In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery (from the Latin avellere, meaning "to tear off"). [1] The term most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures (i.e., subcutaneous tissue, muscle, tendons, or bone). This is similar to an abrasion but more severe, as body parts such as an eyelid or an ear can be partially or fully detached from the body.
The most common avulsion injury, skin avulsion often occurs during motor vehicle collisions. The severity of avulsion ranges from skin flaps (minor) to degloving (moderate) and amputation of a finger or limb (severe). Suprafascial avulsions are those in which the depth of the removed skin reaches the subcutaneous tissue layer, while subfascial avulsions extend deeper than the subcutaneous layer. [2] Small suprafascial avulsions can be repaired by suturing, but most avulsions require skin grafts or reconstructive surgery.
In rock climbing, a "flapper" is an injury in which parts of the skin are torn off, resulting in a loose flap of skin on the fingers. [3] This is usually the result of friction forces between the climber's fingers and the holds, arising when the climber slips off a hold.
To fix this injury and to be able to continue climbing, many climbers will apply sports tape to the flapped finger to cover up the sensitive area of broken skin. Some climbers may even use super-glue to adhere the loose skin back to the finger.
The ear is particularly vulnerable to avulsion injuries because of its position on the side of the head. [4] The most common cause of ear avulsions is human bites, followed by falls, motor vehicle collisions, and dog bites. [4] A partially avulsed ear can be reattached through suturing or microvascular surgery, depending on the severity of the injury. [5] [6] Microvascular surgery can also be used to reattach a completely avulsed ear, [7] [8] [9] but its success rate is lower because of the need for venous drainage. [10] [11] The ear can also be reconstructed with cartilage and skin grafts [10] or an external ear prosthesis can be made by an anaplastologist.
Eyelid avulsions are uncommon, [12] but can be caused by motor vehicle collisions, [13] dog bites, [14] [15] or human bites. [14] Eyelid avulsions are repaired by suturing after a CT scan is performed to determine where damage to the muscles, nerves, and blood vessels of the eyelid has occurred. [13] More severe injuries require reconstruction, however, this usually results in some loss of function and subsequent surgeries may be necessary to improve structure and function. [16] Microvascular surgery is another method of repair but is rarely used to treat eye avulsions. [15] Sometimes botulinum toxin is injected into the eyelid to paralyze the muscles while the eyelid heals. [13]
Trauma to the nail can cause the nail plate to be torn from the nail bed. [17] Unlike other types of avulsion, when a nail is lost, it is not typically reattached. Following the loss of the nail, the nail bed forms a germinal layer which hardens as the cells acquire keratin and becomes a new nail. [18] Until this layer has formed, the exposed nail bed is highly sensitive, and is typically covered with a non-adherent dressing, as an ordinary dressing will stick to the nail bed and cause pain upon removal. [19] In the average person, fingernails require 3 to 6 months to regrow completely, while toenails require 12 to 18 months.
In brachial plexus avulsions, the brachial plexus (a bundle of nerves that communicates signals between the spine and the arms, shoulders, and hands) is torn from its attachment to the spinal cord. One common cause of brachial plexus avulsions is when a baby's shoulders rotate in the birth canal during delivery, which causes the brachial plexus to stretch and tear. [20] It occurs in 1 to 2 out of every 1,000 births. [21] Shoulder trauma during motor vehicle collisions is another common cause of brachial plexus avulsions. [22] Detachment of the nerves can cause pain and loss of function in the arms, shoulders, and hands. Neuropathic pain can be treated with medication, but it is only through surgical reattachment or nerve grafts that function can be restored. [22] For intractable pain, a procedure called dorsal root entry zone (DREZ) lesioning can be effective. [22]
During a tooth avulsion, a tooth is completely or partially (such that the dental pulp is exposed) detached from its socket. Secondary (permanent) teeth can be replaced and stabilised by a dentist. [23] Primary (baby) teeth are not replaced because they tend to become infected and interfere with the growth of the secondary teeth. [23] A completely avulsed tooth that is replaced within one hour of the injury can be permanently retained. [23] The long-term retention rate decreases as the time that the tooth is detached increases, and eventually root resorption makes replacement of the tooth impossible. [23] To minimize damage to the root, the tooth should be kept in milk or sterile saline while it is outside the mouth. [23] [24]
During a periosteal avulsion, the periosteum (a fibrous layer that surrounds a bone) detaches the bone's surface. An example of a periosteal avulsion is an ALPSA (anterior labral periosteal sleeve avulsion).
An avulsion is sometimes performed surgically to relieve symptoms of a disorder, or to prevent a chronic condition from recurring. Small incision avulsion (also called ambulatory phlebectomy) is used to remove varicose veins from the legs in disorders such as chronic venous insufficiency. [25] A nail avulsion is performed to remove all or part of a chronic ingrown nail. [26] Facial nerve avulsion is used to treat the involuntary twitching involved in benign essential blepharospasm. [27] [28] However, it often requires additional surgeries to retain function [27] and botulinum toxin injections have been shown to be more effective than surgical avulsions in treating benign essential blepharospasm, while causing fewer complications. [28]
Otorhinolaryngology is a surgical subspecialty within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face, scalp, and neck.
Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery covers a wide range of specialties, including craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. This category of surgery focuses on restoring a body part or improving its function. In contrast, cosmetic surgery focuses solely on improving the physical appearance of the body. A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.
The brachial plexus is a network of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve. This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit, it supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand.
An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies. A set of specialized hairs known as lashes grow from the upper and lower eyelid margins to further protect the eye from dust and debris.
The musculocutaneous nerve is a mixed branch of the lateral cord of the brachial plexus derived from cervical spinal nerves C5-C7. It arises opposite the lower border of the pectoralis major. It provides motor innervation to the muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis. It provides sensory innervation to the lateral forearm. It courses through the anterior part of the arm, terminating 2 cm above elbow; after passing the lateral edge of the tendon of biceps brachii it is becomes known as the lateral cutaneous nerve of the forearm.
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Microsurgical techniques are utilized by several specialties today, such as general surgery, ophthalmology, orthopedic surgery, gynecological surgery, otolaryngology, neurosurgery, oral and maxillofacial surgery, endodontic microsurgery, plastic surgery, podiatric surgery and pediatric surgery.
A facelift, technically known as a rhytidectomy, is a type of cosmetic surgery procedure intended to give a more youthful facial appearance. There are multiple surgical techniques and exercise routines. Surgery usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Exercise routines tone underlying facial muscles without surgery. Surgical facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.
Klumpke's paralysis is a variety of partial palsy of the lower roots of the brachial plexus. The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb. The paralytic condition is named after Augusta Déjerine-Klumpke.
Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1. These injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult birth. Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery.
A brachial plexus injury (BPI), also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. These nerves originate in the fifth, sixth, seventh and eighth cervical (C5–C8), and first thoracic (T1) spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand.
The lateral pectoral nerve arises from the lateral cord of the brachial plexus, and through it from the C5-7.
Harry J. Buncke was an American plastic surgeon who has been called "The Father of Microsurgery" for his contributions in the history and development of reconstructive microsurgical procedures. He is a past president of the American Society for Surgery of the Hand, the International Society of Reconstructive Microsurgery, and the American Association of Plastic Surgery. He served as a clinical professor of surgery at both Stanford University and the University of California - San Francisco. He was the author of 15 movies and television tapes, four surgical textbooks, and more than 400 peer-reviewed publications.
Replantation or reattachment is defined as the surgical reattachment of a body part that has been completely cut from the body. Examples include reattachment of a partially or fully amputated finger, or reattachment of a kidney that had had an avulsion-type injury.
Degloving occurs when skin and the fat below it, the subcutaneous tissue, are torn away from the underlying anatomical structures they are normally attached to. Normally the subcutaneous tissue layer is attached to the fibrous layer that covers muscles known as deep fascia.
Jersey finger, also known as rugby finger, is a finger-related tendon injury that is common in sport and can result in permanent loss of flexion of the end of the finger if not surgically repaired. The injury is common when one player grabs another's jersey with the tips of one or more fingers while that player is pulling or running away. It is the most common closed flexor tendon injury and occurs in the ring finger in 75% of cases.
Flap surgery is a technique in plastic and reconstructive surgery where tissue with an intact blood supply is lifted from a donor site and moved to a recipient site. Flaps are distinct from grafts, which do not have an intact blood supply and relies on the growth of new blood vessels. Flaps are done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, wound contraction is to be avoided or to rebuild more complex anatomic structures like breasts or jaws.
Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma, such as can be caused by a fall, road traffic accident, assault, sports, or occupational injury. Typically, a tooth is held in place by the periodontal ligament, which becomes torn when the tooth is knocked out.
The cheek constitutes the facial periphery and plays a key role in the maintenance of oral competence and mastication. It is also involved in the facial manifestation of human emotion and supports neighboring primary structures.
A penile injury is a medical emergency that afflicts the penis. Common injuries include fracture, avulsion injury, strangulation, entrapment, and amputation.
Tooth replantation is a form of restorative dentistry in which an avulsed or luxated tooth is reinserted and secured into its socket through a combination of dental procedures. The purposes of tooth replantation is to resolve tooth loss and preserve the natural landscape of the teeth. Whilst variations of the procedure exist including, Allotransplantation, where a tooth is transferred from one individual to another individual of the same species. It is a largely defunct practice due to the improvements made within the field of dentistry and due to the risks and complications involved including the transmission of diseases such as syphilis, histocompatibility, as well as the low success rate of the procedure, has resulted in its practice being largely abandoned. Autotransplantation, otherwise known as intentional replantation in dentistry, is defined as the surgical movement of a tooth from one site on an individual to another location in the same individual. While rare, modern dentistry uses replantation as a form of proactive care to prevent future complications and protect the natural dentition in cases where root canal and surgical endodontic treatments are problematic. In the modern context, tooth replantation most often refers to reattachment of an avulsed or luxated permanent tooth into its original socket.
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