scholarly journals Stage treatment of patient with gunshot shin wound possessing bone and soft tissue defects in conditions of osteomyelitis

2020 ◽  
Vol 36 (6) ◽  
pp. 95-101
Author(s):  
N. M. Belokrylov ◽  
A. N. Belokrylov ◽  
D. V. Antonov ◽  
A. V. Schepalov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Structural Integrity ◽  
Skin Flap ◽  
Anterior Tibial Artery ◽  
Dynamic Correction ◽  
Total Period ◽  
Ilizarov Apparatus ◽  
The Right

The paper presents a case of severe gunshot wound of the shin in a 16-year-old adolescent as a result of gunshot from a small distance. Comminuted fracture of the tibia, damage of the anterior tibial artery, defect of the soft tissue in the injured area were detected. When admitted to the hospital, the patient underwent surgical treatment of the wound and fixation of fragments in carboxylic rod apparatus of external transosseous fixation. Osteomyelitis was developed. Ten days later, reosteosynthesis was performed. The first stage of bilocal osteosynthesis of the right shin was implemented, necrotized soft tissues and bone fragments and detritus were removed, initial purulent process was arrested. There was started distraction of the distal fragment of the tibia obtained as a result of its corticotomy in the lower third into the bone defect measuring 5 cm, which occurred when implementing surgical treatment of the wound. Twenty-eight days after, open alignment of tibial fragments in the upper third and reinstallation of Ilizarov apparatus was performed. The site of fragment junction was closed with unfree skin flap on the pedicle measuring 4 6 cm, the transplant bed was closed with full-layer skin graft using Parins technique. The further consolidation of fragments was reached simultaneously with maturation of the bone regenerate. The total period of fixation in Ilizarov apparatus lasted for 8 months. The bone and soft tissue structural integrity was restored, full function of the lower limb and adjacent joints was reached. Ilizarov apparatus is indispensable in multistage treatment of gunshot fractures and provides dynamic correction in changeable conditions; it permits to preserve the limb and its functionality.

scholarly journals Emergency surgical treatment of a child with a traumatic brain injury and complete rejection of the scalp due to a bite (clinical case)

2021 ◽  
pp. 84-89
Author(s):  
E.V. Zakharchuk ◽  
◽  
I.A. Zakharchuk ◽  
S.S. Gaibov ◽  
A.A. Utukina ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Skin Flap ◽  
Craniocerebral Trauma ◽  
Symptomatic Therapy ◽  
Adult Women ◽  
Anatomical Features

Total separation of the scalp is a serious trauma in clinical practice. Common in adult women and rare in children. Among children, the most common cause of such injuries is animal bites, including dog bites. The article presents the experience of treating a two-year-old child who was admitted to the Regional Clinical Hospital No. 2 in Tyumen (Russia) with an extensive scalped wound of the scalp in combination with craniocerebral trauma, traumatic shock, multiple bitten wounds of the soft tissues of the head with a violation of the integrity of the upper lacrimal tubule. Immediately from the moment the child was transported by the ambulance team, anti-shock, antibacterial, decongestant, symptomatic therapy was started, primary surgical treatment of wounds was performed with restoration of the integrity of the upper lacrimal canal of the right eye. The child had no indications for neurosurgical intervention. The standard treatment for a detached scalp is, if possible, microsurgical replantation, but due to the impossibility of performing microsurgical replantation in this case (an infected wound, a skin flap was recognized as unviable by an interdisciplinary council), the defect was closed on a delayed basis with a fullthickness skin graft taking into account the blood supply and anatomical features bed. In this case, during the period of scalp plasty, there were no postoperative complications, the engraftment of autodermal grafts was satisfactory, and the healing of donor wounds was also satisfactory. The child was discharged for the outpatient follow-up stage after 3 months of inpatient treatment. In our opinion, the main reasons for achieving a good clinical result were an interdisciplinary approach to treatment, a combination of correctly performed primary surgical treatment of a wound, subsequent timely complex treatment in a specialized department, and a high regenerative potential of the child. In our opinion, the choice of the method of reconstructive intervention in patients with soft tissue and soft tissue bone defects of the scalp requires a differentiated approach, taking into account the etiology of the defect, its anatomical features and the possibility of compensating for aesthetic disorders. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: children, traumatic brain injury, scalp wound, scalp avulsion, treatment.

NECROTISING SOFT TISSUE INFECTION OF BILATERAL UPPER LIMB CAUSED BY THE INJECTION OF ORAL BACTERIA: A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 243-246 ◽  
Author(s):  
Yuichi Yoshii ◽  
Tomoo Ishii ◽  
Shinsuke Sakai
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Soft Tissue Infection ◽  
Soft Tissues ◽  
Biceps Brachii ◽  
Subcutaneous Tissue ◽  
Oral Bacteria ◽  
Tissue Infection ◽  
Left Elbow ◽  
The Right

Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.

Atypical Form of Cervicofacial Actinomycosis Involving the Skull Base and Temporal Bone

2018 ◽  
Vol 128 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Adam McCann ◽  
Sameer A. Alvi ◽  
Jessica Newman ◽  
Kiran Kakarala ◽  
Hinrich Staecker ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skull Base ◽  
Temporal Bone ◽  
Soft Tissues ◽  
Trauma Surgery ◽  
Oral Antibiotic ◽  
Facial Skeleton ◽  
Atypical Form ◽  
Unsuccessful Treatment ◽  
The Right

Background: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. Methods: Case report with literature review. Results: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. Conclusions: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.

scholarly journals A CLINICAL CASE OF REMOVING A RESIDUAL FOREIGN BODY FROM THE LEFT SUPRACLAVICULAR REGION

2017 ◽  
Vol 4 (3) ◽  
pp. 120-122
Author(s):  
V.V. Boyko ◽  
V.V. Makarov ◽  
A.L. Sochnieva ◽  
V.V. Kritsak
Keyword(s):  
Surgical Treatment ◽  
Foreign Body ◽  
Soft Tissue ◽  
Clinical Case ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Life Quality ◽  
The Other ◽  
Practical Case ◽  
The One

Boyko V.V., Makarov V.V., Sochnieva A.L., Kritsak V.V.Residual foreign bodies in soft tissues are one of the main causes of chronical infection lesions and decrease in life quality. Surgical treatment is the most common way to relieve the patient from a foreign body. Often there is a question whether to remove a foreign body? On the one hand, all foreign bodies that are in the human body must be removed. On the other hand, in the absence of symptoms, the risk of surgery performed for the purpose of removal exceeds the risk associated with finding the foreign body. We would like to describe a practical case of removing a foreign body (Kirschner`s wires) from the left supraclavicular region. The young patient lived with a fragment of Kirschner's wire left after the osteosynthesis of the fractured clavicle for 5 years. Surgery to remove the residual foreign body was successful. On the 7th postoperative day the patient was discharged from the hospital under the supervision of surgeons at the place of residence.Key words: foreign body in soft tissue, Kirschner`s wire, surgical treatment. КЛІНІЧНИЙ ВИПАДОК ВИДАЛЕННЯ ЗАЛИШКОВ СТОРОННЬОГО ТІЛА З ЛІВОЇ НАДКЛЮЧИЧНОЇ ОБЛАСТІБойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Залишкові чужорідні тіла м'яких тканин залишаються однією з основних причин виникнення вогнища хронічної інфекції та зниження рівня якості життя. Хірургічне лікування основний спосіб позбавити хворого від наявності чужорідного агента. Часто виникає питання чи видаляти чужорідне тіло. З одного боку, усі сторонні тіла, що знаходяться в тілі людини, підлягають видаленню, з іншого боку при відсутності симптомів ризик операції, проводимої з метою видалення, перевищує ризик, пов'язаний з перебуванням чужорідного тіла. Ми хотіли б поділитися випадком видалення залишкового стороннього тіла (спиці Кіршнера) лівої надключичної ділянки із власної практики. Молода пацієнтка прожила з уламком спиці Кіршнера, залишеної після металлоостеосинтезу поламаної ключиці протягом 5 років. Операція з видалення залишкового стороннього тіла пройшла успішно. На 7 післяопераційну добу пацієнтка була виписана зі стаціонару під спостереження хірурги за місцем проживання.Ключові слова: чужорідне тіло м'яких тканин, спиця Кіршнера, хірургічне лікування. кЛИНИЧЕСКИЙ СЛУЧАЙ УДАЛЕНИЯ ОСТАТКОВ ИНОРОДНОГО ТЕЛА ИЗ ЛЕВОЙ ПОДКЛЮЧИЧНОЙ ОБЛАСТИ Бойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Остаточные инородные тела мягких тканей остаются одной из основных причин возникновения очага хронической инфекции и снижения уровня качества жизни. Хирургическое лечение основной способ избавить больного от наличия чужеродного агента. Часто возникает вопрос удалять ли инородное тело? С одной стороны, все инородные тела, находящиеся в теле человека, подлежат удалению, с другой стороны при отсутствии симптомов риск операции, производимой с целью удаления, превышает риск, связанный с нахождением инородного тела. Мы хотели бы поделится случаем удаления остаточного инородного тела (спицы Киршнера) левой надключичной области из собственной практики. Молодая пациентка прожила с обломком спицы Киршнера, оставленной после металлоостеосинтеза поломанной ключицы в течении 5 лет. Операция по удалению остаточного инородного тела прошла успешно. На 7 послеоперационные сутки пациентка была выписана из стационара под наблюдение хирурги по месту жительства.Ключевые слова: инородное тело мягких тканей, спица Киршнера, оперативное лечение.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

scholarly journals Stage Reconstructive and Restorative Surgical Treatment of Gunshot Wounds of the Groin, Scrotum and Penis (Case Report)

Health of Man ◽  
2021 ◽  
pp. 85-90
Author(s):  
Serhii Golovko ◽  
Oleksandr Savytskiy ◽  
Oleksandr Netrebko ◽  
Yevhen Bidula ◽  
Volodymyr Bondarchuk
Keyword(s):  
Surgical Treatment ◽  
Gunshot Wound ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Initial Stage ◽  
The Right ◽  
Upper Third ◽  
Tissue Defects

The frequency of external genital lesions in armed conflicts can reach up to 5%. The complexity of gunshot wounds is the presence of significant soft tissue defects, widespread necrosis around the wound, the possibility of progression in the hours and days after injury, the high probability of infection, and the presence of foreign bodies. The tactics of gunshot wounds are determined by the location, nature and extent of damage to soft tissues, organs, large vessels, nerves, bones and includes several stages. At the initial stage, bleeding is stopped, hematomas and foreign bodies are evacuated, non-viable tissues are removed, drainages are installed and skin defects are closed. The stage of reconstructive surgery can be started when the active wound process is over. In this report, we present a clinical case of a 22-year-old man who received a gunshot wound to the right groin, upper third of the right thigh, perineum and external genitalia in a combat zone of Operation Allied Forces, Ukraine. Bullet wound led to: damage to the skin and subcutaneous tissue in the right buttock, right groin, on the inner surface of the upper third of the thigh, penis (skin defect up to 1/3 of the circumference), scrotum, partial destruction of corpora cavernosa, m. iliopsoas and adductor muscles of the thigh, sphincter of the rectum, crushing of the right testicle. The wound was contaminated with earth and foreign bodies At the initial stage, the patient underwent: primary surgical treatment of a gunshot wound, suturing of cavernous bodies with sutures, fixation of the penis in the groin, removal of the right testicle, tamponade of the wound, sigmostomy (due to sphincter damage). Subsequently, the patient underwent regular surgical treatment of wounds, a vacuum suction system VAC was installed. After 7 months (upon completion of the healing process) suturing of the sigmostoma was performed. After 2 months, the penis and the scrotum were reconstructed. Preoperative examination (ultrasound of the penis with assessment of cavernous hemodynamics, MRI) revealed: post-traumatic scarring of the soft tissues of the right groin, inner surface of the right thigh, buttocks, right inguinal canal of the penis and scrotum, deformation of the cavernous cavity, normal indicators of cavernous blood circulation. In the early postoperative period (2 months after the intervention), the patient indicated satisfaction with the cosmetic and functional results, the preservation of morning erections, moderate discomfort in the penis during erection. Prosthetics of the right testicle are planned. The clinical case once again confirms the need for qualified surgical care during the first “golden” hour and subsequent phased treatment at a specialized level using the VAC therapy system in patients with gunshot wounds and large soft tissue defects. The experience of military medicine demonstrates the importance of involving specialists of various profiles in the treatment of combined gunshot wounds of the pelvis. An important stage of treatment in the wounded is plastic and reconstructive surgery in the long term, which is aimed at improving the functional, cosmetic and psychological results of treatment.

Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction

2013 ◽  
Vol 127 (S2) ◽  
pp. S33-S38 ◽  
Author(s):  
J Husseman ◽  
J Szudek ◽  
P Monksfield ◽  
D Power ◽  
S O'Leary ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Hearing Aid ◽  
Skin Flap ◽  
Standard Technique ◽  
Modified Technique ◽  
Skin Reactions ◽  
Invasive Approach ◽  
Bone Anchored Hearing Aid ◽  
Tissue Reduction

AbstractBackground:Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach.Objective:To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction.Patients and methods:Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale.Results:Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures.Conclusion:Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

Bilateral Extracapsular Soft-Tissue Ossification Affecting Range of TMJ Motion in an Airedale Terrier

2013 ◽  
Vol 49 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Sarah Ellenberger ◽  
Christopher Snyder
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Range Of Motion ◽  
Soft Tissues ◽  
Single Treatment ◽  
Medial Aspect ◽  
Temporomandibular Joints ◽  
The Right ◽  
Pterygoid Muscles ◽  
Angular Process

A 3 mo old female Airedale terrier presented with decreased range of motion of the temporomandibular joint (TMJ), which was first recognized at weaning. Computed tomography (CT) revealed abnormal, bilateral ossification of the soft tissues extending from the region of the tympanic bullae to the medial aspect of the angular process of each mandible. Those ossified structures most closely approximated the location of the lateral pterygoid muscles. The ossified structures were present at presentation and initially manifested as complete ossification on the right side. The condition progressed to complete bilateral ossification by 3 yr of age. The mandibular condyles associated with the temporomandibular joints were malformed. The patient had severe mandibular distoclusion with deviation of the mandible to the left. The left mandibular cheek teeth were positioned in a caudal cross bite. A single treatment of manual stretching and breakdown of the ossified muscle of mastication by placement of tongue depressors within the oral cavity resulted in no increase in TMJ range of motion as measured by the incisal opening. This is the first reported case of spontaneous false ankylosis of the TMJ in an Airedale terrier.

scholarly journals Surgical treatment of locally advanced undifferentiated spindle cell paravertebral soft tissue sarcoma. Case report

2020 ◽  
Vol 27 (3) ◽  
pp. 73-78
Author(s):  
Nikolai V. Zagorodnii ◽  
Vadim Y. Karpenko ◽  
Gennady N. Berchenko ◽  
Anatoly L. Karasev ◽  
Alexander S. Zelyanin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Spindle Cell ◽  
Locally Advanced ◽  
Soft Tissue Sarcomas ◽  
Scientific Data ◽  
Reconstructive Plastic Surgery ◽  
Reconstructive Plastic ◽  
Different Origin

Abstract: Soft tissue sarcomas are a rare heterogeneous group of malignant tumor of different origin. The small quantity patients with this diagnosis leads to a lack of scientific data on the treatment of such patients. This article presents a clinical case of a patient with spindle-cell paravertebral sarcoma of soft tissues of pelvic localization, who get surgical treatment in the volume of reconstructive plastic surgery with endoprosthesis of the sacroiliac joint.

Soft Tissue “Chondroma” of the Hand

HAND ◽  
1980 ◽  
Vol os-12 (2) ◽  
pp. 189-192 ◽  
Author(s):  
Nachman Rosenfeld ◽  
Alberto Kurzer
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Middle Finger ◽  
The Right

A case of chondroma of the soft tissues of the right middle finger is presented. The possible origins and treatment are discussed.

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