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The femoral artery sends blood flow to the deep muscles of the thigh, before passing through the adductor hiatus and becoming the popliteal artery. Genicular arteries from the popliteal artery, provides the supply to the knee joint. Similar to the venous system of the upper extremity, the venous system of the lower extremity has valves that help in returning the blood back to the heart against the force of gravity.
Voluntary motor control of the knee is steered by the central nervous system, cerebral cortex. Communication from the periphery to the brain comes from receptors. The receptors are located in the joint capsule and in the muscle spindles, and send signals to the reticular formation and cerebellum about position of the joint and speed of movement. Enhanced with the vestibular centre and ocular vision, as well as the superficial receptors of the skin, these structures allow precision estimation of the limb position in relation to the external environment.
It is better to go to considerable trouble to prevent pressure sores than to have to treat them because they are difficult to heal. Small sores will often heal with simple dressings, after removal of sloughs if necessary. The most important factor in successful treatment is to avoid further pressure. Large sores.
may require wide surgical excision and skin grafting, often by the rotation of thick flaps of skin and subcutaneous tissue. Chronic peripheral ulcers, caused by pressure and usually associated with sensory loss can often be healed by enclosing the limb in a series of ‘ skin-tight ’plaster – casts and avoiding weight – bearing until healing has occurred.
Any recurrent hematoma or recurrent bleeding
which is apparently inexplicable should arouse
suspicion of self – infliction. The dorsum of the
hand and wrist is a particularly common sight. A
period in a plaster – cast will usually allow healing, but the damage may recur when the plaster is removed. These injuries often cease when their cause has been discovered.
Those cases developing during pregnancy often
settle after delivery. A trial of plaster back – slab to immobilize the wrist is often useful. An injection of asteroid preparation into the carpal tunnel is often helpful, but persistent cases can be relieved quickly by operative decompression of the carpal tunnel, although muscle wasting may be permanent.
Nerve injuries can usually be accurately diagnosed by careful consideration of the detailed neurological anatomy. A systematic examination should be carried out, recording the power of all muscle groups, the distribution of sensory loss to various modalities, and the presence or absence of reflexes. In the difficult case, electromyography or conduction studies and occasionally myelography may help to clarify the diagnosis and the prognosis. These tests are also valuable in following the progress of denervation and recovery.
Recovery follows in the same way as after axonotmesis, but the reconnections of fibers and end – organs are likely to be much less satisfactory. Regeneration rarely occurs unless
the nerve ends are opposed. At best, recovery tends to be incomplete, although the prognosis is much better in children. Clean divisions, with little trauma on either side of the lesion, have the best prognosis, and the more peripheral the lesion, the better the outlook.
This is possible with clean wounds and cleanly
divided nerves. It is usually necessary to cut back the nerve ends to remove nerve tissue damaged by bleeding within the sheath. If much cutting back or excision of a length has been necessary, the nerve will have to be mobilized up and down the limb and perhaps the joints fl exed to allow apposition. On occasions the nerve ends are glued together.
This can be carried out when the skin wound is
healed and up to 6 months after the injury. The
scarred and thickened junction is excised and
again the nerve is mobilized and the sheath
sutured. The secondary suture may require more excision of the nerve, but operative conditions and expertise may be more favorable. After both methods of suture, the repair is protected by immobilizing the joints for several weeks.
If the gap is too great for suturing, grafting is possible, using a sensory nerve such as the sural which can be sacrificed without too much functional loss. Nerve grafts can be bundled together to allow several strips of small nerve to function as a larger nerve. Results tend to be indifferent. An interesting experimental technique involves the use of strips of muscle as a nerve graft.
During the last couple of years the city of Baroda has witnessed variety of educational, social, religious & many other activities from the stage of VAISHVI ORTHOPEDIC HOSPITAL.
G-2|3|4 Status Avenue, 9, Sampatroa Colony, Jetalpur Road, Vadodara, Gujarat
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