful planning. Decision-making principles and surgical alternatives are discussed at the end of the article.
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Review Case Reports
Management of farm-related injuries to the upper extremity.
This article familiarizes physicians with common farm equipment that can cause devastating hand injuries. The focus is on farm-related injuries to the hand and stresses the degree of soft tissue injuries, discusses avulsion injuries, and acute management principles. Types of injuries, their pathophysiology, case reports, and treatments also are reviewed. This article also stresses how these injuries differ from the urban trauma patient.