Colgajos en la reconstrucción de los miembros con lesión traumática / Flaps In The Reconstruction Of Limbs With Traumatic Injury

Introducción: Las opciones para el manejo de tejidos blandos en los defectos traumáticos han aumentado con el desarrollo de la microcirugía, con una mejor comprensión de los colgajos pediculados y los avances con terapia con esponja de presión negativa. Objetivo: Revisar y poner a disposición de los especialistas algunos de los tópicos relacionados con estos procederes quirúrgicos de colgajos en las lesiones traumáticas de los miembros. Métodos: Se realiza una búsqueda en PubMed entre los años 2010-2020, en inglés con los términos: cirugía de colgajos en lesiones traumáticas, tratamiento de las lesiones de partes blandas relacionadas con trauma de los miembros, reconstrucción de las lesiones traumáticas de partes blandas de extremidades. Se revisaron también, artículos accesibles de forma libre, o a través del servicio Clinical Key y Hinari. Conclusiones: Existen controversias acerca del momento óptimo para el cierre de las heridas. La definición de reconstrucción primaria versus secundaria depende del tiempo de lesión y del tipo de procedimiento quirúrgico. La terapia de heridas con presión negativa sirve como parte del arsenal para la reconstrucción de tejidos blandos en un trauma de extremidades(AU)

Introduction: Options for soft tissue management of traumatic defects have increased with the development of microsurgery, with a better understanding of pedicle flaps and advances with negative pressure sponge therapy. Objective: To review and make available to specialists some of the topics related to these surgical procedures for flaps in traumatic limb injuries. Methods: A PubMed search was carried out from 2010 to 2020, in English with the terms: flap surgery in traumatic injuries, treatment of soft tissue injuries related to trauma of the limbs, reconstruction of the limbs. traumatic soft tissue injuries of extremities. Articles freely accessible or through the Clinical Key and Hinari service were also reviewed. Conclusions: There are controversies about the optimal time for wound closure. The definition of primary versus secondary reconstruction depends on the time of injury and the type of surgical procedure. Negative pressure wound therapy serves as part of the arsenal for soft tissue reconstruction in extremity trauma(AU)

Conhecimento dos agentes comunitários de saúde sobre trauma de extremidades / Knowledge of community health agents on extremities trauma / Conocimiento de agentes de salud comunitarios en trauma de extremidades

Objetivo: caracterizar o conhecimento dos agentes comunitários de saúde sobre trauma de extremidades. Método: trata-se de um estudo quantitativo, descritivo, realizado a partir do banco de dados da pesquisa intitulada "conhecimento de agentes comunitários de saúde sobre atendimento pré-hospitalar no suporte básico de vida - impacto das ações de extensão". os dados foram coletados por meio de questionário. a amostra foi composta por 15 agentes comunitários de saúde de uma unidade de saúde da família integrada em João Pessoa, paraíba, brasil. analisaram-se os dados por meio de estatística descritiva e foram apresentados os resultados em tabelas. Resultados: observa-se que a média de acertos no pós-teste sobre conhecimento no trauma de extremidades foi de 69,3%. Conclusão: evidenciou-se que o conhecimento dos agentes comunitários de saúde sobre traumas de extremidades, teve um aumento significativo após as intervenções educativas

Objective: to characterize the knowledge of community health agents about trauma to the extremities. Method: this is a quantitative, descriptive study, carried out from the research database titled "knowledge of community health agents on pre-hospital care in basic life support-impact of extension actions". data were collected through a questionnaire. the sample consisted of 15 community health agents from a integrated family health unit in João Pessoa, Paraíba, Brazil. data were analyzed using descriptive statistics and the results were presented in tables. Results: it was observed that the average of post-test hits in knowledge of extremity trauma was 69.3%. Conclusion: it was evidenced that the knowledge of community health agents on trauma of the extremities, had a significant increase after the educational interventions

Objetivo: caracterizar el conocimiento de los agentes de salud de la comunidad sobre trauma en las extremidades. Método: se trata de un estudio cuantitativo y descriptivo, realizado a partir de la base de datos de investigación titulada "conocimiento de los agentes sanitarios comunitarios sobre la atención prehospitalaria en las acciones básicas de apoyo a la vida-impacto de las acciones de extensión". los datos se recopilaron a través de un cuestionario. la muestra consistió en 15 agentes de salud comunitarios de una unidad integrada de salud familiar en joao pessoa, paraíba, brasil. los datos se analizaron utilizando estadísticas descriptivas y los resultados se presentaron en tablas. Resultados: se observó que el promedio de aciertos posteriores a la prueba en el conocimiento del trauma en las extremidades fue del 69,3%. Conclusión: se evidenizó que el conocimiento de los agentes de salud comunitarios sobre trauma de las extremidades, tuvo un aumento significativo después de las intervenciones educativas

Tourniquet use for civilian extremity hemorrhage: systematic review of the literature / Uso de torniquete nas hemorragias de extremidades na população civil: revisão sistemática da literatura

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.

Clinical and morphological justification of the treatment of purulonecrotic lesion in deep structures of limb distal segment in pig: case report / [Justificativa clínica e morfológica do tratamento de lesão purulonecrótica em estruturas profundas do segmento distal de membros em porco: relato de caso]

Surgical pathology of the musculoskeletal system, and in particular the diseases of the limb distal segment in pigs are quite common. Their significant spread leads to economic losses due to culling, compulsory slaughter, short-received pig production and pig crop. The purpose of this work was to reveal clinical and morphological features of limb distal segment diseases in pigs and to study the possibility of preserving their health and productivity. The conservative treatment of purulonecrotic lesions in the deep structures of the limb distal segment in pigs is not promising. It is shown that the best way to treat a given pathology is amputation of a sick limb. The technique of carrying out exarticulation of talus shin consists in separation of soft tissues, capsule and ligaments, ligation of vessels, formation of stump. The postoperative recovery period of the animal body is 25 days.(AU)

A patologia cirúrgica do sistema musculoesquelético e, em particular, as doenças do segmento distal dos membros em suínos são bastante comuns. A sua propagação significativa leva a perdas econômicas devido ao abate seletivo, abate obrigatório, produção de suínos pouco recebida e colheita de suínos. O objetivo deste trabalho foi revelar características clínicas e morfológicas das doenças do segmento distal de membros em suínos e estudar a possibilidade de preservar sua saúde e produtividade. O tratamento conservador das lesões purulonecróticas nas estruturas profundas do segmento distal do membro em porcos não é promissor. Fica estabelecido que a melhor forma de tratar uma determinada patologia é a amputação de um membro doente. A técnica de realizar a exarticulação da canela do talos consiste na separação dos tecidos moles, cápsula e ligamentos, ligadura dos vasos, formação do coto. O período de recuperação pós-operatória do corpo do animal é de 25 dias.(AU)

Factores pronósticos para pérdida de extremidad con trauma arterial periférico en un hospital de Colombia / Prognostic factors for extreme loss in peripheral arterial trauma at a Colombian hospital

INTRODUCCIÓN: El trauma vascular es un evento de baja frecuencia, con alta morbimortalidad que afecta la población joven; requiere en general un manejo quirúrgico. Se asocia a complicaciones desde la reintervención quirúrgica hasta la amputación de la extremidad, influenciado por variables tanto asociadas al trauma como a la atención hospitalaria. OBJETIVO: Determinar los factores de riesgo relacionados con amputación, en pacientes con trauma arterial periférico (TAP), atendidos en un Hospital de III nivel Huila- Colombia entre 2014-2017. MATERIALES Y MÉTODOS: Estudio observacional, analítico de corte retrospectiva con pacientes mayores de 13 años con TAP. RESULTADOS: Se incluyeron 79 pacientes, con un 1,56% de las consultas en nuestro Servicio de Urgencia. 89% hombres, promedio de edad 28,5 años. La principal comorbilidad fue la farmacodependencia 8,8%. El MESS (mangled extremity severity) promedio fue de 5,27 puntos y un tiempo critico de isquemia de extremidad > a 6 horas en el 38%. El mayor compromiso fue de miembros superiores, secundario a heridas por arma cortopunzante. La lesión predominante fue la transección arterial. Las principales complicaciones posquirúrgicas fueron la trombosis del vaso (21,5%) y la amputación (13,9%). Factores de riesgo asociados a amputación fueron la edad > 20 años, estancia hospitalaria > 7 días, MESS > 7 puntos, que presentaran como complicación quirúrgica la trombosis arterial y que requirieran reintervención quirúrgica. CONCLUSIONES: El trauma arterial periférico es una patología con gran repercusión socioeconómica y secuelas funcionales. Es necesaria la atención oportuna con tratamiento de las variables relacionadas con mal pronóstico, con el fin de disminuir las tasas de morbimortalidad.

INTRODUCTION: Vascular trauma is a low frequency event, with high morbidity and mortality that affects the young population; In general, it requires surgical management. It is associated with complications from surgical reintervention to amputation of the limb, influenced by trauma associated variables such as hospital care. AIM: Determine risk factors related to amputation, in patients with peripheral arterial trauma (TAP), treated at a Hospital of III level Huila-Colombia between 2014-2017. MATERIALS AND METHOD: Observational, retrospective analytical study with patients older than 13 years with TAP. RESULTS: We included 79 patients with an incidence of 1.56%. 89% men, average age 28.5 years. The main comorbidity was 8.8% drug dependence. The MESS (Mangled extremity severity) average was of 5.27 points and a critical time of limb ischemia > to 6 hours in 38%. The greater commitment was of superior members, secondary to injuries by sharp weapon. The predominant lesion was arterial transection. The main postoperative complications were vessel thrombosis (21.5%) and amputation in 13.9%. Risk factors associated with amputation were determined by age > 20 years, hospital stay > 7 days, MESS > 7 points, and that they presented arterial thrombosis as a surgical complication and finally required surgical reoperation. CONCLUSIONS: Peripheral arterial trauma is a pathology with great socioeconomic impact and functional sequelae. It is necessary the timely attention with treatment of the variables related to poor prognosis, in order to decrease the morbidity and mortality rates.

Automobile Traffic Accident Death Case Analysis of Characteristics of Driver Injury / 法医学杂志

OBJECTIVES@#To distinguish the injury characteristic changes on the drivers between the injuries of drivers and passengers in traffic accidents, and to provide scientific evidence for confirming the identity of driver in traffic accidents.@*METHODS@#Data of 126 automobile traffic accident death cases in the reclamation areas of Heilongjiang province from 2006-2014 were retrospectively studied. The injury characteristics on the drivers of automobile traffic accident death cases were analyzed and the forensic identification problem in the injuries of drivers and passengers were discussed.@*RESULTS@#Injuries were frequently observed on driver's neck, chest and abdomen. The characteristic injuries caused by auto parts were also found, which appeared at the places of passenger's head, face and limbs contacted with automobile. Such characteristic injuries were not found at other places.@*CONCLUSIONS@#The location and type of injury are associated with the identity of the deceased.

Remote limb ischemic post-conditioning attenuates ischemia-reperfusion injury in rat skin flapby limiting oxidative stress

PURPOSE: To investigate the effect of remote ischemic post-conditioning (RIPoC) against ischemia-reperfusion (I/R) injury on flaps of rats. METHODS: Sprague-Dawley rats were randomized into the Sham, Control, RIPoC1 and RIPoC2 groups. All the animals were submitted to a 5×4 cm superficial inferior epigastric artery flap. Eight hours of flap ischemia was induced and two protocols of limb RIPoC were applied. Tissue MDA level and SOD activity in 24-h reperfusion were assessed. Flap survival was assessed 7 days postoperatively. RESULTS: Compared to the Control group, the RIPoC1 group showed statistically decreased MDA level at 6-, 12-, and 24-h reperfusion (P = 0.01, P < 0.01 and P < 0.01, respectively), and statistically increased SOD activity at 12- and 24-h reperfusion (P < 0.05 and P < 0.01, respectively). Flap survival rate on the 7th day was significantly higher in the RIPoC1 group than the control group (47.9 ± 6.4 vs . 29.4 ± 7.1 %, P < 0.01). CONCLUSION: Three cycles of 5-min Limb remote ischemic post-conditioning rather than a single cycle of 15-min limb RIPoC has protective effect on flaps against ischemia-reperfusion injury by attenuating oxidative stress.

Assessment of Function of a Single Limb after Injury / 法医学杂志

OBJECTIVE@#To explore the method for the objective evaluation of single limb function after in- jury in forensic medical practice.@*METHODS@#The score of activities of daily living (ADL) were graded for a single limb function after injury from 47 cases. All cases were simultaneously evaluated using the different methods including Fugl-Meyer motor function assessment (FMA), weighting, look-up table (LUT). The correlation were compared between ADL and the other three methods.@*RESULTS@#Injured part and the score using the three methods were correlated with ADL score (P < 0.05). The correlation coeffi- cient (|r| value) showed highest using LUT method, and lowest using FMA method.@*CONCLUSION@#The loss function of limb is affected by the injuried parts. The methods of FMA, weighting and LUT show a good accuracy for evaluating the limb function after injury and the correlation presents higher using LUT method.

delayed management of main arterial injuries in extremity trauma: surgical challenges and outcomes

To analyse the early outcome of main arterial injuries with delayed treatment in extremity trauma and help vascular surgeons in determining proper treatment strategy for such injuries. Forty-three patients with delayed treatment of main arterial injuries during May 2003 and January 2008 were reviewed retrospectively. In 43 patients, injuries were caused by blunt trauma in 26 cases and penetrating trauma in 17 cases. The maximum ischaemia time was 38 hours and the minimum was 13 hours. Eight patients underwent primary amputations and four patients underwent secondary amputation. There was no perioperative mortality, while wound infection occurred in five patients, followed by graft occlusion in four patients, arteriovenous fistulae in two patients and pseudoaneurysm in one patient. The delayed intervention in main arterial injuries is associated with higher risk of amputation, while the suitable surgical techniques may decrease the risk of limb loss. Viable limbs should be revascularized in otherwise stable patients even with long periods of ischaemia

Trauma de extremidades: avaliação e manejo inicial das lesões graves e ameaçadoras da vida / Trauma of limbs: evaluation and initial management of severe, life-threatening injuries

Este artigo versará sobre as lesões musculoesqueléticas graves que podem trazer risco à vida, na importância do seu reconhecimento precoce e manejo inicial dessas lesões, que deverão ser realizadas pelo médico no departamento de emergência.

This article discusses the severe musculoskeletal injuries that can bring serious risk to life, the initial evaluation and management of these injuries that must be performed by the physician in the emergency department.

Análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado / Comparative analysis of injuries observed in motorcycle riders involved in traffic accidents and victims of other blunt trauma mechanisms

OBJETIVO: Realizar uma análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado. MÉTODOS: Análise dos protocolos (colhidos prospectivamente) dos traumatizados com idade superior a 13 anos, admitidos de 10/06/2008 a 01/09/2009, vítimas de trauma fechado. Foram coletadas informações sobre mecanismo de trauma, dados vitais à admissão, exames complementares, lesões e tratamento. A estratificação da gravidade do trauma e das lesões foi realizada pelo cálculo dos índices de trauma: RTS, escala de coma de Glasgow (ECG), AIS, ISS e TRISS. Comparamos as variáveis entre os motociclistas (grupo A) e os demais (grupo B). Consideramos graves as lesões com AIS > 3. Para a análise estatística, utilizamos os testes t de Student, Mann Whitney, qui-quadrado e Fisher, considerando p < 0,05 significativo. RESULTADOS: Foram incluídos no estudo 3.783 vítimas de trauma fechado, com idade de 14 a 99 anos, sendo 76,0 por cento do sexo masculino. Os mecanismos de trauma mais frequentes foram os acidentes com motociclistas (24,4 por cento) e atropelamentos (22,6 por cento). Na comparação das variáveis entre os grupos A e B, observamos que os motociclistas apresentaram, significativamente, (p < 0,05), menor média etária (28,9 ± 8,5 anosvs. 42,4 ± 18,5 anos) e menor média de AIS em segmento cefálico (0,3 ± 0,9 vs. 0,8 ± 1,1), como também, maior média da ECG à admissão (14,5 ± 1,9vs. 14,2 ± 2,2), de AIS em extremidades (1,5 ± 1,2 vs. 0,9 ± 1,2), de RTS (7,8 ± 0,5 vs. 7,7 ± 0,6) e de TRISS (0,98 ± 0,1 vs. 0,97 ± 0,1). O gênero masculino foi significativamente mais frequente no grupo A (87,9 por centovs. 72,6 por cento). Na comparação das lesões entre os grupos, notamos que os motociclistas apresentaram, significativamente, (p < 0,05), menor frequência de hematomas extradurais (0,6 por cento vs. 2,1 por cento), hematomas subdurais (0,9 por cento vs. 2,1 por cento), hemorragia subaracnóidea (0,9 por cento vs. 2,2 por cento), contusão encefálica (1,2 por cento vs. 3,6 por cento) e lesões graves em crânio (4,8 por centovs. 9,4 por cento), bem como maior frequência de lesão axonal difusa (1,6 por centovs. 0,7 por cento), fraturas de membros superiores (7,9 por centovs. 4,4 por cento), inferiores (7,7 por centovs. 5,2 por cento), e lesões graves em extremidades (20,6 por centovs. 12,6 por cento). CONCLUSÃO: Em comparação às vítimas dos demais mecanismos de trauma, os motociclistas apresentaram menor frequência e gravidade das lesões em segmento cefálico, bem como maior frequência e gravidade das lesões em extremidades.

OBJECTIVE: To conduct a comparative analysis of the lesions found among motorcycle riders involved in traffic accidents and victims of other mechanisms of blunt trauma. METHODS: Analysis of data prospectively collected on protocols for trauma patients older than 13 years, admitted from 06/10/2008 to 09/01/2009, victims of blunt trauma. Data collected included trauma mechanism, vital signs at admission, laboratory tests, injuries, and treatment.Stratification of trauma and lesion severity was performed by calculating the trauma index: Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and TRISS. We compared the variables between motorcycle riders (group A) and the others (group B). Severe injuries were considered when AIS > 3. For statistical analysis, we used Student's t, Mann Whitney, chi-square and Fisher's test, with p < 0.05 considered statistically significant. RESULTS: The study included 3,783 blunt trauma victims, aged 14 to 99 years, of which 76.0 percent were males. The most frequent trauma mechanisms were accidents involving motorcycle riders (24.4 percent) and pedestrians (22.6 percent). When comparing the variables between groups A and B, we observed that motorcycle riders were significantly (p < 0.05) younger (28.9 ± 8.5 years vs. 42.4 ± 18.5 years) and had lower mean AIS in the head segment (0.3 ± 0.9 vs. 0.8 ± 1.1), as well as higher mean GCS at admission (14.5 ± 1.9 vs. 14.2 ± 2.2), AIS in the extremities (1.5 ± 1.2 vs. 0.9 ± 1.2), RTS (7.8 ± 0.5 vs. 7.7 ± 0.6) and TRISS (0.98 ± 0.1 vs. 0.97 ± 0.1). Men were significantly more frequent in group A (87.9 percent vs. 72.6 percent). When comparing injuries between groups, we observed that the motorcycle riders had significantly (p < 0.05) lower frequency of extradural hematomas (0.6 percent vs. 2.1 percent), subdural hematomas (0.9 percent vs. 2.1 percent), subarachnoid hemorrhage (0.9 percent vs. 2.2 percent), brain injury (1.2 vs. 3.6 percent), and severe head injuries (4.8 percent vs. 9.4 percent ), as well as higher frequency of diffuse axonal injury (1.6 percent vs. 0.7 percent), upper- (7.9 percent vs. 4.4 percent) and lower-limb fractures (7.7 percent vs. 5, 2 percent), and severe extremity lesions (20.6 percent vs. 12.6 percent). CONCLUSION: Compared to victims of other trauma mechanisms, motorcycle riders had a lower frequency and severity of head injuries, as well as increased frequency and severity of lesions in the extremities.

A influência das condições de visibilização na análise de radiografias de pacientes vítimas de trauma de extremidade / The impact of visualization conditions on the analysis of radiographies of extremity fracture patients

Para que o tratamento de uma fratura de extremidade seja instituído, é fundamental que se faça minucioso exame físico, complementado pela radiografia. No entanto, não raramente, a análise radiográfica é feita confrontando-se o filme com a luz da janela ou da sala de emergência, e não com o negatoscópio. O presente estudo tem como objetivo observar se as condições da visibilização realmente influenciam na análise radiográfica de pacientes vítimas de trauma de extremidade.

Before prescribing a treatment, physicians are supposed to carry on detailed physical exams complemented with radiography analysis. However, they frequently analyze radiographies against the light shining from the window or in the emergency room, instead of using a negatoscope. This study aims at investigating whether visualization conditions do have an impact on the analysis of radiographies of extremity fracture patients.

[Crush injury and compartment syndrome]

Crush injury of an extremity occurs when a limb is compressed between two hard surfaces, to the point where vascular supply is impaired and vulnerable tissues undergo necrosis. Most commonly, limbs are crushed during auto versus pedestrian accidents, motor vehicle crashes, and industrial accidents. However, during natural disasters such as earthquakes, building collapses, landslides, mine cave-ins, and acts of war with mass civilian casualties, epidemics of limb crush injuries can occur. The large number of casualties requiring specialized medical care can easily overwhelm medical systems, particularly if medical facilities are simultaneously affected by the disaster. This article reviews the acute management of vascular and soft tissue injuries in the emergency department

[Disability evaluation of traumatic injuries of extremities from the forensic medicine standpoint]

The problem of disability evaluation of traumatic injuries is one of the real problems in the work of courts because of the absence of a standardized method consistent with the Syrian Penal Code and the law of insurance and cope with the real meaning of the concept of disability from the viewpoint of the Criminal Code, leading forensic doctors to adopt schedules disability of social insurance to estimate the disability from the standpoint of the judiciary. our goal is to find a method to assess the degree of disability judicial compatible with the characteristics of the Syrian society [for Penal and Insurance Act] beneficiaries of all methods. this method must be easy application-scientific-measurable-logical and far from the personal forensic physicians estimates. he most important methods used to estimate the degree of disability are "totalitarian tables [d. Maher], Rice method, American method and Canadian. Every one of these methods disadvantages which make it inapplicable in Syria. Ten simple equations has been found to define all forms of Traumatic injuries of limbs. Our research also created concept of wind weighting for some special injuries which are influenced by some factors as age, sex. in addition to, the agenda to estimate the possibility of a permanent impairment in some Traumatic injuries was given

[Angiographic findings of arterial injuries in extremity trauma]

Nowadays traumatic injuries are the third cause of mortality in human societies and vascular injury as a main part of them are one of the main problems in medicine. Tissue ischemia resulted from vascular injuries is an emergency and if it continues irreversible ischemia and damage will result after 6 hours. In vascular injuries, early diagnosis and treatment is very important. Since the causes, types and resulting damages are different in our country from developed countries, we designed this study to compare these factors based on angiography which is the method of choice in vascular injuries. In this descriptive - analytical study, 75 patients with vascular injuries were studied by angiography in Imam Khomeini Hospital of Tabriz during 12 months. 94.7% of our patients were male and remaining 5.3% were female. The most common cause of trauma in this study was traffic accidents [93.3%] and the most common site of trauma was leg [62.2%] and associated fracture was detected in 86.75% of cases. The most common fracture was double fracture of leg [55.4%]. The most common injured artery was anterior tibial artery [36%] and the most common type of vascular injuries was complete arterial occlusion [62.7%]. Vascular injuries were more common in young males than the other groups and the most common cause was blunt trauma specially motorcycle accidents

Incontinencia pigmenti: comunicación de un caso y revisión de la literatura / Incontinentia pigmenti: case report and literature review

La incontinencia pigmenti es una genodermatosis de herencia dominante ligada al cromosoma X, generalmente letal intra-útero en varones. Se caracteriza por lesiones cutáneas y afectación de otros órganos como ojos, dientes, uñas, pelo y sistema nervioso central. Presentamos el caso de una niña de un año de edad, sin antecedentes familiares, con lesiones clásicas de piel de incontinencia pigmenti y afectación de ojos y pelo

Incontinentia pigmenti is an X-linked dominant genodermatosis, generally lethal in-utero in males. It is characterized by cutaneus lesions associated to dental, ocular, nail, hair and central nervous system affection. We describe the case report of a 1-year girl, without family history, with the classic skin lesions and eye and hair involvement

Síndrome de Sweet: revisión de la literatura y experiencia del Hospital Infantil de México / Sweet's syndrome: review of literature and experience of the Hospital Infantil de Mexico

El síndrome de Sweet es el prototipo de las dermatosis neutrofílicas. Fue descripto por primera vez por el Dr. Douglas Sweet en 1964. La enfermedad presenta distribución mundial. Es poco frecuente en la población general y su ocurrencia en la infancia es aún más rara. Su etiología es desconocida, sin embargo existen varias hipótesis que la vinculan con infecciones, trastornos autoinmunitarios, enfermedad inflamatoria intestinal y procesos malignos. Se caracteriza por cinco rasgos principales: 1) aparición brusca de placas eritemato-edematosas dolorosas a nivel de cabeza, cuello y extremidades superiores; 2) fiebre; 3) leucocitosis neutrofílica; 4) denso infiltrado dérmico de predominio polimorfonuclear; 5) rápida respuesta a la terapéutica esteroidea. Presentamos la experiencia clínica de los últimos 20 años del Hospital Infantil de México Federico Gómez.

Sweet syndrome is the prototype of the neutrophilic dermatoses. It was first described in 1964 by Dr. Douglas Sweet. It has a worldwide distribution. It is a very infrequent disease in the general population and even during childhood. Its etiology is unknown, however, there are various hypothesis given its association with infections, autoinmune disorders, intestinal inflammatory disease and tumors. It is characterized by 1) sudden onset of erythematous and painful plaques in the head, neck, and upper extremities; 2) fever; 3) neutrophilic leukocytosis; 4) dense polymorphonuclear infiltrate in dermis; 4) rapid response to steroid therapy. We present the clinic experience of the Hospital Infantil de Mexico Federico Gomez in the last 20 years.

Epidemiological features of the injured in road traffic accidents in Shanghai / 法医学杂志

OBJECTIVE@#To provide reference data for enacting and revising the laws and regulations of the disability expertise.@*METHODS@#The epidemiological features of the disabled caused by road traffic accident in Shanghai during 2005 were retrospectively analyzed.@*RESULTS@#The most common injuries were in extremities (53.3%), followed by head (23.3%), spine (9.7%), thorax (5.8%), and abdomen (4.4%). The cumulative incidence rate of disability due to traffic injuries was 414.8 cases per 100,000 inhabitants, higher for men (505.7/100,000) than women (318.7/100,000). The highest incidence rate of disability was between age 35 and 59 (538.2/100,000). The most disabled was bicyclist, followed by pedestrian.@*CONCLUSION@#The incidence rate of disability among 35-59 age group was the highest in Shanghai during 2005. It has resulted in loss of labor force with a negative effect on the economic development.

Driveway motor vehicle and bicycle injuries in children at Alwahda Hospital, Derna-Libya [2005-2006]

To describe the frequency, nature and outcome of driveway injuries in children. A retrospective study of driveway-related injuries in children less than 16 years of age admitted to Alwahda Hospital, Derna-Libya, from January 2005 to December 2006, and deaths reported. Circumstances of injury; type and number of injuries were identified. A total number of 104 children were admitted to Alwahda Hospital with driveway-related injuries [2005-2006], representing 17.3% of all with motor vehicle injuries. Fourteen deaths representing 13.5% of cases were reported. Males were 85 [81.7%] and females were 19 [18.3%]. Head injuries represented 41.3% [43/104] of cases followed by extremities 31.7% [33/104] then extremities with multiple injuries - 16.3% [17/104]. Sprain or contusions represented 43.3% [45/104] of cases, open wound 26.9% [28/104] and fractures 20.2% [21/104]. Cars were involved in 79% of all injuries, light commercial vehicles or bicycles were involved in 21%. About 75% of injuries occurred in the afternoon or night, and 45% of injuries took place in the summer months. Driveway injuries in children account for a significant proportion of paediatric pedestrian motor vehicle injuries and deaths in Derna. Prevention represents the only effective approach to reducing deaths from this cause