Biomedical subjects

Miguel A Pirela-Cruz

Publications and source records attributed to Miguel A Pirela-Cruz.

5 recordsLinked to original sources

PubMed2006

A case study of negative pressure wound therapy to manage acute necrotizing fasciitis.

Acute necrotizing fasciitis is a devastating infectious process that requires immediate surgical debridement. Intravenous antibiotic treatment, hyperbaric oxygen therapy, and wound management are considered the standard of care. Subsequent wound closure is achieved with split-thickness skin grafting, delayed surgical closure, or healing by secondary intention. When a patient refuses additional surgical treatment or is no longer a surgical candidate, as was the case with a patient who presented with acute necrotizing fasciitis caused by Clostridium perfringens in the upper extremity, secondary intention healing is the only treatment option. Following surgery and intravenous antibiotic treatment, her wounds were managed with topical negative pressure wound therapy. No adverse events occurred and the wounds were almost completely healed 63 weeks following surgery. Research to develop evidence-based protocols of care for the closure of these wounds is needed.

Debridement↗

PubMed2005

Distraction lengthening of the thumb following replantation.

Distraction lengthening is one of several surgical reconstructive methods used to obtain length of an amputated digit and to improve function. However, the use of this technique following replantation is a relatively new concept. A case of a 32-year-old male who sustained a traumatic amputation of his left nondominant thumb and index finger is described. The injury and the replantation surgery each resulted in a significant amount of bone loss from the thumb. Nine months following the replantation, distraction osteogenesis was utilized to lengthen the thumb and to improve both function and cosmesis.

Adult↗

PubMed2005

A technical note on percutaneous scaphoid fixation using a hybrid technique.

This article describes a percutaneous fixation technique for a midwaist scaphoid fracture using an antegrade (dorsal) guidewire and a retrograde (volar) cannulated screw placement. This simplified hybrid technique allows for accurate dorsal central wire placement and stable internal fixation with minimal violation of the articular cartilage of the proximal pole of the scaphoid.

Adult↗

PubMed2003

Assessment of midcarpal deformity of the wrist using the triangulation method.

PURPOSE: The purpose of this study is to present an alternative method for static radiologic assessment of the wrist for midcarpal instability (ie, palmar intercalated segmental instability [PISI] and dorsal intercalated segmental instability [DISI]). The triangulation method uses 3 anatomic landmarks observed on the standard lateral x-ray of the wrist. METHODS: A total of 125 normal lateral radiographs were measured to determine the normal range for the dorsal limb (DL) to palmar limb (PL) ratio. A 2-step process of performing triangulation is described. The first step is nonspecific screening of the radiograph and defines values greater than 1.0 as having a DISI deformity and values less than 0.5 as having a PISI deformity. The second step is used only for borderline values, which takes the position of the wrist into consideration and uses a normagram (reference chart) to match the DL:PL ratio with the radiometacarpal (RM) angle. RESULTS: The average lateral wrist position was 8.4 degrees of extension (-8.4). The average DL:PL ratio was 0.75 +/- 0.09 (range, 0.93-0.57). CONCLUSIONS: Based on these data we defined DISI deformity of the wrist as DL:PL ratios greater than 1.0, and ratios less than 0.5 representing PISI deformities. The triangulation method of assessing midcarpal alignment of the carpus is a practical and simple alternative to the traditional static radiologic method of assessing midcarpal instability of the wrist.

Adult↗

PubMedDate not supplied

Management of posttraumatic segmental bone defects.

Because of difficulty in managing posttraumatic segmental bone defects and the resultant poor outcomes, amputation historically was the preferred treatment. Massive cancellous bone autograft has been the principal alternative to amputation. Primary shortening or use of the adjacent fibula as a graft also has been used to attempt limb salvage. Of more recent methods of management, bone transport with distraction osteogenesis has been suggested as the leading option for defects of 2 to 10 cm, but problems include delayed union at the docking site and prolonged treatment time. Free vascularized bone transfer has been suggested as the leading option for defects of 5 to 12 cm, but hypertrophy of the graft is unreliable and late fracture, common. Bone graft substitutes continue to be developed, but they have not yet reached clinical efficacy for posttraumatic segmental bone defects. Although each of the new techniques has shown some limited success, complications remain common.

Amputation, Surgical↗