Mutilating electrotrauma--case report.

The passage of electric current through a human body causes polarization changes in cell membranes, which can possibly lead to the death of these cells. At the same time, electric energy is transformed to thermal energy, primarily in high resistance tissues. We present a case report of a 22-year-old male who was hit by an electric current with a voltage of 22 kV when he was working on a high-voltage overhead line tower. Primary treatment which included fasciotomies was completed two hours after the injury. Fasciotomies and revisions of all muscle groups were completed on the left upper extremity and right shank. On the right upper extremity fasciotomies were completed on the forearm. Retinaculum flexorum was cut in the area of both wrists. Despite the complex therapy including higher doses of a low-molecular-weight heparin, ischemization of the whole left upper extremity and distal part of right shank and foot occurred. On the sixth day after the injury it was necessary to amputate the right lower extremity in shank and on the eighth day after injury to amputate the left upper extremity below the shoulder, and on the fourteenth day, due to progressive ischemic necrosis, it was necessary to complete exarticulation of the left shoulder. The 45th day after the injury our team of micro-surgeons closed the defect of soft tissues in the distal part of right forearm and radial part of right hand by transferred parascapular fasciocutaneous flap. The right median nerve appeared to be necrotic in the distal part of forearm even at the day of injury. Four months after the injury the 12 cm long defect of the right median nerve was bypassed by a graft from the suralis nerve. Outpatient care followed as well as physical and psychological rehabilitation. The support of the family was admirable. One and a half years after the injury reconstruction of the right thumb flexor tendon was completed. Two years after the injury function of the right hand in terms of grip function was satisfactory (patient was able to complete pinch grip and sign). Gait with the prosthesis was very good.

Simultaneous coverage of ipsilateral ischial and trochanteric pressure sores--a case report.

Multiple pressure sores represent recurrent problem in immobilized, mostly paretic patients. A lot of them undergo repeated surgeries and thus the positions of scars, directions of rotation or transposition of flaps limit other operations in the region. Then usually the length of hospital stay grows proportionally with the number of necessary operations and often exceeds 6 weeks. The authors present, in form of a case study, the simultaneous coverage of ipsilateral ischial and trochanteric pressure sores with V-Y advancement fasciocutaneous dorsal thigh flap supplied by perforators from the deep femoral artery, in a patient with multiple repeated decubiti.

[Ulnar-carpal impingement after fractures of the distal radius]. / Ulnokarpální impingement po zlomeninách distálního radia.

The authors describe the group of 23 patients (16 women, 7 men), who were operated during 2000-2003 on ulna-carpal impingement or the syndrome of ulna impact on the basis of "plus variant" of ulna or also "long ulna". There was a fracture of distal radius in anamnesis of all these patients. The condition was solved in 18 patients (mean age 51 years) by reducing the ulna by 4.5 cm on the average (range 2-10 mm). In five patients (mean age 49 years), the radius-ulna desis sec. Sauvé-Kapandij was performed. The results are evaluated with the time lapse of 6 months on the average (range 3-26). The resulting evaluation indicates that in all patients, who were not affected by radius-ulna arthrosis, a simple reduction of ulna resulted in an improvement of the extent of movements and improved subjective complaints. Patients with radius-ulna arthrosis, where the ulna-carpal impingement was solved by radius-ulna desis, suffer from worse long-term functional results. The authors also analyze complications of the interventions. Posttraumatic deformations in the area of distal forearm should be solved early before degenerative changes develop. The is the only way how to expect good results of the operation and favorable effect for the patient.

Depth of the graft bed influences split-skin graft contraction.

Contraction of a split-thickness skin graft used for coverage of large defects remains a great problem in plastic, burn and reconstructive surgery. In this study we evaluated healing of split-thickness skin grafts transplanted in wounds on the subcutaneous fat and muscle fascia in pigs. Four young domestic female pigs were included in the study, and the contraction was measured planimetrically during a 3-months' follow-up. At the end of the study the scar tissue was histologically assessed. From day 42 till the end of the study grafts transplanted on the muscle fascia were significantly more contracted than grafts on the subcutaneous fat without (p < 0.001) and with (p < 0.005, unpaired t-test) correction for the growth of the animal. The histological assessment showed that after 3 months the regenerated dermal tissue in the muscle fascia wounds was thicker, and less remodeled (higher tissue cellularity and thinner collagen bundles). In conclusion, in pigs, split-thickness skin grafts transplanted into deeper wounds contract more, and scar tissue maturation seems to last longer.

Reconstruction of functional handgrip in traumatic tetraplegia--case study.

The objective of this study is reconstruction of functional handgrip in tetraplegic patients, using transfers of the forearm tendons. Authors present two case studies of tendon transfers--the first case introduces reconstruction of fingers and thumb extension--the second case introduces reconstruction of fingers and thumb flexion. The two case studies explain basic principles of tendon transfers and assessment criterions. The aim of this study is to point out the possibility to create functional unit from a plegic hand by surgical intervention, and to improve significantly quality of patients' lives.

[Post-traumatic corrective osteotomy of the distal radius with a new plate]. / Poúrazová korekcní osteotomie distálního radia s novou dlahou.

PURPOSE OF THE STUDY: Mal-union of distal radius fractures cause functional limitation and progressive degenerative changes of the wrist. The authors evaluate both radiograph and functional outcomes in a group of patients with a post-traumatic deformation of the distal radius treated by corrective osteotomy and fixation by a newly developed T-plate. MATERIAL: A retrospective evaluation covered a group of 13 patients of the average age of 51 years (range, 35-60 years) operated on in 2001 for post-trauma symptomatic mal-union of the distal radius of the Colles type. The group included only patients in which a new implant was used. The time interval between the primary fracture and corrective osteotomy was on average 11 months. METHODS: Corrective osteotomy for Colles deformations was performed in all patients from the dorsal approach with the application of a cortico-cancellous bone graft. Stabilisation was performed by the mentioned plate. Radiograph and functional outcomes were evaluated statistically. RESULTS: The radiographic evaluation proved the restoration of the normal anatomic relationship between the distal radius and ulna as well as statistically significant improvement of the function of the hand as concerns the range of motion and muscular strength Except for one patient, all involved evaluated the outcome as a subjective improvement. DISCUSSION: Corrective osteotomy of the distal radius is a standard surgery performed routinely by plate fixation with the application of a cortico-cancellous bone graft. Despite a perfect coverage of the issues relating to potential consequences resulting from non-anatomic position of the articular surface of the distal radius, this surgery was not very frequent in the past. Nevertheless, recently, there is a growing number of works in the literature dealing with corrective osteotomies for mal-union of the distal radius after fractures not only for the Colles but also Smith type. CONCLUSIONS: Treatment of deformation of the distal radius is a rewarding procedure which brings the patients a significant improvement of the function of the hand. The implant used by the authors proved useful for a plate fixation on the distal radius.

Effectiveness and Safety of the PEGT/PBT Copolymer Scaffold as Dermal Substitute in Scar Reconstruction Wounds (Feasibility Trial).

Skin defects left after excision of hypertrophic scars were treated with a dermal substitute and split-thickness skin grafts transplanted after vascularisation of the substitute. The used substitute was a synthetic porous scaffold made from the biodegradable copolymer polyethyleneglycol-terephtalate and polybuthylene-terephtalate. The study was designed to assess the rate of granulation tissue formation, graft take, and after 3 and 12 months the quality of life (pain, comfort of treatment, cosmetic or functional nuisance), scar formation and wound contraction. In addition, scaffold biodegradation and scar tissue formation were evaluated histologically.Seven patients with different causes of burn injury were enrolled, of which 5 completed the study. In the first 4 patients the time between scaffold application and split-thickness skin overgrafting was in between 17 and 24 days. The time point of overgrafting was significantly reduced to 10-12 days by meshing of the dermal scaffold as evidenced in the last 3 patients. Histological evaluation at 3 months revealed normal generation of dermal tissue, however, the collagen bundles were parallel organized like in scar tissue. In the deeper layers of the neodermis, fragments of the dermal substitute were present, causing a mild inflammatory response. One year post-treatment, some fragments of the copolymer were still observed. The extent of wound contraction after successful overgrafting ranged from 30% to 57% after 1 year. All 5 patients showed an improvement in the total Vancouver Scar Score compared to the value before scar removal being similar to what can be expected when treated with split-thickness skin grafts alone. No unanticipated adverse effects due to application of the substitute were observed.We conclude that although this synthetic dermal substitute can be safely used in humans, the presence of 3D dermal template in a full-thickness skin defect will not automatically improve the skin tissue regeneration process or inhibit wound contraction.