The Kutler repair for fingertip amputations.
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Biomedical subjects
Publications and source records attributed to A Freiberg.
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Injuries resulting from the use of high pressure injectors and spray guns are relatively rare; however, the potential tissue damage caused by the injury as well as the extent of the injury itself may go unrecognized by the primary physician. The purpose of this paper is to inform the emergency physician of the nature and standard management of this type of injury. A basic understanding of the pathophysiology of the high pressure injection injury (HPII) is essential in avoiding the mistakes in management that have been reported in the literature. The emergency management of the HPII includes: evaluation and immobilization, tetanus and antimicrobial prophylaxis, supportive and resuscitative measures, analgesia, and minimizing the time to definitive surgical treatment.
This report documents the treatment of 33 foot and ankle ganglia. The average patient age was 39 years (versus 25 years for patients with ganglia about the wrist joint). Twenty-one ganglia were treated operatively and nine recurred. Three patients suffered cutaneous nerve injury. The other 12 ganglia were treated by aspiration and steroid injection. There were four recurrences, one of which was cured by a second injection. Two of the four recurrences were small and asymptomatic and required no treatment. There were no complications with aspiration and injection. In view of the high recurrence rates and inconvenience of ganglionectomy in the foot, aspiration and steroid injection is a more safe, simple, and effective treatment. We feel that surgery should generally be reserved for failures of nonoperative treatment.
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