A NOVEL TECHNIQUE FOR POST IMPLANT DIFFICULT SKIN CLOSURE

The management of grossly displaced fractures sometimes needs immediate reduction to relieve pressure on neurovascular structures and simultaneous stabilization with plates & screws. Surgeons frequently encounter difculty in the nal stage of surgery which is skin closure due to signicant swelling. Delayed secondary closure increases the risk of exposing the fracture site & implant to infection. Also counselling relatives postop for second surgery and for additional expenditure is difcult. Here we present our experience of managing difcult closures using multiple tension relieving small skin incisions to relieve compartmental pressure and catostrophic wound complications. Here we have shown an example of difcult closure on a complex displaced distal radius fracture post xation.

Non-Invasive Diagnostics in Acute Compartment Syndrome

Diagnosis of acute compartment syndrome (ACS) of the extremities is based on clinical signs with or without complementary measurement of muscle compartmental pressure. However, in cases of imminent compartment syndrome, unconscious patients or children the appropriate diagnose remains challenging. Despite all efforts to improve technical devices to objectify the signs by measurements of numerous parameters, needle compartment pressure measurement is to date accepted as the gold standard to facilitate decision making. But its invasiveness, the controversy about pressure thresholds and its potentially limited validity due to a single measurement support the need for further developments to diagnose ACS. Numerous technical improvements have been published and revealed promising new applications for non-invasive diagnostics. Since the pathology of an ACS is well characterized two approaches of measurements are described: to detect either increasing compartmental pressure or decreasing perfusion pressure. In the following, currently known investigations are reviewed and related to their pathophysiological principals, modes of clinical application, value and reliability.

Deep Learning Algorithm for Image Classification of Waveforms Obtained From Electrically Stimulated Hypoxic Skeletal Muscle Bundles

Acute compartment syndrome is a serious condition that requires urgent surgical treatment. While the current emergency treatment is straightforward — relieve intra-compartmental pressure via fasciotomy — the diagnosis is often a difficult one. A deep neural network is presented here that has been trained to detect whether isolated muscle bundles were exposed to hypoxic conditions and became ischemic.

Releasing Burn-Induced Compartment Syndrome by Enzymatic Escharotomy-Debridement: A Case Study

Burn-induced compartment syndrome represents a serious and acute condition in deep circumferential burns of the extremities which, if left untreated, can cause severe complications. The surgical escharotomy that releases the high subdermal pressure is the therapeutic treatment of choice for burn-induced compartment syndrome. Guidelines for escharotomy indications and timing include pressure greater than 30 mm Hg and 6 Ps (Pain, Pallor, Paresthesia, Paralysis, Pulseless, and Poikilothermia). Nevertheless, despite the need for an early as possible pressure release, escharotomy is often delayed when a capable surgeon is not available, or if the indication is not completely clear to justify potential risks associated with surgical escharotomy. Early treatment of circumferential burns of the extremities with a Bromelain-based enzymatic agent NexoBrid® may represent a less traumatic and invasive procedure to reduce intra-compartmental pressure, replacing surgical escharotomy. This case study of 23 patients describes the variation of compartmental pressure in patients with circumferential burns of the extremities treated with NexoBrid® enzymatic escharotomy-debridement. All the patients were treated with NexoBrid® within 2 to 22 hours post-injury in our Burn Intensive Care Center. The excessive pressure recorded before treatment returned to normal below 30 mm Hg and an approximately 60% reduction of the compartmental pressure was observed in most cases within 1 hour from NXB application. On NexoBrid® removal after 4 hours complete debridement-escharotomy of the burns was achieved. Enzymatic escharotomy-debridement appears to be a useful and safe method to reduce postburn compartmental pressure. Additional randomized, well-controlled powered studies are needed to further support these results.

Flexor carpi ulnaris herniation after cubital tunnel release: A case report

Muscle herniation in the upper extremity is a rare but recognized phenomenon with a paucity of reports in the current literature. In the majority of cases, the herniation is secondary to trauma, with some of the cases due to muscle hypertrophy and increased intra-compartmental pressure from the forced exertion. Treatment for this condition ranges from nonsurgical, repair, or reconstruction to fasciotomy of the flexor carpi ulnaris fascia. Here, we present a case of flexor carpi ulnaris herniation after an open in situ cubital tunnel release in a 57-year-old male 6 years after initial surgery. The patient’s symptoms did not improve with conservative management, and the patient subsequently underwent endoscopic fasciotomy with resolution of his symptoms and maintenance of his wrist and grip strength. The rationale for the treatment chosen is discussed.