ABSTRACT
This case report presents a very rare fracture combination in a perilunate dislocation including the scaphoid, capitate, hamate and triquetrum and the cornu anterior of the lunate, with an intact scapholunate ligament in a left wrist. An open reduction and internal fixation of the scaphoid, capitate, hamate and triquetrum was performed.
Subject(s)
Carpal Bones/injuries , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/surgery , Fracture Dislocation/etiology , Fracture Fixation, Internal , Humans , Male , Open Fracture Reduction , Young AdultABSTRACT
Saving the outer ear in burn injuries is a challenging task for the treating surgeon that should not be underestimated. Burns which are initially evaluated as superficial, particularly in this region, often have a tendency to undergo progressive tissue destruction whereby conservative treatment is often no longer sufficient to preserve the skin of the auricle with the underlying cartilage. Various possibilities for saving the ear and for ear reconstruction are described, but in the case of severely burned patients it is often necessary to carry out a quick and relatively simple treatment. In the complicated case of a severely burned patient involving the external ear, a good cosmetic result could be finally obtained with preservation of form and function by means of an economical cartilage resection with subsequent adaptation.
Subject(s)
Burns/surgery , Ear, External/surgery , Organ Sparing Treatments/methods , Adult , Ear Cartilage/injuries , Ear Cartilage/surgery , Female , Humans , Plastic Surgery Procedures , Suture TechniquesABSTRACT
OBJECTIVE: The aim is to analyse a modified standardised HILP procedure regarding the response rates, local recurrences and complication rates. PATIENTS AND METHODS: 152 patients (101 females, 51 males) with an average age of 62 years and locoregionally metastasised malignant melanoma underwent HILP using melphalan and dactinomycin between 1992 and 2007. Using M.D. Anderson's classification at the time of the perfusion 51 patients presented in stage IIIA, 43 patients in stage IIIAB and 58 patients in stage IV. If indicated, lymph node dissection was performed simultaneously just before perfusion of the extremity. RESULTS: Complete remission was observed in 91 (62.7%) of 145 patients, partial remission in 26 (17.9%) patients. 28 (19.3%) patients showed no response. The overall response rate was 80.7% (117 of 145 patients). Severe complications (Wieberdink IV/V) were seen in eight cases. The average recurrence-free survival was 17 months. The median survival was 39 months; the five-year overall survival rate was 38%. The overall survival rate was significantly influenced by the stage of the disease. CONCLUSION: HILP is an efficient therapy for multiple or recurrent in-transit metastases of malignant melanoma of the lower extremities. The efficiency increased by improving the technique of the perfusion. Long-term survival can be observed in patients without regional lymph node metastases or distant metastases.
Subject(s)
Chemotherapy, Cancer, Regional Perfusion/methods , Hyperthermia, Induced/methods , Melanoma/therapy , Neoplasm Metastasis/therapy , Skin Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Chemotherapy, Cancer, Regional Perfusion/adverse effects , Dactinomycin/administration & dosage , Extremities/pathology , Female , Humans , Hyperthermia, Induced/adverse effects , Kaplan-Meier Estimate , Male , Melanoma/pathology , Melphalan/administration & dosage , Middle Aged , Skin Neoplasms/pathology , Treatment OutcomeABSTRACT
A systematic review was undertaken using the Cochrane and PubMed databases to answer the question of how wound closure affects wound healing after gynecologic surgery. Leaving the vaginal vault open after vaginal and abdominal hysterectomy is as safe as closing it. When closing the vaginal vault, there is no difference between sutures and staples. Nonclosure of the peritoneum is a safe method after vaginal and abdominal hysterectomy. After laparotomy there is no difference between continuous and interrupted sutures regarding wound infection and/or dehiscence. After vertical midline incisions it is possible to close Camper's fascia, use drainage or close the skin only. The overall wound complication rate after laparoscopic surgery is lower when using transcutaneous as compared to subcuticular sutures. Adhesive paper tapes save time when closing smaller skin incisions. In conclusion, specific wound closure techniques improve wound healing after gynecologic operations.
