ABSTRACT
High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.
Subject(s)
Humans , Burns , Debridement , Forearm , Free Tissue Flaps , Hand , Joints , Leg , Necrosis , Skin , Surgical Procedures, Operative , Tendons , Thigh , Wound Healing , Wounds and Injuries , Wrist Injuries , WristABSTRACT
For treatment of the pressure sore, varieties of methods have been developed such as skin graftings, local flap, myocutaneous or fasciocutaneous flap, etc.. Except mild cases, myocutaneous flaps have been used commonly for the best coverage and padding of the wound. But the gluteus maximus muscle is not an expendable muscle, so the myocutaneous flaps using gluteus maximus muscle result in significant functional loss in ambulatory patients. Various methods as fasciocutaneous flap to reserve a function of the gluteus maximus muscle have been developed. We especially designed a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement in sacral sore when the defect is fusiform transversely in shape. With this design, we obtained reduced tension in the midline suture with less dissection in medial portion of the fasciocutaneous flap and made the flap more rleliable by including more parasacral perforators within the flap. We have experienced the eight cases of gluteal fasciocutaneous V-Y advancement flap and obtained the excellent results without flap necrosis. We conclude that a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement is useful in sacral sore when the defect is fusiform transversely in shape.
Subject(s)
Humans , Myocutaneous Flap , Necrosis , Pressure Ulcer , Skin Transplantation , Sutures , Wounds and InjuriesABSTRACT
When operations in the field of plastic surgery are performed under local anesthesia, the degree of pain suffering the patients becomes different depending on the kind, dosage effective duration of anesthetic agent and the technique of the operator. Patients suffer from pain physically and psychologically when skin infiltration is carried out. Recently, out-patient surgery has increased in number, so the necessity of more complete analgesia for the patient undergoing surgery is required. Patients were operated under the local infiltrative anesthesia, and the supplemental intravenous anesthesia to kill pain. Patients were randomly divided into four groups differing in combinations of intravenous anesthetic agents, such as ketamine, midazolam, fentanyl that have potent analgesic sedative and amnesic effects. By random allocation patients received ketamine and midazolam(Group I), ketamine and fentanyl(Group II), midazolam and fentany l (Group III), ketamine, fentanyl arts midazolam(Group IV). The purpose of this study is to focus on the results obtained in four groups for finding out a more safe and less complicated combination of intravenous anesthetic agents and for standardization of dosage. In conclusion the group I (ketamine and midazolam) showed better results than other groups for the following reasons; no significant change in vital signs, no hypoxia no complication such as nausea, headache unpleasant dream, and hallucination, potent analgesia effects, amnesia. We have found this combination to be a highly satisfactory anesthesia and analgesia technique for outpatient plastic surgery from the standpoints of the surgeon and the patient.
Subject(s)
Humans , Amnesia , Analgesia , Anesthesia , Anesthesia and Analgesia , Anesthesia, Intravenous , Anesthesia, Local , Anesthetics , Anesthetics, Intravenous , Hypoxia , Dreams , Fentanyl , Hallucinations , Headache , Ketamine , Midazolam , Nausea , Outpatients , Random Allocation , Skin , Surgery, Plastic , Vital SignsABSTRACT
When operations in the field of plastic surgery are performed under local anesthesia, the degree of pain suffering the patients becomes different depending on the kind, dosage effective duration of anesthetic agent and the technique of the operator. Patients suffer from pain physically and psychologically when skin infiltration is carried out. Recently, out-patient surgery has increased in number, so the necessity of more complete analgesia for the patient undergoing surgery is required. Patients were operated under the local infiltrative anesthesia, and the supplemental intravenous anesthesia to kill pain. Patients were randomly divided into four groups differing in combinations of intravenous anesthetic agents, such as ketamine, midazolam, fentanyl that have potent analgesic sedative and amnesic effects. By random allocation patients received ketamine and midazolam(Group I), ketamine and fentanyl(Group II), midazolam and fentany l (Group III), ketamine, fentanyl arts midazolam(Group IV). The purpose of this study is to focus on the results obtained in four groups for finding out a more safe and less complicated combination of intravenous anesthetic agents and for standardization of dosage. In conclusion the group I (ketamine and midazolam) showed better results than other groups for the following reasons; no significant change in vital signs, no hypoxia no complication such as nausea, headache unpleasant dream, and hallucination, potent analgesia effects, amnesia. We have found this combination to be a highly satisfactory anesthesia and analgesia technique for outpatient plastic surgery from the standpoints of the surgeon and the patient.