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Papers by Emmanuel Estrella

Research paper thumbnail of The Management of Diabetic Foot Ulcers in Patients with SARS-CoV-2 During the COVID-19 Pandemic

Acta Medica Philippina, 2021

Research paper thumbnail of Aneurysm of the superficial palmar arch

International Orthopaedics, 1995

We describe a case of compression of the median nerve by an aneurysm of the superficial palmar ar... more We describe a case of compression of the median nerve by an aneurysm of the superficial palmar arterial arch which presented with symptoms of the carpal tunnel syndrome. The traumatic and occupational nature of true palmar aneurysms are discussed. Nous rapportons une cause rare de compression du nerf médian par un anevrisme de l'arcade palmaire superficielle, se présentant comme un syndrome du canal carpien. La discussion porte sur l'origine traumatique et souvent professionelle des anevrismes palmaires.

Research paper thumbnail of Restoration of Elbow Flexion for Upper Trunk Brachial Plexus Injuries: Evaluation of Nerve Transfers and Modified Steindler Flexorplasty

Acta Medica Philippina

Introduction. In patients with delayed presentation between 6 to 12 months, surgical treatment gu... more Introduction. In patients with delayed presentation between 6 to 12 months, surgical treatment guidelines are not well defined in brachial plexus injury. Still, several authors have agreed that functional outcomes in patients treated within six months from the date of injury have the best results. Nerve transfers are still considered one of the treatment options in the said subset of patients even after six months. In contrast, a primary Steindler flexorplasty, or proximal advancement of the flexor-pronator group, is an ideal technique for elbow flexion with an elapsed time from injury >6 to 9 months. Objective. The purpose of this investigation was to compare the clinical outcome s of nerve transfers versus modified Steindler flexorplasty for the restoration of elbow flexion in upper type brachial plexus injuries (BPI). Methods. A retrospective review of 28 patients who underwent nerve transfers (NT) and 12 patients who underwent modified Steindler flexorplasty (MSF) was done to...

Research paper thumbnail of Investigation on the Level of Evidence in Researches Done by Orthopedic Residents of the Department of Orthopedics, Philippine General Hospital over the Past Twenty-seven Years

Research paper thumbnail of Vascularized Proximal Fibular Epiphyseal Transfer for Shoulder Reconstruction after Tumor Resection: A Case Report

Research paper thumbnail of Fascial versus Fascio-cutaneous Pedicled Sural Flaps in the Reconstruction of Distal Leg, Ankle and Foot Soft Tissue Defects

Research paper thumbnail of Non-Microsurgical Technique of Fingertip Replantation: A Report of Three Cases

Research paper thumbnail of Distal Radius Fractures: Relationship between Radiologic Parameters and Functional Outcome

Research paper thumbnail of Quality of life of patients with traumatic brachial plexus injuries

Research paper thumbnail of Material selection and design of external fixator clamp for metacarpal fractures

Materials Today: Proceedings

Research paper thumbnail of Risk Factors for Hand Wound Infections in People with Diabetes: A Case-control Study

Wound Management & Prevention

Research paper thumbnail of The Validity, Reliability and Internal Consistency of the Cross-Cultural Adaptation of the FIL-DASH (Filipino Version of the Disability of the Arm, Shoulder and Hand) Questionnaire in Patients with Traumatic Brachial Plexus Injuries

The Journal of Hand Surgery (Asian-Pacific Volume)

Background: The objective of this paper was to determine the validity, reliability and internal c... more Background: The objective of this paper was to determine the validity, reliability and internal consistency of the translated FILIPINO DASH (FIL-DASH) questionnaire in patients with traumatic brachial plexus injuries. Methods: Thirty-five adult patients with traumatic brachial plexus injury were enrolled in the validation stage. The same questionnaire was given to the patient between 7 to 14 days for the test-retest reliability. The validated Filipino version of the SF-36 was used as the gold standard to determine the construct validity of the translated DASH. We also compared the DASH score with the SF-36 total and subscale, validated Brief Pain Inventory Severity and Interference Scale and the Visual Acuity Scale (VAS) for Pain. Results: The internal consistency was adequate, with Cronbach’s Alpha for the 30 items of 0.93 and an average inter-item covariance of 0.399. The test-retest reliability was 0.87 (p < 0.001). There was no significant difference in establising the validi...

Research paper thumbnail of Report on the 11th Asian Pacific Federation of Societies for Surgery of the Hand (APFSSH)

The Journal of Hand Surgery (Asian-Pacific Volume)

Research paper thumbnail of A Comparison of Vascularized Free Fibular Flaps and Nonvascularized Fibular Grafts for Reconstruction of Long Bone Defects after Tumor Resection

Journal of Reconstructive Microsurgery, 2016

Background The use of the fibula autograft has been a reliable method in the reconstruction of lo... more Background The use of the fibula autograft has been a reliable method in the reconstruction of long bone defects after tumor resection. The objective of this study was to report the outcomes fibular grafting in terms of graft union, functional score, complications, and oncologic outcome. Methods A retrospective review of patients with fibular grafting after tumor resection was done from January 1, 1993 to December 31, 2013. The primary outcome was graft union and the revised musculoskeletal tumor society scoring system (MSTS score). The secondary outcomes were oncologic outcomes, complications, and the factors associated with graft union. Results A total of 52 patients with a mean follow-up of 42 months (SD, 33; range, 12-132 months) were included. The overall union for all fibular grafts was 37 of 52. The use of vascularized free fibula flaps had a higher union rate compared with nonvascularized fibula grafts. The use of a vascularized free fibular flap was four times likely to unite (95% CI 1.1-12.8, p = 0.039) compared with nonvascularized fibular grafts. The mean MSTS score in 36 patients was 82.5 (SD, 12.9) at 35 months from surgery (SD, 30). A total of 39 complications were present in 29 patients. On final follow-up, 45 of 52 patients were alive, six patients had died of disease and one died of other causes. Conclusion A higher union rate was achieved using vascularized free fibular flaps compared with nonvascularized fibular grafts for long bone reconstruction after tumor resection. There was no difference in terms of MSTS score between the two types of grafts.

Research paper thumbnail of Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients

Research paper thumbnail of Evaluation of C5 Nerve Root Repairability in Traumatic Brachial Plexus Injuries: Proposal of an Evaluation Scoring System

Journal of Reconstructive Microsurgery, Feb 1, 2008

We reviewed 36 traumatic brachial plexus injury patients with C5 nerve root injury. We used the c... more We reviewed 36 traumatic brachial plexus injury patients with C5 nerve root injury. We used the choline acetyltransferase (CAT) activity measurement as a gold standard indicator of repairability to assess the reliability of the conventional techniques (preoperative clinical, electrophysiologic, and radiologic examination and intraoperative clinical and electrophysiologic examinations). We proposed a repairability scoring system composed of the correlated conventional techniques and tested the validity of this scoring system using the same reference technique (CAT activity measurement). We found no significant correlation between sensation at C5 dermatome and electromyography study with C5 repairability. On the other hand, we found a significant correlation of Tinel sign, myelography, macroscopic and microscopic examination, and electrical stimulation with C5 repairability. Based on these results, we propose a simple 21-point scoring system to evaluate the repairability of C5 nerve root that is composed of Tinel sign, myelography, macroscopic and microscopic appearance, and electrical stimulation. The scoring system was found to be highly significantly correlated with C5 repairability. We concluded that our proposed evaluation scoring system is a reliable method for C5 repairability evaluation, and it can replace sophisticated techniques.

Research paper thumbnail of Functional Outcomes of Reconstruction for Soft Tissue Sarcomas of the Foot and Ankle

The Foot and Ankle Online Journal, 2009

Research paper thumbnail of Vascularised fibula graft for tumours

Research paper thumbnail of The "local dorsal adipofascial flap" for volar digital defects: a case report

Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 2011

The coverage of volar digital defects can be achieved by a variety of surgical options. Although ... more The coverage of volar digital defects can be achieved by a variety of surgical options. Although frequently used and reliable, these procedures entail the need for a second stage for flap release, meticulous dissection, sacrifice of a digital artery of the uninvolved digit, or delayed mobilization resulting in digital stiffness. The ideal surgical procedure for such defects should be a simple, single-stage surgery that allows early mobilization and return to function and at the same time avoiding unnecessary donor site morbidity from an uninvolved digit. The "local dorsal adipofascial flap" is a simple procedure that does not need a secondary procedure for flap release and affords early range of motion and return to function. We used this new flap technique in two digits with volar defects in a single patient. At ten months after flap coverage, the fingers were fully functional with good healing of the "local dorsal adipofascial flap."

Research paper thumbnail of Arthroscopically assisted reduction with volar plating or external fixation for displaced intra-articular fractures of the distal radius in the elderly patients

Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 2007

Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treat... more Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treated with arthroscopically assisted reduction combined with volar plating or external fixation. The patients were followed up for an average of 24.9 +/- 16.1 months. The average score was 80.1 +/- 10.5 according to the modified system of Green and O'Brien. Eight patients had an excellent result, 11 had a good result, seven had a fair result, and two had a poor result. Twenty-three patients were able to return to their previous activities level or occupation without any restriction. On the basis of these results, we concluded that arthroscopically assisted reduction combined with volar plating or external fixation is one of the useful options for the treatment of a displaced intra-articular fracture of the distal radius in elderly patients who are physiologically young or active.

Research paper thumbnail of The Management of Diabetic Foot Ulcers in Patients with SARS-CoV-2 During the COVID-19 Pandemic

Acta Medica Philippina, 2021

Research paper thumbnail of Aneurysm of the superficial palmar arch

International Orthopaedics, 1995

We describe a case of compression of the median nerve by an aneurysm of the superficial palmar ar... more We describe a case of compression of the median nerve by an aneurysm of the superficial palmar arterial arch which presented with symptoms of the carpal tunnel syndrome. The traumatic and occupational nature of true palmar aneurysms are discussed. Nous rapportons une cause rare de compression du nerf médian par un anevrisme de l'arcade palmaire superficielle, se présentant comme un syndrome du canal carpien. La discussion porte sur l'origine traumatique et souvent professionelle des anevrismes palmaires.

Research paper thumbnail of Restoration of Elbow Flexion for Upper Trunk Brachial Plexus Injuries: Evaluation of Nerve Transfers and Modified Steindler Flexorplasty

Acta Medica Philippina

Introduction. In patients with delayed presentation between 6 to 12 months, surgical treatment gu... more Introduction. In patients with delayed presentation between 6 to 12 months, surgical treatment guidelines are not well defined in brachial plexus injury. Still, several authors have agreed that functional outcomes in patients treated within six months from the date of injury have the best results. Nerve transfers are still considered one of the treatment options in the said subset of patients even after six months. In contrast, a primary Steindler flexorplasty, or proximal advancement of the flexor-pronator group, is an ideal technique for elbow flexion with an elapsed time from injury >6 to 9 months. Objective. The purpose of this investigation was to compare the clinical outcome s of nerve transfers versus modified Steindler flexorplasty for the restoration of elbow flexion in upper type brachial plexus injuries (BPI). Methods. A retrospective review of 28 patients who underwent nerve transfers (NT) and 12 patients who underwent modified Steindler flexorplasty (MSF) was done to...

Research paper thumbnail of Investigation on the Level of Evidence in Researches Done by Orthopedic Residents of the Department of Orthopedics, Philippine General Hospital over the Past Twenty-seven Years

Research paper thumbnail of Vascularized Proximal Fibular Epiphyseal Transfer for Shoulder Reconstruction after Tumor Resection: A Case Report

Research paper thumbnail of Fascial versus Fascio-cutaneous Pedicled Sural Flaps in the Reconstruction of Distal Leg, Ankle and Foot Soft Tissue Defects

Research paper thumbnail of Non-Microsurgical Technique of Fingertip Replantation: A Report of Three Cases

Research paper thumbnail of Distal Radius Fractures: Relationship between Radiologic Parameters and Functional Outcome

Research paper thumbnail of Quality of life of patients with traumatic brachial plexus injuries

Research paper thumbnail of Material selection and design of external fixator clamp for metacarpal fractures

Materials Today: Proceedings

Research paper thumbnail of Risk Factors for Hand Wound Infections in People with Diabetes: A Case-control Study

Wound Management & Prevention

Research paper thumbnail of The Validity, Reliability and Internal Consistency of the Cross-Cultural Adaptation of the FIL-DASH (Filipino Version of the Disability of the Arm, Shoulder and Hand) Questionnaire in Patients with Traumatic Brachial Plexus Injuries

The Journal of Hand Surgery (Asian-Pacific Volume)

Background: The objective of this paper was to determine the validity, reliability and internal c... more Background: The objective of this paper was to determine the validity, reliability and internal consistency of the translated FILIPINO DASH (FIL-DASH) questionnaire in patients with traumatic brachial plexus injuries. Methods: Thirty-five adult patients with traumatic brachial plexus injury were enrolled in the validation stage. The same questionnaire was given to the patient between 7 to 14 days for the test-retest reliability. The validated Filipino version of the SF-36 was used as the gold standard to determine the construct validity of the translated DASH. We also compared the DASH score with the SF-36 total and subscale, validated Brief Pain Inventory Severity and Interference Scale and the Visual Acuity Scale (VAS) for Pain. Results: The internal consistency was adequate, with Cronbach’s Alpha for the 30 items of 0.93 and an average inter-item covariance of 0.399. The test-retest reliability was 0.87 (p < 0.001). There was no significant difference in establising the validi...

Research paper thumbnail of Report on the 11th Asian Pacific Federation of Societies for Surgery of the Hand (APFSSH)

The Journal of Hand Surgery (Asian-Pacific Volume)

Research paper thumbnail of A Comparison of Vascularized Free Fibular Flaps and Nonvascularized Fibular Grafts for Reconstruction of Long Bone Defects after Tumor Resection

Journal of Reconstructive Microsurgery, 2016

Background The use of the fibula autograft has been a reliable method in the reconstruction of lo... more Background The use of the fibula autograft has been a reliable method in the reconstruction of long bone defects after tumor resection. The objective of this study was to report the outcomes fibular grafting in terms of graft union, functional score, complications, and oncologic outcome. Methods A retrospective review of patients with fibular grafting after tumor resection was done from January 1, 1993 to December 31, 2013. The primary outcome was graft union and the revised musculoskeletal tumor society scoring system (MSTS score). The secondary outcomes were oncologic outcomes, complications, and the factors associated with graft union. Results A total of 52 patients with a mean follow-up of 42 months (SD, 33; range, 12-132 months) were included. The overall union for all fibular grafts was 37 of 52. The use of vascularized free fibula flaps had a higher union rate compared with nonvascularized fibula grafts. The use of a vascularized free fibular flap was four times likely to unite (95% CI 1.1-12.8, p = 0.039) compared with nonvascularized fibular grafts. The mean MSTS score in 36 patients was 82.5 (SD, 12.9) at 35 months from surgery (SD, 30). A total of 39 complications were present in 29 patients. On final follow-up, 45 of 52 patients were alive, six patients had died of disease and one died of other causes. Conclusion A higher union rate was achieved using vascularized free fibular flaps compared with nonvascularized fibular grafts for long bone reconstruction after tumor resection. There was no difference in terms of MSTS score between the two types of grafts.

Research paper thumbnail of Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients

Research paper thumbnail of Evaluation of C5 Nerve Root Repairability in Traumatic Brachial Plexus Injuries: Proposal of an Evaluation Scoring System

Journal of Reconstructive Microsurgery, Feb 1, 2008

We reviewed 36 traumatic brachial plexus injury patients with C5 nerve root injury. We used the c... more We reviewed 36 traumatic brachial plexus injury patients with C5 nerve root injury. We used the choline acetyltransferase (CAT) activity measurement as a gold standard indicator of repairability to assess the reliability of the conventional techniques (preoperative clinical, electrophysiologic, and radiologic examination and intraoperative clinical and electrophysiologic examinations). We proposed a repairability scoring system composed of the correlated conventional techniques and tested the validity of this scoring system using the same reference technique (CAT activity measurement). We found no significant correlation between sensation at C5 dermatome and electromyography study with C5 repairability. On the other hand, we found a significant correlation of Tinel sign, myelography, macroscopic and microscopic examination, and electrical stimulation with C5 repairability. Based on these results, we propose a simple 21-point scoring system to evaluate the repairability of C5 nerve root that is composed of Tinel sign, myelography, macroscopic and microscopic appearance, and electrical stimulation. The scoring system was found to be highly significantly correlated with C5 repairability. We concluded that our proposed evaluation scoring system is a reliable method for C5 repairability evaluation, and it can replace sophisticated techniques.

Research paper thumbnail of Functional Outcomes of Reconstruction for Soft Tissue Sarcomas of the Foot and Ankle

The Foot and Ankle Online Journal, 2009

Research paper thumbnail of Vascularised fibula graft for tumours

Research paper thumbnail of The "local dorsal adipofascial flap" for volar digital defects: a case report

Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 2011

The coverage of volar digital defects can be achieved by a variety of surgical options. Although ... more The coverage of volar digital defects can be achieved by a variety of surgical options. Although frequently used and reliable, these procedures entail the need for a second stage for flap release, meticulous dissection, sacrifice of a digital artery of the uninvolved digit, or delayed mobilization resulting in digital stiffness. The ideal surgical procedure for such defects should be a simple, single-stage surgery that allows early mobilization and return to function and at the same time avoiding unnecessary donor site morbidity from an uninvolved digit. The "local dorsal adipofascial flap" is a simple procedure that does not need a secondary procedure for flap release and affords early range of motion and return to function. We used this new flap technique in two digits with volar defects in a single patient. At ten months after flap coverage, the fingers were fully functional with good healing of the "local dorsal adipofascial flap."

Research paper thumbnail of Arthroscopically assisted reduction with volar plating or external fixation for displaced intra-articular fractures of the distal radius in the elderly patients

Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 2007

Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treat... more Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treated with arthroscopically assisted reduction combined with volar plating or external fixation. The patients were followed up for an average of 24.9 +/- 16.1 months. The average score was 80.1 +/- 10.5 according to the modified system of Green and O'Brien. Eight patients had an excellent result, 11 had a good result, seven had a fair result, and two had a poor result. Twenty-three patients were able to return to their previous activities level or occupation without any restriction. On the basis of these results, we concluded that arthroscopically assisted reduction combined with volar plating or external fixation is one of the useful options for the treatment of a displaced intra-articular fracture of the distal radius in elderly patients who are physiologically young or active.