Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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In a prospective study of 50 consecutive patients primary wound closure was examined on cases with contaminated wounds. In 42 patients the period from the injury to the attendance of the ambulance ranged from 12 to 72 hours. Eight wounds were butcher's knife lesions in professionally exposed persons. ⋯ After removing sutures undisturbed healing was observed in both cases. Due to these results we no longer see a contraindication in the primary closure of contaminated wounds. With careful debridement and conscientious wound control during the first 72 hours, primary suture is of low risk, comfortable to the patients and cost saving.
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Retrospective analysis of 725 patients with perforated gastroduodenal ulcer treated at our institution between 1946 and 1985 revealed an increase of hospital mortality from 13.5 percent (1946-1955) to 19.5 percent (1976-1985). Age, site of perforation, interval and the degree of peritonitis were identified as significant prognosticators. Changes of these features are held responsible for increased hospital mortality of patients with perforated gastroduodenal ulcer.
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During a period when 6 patients were operated following a cardiac stab wound 4 patients survived the procedure. In 45 persons forensic autopsies were performed. ⋯ But this situation must be treated very quickly avoiding cardiac arrest due to cardial blockage. In contrast to the autopsies in the clinical group no atrial wounds or incisions of coronary arteries were observed.