outcome of multidisciplinary approach to mangled extremity

Mangled extremities are associated with high rate of amputations and non-functional limbs. Factors responsible for such poor outcome were studied. Thirty patients with mangled extremities underwent vascular reconstruction, orthopedic fixation and soft tissue coverage sequentially, as required. Vascular injuries were treated using autogenous vein, primary repair, ligation and observation. Fracture fixation of 26 extremities included closed management [17 fractures and 2 dislocations], external or internal fixation. Twenty-eight patients had soft tissue injuries that required primary closure. Split-thickness skin grafts, fasciocutaneous flaps, muscle flaps and a fasciocutaneous and a muscle flap. Two out of 14 nerve injuries were successfully repaired early. Functional limb salvage was achieved in 23 patients. Two non-functional upper extremities resulted from non-repairable nerve injuries. Two amputations resulted from none or failure of revascularization. Three patients died from associated severe head injuries. Successful salvage of mangled extremity can be achieved by implementing a multidisciplinary team approach

Postoperative pain relief in pediatric patients after subumbilical operations: regional versus systemic analgesia

This study was done to evaluate the postoperative pain relief produced by either caudal block, nerve blocks [ilioinguinal, iliohypogastric, and dorsal nerve of the penis], or instillation of bupivacaine locally into the operative wound, in pediatric patients. These effects were compared with the effect of systemic analgesia using acetaminophen alone postoperatively. Eighty children [mean age 44.8 +/- SD 22. 7 months, range 6 to 118 months] undergoing elective subumbilical operations under general anesthesia, were randomly allocated into four equal groups. Group I was given a caudal block with bupivacaine 0.25 percent [0.75mg/kg]. Group II had selected nerve blocks with the same solution. In group III, their wounds were irrigated with the same anesthetic before closure of the wound. Group IV did not receive any local anesthetic during operation. Postoperative systemic analgesia, in the form of acetaminophen pediatric suppository, was administered according to the requirement. The differences in pain scores among the different groups were assessed. All groups were comparable regarding the demographic data with no statistically significant difference. Our results demonstrated that caudal block was the most effective method for pediatric postoperative pain relief. Nerve block was as effective as local instillation. These results were demonstrated by early recovery, better pain scores, less analgesic consumption during the first 24 hours postoperatively, and early discharge