By Alain C. Masquelet, Acacio C. Ferreira
Assembling overseas specialists and that includes greater than three hundred representation, this article offers the most recent scientific considering at the right technique to undertake in surgical administration of higher limb trauma. After defining present concerns, the publication covers gentle tissue fix, bone reconstruction, joint reconstruction, nerve disorder fix, tendon disorder fix, and compound transfers. the ultimate bankruptcy is dedicated to basic symptoms. The booklet highlights of flap strategies, bone reconstruction and bone substitutes, joint reconstruction and substitute, nerve grafts and substitute tools for reinervation, tendon grafting and move, and destiny advances in hand and top limb surgical procedure.
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Extra resources for Severe Tramatic Defects of the Upper Limb: Published in association with the Federation of European Societies for Surgery of the Hand
Postoperatively the range of motion of the shoulder was limited (Fig. 4g). The patient achieved 40° forward elevation, 30° lateral elevation and 30° external rotation. However, 7 years after the operation the patient showed stable wound coverage, there was no sign of infection and the patient was pain free. Figure 4(a,b) (a) Infected right glenohumeral joint. (b) Flap design of a pedicled pectoralis major flap. Severe traumatic defects of the upper limb 32 Figure 4(c,d) (c) Cranially reflected pectoralis major muscle with arrows indicating the thoracoacromial pedicle and the pectoral nerve.
The paraesthesias reported by some authors (Christie et al 1994, Amarante 1990), resulting from the execution of the ulnar flap, are probably, to a greater extent, related to the minor trauma verified during the dissection of the flap than a diminution of the vascular flow, as recuperation from this complication is usually fast. Relative to the repercussions of the diminution of the blood supply at the level of the hand owing to the utilization of these flaps, it must be said that the perfusion by the distal septocutaneous ulnar artery as well as by the posterior interosseous artery contributes minimally to the vascularization of the hand through their anastomoses with the palmar and dorsal arcs.
Pedicled pectoralis major flap The pectoralis major muscle is located in the anterior chest wall and in many ways matches the characteristics of the latissimus dorsi muscle. The pectoralis major is particularly useful for the repair of anterior shoulder defects. The pectoralis can be dissected out from beneath the skin, rotated into position, and split skin applied to its exposed surface, or it can be used as a myocutaneous flap. The pectoralis muscle receives its main blood supply from the thoracoacromial artery, a branch of the subclavian artery.