Extremidad superior gravemente lesionada. Reporte de un caso clínico. [Mangled upper extremity. Case report]

• Sánchez Villanueva, Francisco Javier ^[1] ; Suárez Villalobos, Pablo ^[1] ; Grau Núñez, Luis ^[1] ; Sepúlveda Oviedo, Matías ^[1]
  1. [1] Hospital Base Valdivia, Chile
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 84, Nº. 1, 2019, págs. 63-69
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2019.84.1.806
• Títulos paralelos:
  • Mangled upper extremity. Case report.
• Enlaces
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• Resumen
  • español

    Se presenta un paciente con una extremidad superior gravemente lesionada por arma de fuego. Inicialmente fue tratado con múltiples limpiezas quirúrgicas y colocación de tutor externo AO. El tratamiento definitivo consistió en tutor externo monolateral, además de injerto estructural de cresta ilíaca. Durante el manejo inicial, se detecta lesión del nervio radial, con nervio en continuidad. Dado el proceso cicatricial y la infección de partes blandas, no se logra manejar en la etapa aguda. Posteriormente se realizan transferencias tendinosas para nervio radial. La evolución fue favorable y la función de la extremidad superior resultó satisfactoria. Se comunica este caso debido a su complejo manejo a causa de las lesiones óseas, neurovasculares, cutáneas y de partes blandas. 

  • English

    We present a patient with a severely injured upper extremity due to a shotgun. Patient was initially managed with multiple surgical debridements and an AO external fixator. Final treatment was performed with a monolateral external fixator, in addition to an iliac crest structural bone graft. During initial management, a radial nerve injury was observed; the nerve was intact, though devitalized. Given the scarring process and soft tissue infection, treatment was performed in the acute phase. Subsequently, tendon transfers were made to treat a radial nerve injury. Patient evolved favorably and regained adequate function of the upper extremity.This case is presented due to its complex management due to bone, neurovascular, skin, and soft tissue involvement.

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