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Rehabilitation of post-traumatic deficits of the upper and lower limb


Rehabilitation of post-traumatic deficits of the upper and lower limb

1.Rehabilitation of post-traumatic deficits of the upper and lower limb

The upper and lower limb traumas, as result of car, work or other accidents, are initially addressed from doctors of other specialties (surgeons, orthopedics etc), either because traumas that is necessary to be addressed first co-exist, in order to stabilize the patient, either because there is no plastic surgeon available. After the first treatment and problem siolution such as a fracture osteosynthesis, the reconstructive surgeon is called to address various problems.

Those could derive from the injury, like extruding bones, osteosynthesis materials, tendon nerve vessels, etc, which need to be covered with well-blooded tissues. Some problems may appear afterwards (even after years), such as the reveal of osteosynthesis matrials, and chronic osteonyelitis

The plastic surgeon is to provide solutions for all these problems, which will ensure the viability of the limb, the full or at least satisfactory functional rehabilitation and the improvement of its appearance.

A line of operations is often necessary to achieve the desired result. In some cases, the only solution is the microsurgery, namely the tissue transport (bones, muscles etc) from other body areas, with the use of surgical microscope and the appropriate equipment, which demands increased operational time.

2. Rehabilitation of problematic amputated stumps

Patients who had to be amputated from traumas or oncological reasons, need prosthetic limbs so they can walk again. However, chronic ulcus in the pressure points are created, which derive from the inadequate coverage with healthy and well-blooded tissues of the bone edges of the amputated stump.

Ulcus may often appear after the amputation, never allowing the patient to be able to use prosthetic limbs.

The treatment includes various methods, simple or complex, depending on the problem and the capability and mood of the patient to succumb to hourly operations.

For example, after the surgical cleaning of the ulcus, a simple shortening of the calf bone (for amputations under the knee) may provide surplus of tissues which can easily cover the bone and provide a new, healthy amputated stump.

In other cases, the calf bone may be not long enough (in close distance to the knee) and an extra shortening may not be possible. The patient has to choose between the simple procedure of the further amputation above the knee, which will, however, remove this valuable joint and the complex operation of microscopic tissue transplant from other body parts that will cover the bone and save the joint.

In any case, the knee joint (if exists) must be preserved, because it ensures better walking, better capability to make our daily activities and a more natural way of life in the end. It is worth mentioning that the patient who was amputated under the knee needs 25% more energy to walk compared to a normal man, but this percentage is increased to 65% for those who were amputated abobe the knee!!!

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