Foot Salvage After Loss of the First and Second Metatarsal Rays with a Free Fibular Osteocutaneous Flap

2011 ◽  
Vol 101 (6) ◽  
pp. 531-536 ◽  
Author(s):  
Christopher J. Salgado ◽  
Chih-Hung Lin ◽  
David A. Fuller ◽  
Alissa N. Duncan ◽  
Liliana Camison ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
High Energy ◽  
Metatarsal Bone ◽  
Tissue Loss ◽  
Metatarsal Bones ◽  
Second Metatarsal ◽  
Independent Ambulation ◽  
Soft Tissue Loss ◽  
Osteocutaneous Flap

Severely comminuted fractures of the metatarsal bones with significant bone and soft-tissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second metatarsal bones with overlying soft-tissue trauma not amenable to local coverage. In both cases, a vascularized free fibular osteocutaneous flap was used to reconstruct the metatarsal bone defect and traumatized soft tissues so that a proximal amputation was avoided. At an average of 14 months of follow-up, both patients had recovered well and regained independent ambulation, with one patient being able to play soccer. We show that the free fibular osteoseptocutaneous flap is useful in reconstructing significant metatarsal bone defects and in avoiding amputations in this patient population. The skin component of the flap may be used to fill soft-tissue losses, and the fibula bone may be osteotomized so that more than one ray may be reconstructed. (J Am Podiatr Med Assoc 101(6): 531–536, 2011)

scholarly journals 99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis

2008 ◽  
Vol 65 (4) ◽  
pp. 325-327 ◽  
Author(s):  
Ljiljana Jaukovic ◽  
Boris Ajdinovic ◽  
Ksenija Gardasevic ◽  
Marija Dopudja
Keyword(s):  
Case Report ◽  
Bone Scintigraphy ◽  
Stress Fracture ◽  
Soft Tissues ◽  
Callus Formation ◽  
Proximal Part ◽  
Metatarsal Bone ◽  
Plain Radiography ◽  
Metatarsal Bones ◽  
Second Metatarsal

Background. Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. Case report. We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. Conclusion. Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activites.

scholarly journals Longline hook testing in the mouths of pelagic odontocetes

2014 ◽  
Vol 72 (5) ◽  
pp. 1706-1713 ◽  
Author(s):  
William A. McLellan ◽  
Logan H. Arthur ◽  
Sarah D. Mallette ◽  
Steven W. Thornton ◽  
Ryan J. McAlarney ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Mechanical Tests ◽  
Tissue Loss ◽  
Grampus Griseus ◽  
Pilot Whales ◽  
Serious Injury ◽  
Soft Tissue Loss ◽  
Longline Fisheries ◽  
Pseudorca Crassidens

Abstract Several species of odontocete cetaceans depredate bait and catch and, as a result, become hooked and entangled in pelagic longline fisheries. The present study measured how selected commercial longline hooks, including “weak hooks”, behaved within odontocete mouths. Five hooks (Mustad-16/0, Mustad-18/0, Mustad J-9/0, Korean 16, and Korean 18) were tested on three species of odontocetes known to interact with longline fisheries—short-finned pilot whales (Globicephala macrorhynchus), Risso's dolphins (Grampus griseus), and false killer whales (Pseudorca crassidens). Specimens were secured to a stanchion, hooks were placed in the mouth at multiple positions along the dorsal lip, and the force required to pull each hook free was measured. The soft tissue lips of these odontocetes were capable of resisting forces up to 250 kg before failing. The polished steel M-16, M-18, and J-9 hooks straightened at forces between 50 and 225 kg, depending on hook gauge. When straightened, these hooks exposed the sharpened barb, which sliced through the lip tissue, usually releasing the hook intact. The K-16 and K-18 hooks behaved very differently, breaking at higher forces (110–250 kg) and consistently just at the barb; usually, there was measurable soft-tissue loss and often shards of the hook were retained within those soft tissues. The different behaviours of these two hook types—the M and J type polished steel vs. the K type carbon steel—were consistent across all species tested. Mechanical tests were also conducted to determine if hooks could fracture the mandible of these same odontocetes. Only the M-18 and K-18 hooks had sufficiently large gapes to hook around the mandible, and both hook types fractured bone in short-finned pilot whales and Risso's dolphins. These results support other lines of evidence indicating that longline hooks can cause serious injury to these species, and suggest possible steps to mitigate these impacts.

A review of 10 years of scapula injuries sustained by UK military personnel on operations

2017 ◽  
Vol 164 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Darren C Roberts ◽  
D M Power ◽  
S A Stapley
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Military Personnel ◽  
High Energy ◽  
Tissue Loss ◽  
Multiple Injuries ◽  
Severity Scores ◽  
Soft Tissue Loss ◽  
Scapula Fractures

BackgroundScapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel.MethodsAll UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014).ResultsForty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (p<0.0001). Brachial plexus injuries occurred in 17%. While military personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united.ConclusionScapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.

Flexible Intramedullary Nailing in High-Energy Tibial Fractures With Extensive Soft-Tissue Loss

2020 ◽  
Vol 10 (2) ◽  
pp. e0030-e0030
Author(s):  
Jung-Mo Hwang ◽  
Chan Kang ◽  
Deuk-Soo Hwang ◽  
Gi-Soo Lee ◽  
Jeong-Kil Lee ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Intramedullary Nailing ◽  
High Energy ◽  
Tibial Fractures ◽  
Tissue Loss ◽  
Flexible Intramedullary Nailing ◽  
Soft Tissue Loss

Injectable Soft Tissue Nano/Micro Fillers for Facial Reconstruction

2021 ◽  
Vol 17 (1) ◽  
pp. 1-17
Author(s):  
Yue Pan ◽  
Ying Hao ◽  
Yao Xiao ◽  
Kun Shi ◽  
Ying Qu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Facial Reconstruction ◽  
Soft Tissue Augmentation ◽  
Tissue Loss ◽  
Competitive Performance ◽  
Filling Materials ◽  
Tissue Augmentation ◽  
Soft Tissue Loss ◽  
Injectable Fillers ◽  
Micro Fillers

Soft Tissue augmentation is a way to restore lost tissue and also a way to reshape confidence for patients who suffer from soft tissue loss. Materials that can realize such a function are called soft tissue fillers. Among the large number of fillers, injectable fillers have attracted widespread attention in facial cosmetic fields due to their convenience and competitive performance. Meanwhile, there is a huge demand for better injectable soft tissue fillers in medical cosmetology market. This review introduces several fillers which were once used in clinical or are now still in use. Furthermore, we update recent improvements and progress on injectable filling materials hoping to contribute to its further developments.

scholarly journals Intravascular Shunt in Management of Limb Trauma- A Review

2021 ◽  
pp. 274-281
Author(s):  
Hashem Bark Awadh Abood ◽  
Abdulaziz Munahi Alanazi ◽  
Falah Bader Alhajraf ◽  
Wejdan Nawaf Mesfer Alotaibi ◽  
Bushra Saad Alghamdi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Patient Survival ◽  
Survival Rates ◽  
Tissue Loss ◽  
Vascular Injuries ◽  
Limb Trauma ◽  
Life Threatening ◽  
Arterial Insufficiency ◽  
Soft Tissue Loss

Vascular injuries to the upper or lower limb in the context of significant soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Complex extremity vascular injuries in which acute arterial insufficiency combined with severe or prolonged shocks are unacceptable because warm, warm, skeletal muscle time is often exceeded before adequate revascularization, and are associated with extended ischemia periods or fractures or soft tissue wounds. Revascularizing the limb is essential for the success of the limb rescue. Selective intravascular temporary shunting hence allows better overall care of the patient and can therefore be predicted to increase both limb rescue and patient survival rates. The aim of this article was to review and summarize results of previous literature regarding effectiveness on intravascular shunting as management of limb trauma as well as reviewing its potential complications.

Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: indications, technique and results

2013 ◽  
Vol 40 (3) ◽  
pp. 276-280 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Soft Tissue ◽  
Extensor Tendon ◽  
Tissue Loss ◽  
Soft Tissue Coverage ◽  
Metacarpophalangeal Joints ◽  
Tendon Reconstruction ◽  
Car Accidents ◽  
Active Flexion ◽  
Palmaris Longus Tendon ◽  
Soft Tissue Loss

Over a 20-year period, six patients (19 tendons) underwent two-staged extensor tendon reconstruction using silicone rods followed by palmaris longus tendon grafts sutured proximally to the divided flexor carpi radialis tendon. All patients were young men (mean age, 22 years) who sustained the injury in car accidents. The soft tissue loss from the dorsum of the hand was associated with extensor tendon loss over the entire zone 6 with or without loss in zone 7. Primary soft tissue coverage was done elsewhere, and patients presented for secondary tendon reconstruction. All patients had supple metacarpophalangeal joints before reconstruction. After the two-staged tendon reconstruction, full or near-full active flexion at the metacarpophalangeal joints was obtained in all patients. However, minor extension lags (10°–15°) at the metacarpophalangeal joints were seen in 15 out of 19 reconstructed fingers.

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