The American surgeon
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The American surgeon · Dec 2011
Comparative StudyManagement of fasciotomy wounds--does the dressing matter?
Fasciotomy is a limb-saving procedure in the management of ischemic extremities. Little evidence exists as to the best method of fasciotomy wound management. We hypothesized that the use of vacuum dressing (VAC) or creation of dynamic tension (DYN) would increase rates of primary closure, reducing the need for split thickness skin grafting (STSG). ⋯ A trend toward more primary closure was seen in the DYN group. LOS was longer for patients receiving STSG. The DYN cohort had a significantly shorter LOS.
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The American surgeon · Dec 2011
Comparative StudyOutcomes and long term follow-up after emergent cricothyroidotomy: is routine conversion to tracheostomy necessary?
The purpose of this study is to identify factors associated with survival after cricothyroidotomy (CRIC), and to ascertain long-term outcomes in patients simply decannulated after CRIC versus those revised to tracheostomy. All CRICs between October 1, 1995 and June 20, 2010 were reviewed. Patients were contacted by phone, visited at their last known address, or queried in the Center for Disease Control's National Death Index. ⋯ At follow-up, no patient in either group had suffered a clinically evident airway complication. The need for cardiopulmonary resuscitation before or during CRIC portends poorly for neurologically intact survival. Simple decannulation is appropriate for CRIC patients when their need for airway protection has resolved.
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The American surgeon · Dec 2011
Comparative StudyLactate in trauma: a poor predictor of mortality in the setting of alcohol ingestion.
Resuscitation end point markers such as lactate and base deficit (BD) are used in trauma to identify and treat a state of compensated shock. Lactate and BD levels are also elevated by alcohol. In blunt trauma patients with positive blood alcohol levels, lactate may be a poor indicator of injury. ⋯ Linear regression showed lactate is not a significant predictor of mortality. Regardless of Injury Severity Score, lactate appeared to be more often abnormal than BD in the setting of alcohol ingestion. Additionally, because BD, and not lactate, was shown to be an independent predictor of mortality, lactate may not be a reliable marker of end point resuscitation in this patient population.
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The American surgeon · Dec 2011
Comparative StudyRegional block anesthesia for mastectomy: a community hospital experience.
This report describes a community hospital experience with regional anesthesia for mastectomy. The authors believe this is a modality deserving of wider application. This report is intended to illuminate the benefits of the approach.