Annals of plastic surgery
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Annals of plastic surgery · Jul 1986
Successful treatment of acute head and neck dog bite wounds without antibiotics.
Dog bites continue to be the most common bite injury in the United States. We previously reported a series of 61 patients with 215 dog bite wounds. Of these, 55 patients had 188 dog bite wounds of the head and neck area which were treated with copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic coverage, wound closure, and close postoperative monitoring. ⋯ Our present study uses the same protocol with the exclusion of antibiotic coverage. Our series of 49 patients with 145 head and neck wounds reveals a wound infection rate of 1.4% and a patient infection rate of 4%. This is not statistically significantly different from the outcome of the previous study.
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Annals of plastic surgery · Feb 1986
Hemodynamic alterations secondary to an electrical burn in the rat: a pilot study.
Rats subjected to a standard electrical burn of 250 volts for 10 seconds receive a severe injury stimulating a pronounced systemic circulatory response. Initial postinjury hyperemia is replaced by a low perfusion state within 24 hours. Our study demonstrates the difficulty in isolating regional microcirculatory alterations under such circumstances. Modification of the burn model or the method of fluid resuscitation may minimize the influence of this dynamic systemic response.
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Eleven circumscribed, full-thickness burns were treated in 9 patients with immediate excision and primary closure of the defect or by using a variety of local random cutaneous and musculocutaneous flaps. The burns were located on the face, trunk, and extremities. In 2 patients this technique was used in the management of smaller burns on one surface of the body, thus facilitating skin grafting of larger wounds on the opposite surface. ⋯ The timing of the excision and closure varied from 2 hours to 2 weeks following thermal injury, with no postoperative wound infections. In selected cases primary excision of deep burns and closure by use of local tissue approach ideal treatment. With certainty of the depth of destruction, this procedure should be carried out regardless of locality when technically and anatomically feasible.
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Annals of plastic surgery · Mar 1985
Experimental study of vascularized nerve grafts: morphometric study of axonal regeneration of nerves transplanted into silicone tubes.
Rat sciatic nerves were used in a comparative study of vascularized and free (nonvascularized) nerve grafts transplanted into silicone tubes. A total of 39 sciatic nerves were used, 21 as vascularized nerve grafts and 18 as free nerve grafts. ⋯ Furthermore, the diameters of myelinated axons in the vascularized nerve graft were larger than those in the free nerve graft at all specimen sites during all postoperative weeks. We suggest that the preservation of the vascular system in vascularized nerve grafts would decrease the likelihood of fibrosis and result in better regeneration of axons.
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The oft-quoted 5-cm rule for melanoma excision is not valid. Substitute guidelines are offered and their scientific basis is discussed. A 1-2-3-cm rule is carefully outlined in terms of maximum rather than minimum margins, because little evidence exists to support the importance of wide excision limits in the treatment of melanoma.