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1.
Pretibial lacerations and lower limb wounds are referred to plastic surgery teams for split skin graft surgery. Traditionally, these patients have been immobilised on bedrest following surgery. More recently, patients have commenced ambulation earlier to avoid medical complications and facilitate discharge. The objective of this literature review was to determine when such patients should begin walking. A literature search was undertaken using the electronic databases AMED, Cinahl, Embase, Medline (via Ovid), PEDro and Pubmed. Clinical trials using human subjects, written in English, were included. Seventeen (of 1137) papers met the inclusion criteria and were reviewed. The literature suggested that patients should begin walking immediately or at the earliest possible opportunity after lower limb skin graft surgery. Although the literature advocated early ambulation, the evidence base presented with a number of recurrent methodological limitations, including small sample sizes, lack of a control sample, and limited follow-up. Accordingly, further research employing large, well-designed, randomised controlled trials is recommended. It will then be possible to understand with greater certainty when patients should begin walking after lower extremity split skin graft surgery. 相似文献
2.
Kevin L. Greason M.D. Jose A. Acosta M.D. Thomas J. Magrino M.D. Moogil Choe M.D. 《Diseases of the colon and rectum》1996,39(6):702-704
PURPOSE: This study was undertaken to clarify the importance of bleeding vascular ectasia of the colon as the etiology of massive lower gastrointestinal hemorrhage in patients 40 years of age or younger. METHODS: An otherwise healthy 21-year-old male was admitted to a tertiary medical center with massive lower gastrointestinal hemorrhage. Technetium-labeled red blood cell scan, selective visceral angiography, and colonoscopy identified the source of bleeding as vascular abnormality of the descending colon. Segmental colonic resection was performed. RESULTS: Histologic review of the specimen demonstrated a vascular ectasia. The patient recovered uneventfully and has had no further stigmata of hemorrhage. A review of the literature was undertaken to make clear the significance of vascular ectasia as the source for massive colonic hemorrhage in the young adult. CONCLUSION: This is the first report that documents histologically a vascular ectasia as the source of massive lower gastrointestinal hemorrhage in an otherwise healthy patient less than 40 years of age. Vascular ectasia is an uncommon cause of lower gastrointestinal hemorrhage in the young adult.The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program sponsored this report #84-16-1968-532, as required by HSETCINST 6000.41A. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. 相似文献
3.
Summary Split or full thickness eyelid defects resulting from tumor destruction or surgical excision present a dilemma for plastic and reconstructive surgeons. Full thickness eyelid replacement requires composite grafting of the skin, together with tarsal support of its substitute and mucosa. The flap described by Fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid defects. In three of our cases chondromucosal grafts taken from nasal septum were utilized for posterior lamella repair. The results have been satisfactory from a functional and cosmetic standpoint. 相似文献
4.
5.
目的探讨颞筋膜瓣或颞肌筋膜瓣与自体全厚皮片移植,在下睑凹陷性瘢痕畸形修复中的应用效果。方法设计以颞浅动脉为蒂的颞筋膜瓣,对伴眶下壁骨缺损者同时行以颞浅、深动脉为蒂的颞肌筋膜瓣,并取耳后全厚皮片移植联合矫正下睑凹陷性畸形。结果8例患者,术后组织瓣及皮片成活良好,凹陷处填充效果满意。随访6个月至1年,睑外翻矫正,瘢痕不显,颞部供区毛发生长良好。结论应用颞筋膜瓣或颞肌筋膜瓣与全厚皮片移植,联合矫正下睑凹陷性畸形的方法,具有操作简便,且无明显的供区损害的特点,是修复下睑凹陷性瘢痕畸形较理想的方法。 相似文献
6.
目的:探讨髋臼骨折合并同侧下肢骨折的创伤机制和治疗方法。方法:髋臼骨折并同侧下肢骨折14例,男9例,女5例;年龄18~65岁,平均35岁。髋臼骨折按Letournel分型,后壁伴后柱骨折11例,单纯后柱骨折3例,均行钢板内固定。伴同侧股骨转子间骨折3例,1例行起重机架外固定,2例行DHS固定;伴同侧股骨颈骨折3例,均行空心钉加压固定;伴同侧股骨干骨折6例,1例行钢板固定,余5例行带锁髓内钉固定;伴同侧胫骨平台骨折2例,行钢板内固定。结果:1例半年后死亡,余13例获得随访,随访时间18个月~5年,平均30个月。按照美国矫形外科研究院髋关节疗效评定标准,优9例,良3例,差1例。结论:髋臼骨折合并同侧下肢骨折受伤暴力大、机制复杂、合并创伤多、易漏诊,应早期明确诊断,合理内固定。 相似文献
7.
Lee L. Q. Pu 《European journal of plastic surgery》2007,30(1):19-24
A soleus flap as a local reconstructive option for soft-tissue coverage of a tibial wound in the distal third of the leg has
never been well recognized. In a 2-year period, seven patients underwent reconstruction of a less extensive tibial wound (4 × 3
to 10 × 4 cm) in the distal third of the leg after orthopedic trauma with the laterally extended medial hemisoleus flap. The
flap was elevated with emphasis on the preservation of the most distal perforators from the posterior tibial vessels to the
flap as possible while allowing adequate rotation of the flap to cover the exposed tibia and/or hardware and on the possible
preservation of foot planter flexion by reconstruction of the proximal Achilles’ tendon. In this series, there was no total
or partial flap loss. All patients healed their tibial wounds primarily with reliable soft-tissue coverage, evidenced fracture
healing, and good cosmetic outcome during follow-up. Thus, the laterally extended medial hemisoleus flap described by the
author can be a reliable option for soft-tissue coverage of a less extensive tibial wound in the distal third of the leg.
It offers a more cost-effective approach for managing this unique problem and can be performed by most reconstructive surgeons
without microsurgical expertise. 相似文献
8.
目的:探讨黄杆菌属致下呼吸道感染的临床特点及对常用抗生素的耐药情况。方法:分析我院六年来机械通气致下呼吸道黄杆菌感染的11例临床资料,平板稀释法测定常用抗菌药物对该菌株的最低抑菌浓度,采用法国生物梅里埃公司API系统进行细菌学鉴定,以美国国家实验室标准化委员会NCCLS的标准判定结果。结果:全部应用广谱抗生素,年龄>60岁者8例,机械通气到发生黄杆菌感染的平均时间为18天,死亡4例;耐药率高,仅对头孢哌酮/舒巴坦、复方磺胺甲恶唑、哌拉西林、左氧氟沙星等较敏感。结论:机械通气致下呼吸道黄杆菌感染常发生在基础状态较差,机械通气时间较长,且长期应用广谱抗生素的老年患者,临床表现常无特征性,细菌耐药严重,病死率高 相似文献
9.
László Bajnok Bertalan Kozlovszky József Varga Judit Antalffy Sándor Olvasztó Tamás Fülöp Jr. 《European journal of nuclear medicine and molecular imaging》1994,21(12):1326-1332
Technetium-99m sestamibi was used for functional investigation of the muscle perfusion of lower extremities in 35 patients
with peripheral vascular disease. The aim was to test what useful information could be obtained by additional imaging of the
legs in patients referred for risk stratification with dipyridamole myocardial scanning. Posterior images were acquired over
the thighs and calves after postocclusive reactive hyperaemia and at rest. Inter- and intraextremity ratios and differences
between the stress and rest data were used for the assessment of abnormal circulation. Arteriography was performed in every
case, and surgical procedures or transluminal angioplasty in 31 patients. To estimate diagnostic accuracy, the results of99mTc-sestamibi scintigraphy were compared with those of angiography and the functional consequences of revascularization procedures.
The sensitivity and specificity of99mTc-sestamibi scintigraphy were 55% and 25%, respectively, with an overall accuracy of 50%. Apparently methodological error
was not responsible for these poor results. Instead, a paradoxically high uptake of the radiopharmaceutical in muscles supplied
by significantly stenosed vessels was identified as the main source of both false-negative and false-positive results. This
phenomenon resembles the findings of a previous study involving delayed administration of thallium-201 after exercise. In
conclusion,99mTc-sestamibi scintigraphy has not proved sufficiently reliable to help in the management strategy for patients with peripheral
vascular disease. 相似文献
10.
A.P. Uzel R. Massicot P. Grignon V. Casoli 《Journal of orthopaedics and traumatology》2003,4(1):45-49
We report the case of a fracture separation of the articular pillar at the lower cervical spine. The trauma, following a
brass knuckles, repeats almost in an experimental way the rotation and extension mechanism given in literature for the genesis
of such injuries. From the admission in the orthopaedic service to the surgery, the development went in a characteristic way
towards a rotatory displacement.
Received: 12 July 2002, Accepted: 18 August 2002
Correspondence to: R. Massicot 相似文献