American journal of surgery
-
The advantages of performing carotid endarterectomy in the awake patient have been presented based on a 13 year experience. Anesthesia consisted of either local infiltration of local lidocaine or regional neck block supplemented by intravenous sedation. ⋯ One hundred consecutive carotid endarterectomies have been reported with one late death and one mild, permanent neurologic deficit. These results support the belief that carotid endarterectomy can be performed with very low morbidity and mortality rates by operating on the awake patient.
-
Electrical current injuries involving the extremities occurred in 41 of 75 patients with electrical burns admitted to the Oregon Burn Center over an 11 year period. Based solely on physical findings, the muscle compartments of 27 limbs in 14 patients were promptly explored, decompressed, and debrided of necrotic tissue on admission. This resulted in the salvage of 10 useful extremities. ⋯ After exploration and fasciotomy, exposed tissues were protected with biologic dressings until repeated explorations and debridements demonstrated the absence of necrotic tissues and closure could be accomplished. The use of both local and free flaps was helpful in closing the wounds. No evidence or renal failure and no deaths attributable to retained necrotic tissue occurred.