Articles: surgery.
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Clin Podiatr Med Surg · Jul 2007
ReviewAdvanced plastic surgery techniques for soft tissue coverage of the diabetic foot.
Obtaining stable, durable, and functional wound closure of a diabetic foot wound or open pedal amputation through plastic surgical techniques is essential to limit the potential for repeated ulceration, infection, and "supra-pedal" amputation. Myriad conservative and surgical techniques can be used to obtain wound closure. The authors discuss their approach and present operative pearls for their most commonly employed plastic surgical techniques to provide adequate soft tissue coverage of diabetic foot wounds. Emphasis is placed on the techniques necessary to perform these procedures and the surgical thought process involved in closing diabetic foot wounds.
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Ilioinguinal/iliohypogastric nerve block combined with general anaesthesia facilitates inguinal herniorrhaphy in an ambulatory setting by improving analgesia and reducing opioid requirements. Case reports in children indicate the possibility of colonic puncture and associated morbidity with blind ilioinguinal and iliohypogastric blockade. ⋯ Ultrasound guidance for ilioinguinal and iliohypogastric nerve block in the inguinal region is both feasible and a promising technique.
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Comput. Aided Surg. · Jul 2007
Comparative StudyIntraoperative cone-beam CT for image-guided tibial plateau fracture reduction.
A mobile isocentric C-arm was modified in our laboratory in collaboration with Siemens Medical Solutions to include a large-area flat-panel detector providing multi-mode fluoroscopy and cone-beam CT (CBCT) imaging. This technology is an important advance over existing intraoperative imaging (e.g., Iso-C(3D)), offering superior image quality, increased field of view, higher spatial resolution, and soft-tissue visibility. The aim of this study was to assess the system's performance and image quality in tibial plateau (TP) fracture reconstruction. ⋯ This study demonstrated a clear advantage of intraoperative CBCT over 2D fluoroscopy and Iso-C(3D) in TP fracture fixation. CBCT imaging provided benefits in fracture type diagnosis, localization of fracture fragments, and intraoperative 3D confirmation of anatomic reduction.
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Clin. Orthop. Relat. Res. · Jul 2007
Computer navigation allows for accurate reduction of femoral fractures.
Femoral nailing for reduction and stabilization of femoral fractures is a common orthopaedic procedure. However, angular and rotational malalignment is not an infrequent result, and extensive use of fluoroscopy is commonly involved. We tested the accuracy of a computerized navigation system to enhance multiplanar fracture reduction and to decrease the requirement for fluoroscopy. ⋯ Rotational accuracy was 1.7 degrees +/- 1.9 degrees and 2.5 degrees +/- 1.8 degrees, respectively. Open reduction using this model yielded no difference between the reduced fracture and the intact bone in coronal and rotational alignment. Computerized navigation has the potential for increasing precision in fracture reduction while minimizing fluoroscopic requirements.
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The aim of this study was to investigate the severity and duration of postoperative pain and hyperalgesia in sheep undergoing mandibular reconstructive surgery. Stimulus-evoked sensitivity at the surgical site and an area remote from injury, the ipsilateral and contralateral forelimbs, was measured as objective indicators of altered pain processing in adult female sheep (n = 7). Responses were recorded before surgery and one, two, three, seven and 14 days afterwards. ⋯ A significant decrease in forelimb mechanical withdrawal thresholds (secondary hyperalgesia) and response thresholds to punctate stimulation of the area surrounding the surgical incision (allodynia) was detected one day after surgery and persisted for at least three days, despite intra- and postoperative analgesic treatment. Concentrations of haptoglobin were significantly increased one day post-surgery, indicating the presence of a significant acute inflammatory response, and returned to pre-surgical concentrations by seven days. These data provide a deeper insight into understanding the impact of surgery in experimental animals, and may assist in formulating more effective analgesic and antihyperalgesic treatment regimens postoperatively.