Yüz bölgesinde meydana gelen hayvan ısırıkları ciddi defektlere yol açabilir. Kısıtlı vakalarda kopmuş parça iyi saklandığı ve hastayla beraber getirildiği takdirde en iyi çözüm replantasyondur. Kalan vakalarda birkaç tedavi yöntemi kullanılmaktadır. Klasik bir tedavi yöntemi olarak "tetikte bekleme" stratejisi, yaranın kendiliğinden iyileşmesine izin vermek ve ancak öyle rekonstrüksiyona başlamak olarak tarif edilebilir. Fakat iyileşmenin erken döneminde ileriye dönük rekonstrüksiyonu başlatmak, hızlı rehabilitasyonu sağlamaktadır. Bu çalışmada genç bir kızda köpek ısırığı sonrası perioral bölgede gelişen defektin erken dönemde başarılı rekonstrüksiyonu ayrıntısıyla tarif edilmiştir. Rekonstrüksiyonda anatomik, fonksiyonel ve estetik özellikler dikkate alınarak gerçekleştirildi. İleriye dönük rekonstrüksiyonun baş ve boyun cerrahisinde önemli bir yere sahip olduğuna inanmaktayız. Anahtar Kelimeler: Abbe flebi, köpek ısırığı, radyal ön kol flebi, perioral rekonstrüksiyon. Animal bites to the face can cause serious defects. In select cases when the avulsed part has been carefully preserved and brought-in with the patient, replantation may be the best solution. In other cases, few strategies are present. The classical "watchful waiting" strategy to treat such patients could be described as letting the wound to heal and only then, initiate reconstruction. Wound scarring and patient's psychological disturbance due to prolonged rehabilitation are its biggest disadvantages. However, a proactive method with reconstruction initiated early during the convalescent phase, can result in faster rehabilitation. Herein, we present detailed description of a successful early reconstruction of the perioral area in a teenage girl following a dog bite; the reconstruction encompassing the anatomical, functional and aesthetic spectrum. Thus, we believe, proactive strategy has a huge potential in the modern era of reconstructive head and neck surgery.
Introduction: The survey presents three clinical cases of successful treatment of chronic damage to the shoulder girdle and rotator cuff muscles with varying severity in people of working age. The patient with the most severe clinical symptoms of disorders had an episode of thromboembolism of the small pulmonary artery in past medical history. The aim of the study was to demonstrate, using the example of clinical cases, treatment options for patients with post-traumatic neuropathy of the axillary nerve associated with the rotator cuff damage, with improvement of the upper limb function and the patient's quality of life. Materials and Methods: A comprehensive study of the outpatient and inpatient records materials, the results of clinical laboratory methods of patient work-up was carried out, a selected conservative and surgical treatment, a rehabilitation program and drug prevention of thrombus formation are described in detail. Results: 8 months after the end of treatment, there was general, significant improvement of the damaged shoulder joint and limb function in all patients, and in the first two cases with moderate and medium deficiency, the level of complete recovery was almost achieved. The third patient, with the most adverse consequences and hemostatic comorbid pathology, underwent multi-team muscle-fascial transfer. As a result, there was a significant improvement in the right shoulder function. Discussion: A personalized approach to the choice of treatment tactics, depending on the degree of existing clinical disorders, whether a complex conservative treatment solely, or combined with an arthroscopic technique, as well as a reasonable implementation of techniques for transfer of preserved muscles to replace the lost function of damaged muscles in the most complex case was a condition and guarantee for achieving significant progress in the patient's anatomical and functional status. Nevertheless, it seems appropriate to carry out a further search for more rational technologies of restorative reconstruction for the disorders under consideration. Conclusion: An individualized tactical and technical approach to the rehabilitation of such a complicated cohort of patients, correctly selected, taking into account the clinical and instrumental data, allows to improve the upper limb function of and the patients' quality of life, and the reasonable tactics of clotting prevention ensures hemostasis control and the absence of vascular catastrophes.
Introduction A case of a successful surgical treatment of a neglected injury of the upper arm muscles and rotator cuff in a working-age man with a history of an episode of thromboembolism of small branches of the pulmonary artery is presented. The aim of this study was to demonstrate one of the approaches to surgical treatment of this pathology that resulted in the improvement of upper limb function and the quality of life of the patient. Material and methods A comprehensive study of the patient's outpatient and inpatient records, results of clinical, instrumental and laboratory methods, the types of intervention and rehabilitation along with medical prevention of thrombosis are described in detail. Results Eight months after the surgery, there was an improvement in the function of the right shoulder joint. The range of active motion significantly increased; the DASH score decreased from 136 to 52 points; pain decreased from 46 to 31 points according to VAS; the level of self-service significantly improved. Discussion Сombined techniques of preserved muscle transposition to replace the lost function of the damaged ones was a condition and a guarantee of the achieving significant progress in the anatomical and functional status of the patient. Nevertheless, a further search for more rational technologies for restorative reconstruction in the disorders under consideration seems appropriate. Conclusion A correctly chosen and based on clinical and instrumental data transposition of the tendons of the active muscles of the shoulder joint area to replace the lost shoulder antagonists provides improvement of the upper arm function and patients’ quality of life while the justified tactics of thromboprophylaxis allows control of hemostasis and absence of vascular failures.
Background. The treatment of post-traumatic of the clavicle false joint remains a subject of discussion regarding the technology of the surgical intervention. Recently, the use of vascularized fibular flap reconstruction technique has been popularized, but the potential of the external osteosynthesis remains relevant. Clinical case description. A 70-year-old patient got a fracture of the middle third of the left clavicle diaphysis as a result of a fall. He underwent four surgical treatment options: plate osteosynthesis; plate osteosynthesis + bone autoplasty; plate osteosynthesis + vascularized fibular flap reconstruction; external osteosynthesis. A month after the fourth attempt of surgical treatment, fusion, improvement of the function of the right upper limb and the quality of life of the patient were achieved. Technological inaccuracy, namely, the lack of the fragments fixation stability due to the incorrectly chosen length of the plate, as well as an incomplete assessment of the anamnesis and the identified cognitive behavioral features of the patient, are considered as possible reasons for the treatment failure. Conclusion. Attempts of surgical treatment using plates in combination with bone autoplasty, including vascularized skin-bone flaps, do not always ensure the achievement of clavicle fractures fusion. In such situations, it is advisable to use the potential of external osteosynthesis with the reasonable planning.
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