scholarly journals Limited Intercarpal Fusion as a Salvage Procedure for Advanced Kienbock Disease

Hand ◽  
2014 ◽  
Vol 10 (3) ◽  
pp. 472-476 ◽  
Author(s):  
Matthew L. Iorio ◽  
Colin D. Kennedy ◽  
Jerry I. Huang
2015 ◽  
Vol 35 (02) ◽  
pp. 83-89
Author(s):  
R. Scholz
Keyword(s):  

ZusammenfassungDie endoprothetische Versorgung des Ellenbogengelenkes zählt zu den eher seltenen, technisch anspruchsvollen und komplikationsbehafteten Verfahren in der Kunstgelenkchirurgie. Ihr Einsatz beschränkt sich, von seltenen Ausnahmeindikationen abgesehen, auf die stark schmerzhaften Funktionseinschränkungen bei fortgeschrittenen, zumeist sekundären Cubitalarthrosen und ausgeprägten traumatischen Schäden. Andererseits ist sie bei hochgradiger Gelenkzerstörung nach ausgeschöpfter gelenkerhaltender Therapie weitgehend alternativlos. Hinsichtlich der Implantate werden heute überwiegend halb -gekoppelte Systeme verwendet, wohingegen die in der Vergangenheit in vergleichbarer Anzahl implantierten ungekoppelten Endoprothesensysteme an Bedeutung verloren haben. In den vergangenen Jahren sind erste Ansätze technischer Neuerungen für die Entwicklung modularer Systeme entstanden. Dennoch muss häufiger als an anderen Gelenken nach Versagen der Endoprothese auf individuell angefertigte Sonderimplantate zurückgegriffen werden. Arthrodesen oder Resektions-Interpositions-Arthroplastiken sind als Salvage-Procedure nur selten sinnvoll möglich und oft mit erheblichen funktionellen Einschränkungen verbunden. Sie stellen somit keine wirklichen Alternativen zur Revisions -alloarthroplastik dar. Ein besonders großes Problem ist in einer septischen Lokalsituation zu sehen.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fausto Biancari ◽  
Giovanni Mariscalco ◽  
Hakeem Yusuff ◽  
Geoffrey Tsang ◽  
Suvitesh Luthra ◽  
...  

Abstract Background Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD. Trial registration ClinicalTrials.gov Identifier: NCT04831073.


2010 ◽  
Vol 62 (4) ◽  
pp. 1201-1201
Author(s):  
Jean-Philippe Hauzeur ◽  
Valérie Gangji

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.


Author(s):  
V. Purushothaman ◽  
K. Vinoth Kumar ◽  
Sabari Girish Ambat ◽  
R. Venkataswami

Abstract Background Total brachial plexus palsy (TBPP) accounts for nearly 50% of all brachial plexus injuries. Since achieving a good functional hand was almost impossible, the aim was settled to get a good shoulder and elbow function. It was Gu, who popularized the concept of utilizing contralateral C7 (CC7) with vascularized ulnar nerve graft (VUNG) to get some hand function. We have modified it to suit our patients by conducting it as a single-stage procedure, thereby trying to get a functional upper limb. Methods From 2009 to 2014, we had 20 TBPP patients. We feel nerve reconstruction is always better than any other salvage procedure, including free muscle transfer. We modified Gu's concept and present our concept of total nerve reconstruction as “ALL IN ONE OR (W)HOLE IN ONE REPAIR.” Results All patients able to move their reconstructed limbs independently or with the help of contralateral limbs. Three patients developed hook grip and one patient was able to incorporate limbs to do bimanual jobs. One important observation is that all the reconstructed limbs regain the bulk, and to a certain extent, the attitude and appearance looks normal, as patients no longer hide it or hang it in a sling. Conclusion Adult brachial plexus injury itself is a devastating injury affecting young males. By doing this procedure, the affected limb is not dissociated from the rest of the body and rehabilitation can be aimed to get a supportive limb.


2007 ◽  
Vol 22 (10) ◽  
pp. 1277-1281 ◽  
Author(s):  
Vincenzo Violi ◽  
Renato Costi ◽  
Federico Marchesi ◽  
Stefano Cecchini ◽  
Leopoldo Sarli ◽  
...  

2017 ◽  
Vol 43 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Amaury Charre ◽  
Stephanie Delclaux ◽  
Costel Apredoai ◽  
Jean-Emmanuel Ayel ◽  
Michel Rongieres ◽  
...  

Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. Level of evidence: IV


2015 ◽  
Vol 3 (8) ◽  
pp. e480
Author(s):  
Rebekka Brodbeck ◽  
Raymund E. Horch ◽  
Andreas Arkudas

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