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Biomedical subjects

D P Hanel

Publications and source records attributed to D P Hanel.

48 records · Page 3Linked to original sources
PubMed1990

Free tissue transfer and calcanectomy as treatment of chronic osteomyelitis of the os calcis: a case report.

Chronic osteomyelitis of the os calcis presents a formidable management dilemma. Successful treatment requires aggressive surgical debridement of devitalized bone and soft tissue and appropriate antibiotic therapy. Difficulties arise, however, when radical debridement results in significant loss of weight-bearing bone. Recalcitrant osteomyelitis of the os calcis or major loss of bone secondary to debridement has been treated by amputation. Advances in microsurgical reconstruction now provide the opportunity for limb salvage in this situation.

Adult↗
PubMed1989

Bupivacaine: a safe local anesthetic for wrist blocks.

Seventy-one patients having minor hand surgical procedures under wrist block anesthesia were studied, with the goal of identifying a possible neurotoxic potential of bupivacaine when used according to standard clinical practice. This drug was compared with lidocaine at equipotent analgesic concentrations (bupivacaine: 5 mg/ml; lidocaine: 20 mg/ml) by use of a double-blind randomized protocol. At postoperative follow-up, four (5.6%) patients had new neurologic symptoms. Mechanical factors, e.g., nerve manipulation during surgery, or nerve trauma during performance of the block, were identified in three patients. In the remaining patient, anesthesia was induced with lidocaine, and no cause could be identified. It was concluded that bupivacaine, when used in clinical concentrations, is not associated with an increased incidence of neural complications.

Bupivacaine↗
PubMed1989

Vascularized tissue transfer. An adjunct to the treatment of osteomyelitis.

Debridement is paramount in the treatment of chronic or acute posttraumatic osteomyelitis. Aggressive removal of all infected soft tissue and bone results in a wound characterized by large dead space and exposed or missing bone. Vascularized tissue transfer eliminates dead space and provides easily mobilized tissue, a necessity for later bony reconstruction. With its independent blood supply, the transferred tissue provides a well oxygenated environment and a potential transport mechanism for antibiotics. Local muscle or fasciocutaneous flaps are used when available. However, in the majority of cases free tissue transfer is necessary.

Debridement↗
PubMed1988

Irreducible fracture-dislocation of the distal radioulnar joint secondary to entrapment of the extensor carpi ulnaris tendon.

Entrapment of the extensor carpi ulnaris (ECU) tendon between the ulnar head and the sigmoid notch of the radius occurred in a 12-year-old boy. This led to an irreducible dorsal dislocation of the distal radioulnar joint (DRUJ). Irreducible DRUJ dislocations are uncommon, and the entrapped ECU has not been previously described in a skeletally immature patient. The physical and roentgenographic findings of a dorsally displaced ulna, a widened DRUJ, and the inability to obtain a closed reduction should alert the examiner to the need for exploration. A dorsal exposure is required to free the ECU and reconstruct the triangular fibrocartilage complex.

Child↗
PubMed1987

Lateral arm composite tissue transfer to ipsilateral hand defects.

Different applications in the use of the ipsilateral lateral arm free flap in 29 patients treated in our unit from November 1983 to December 1984 are described. The flap was used in both elective and emergency reconstruction with a success rate of 96.5%. This flap is elevated from the same limb as the injured hand, permitting the entire operative procedure to be performed with the patient under a single regional block anesthesia, both flap and recipient sites being prepared synchronously in a bloodless field.

Adolescent↗
PubMedDate not supplied

Monoarticular gout following trauma: MR appearance.

We report a case of gout with monoarticular tophaceous involvement of the proximal interphalangeal joint of the middle finger, emphasizing MR findings. To the best of our knowledge, the MR appearance of gout is not commonly known.

Arthritis, Gouty↗
PubMedDate not supplied

Neurological complications resulting from supracondylar fractures of the humerus in children.

One hundred thirty-eight children with supracondylar fractures of the humerus were reviewed. Seventeen (12%) exhibited neurological deficits. Nine median, four ulnar, and four radial neuropathies were encountered. The neurological deficit was treated expectantly. The osseous injury was treated by a variety of methods. All patients except two recovered spontaneously in an average of 9 weeks. One patient was still improving at 9 months' follow-up. Another patient with radial neuropathy underwent exploration 6 months after injury and was found to have a transected radial nerve. This study demonstrates that neurological deficits from supracondylar humeral fractures remain common, involve all three major nerves of forearm, and, with rare exception, recover with conservative therapy.

Child↗
PubMedDate not supplied

Free tissue transfer in children.

We reviewed 11 cases of free tissue transfer used to salvage limbs in young patients (age range 4-16 years, mean 8.9 years). The defects were the result of acute trauma in eight cases, osteomyelitis in one, unstable scar over bony prominence in one, and correction of a previously infected talipes equinovarus repair in another patient. Donor tissues used were the latissimus dorsi muscle, scapular skin, lateral arm skin, and vascularized fibular graft. Defect sizes included 3 x 3 to 10 x 40 cm and 11 cm of humeral diaphysis. Microvascular success rate was 100%. In each case, the successful transfer provided the viable tissue required and resulted in salvage of the limb. Our results suggest that free tissue transfer is a viable solution to limb salvage in pediatric patients.

Adolescent↗