Traumatic Deformities Research Articles

The Island Myocutaneous Flap Reconstruction in Electrical Burn Injuries of Severely Traumatized Cervical Region

Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and require recruitment of vascularized and massive tissues. The objective of this study was to evaluate the utility of the island myocutaneous flap for the reconstruction of the electrical burn injuries on the cervical region. We conducted a retrospective chart review on all trauma patients treated by the Department of Plastic Surgery at Changhai Hospital, Second Military Medical University who required a large amount of vascularized tissue for the reconstruction of the electrical burn injuries on the cervical region from July 1994 to June 2006. Of them, 23 patients underwent reconstruction of severe traumatic deformities and disfunction on the cervical region with 23 island myocutaneous flaps from adjacent regions. Of the 23 patients, 17 were male and 6 were female, with an average age of 38 years. Conservative surgery method for debriding necrotic tissues and three different types of island myocutaneous flaps, including pectoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap and trapezius island myocutaneous flap were used. The defect area ranged from 6 cm x 4 cm to 20 cm x 15 cm. The sizes of the dissected myocutaneous flap ranged from 8 cm x 6 cm to 35 cm x 15 cm. All the 23 cases acquired complete recovery. The secondary defect of donor areas had primary closure after being directly sutured or covered with skin grafts. Island myocutaneous flaps have distinctive advantages in treatment of electrical burn injuries on cervical region and it can obtain satisfactory functional and cosmetic outcomes.

The Reconstruction of Venus: Following Our Legacy

Plastic surgery is an art form—an exacting discipline characterized by a special approach to handling tissues, repairing wounds, and reconstructing deformities. The aspect that most strikingly distinguishes plastic surgery from all other surgical disciplines is the instantaneous, visual, aesthetic physical result and often dramatic psychological change which it affords the patient. By virtue of this visual impact, the surrounding family and society are correspondingly affected, and plastic surgery thus exerts an effect that extends well beyond the obvious and immediate needs of the patient. Uniquely, plastic surgery’s effectiveness often depends on a harmonious blend of medical science and art. To transfer bulk tissue and maintain its viability is applied science; to shape that tissue into graceful anatomic form is art. And thus, the graceful figure of Venus de Milo was chosen to symbolize the artistic aspect of our specialty on the seal of the American Society of Plastic Surgeons (Fig. 1). The ancient Greek statue Venus de Milo was created circa 100 b.c. and depicts Aphrodite, the Greek goddess of love and beauty. She was discovered by a peasant within the buried ruins of the Aegean island Milos in 1820. Venus lost her arms when several French sailors heard of the discovery, came to explore the remote island, and roughly dragged the sculpture across the rocky terrain to the ship that waited to carry Venus off to France.1,2 Eventually, King Louis XVIII presented her to the Louvre museum in Paris, where Venus de Milo still stands on public display. She is the universal symbol of artistic beauty. Although the American Society of Plastic Surgeons was founded in 1931, the Journal was not realized until Dr. Gustave Aufricht’s presidency from 1944 to 1946. During that period, Charles Liedl, Dr. Aufricht’s artist friend and illustrator, created the logo that became the emblem for the Journal and seal of the Society.3 Mr. Liedl designed the emblem according to Aufricht’s suggestions: a surgeon’s hand in the foreground, Venus de Milo in the background to represent art, and a stylized Aesculapian staff at the base “as a reminder that first and foremost we are physicians, protectors of the patient’s health.”4 We are indeed privileged to have the skills and opportunity to make the difference between a disastrous and a normal existence for an individual. During my career, I have witnessed tremendous advancements and growth in our specialty, such as the birth of craniofacial surgery, the development of reconstructive microsurgery, the employment of myriad myocutaneous flaps, and the launching of transplantation surgery. These fields, which we almost take for granted now, were only dreams when I first began training. If Vincent Van Gogh’s tragedy happened today, we could easily reconstruct his ear. By the same token, great advances in our specialty make it possible to now do miraculous extremity repairs. It is time that we follow our legacy and reconstruct Venus. To this end, I have redesigned our seal to symbolically reflect the progress, sophistication, and strides our specialty has made during the years since its inception (Fig. 2). Although cosmetic surgery has captured much of the attention of various medical specialties (and the media), as plastic surgeons, first and foremost we are physicians who restore the lives of those afflicted with congenital or traumatic deformity using our reconstructive efforts.5–7 This transformed logo is meant to embody and honor our roots while reflecting our commitment as healers to society.

External fixation for treatment of traumatic limb shortening deformity

目的 探讨创伤性肢体短缩畸形的骨外固定技术治疗方法.方法 回顾性分析1992年1月～2006年6月采用骨外固定技术治疗62例(68侧)患者资料.肢体短缩4～16 cm,平均5.7 cm.其中,单纯短缩9侧(短缩4～8 cm,平均5.3 cm),短缩伴骨不连21侧(短缩4～7 cm,平均5.6cm),短缩伴骨缺损38侧(短缩4～16 cm,平均7.2 cm;骨缺损2～11 cm,平均3.8 cm),18侧合并感染.分别采用干骺端截骨延长、骨端端加压结合肢体延长和骨节段性转位延长术.结果 68侧经1.5～5.0年(平均3.5年)随访,所有骨不连3～7个月内愈合(平均5.0个月),肢体长度恢复,延长区平均骨愈合指数37 d/cm,感染病例无复发,外固定器针道感染率7.3%.结论 骨外固定技术治疗创伤性肢体短缩畸形方法简便,既可修复骨缺损又能恢复肢体长度,并可同时治疗骨感染,疗效满意。

The Utility of the Anterolateral Thigh Donor Site in Reconstructing the United States Trauma Patient

Identification of a single donor site capable of providing all the components of the soft tissue envelope and the ability to selectively harvest a subset of these components is a central requirement for the microvascular reconstruction of the trauma patient. The anterolateral thigh (ALT) flap's long pedicle and adaptability in supporting a variety of tissues (muscle, fascia, soft tissue) make it a valuable tool for microsurgical reconstruction in these challenging patients. We investigated the utility of the ALT as a donor for microvascular tissue reconstruction in a Level I trauma center. We conducted a retrospective chart review on all trauma patients treated by the plastic surgery service at the R Adams Cowley Shock Trauma Center who required microsurgical free flap coverage from July 2002 to March 2005. Fifty-eight patients underwent reconstruction of traumatic deformities with 62 microvascular free flaps from the ALT region. Of the 58 patients, 42 were male and 16 were female with an average age of 39 years. Recipient site locations for the 62 flaps were lower extremity, upper extremity, trunk, and head and neck. Analysis of flap anatomy revealed that 43 were fasciocutaneous, 14 were myocutaneous, 2 were adipofascial, and 3 were myofascial (vastus lateralis muscle). Six flaps were based on septocutaneous perforators, whereas the remainder contained myocutaneous perforators. Nine thigh donor sites required a split thickness skin graft, and 53 were closed primarily. The size of the flaps ranged from 36 cm2 to 600 cm2. The ALT is a predictable donor site that facilitates a 2-team approach. ALT displays minimal donor site morbidity and in most cases provided sufficient tissue to cover the entire traumatic defect. Our results suggest the ALT is a reliable tissue source and an ideal donor site for the management of complex traumatic wounds in the United States.

Deviation of the nasal septum is one of the common causes of nasal obstruction

In Japan, the majority of surgical cases of deviated nasal septum are treated via Killian's submucosal incision technique. With this method, however, incision is made directly over the septal cartilage and the caudal end is not exposed, therefore the deformity around the caudal end cannot be corrected. It has been believed that, in Japan, few patients with nasal obstruction have stenosis in the nasal valve area, but some cases do exist. We treated the nasal septum deviation of such cases via the maxillapremaxilla approach as described by Cottle. With this method, we could obtain good visualization of the nasal septum structure and correct the septum deformity around the nasal valve. This method is also applicable to difficult cases such as traumatic deformity of the nasal septum and a second approach after surgical failure.

Acceptance of angulation in the non-operative treatment of paediatric forearm fractures

Forearm fractures are the most common injury in paediatric traumatology. The unique properties of the juvenile skeleton make it possible to cope well with traumatic deformities such as angulation, apposition and displacement. While we make use of these properties, the exact mechanism and degree of healing remains obscure. Different types of forearm fractures require specific treatment options, each with its limitations. A meta-analysis of recent literature was carried out, and together with the opinions of 18 international experts an effort was made to provide insight into the limits of acceptance of angular deformation in the non-operative treatment of paediatric forearm fractures. With this information we constructed graphs (age versus angulation) for each of the eight types of paediatric forearm fractures. In the absence of proper trials, it is our opinion that the presented Isala graphs can provide useful support in the decision-making process of acceptance of angular deformities in paediatric forearm fractures.

P.344 Outline reparation of traumatic defects and deformities of skull

P.344 Outline reparation of traumatic defects and deformities of skull

P96. Correction of Late Traumatic Kyphotic Spinal Deformities Using Posteriorly Placed Intervertebral Distraction Cages

BACKGROUND CONTEXT: The delayed surgical correction of traumatic deformities is typically performed through combined anterior and posterior approaches. Advances in interbody technology have now provided solutions for the surgeon desiring to correct such kyphotic deformities from a posterior approach. Modularized or expandable cage devices can now be expanded along their sagittal dimension in situ. This method not only simplifies initial interbody cage placement, but also can aid in the restoration of spinal alignment.

Correction of post-traumatic kyphosis using intermediate facet joints as fulcrum in dorso-lumbar spine injuries

Background : Post traumatic kyphotic deformity are managed by different methods. Posterior stabilization of dorso-lumbar fractures with transpedicular screws and rods using intermediate facets as fulcrum can restore body height. Methods and material : In a retrospective clinical study 6 consecutive patients with complete or incomplete neurological deficits as a result of the dorso-lumbar fractures were included. Local kyphosis was measured as the angle between the upper and lower end plates of the collapsed vertebrae preoperatively, postoperatively and at the last follow-up visit. The neurological condition of the patients was recorded in the pre-op and follow up period according to Frankel grading systems. Stabilization with pedicle screw fixation and posterior fusion with autogenous bone chips were done after decompression in all 6 patients included in this study. The outcome of the study was evaluated with regard to the correction of kyphotic deformity and increase in vertebral body height after adequate neural canal decompression and fusion. Results : Of the 6 patients 4 were Frankel A and 2 Frankel C pre-operatively. Three patients sustained wedge fracture and three sustained burst fracture. The most commonly affected vertebra was L 1 with 4 cases followed by L 2 . The preoperative mean kyphotic angle was 23.3° (17°-28°), and was corrected to 15.8 (12° - 22°) with a correction rate of 32.3% (21.4 - 43.5 %) in the post-operative period and this correction was improved at three months follow up and the final correction was measured to be 46.3% (22.7-59.0 %). Serial postoperative radiographic follow up assessment showed maintenance of kyphotic correction. Minimum correction of body height was .05 cm (correction rate 1.8%) and maximum correction was .65 cm (correction rate 28.9%) in post-operative period with a mean of 0.29 cm (correction rate13.1%). Conclusions : Preserved the intermediate articular processes can be used as fulcrum to reduce the kyphosis that can be maintained as they provides continuous support and traction.

Treatment of Traumatic Radial Clubhand Deformity With Bone Loss Using the Ilizarov Apparatus

Treatment of Traumatic Radial Clubhand Deformity With Bone Loss Using the Ilizarov Apparatus

Computernavigation am Kniegelenk, was können wir erwarten?

Navigation systems for operative assistance in knee joint surgery have been established in the last 5 years. Among the large number of variable systems, the image-free kinematic systems have won widespread acceptance. The C-arm based systems are not superior to the image-free systems. The CT-based systems are advantageous in completely destroyed joints (with marked joint erosion) or advanced congenital or traumatic deformities. The intraoperatively-performed Iso-C (3D) technique presents data sets in CT-quality, but because of its small data volume currently is limited to the reconstruction of articular surfaces following fractures. The use of image-free navigation in resurfacing knee arthroplasty is in the meantime beyond controversy whereby deviations in the mechanical axis from normal values can be significantly reduced. For high tibial osteotomies navigation modules will be soon available for marketing. However, with these modules, intraoperative imaging is indispensable, but it will be image-free in the future. The early clinical results are promising. Cruciate ligament navigation is not yet a clinical standard be-cause of the considerable associated time expenditure. The appropriate modules are still under development.

Salvage of Infected Cartilage Grafts for Nasal Reconstruction With a Through-and-Through Irrigation System

Development of a wound infection after nasal reconstruction can place the entire reconstructive effort in jeopardy. The approach to management in these cases has traditionally entailed wound drainage, removal of involved graft material, and debridement of nonvital tissue. Following adequate wound healing, delayed reconstruction is then performed, with the final result often compromised in form and function. We present a case of a postoperative wound infection following reconstruction of a traumatic nasal deformity utilizing autologous cartilage grafts. Treatment consisted of hospitalization with administration of culture-specific parenteral antibiotics and continuous through-and-through antibiotic irrigation of the wound via an indwelling catheter. The infection was completely eradicated and all cartilage grafts were salvaged utilizing this technique. At 3 years postoperatively, the patient has maintained the shape and quality of her reconstruction, without evidence of recurrent infection.

Nasal Augmentation Using Calcium Phosphate Cement

This report describes a simple technique for augmentation rhinoplasty using calcium phosphate cement paste for postoperative and posttraumatic nasal deformities. This biomaterial was used to correct traumatic nasal bone deformity in one patient and for augmentation rhinoplasty after removal of the nasal implant in two patients. These patients were followed for a minimum 6 months and a maximum of 26 months. The esthetic results were satisfactory with no complication. Calcium phosphate cement consisting of alpha-tricalcium phosphate, dicalcium phosphate dibasic, and tetracalcium phosphate monoxide has been used for bone replacement and augmentation because of its good biocompatibility and osteoconductivity. This technique is easy and safe. It seems to be a suitable material for augmentation rhinoplasty in the Orient. Its long-term safety and reliability require proof with longer follow-up periods, however.

Glenohumeral relationship in the transverse plane of the body

Reconstruction of a normal glenohumeral relationship is desirable for a successful arthroplasty. Double-contrast computed tomography was performed on 49 healthy shoulders in young volunteers. For creation of a uniform spatial reference system, the subjects were positioned in a thoracobrachial orthosis with the arm adducted in the coronal plane and the forearm flexed in the sagittal plane, and they were examined in dorsal recumbency. The classical anatomic angles were measured, and the anatomic axes were determined and quantified as angles to the coronal plane. When the axis of the glenoid was correlated to the axis of the humeral head, a mean of 8.5° divergence in a clear Gaussian distribution was found. This contrasts with the variability of the version of the humeral head and of the glenoid and offers a useful guideline in difficult prosthetic surgery of the shoulder in which normal anatomic landmarks are lost because of arthritic or traumatic deformity.

Operative Treatment of Tardy Ulnar Nerve Palsy

Purpose : To compare postoperative outcomes in tardy ulnar nerve palsy. Materials and Methods : Between January 1997 and June 2000, 31 patients with the tardy ulnar nerve palsy, who have received operative treatment were divided into a traumatic group and an idiopathic group, and were analyzed with respect to preoperative factors, severity, nerve conduction velocity and postoperative result retrospectively. Results : The traumatic group was composed of 17 cases and the idiopathic group of 14 cases. The average age was 35.7 years in the traumatic group, and 50.6 years in the idiopathic group, and this was statistically different (p=0.001). Other factors were not statistically different between the two groups. The improvement rate, which excluded mild degree patients, was 58.3% (7 in 12 cases) in the traumatic group and 90.9% (10 in 11cases) in the idiopathic group, and this was statistically different (p=0.048,) and favorable in the idiopathic group. Conclusion : In cases of tardy ulnar nerve palsy of the elbow joint, the symptoms and the nerve conduction velocity were statistically no different between the two groups. The postoperative result in the traumatic elbow deformity patients was poorer than that in the idiopathic group.

A Hand Surgeon and His Family in Phnom Penh, Cambodia

Those of us who have trained and practice our profession in developed countries, frequently overlook the orthopaedic, and general medical needs, of the developing world. After brief periods in India and more than 4 years practicing in Cambodia, the opportunities for the orthopaedic surgeon to make an impact on patient care and medical education are clear. The challenge of treating patients with untreated congenital and traumatic deformity, advanced tumors, and land mine injuries can be met with dedication to medical education and skills transfer to local personnel. I have experienced many challenges, balanced by the satisfaction of teaching a generation of surgeons and directly helping so many who would have no other opportunity for care, while providing a worthwhile experience personally and for my family. Many will find such work rewarding, knowing that they will leave their mark for good on a hurting world.

Motion of the calcaneus, navicular, and first metatarsal during the stance phase of walking.

One hundred fifty-three subjects between the ages of 18 and 41 years (mean age, 26.2 years) with no history of congenital or traumatic deformity or foot problems walked along a 6-m walkway while the angular and linear displacement of the tibia, calcaneus, navicular, and first metatarsal was measured by means of an electromagnetic motion analysis system. Three-dimensional movement of the calcaneus relative to the tibia, of the navicular relative to the calcaneus, and of the first metatarsal relative to the navicular during the stance phase of gait was calculated. The results of this study provide information on, and an understanding of, how the calcaneus, navicular, and first metatarsal function during the stance phase of normal human walking.

Resorbable plate fixation in pediatric craniofacial surgery: long-term outcome.

To determine the long-term efficacy of resorbable plate fixation in pediatric patients undergoing craniofacial surgery for congenital anomalies, traumatic deformities, or skull base tumors. Retrospective case review. Medical records of 57 consecutive cases using resorbable plates and screws for craniofacial fixation in patients younger than 18 years were analyzed. The status of bone healing postoperatively (anatomical union, malunion, delayed union, or nonunion) and any complications or adverse effects (hardware visibility or palpability, plate extrusion, or infection) were noted. In midfacial and upper face procedures (54 patients) anatomical union and uncomplicated bone healing occurred in 52 (96%) of the patients. In this same group, complications (plate extrusion) occurred in 2 patients (3.7%) and were resolved using conservative treatment without untoward sequelae. These outcomes are comparable to results using metal osteosynthesis in similar situations. Costs of resorbable hardware are similar to existing metal fixation systems. Our data support the use of bioresorbable plate fixation in pediatric craniofacial surgery as a means of avoiding the potential and well-documented problems with rigid metal fixation. Indications include fractures and segmental repositioning in low-stress non-load-bearing areas of the middle and upper craniofacial skeleton. Although there is an initial learning curve in using this technology, we believe the benefits are well worth the effort and represent a major advance in pediatric craniofacial surgery.

Correction of traumatic deformities. Principles and techniques.

The reason for inadequate results after the treatment of spinal lesions may be due to the misinterpretation of the type of lesion thus leading to incorrect therapy. Frequently the biofunctional construction principles of the spine are ignored and biomechanically based reconstruction of the spine is not done. Unsuitable approaches and fusion techniques may result in insufficient stabilisation with predictable failure. In both the first surgery and the salvage procedure, the principles of the load-sharing system as well as the posterior tension band principle must be respected. These principles and the surgery techniques are demonstrated in individual examples. Special attention is drawn to the impact of segmental deformities on the general statics of the spine. Frequently, residual deformities with the typical clinical picture lead to decompensation and the reduction of efficiency only after ten to fifteen years.

11 Callotasis lengthening of the humerus and proximal ULNA for congenital and post traumatic deformities about the elbow and shoulder

11 Callotasis lengthening of the humerus and proximal ULNA for congenital and post traumatic deformities about the elbow and shoulder