Biomedical subjects

V Vanadurongwan

Publications and source records attributed to V Vanadurongwan.

15 recordsLinked to original sources

PubMed2000

Results of 1018 digital replantations in 552 patients.

To find out the influencing factors of the immediate and late outcome of replantation and revascularization of the digits the study was carried out as a prospective survey research during 1983 to 1995 with at least 2 year follow up. Traumatic total or subtotal amputation with inadequate circulation of the digits distal to the metacarpal head were included in the study. There were 552 patients with 366 males (675 digits) and 186 females (343 digits). Successful operation was found in 508 patients (92%) with 946 digits (92.9%). Type of injury was the most important factor influencing immediate and late outcome. Regular cigarette smoking resulted in poor immediate survival rate. Prolonged ischaemia had a significant influence in final functional outcome. Using composite skin and subcutaneous vein graft gave good survival rate. Injury at the no man's land area resulted in poor range of movement of the digit. Connecting the profundus tendon stump of the proximal part to the superficialis tendon of the amputated part gave a better result than 2 tendon repair and repairing only the profundus tendon. Replantation should be carried out even if only one digit is involved. At the 2 year follow up 195 patients (38%) were classified in grade I of Chen et al., functional outcome, while 153 (31%) were in grade II, 124 (24%) were in grade III and 36 (7%) were in grade IV.

Adolescent↗

PubMed2000

The effects of patellar resurfacing in total knee arthroplasty on position sense: a prospective randomized study.

To find out the improvement of joint position sense after total knee arthroplasty with patellar resurfacing compared to total knee arthoplasty without patellar resurfacing, the study was carried out as a randomised parallel trial in patients who had stage III and IV primary osteoarthrosis of only 1 side of the knee with a 2 year follow-up. Twenty-one patients underwent patellar resurfacing and 26 patients had no patellar resurfacing. Joint position sense was evaluated by the average absolute different angle of the operated knees from the non operated knees which was the asymptomatic knee and acted as the reference knee. Position sense was improved significantly in both groups. However, the patients without patellar resurfacing had better improvement. The patients with patellar resurfacing had better results in terms of anterior knee pain and tenderness. Patellar resurfacing should be used in severe articular cartilage damage, not as a routine operation.

Aged↗

PubMed1999

Revascularization of subtotal amputation at the ankle in children following motorcycle-spoke injury.

A prospective study of subtotal amputation of the ankle following motorcycle spoke injury was carried out to define the mechanism of the injury and results of revasculization. Between 1990 to 1995, there were 42 patients with this type of injury. They were 31 boys and 11 girls. All sustained severe skin lacerations, medial, posterior, lateral and anterior to the ankle joint. All tendons and neurovascular bundles medial, lateral and anterior to the ankle were completely torn, leaving tendons of anterior tibial, extensor hallucis longus and extensor digitorum communis intact. Revascularization was performed successfully in 38 patients. All had good functional outcome although varus of the distal tibia, limitation of ankle motion, shortening of the foot and limb length discrepancy were observed. The motorcycle wheel needs to be redesigned.

Accidents, Traffic↗

PubMed1999

Restoration of elbow flexion in brachial plexus avulsion injury: comparing spinal accessory nerve transfer with intercostal nerve transfer.

This study was performed to compare the clinical outcome of 2 types of commonly used nerve transfers, the spinal accessory nerve transfer and the intercostal nerve transfer. This study was a prospective randomized parallel trial involving 205 patients presenting between 1989 and 1994. All patients were males ranging in age from 16 to 43 years. All patients underwent surgery within 6 months of injury. Spinal accessory nerve transfer was performed in 130 patients; better results were obtained in terms of less operative time, fewer blood transfusions, fewer immediate complications, and better motor function (very good and good power in 83% of patients). Intercostal nerve transfer was performed in 75 patients; better results were observed in terms of earlier electromyographic evidence of motor reinnervation, improvement in protective sensation, and reduction of pain. However, very good and good motor recovery was observed in only 64% of patients. There was no significant difference with regard to tidal volume, vital capacity, and the FEV1 to FEV ratio before and after surgery in either group. Smoking adversely affected the rate of recovery. Spinal accessory nerve transfer should be used when motor function of the elbow flexors is the major concern. Intercostal nerve transfer should be performed in patients who need both motor and sensory reconstruction and in those who have chronic pain syndrome after brachial plexus injury.

Adolescent↗

PubMed1999

The role of allopurinol in digital replantation.

The clinical effects of allopurinol on the attenuation of reperfusion injury in thumb replantations after prolonged ischaemic time were studied in a randomized control trial with a 2-year follow-up. There were 60 patients, in the trial group, and 38 patients in the control group. All were young, healthy labourers who had sharp or locally crushed amputations of the thumb at the proximal phalanx with a total ischaemic time of more than 10 hours. The standard management for thumb replantation was used in these patients, except that 300 mg allopurinol was given orally in the trial group on admission and a further 300 mg for another 5 days. After operation, the trial group had a lower infection rate, and less postoperative pain and chronic swelling than the control group. Recovery of sensation was also better in the trial group.

Adolescent↗

PubMed1999

Clinical results of contralateral C7 root neurotization to the median nerve in brachial plexus injuries with total root avulsions.

This prospective study was carried out to assess motor and sensory recovery after contralateral C7 root to median nerve neurotization in brachial plexus injuries with total root avulsions. The survey was carried out from 1993 to 1995 and the patients were followed up for at least 3 years. There were 96 male patients with ages ranging from 13 to 48 years. All had a unilateral brachial plexus injury with avulsion of all roots. This was confirmed by clinical assessment and exploration. The anterior part of the contralateral C7 root was used for neurotization via a reversed pedicular ulnar nerve graft and the proximal end of the graft was connected to the median nerve. Furthermore, phrenic nerve to suprascapular nerve and spinal accessory nerve (via a sural nerve graft) to musculocutaneous nerve neurotizations were also carried out to obtain shoulder abduction and elbow flexion. At the 3 year follow-up, most patients had encouraging recovery of sensory function in the hand but motor function of the forearm and hand muscles was rather poor. Acceptable motor function was found in only 50 to 60% of the patients who were younger than 18 years.

Adolescent↗

PubMed1999

Immediate stabilization of unstable pelvic fractures versus delayed stabilization.

To compare the immediate and long term outcome of immediate stabilization of the unstable pelvic fractures to delayed stabilization with simple external fixation, the study was carried out as a paralell trial with 2 year follow-up. There were 112 patients with 69 males and 43 females who had unstable pelvic fractures. They were allocated randomly into 2 groups. In group 1, 40 patients, conventional management was performed while in group 2, 72 patients, reduction and anterior stabilization of pelvic fractures with a simple external fixator were carried out immediately just after the unstable fractures were detected. Blood transfusion, post operative pain, need of reconstructive surgery of the pelvic fractures and late deformities were less in the group 2. Immediate anterior reduction and stabilization of the unstable pelvic fractures gave encouraging results.

Adult↗

PubMed1998

An aiming device for pin fixation at the iliac crest for external fixation in unstable pelvic fracture.

To improve the accuracy of pinning at the iliac crest during external fixation of the pelvic fracture, an aiming device has been designed. The device consists of 3 parts: a sleeve which accommodates a 5.0 Shanz pin, a handle and guide points. The guide points were designed to grasp the iliac crest to allow proper pin fixation. The device has undergone trials to fix Shanz pins on the iliac crests of 10 cadavers by 10 recently graduated doctors. All pins were fixed in proper position and passed into the bone between the two tables of the iliac crest without penetrating the tables. The device has so far been used in 50 patients who had unstable pelvic fractures. All pins were in the proper positions and there had been no loosening at the time the pins were removed. The use of this aiming device for pinning the iliac crest for external fixation of pelvic fracture has given encouraging results.

Adult↗

PubMed1998

Relationship between foot length and the inter anterior superior iliac distance.

Reduction of unstable pelvic fracture by external fixator might be over or under corrected as there is no proper estimation from the surgical landmark. Radiographic evaluation after reduction must be carried out and improper reduction is found in a certain number. To find a better guide by normal surgical landmark the study was carried out as a survey research in 600 volunteers aged from 10 to 70 years. Simple caliper and tape were used to measure the height, foot length and inter anterior superior iliac spine distance. In 376/420 male volunteers (89%), the length between right heel and tip of the fourth toe was equal to the inter anterior superior iliac spine distance. In 173/180 female volunteers (96%), the length between right heel and tip of big toe was equal to the inter anterior superior iliac spine distance. The length of the right foot can be used as a reference in reducing unstable fractured pelvis by external fixation. These data were used in the management of 36 patients with unstable fractured pelvis with external fixation for reduction and stabilization. All had good results.

Adolescent↗

PubMed1998

Effects of sauna on sperm movement characteristics of normal men measured by computer-assisted sperm analysis.

The effects of sauna exposure on sperm movement characteristics and other semen parameters were evaluated using computer-assisted sperm analysis (CASA). A significant (p < 0.01) decrease in average path velocity (VAP), curvilinear velocity (VCL) and amplitude of lateral head displacement (ALH) was found after exposure to sauna for 2 weeks. The altered parameters returned to their original values within 1 week after cessation of sauna exposure. Mean values for semen volume, sperm count, percentage motility, sperm morphology and sperm penetration assay (SPA) were not statistically different during and after sauna, when compared to the corresponding control values. The results suggest that increasing scrotal temperature by sauna causes a reversible decrease in sperm movement parameters.

Adult↗

PubMed1998

Vascular injuries in compound fractures of the leg with initially adequate circulation.

We carried out a randomised, controlled trial in 157 patients who had isolated severe Gustilo type-IIIa and type-IIIb fractures of the metaphysis or diaphysis of the leg to determine the prevalence of vascular injuries and the role of vascular repair. All patients had stable vital signs and clinically adequate circulation in their legs before operation. In a control group of 64 patients we performed conventional surgery with systematic debridement and primary stabilisation of the fractures. In the trial group of 93 patients the major vessels and nerves adjoining the compound fracture were routinely explored and repaired when necessary after the initial procedure. Two of the 28 control patients (7.1%) with type-IIIb compound fractures had signs of inadequate circulation after the first operation. Both had major vascular injuries which were demonstrated at a second procedure. In the trial group, major vascular injuries were found in two of 54 patients (3.7%) with type-IIIa and 11 of 39 patients (28.2%) with type-IIIb compound fractures. Compared with the control group the trial group showed improved results at both the immediate and long-term follow-up. Routine exploration and early repair of injured major vessels of the leg in severe compound fractures gave encouraging results.

Adolescent↗

PubMed1998

Prognostic factors for major limb re-implantation at both immediate and long-term follow-up.

We performed a prospective study in 186 patients with a minimum follow-up of two years in order to attempt to predict successful major re-implantation of the upper limb. There were 137 men and 49 women with 24 amputations of the palm, 75 of the wrist, 50 of the forearm, 9 disarticulations through the elbow, and 28 amputations through the upper arm. The degree of injury to the amputated segment and the stump were good predictors of the rate of success and the final outcome. Adequate preservation, contraction of the muscle in the amputated part after stimulation, the level of injury and a smoking habit were fair indicators, but the serum potassium concentration in the amputated segment was the best objective predictor. When it is higher than 6.5 mmol/l 30 minutes after re-perfusion, re-implantation should be avoided. A high systemic venous serum potassium concentration was also found before clinical signs of the re-perfusion syndrome were seen.

Adult↗

PubMed1998

The reconstruction twisted wire-screws for internal fixation of two- and three-part fractures of the proximal humerus.

Using the implants for internal fixation of the proximal humeral fractures has several problems which lead to complications and poor results of the fracture treatment. Because there is no suitable implant for internal fixation of the fracture. Therefore, the reconstruction twisted wire was developed in 1990 to improve the results of the fracture treatment. Between 1990 and 1994, the reconstruction twisted wire was used in 31 patients whose ages ranged from 18 to 90 years. Sixteen patients had displaced two-part surgical neck fractures. Fifteen patients had displaced three-part fractures. Postoperative follow-up ranged from two and a half years to five years and one month. All fractures healed. No avascular necrosis of the humeral head was observed at the follow-up. There was temporary subluxation of the shoulder joint in three patients and loosening of the screws in two patients with marked osteoporosis. One had a rupture of wire between the greater tuberosity and the shaft and loosening of the screw at the greater tuberosity and united with 10 degrees varus deformity. According to the functional scale proposed by Hawkins, 28 of the 31 patients achieved a "good" result and 3 patients had a "fair" result.

Adolescent↗

PubMed1997

The talar body prosthesis.

Arthrodesis or talectomy for the treatment of avascular necrosis of the talus or a severe crush fracture of the body of the talus often produces a disability of the ankle and the foot. Therefore, a prosthesis designed to replace the body of the talus and to preserve the function of the ankle and the foot was developed. The prosthesis has a superior curved surface, and the medial and lateral surfaces are inclined for articulation with the tibia and the fibula. The inferior aspect has a concave curved surface at the posterior aspect of the prosthesis to serve as the posterior facet for articulation with the posterior facet of the calcaneus, and there is a convex curved surface at the anterior aspect of the prosthesis for articulation with the middle facet of the calcaneus. The neck and the head of the talus are preserved to allow insertion of the prosthetic stem into bone. A transmedial malleolar approach is used for insertion of the prosthesis. We inserted the talar body prosthesis in sixteen patients - twelve who had avascular necrosis of the talar body and four who had a severe crush fracture of the talar body - between 1974 and 1990. Three patients who were evaluated five years postoperatively had a satisfactory result, and one patient had failure of the prosthesis at eight months because the diameter of the inferior concave curved surface was too small in the region of the posterior facet and had caused erosion of the posterior facet of the calcaneus. All three patients who were evaluated six to ten years postoperatively had a satisfactory result. All except one of the nine patients who were evaluated eleven to fifteen years postoperatively had a satisfactory result; the exceptional patient had an unsatisfactory result because the prosthetic stem had sunk into the talar neck. This patient had a revision thirteen years after the index operation. We believe that the talar body prosthesis can be used to replace the body of a talus with avascular necrosis or a severe crush fracture, thus maintaining the function of the ankle and the foot for a prolonged period.

Adult↗

PubMed1996

Biomechanical aspects of plating osteosynthesis of transverse clavicular fracture with and without inferior cortical defect.

OBJECTIVE: To find out whether superior or anterior plating osteosynthesis of clavicular fractures with and without inferior cortical defect provides more stability. DESIGN: The bearing of maximal bending moment of the osteosyntheses was determined by applying a load from a universal testing machine. BACKGROUND: A plate is recommended for internal fixation of the clavicular fracture. Stability of the osteosynthesis depends on placing of the plate at anterior or superior aspect of the clavicle. Whereas, the pattern of the fracture also influences stability. METHODS: Pairs of fresh cadaveric clavicles were used. The fractures were created at middle clavicle. Both superior and anterior plating fixation of both patterns of the fractures were performed. A compression load was applied at lateral end of the clavicle and maximal bending moment was calculated. RESULTS: For fractures without inferior cortical defect, the superior plating could withstand 12.05 (SD, 1.74) Nm and 8.69 (SD, 1.56) Nm for the anterior plating. For the fractures with inferior cortical defect, the superior plating could withstand 7.87 (SD, 2.58) Nm, but 10.26 (SD, 2.19) Nm for the anterior plating. CONCLUSIONS: The superior plating of the fracture without inferior cortical defect provides more stability against the bending moment than the anterior plating (P = 0.008). Whereas, the anterior plating of the fracture with inferior cortical defect provides more stability (P = 0.025). RELEVANCE: When plating a clavicular fracture without inferior cortical defect is performed, the plate should be placed at superior aspect of the clavicle for achieving more stability of the osteosynthesis against the bending moment. On the other hand, when the fracture has an inferior cortical defect, the plate should be placed at the anterior aspect of the clavicle.

Journal Article↗