Several Methods Of Repair Research Articles

Fractures of the carpus

The carpus is a complex joint, consisting of seven bones arranged in two rows, with multiple ligamentous supports originating from, inserting on and connecting the bones. Individual fractures of the bones of the carpus are rare, and, due to the small size of some bones, repair may not be possible. For the larger carpal bones, repair is indicated where fragments are large enough and especially if the fracture is articular. Several methods of repair are suitable, although compression of the fragments using lag screws or headless, self-compressing cannulated screws is often ideal. Where the fragments are too small, removal may be advised and external coaptation is often used in conjunction. For non-repairable fractures of the articular surfaces, and other carpal injuries precluding primary repair, partial carpal arthrodesis or pancarpal arthrodesis may be considered as salvage procedures. The prognosis for recovery from carpal fractures depends on the type of injury, the bone affected, the method of repair and the desired performance of the patient.

Repair of incisional hernias - Experience with a combined fascial and prosthetic mesh repair

Repairs of incisional (ventral) hernia is one of the commonly performed operation in Bangladesh. This is a prospective study conducted in Shaheed Suhrawardy Hospital, Dhaka and a private Hospital (BDM Hospital) at Dhaka city from June 2001 to 31st May 2004 with a total period of 3 years and with total patients 43. Incisional hernias develop in upto 11% of surgical abdominal wounds with a possible recurrence, following repairs of 44%. There are several methods of repair of incisional hernias, including laparoscopic method of repair which is gaining popularity day by day. But we describe our experience with a combined fascial and prosthetic mesh repair. Of total 43 patients treated, 27 were female & 16 were male. The original operation was gynaecological in 27, bowel related surgery in 15 cases & biliary surgery in 4 patients. The incisions were midline in 31 patients, transverse in 10 patients and paramedian in 2 patients. The hernias were considered subjectively to be large in 21, medium in 16 and small in 6 patients. A parameter was compiled for each patient, noting intraoperative and post postoperative complications , post operative hospital stay and analgesic requirements. Post operative complications included seroma formation in 6 patients. One patient developed wound infection and require removal of the mesh 10 Control infection. Post operative hospital stay ranged from 2 to 17 days. Of total 43 patients 36 were available for follow- up. Seven drops from follow up. Follow up was from 6 months to 36 months. One (2.5%) of these patients complained of persistent lump and one reported persistent pain. Hernia recurrence in one patient (2.5%) , 35 was found to have no recurrence. We advocate these technique because it is applicable to all hernias,most of the mesh is behind the rectus sheath and has two points of fixation, it is relatively pain free allowing early mobilization has a less complication rate and low recurrence rate.DOI: http://dx.doi.org/10.3329/jssmc.v1i2.12158 Journal of Shaheed Suhrawardy Medical College Vol.1, No.2, December 2009 p.6-9

Surgical Pearl: Earlobe repair assisted by guidewire punch technique: A useful method to remove unwanted epithelial tracts caused by body piercing

P iercing earlobes is a common practice the world over. Several complications can arise including tearing of the pierced earlobe, infection, dermatitis, and lengthening of the earlobe hole. The latter can result from the use of telephones against the ear that creates a pull-down effect on the earring, from long-term use of relatively heavy or dangling ear jewelry, or excessively low placement of the earring hole. For aesthetic reasons, patients present for repair of this unwanted lengthened earring hole. Lengthening of a pre-existing earlobe hole without actual outright tear of the hole has been described in the literature as ‘‘incomplete cleft’’ (Fig 1, a). Several methods of repair have been described including converting to a complete earlobe tear with a subsequent repair, use of flaps such as Vand Lplasty, and using a punch technique that removes the preexisting hole, and then subsequently suturing the newly created non-epithelialized tract. An important step in using the punch technique is proper alignment of the punch device to ensure complete removal of the preexisting ear lobe hole tract and thereby minimizing the possibility of the formation of an inclusion cyst. We describe a new technique that helps reliably remove the entire earlobe epithelial tract in a very simple and efficient manner through the use of a cautery tip as a guidewire.

Management and short-term patency of lower extremity venous injuries with various repairs

Background Although several methods of repair of extremity venous injuries have been shown to be efficacious, patency rates have varied significantly from center to center. Methods A retrospective review was made of treatment outcomes of adult and pediatric patients with major venous injuries of the lower extremity. Results From 1997 to 2002, 82 patients sustained 86 major lower extremity venous injuries. Venous injuries were treated with primary repair in 27, complex repair in 37 (autogenous vein, 10, and ringed polytetrafluoroethylene [PTFE], 27) and ligation in 20. Prior to repair, temporary intraluminal venous shunts were used in 18 patients. Follow-up duplex imaging or venography or both were performed on 42 extremities at a mean of 10.9 ± 7.1 days after repair with an overall patency rate of 73.8% (primary repair 76.5%; autogenous vein graft 66.7%; and PTFE 73.7%). Conclusions Overall early patency rate of venous repairs performed by an experienced trauma team is similar irrespective of the type of repair. The use of temporary intraluminal shunts is acceptable in selected circumstances, while ringed PTFE grafts are reasonable alternatives when the contralateral saphenous vein is too small.