The American surgeon
-
The American surgeon · May 1998
Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study.
Necrotizing fasciitis is an aggressive soft-tissue infection that in the past has carried a significant mortality rate. One of the most important determinants of outcome is recognition of the disease process. This is followed by aggressive resuscitation measures and radical debridement at the initial operation to control the infectious spread at the outset. ⋯ Early recognition and expeditious initial wide excision and debridement along with appropriate antibiotic coverage and support of systemic effects of necrotizing fasciitis serve to decrease morbidity and mortality. We believe the above is an absolute necessity followed by frequent washing and minor debridement of the wound until granulating tissue is observed. This can then be followed by procedures to close/cover the surgical defect (i.e., split-thickness skin grafts or various coverage flaps).
-
The American surgeon · May 1998
Blunt splenic trauma: characteristics of patients requiring urgent laparotomy.
In victims of blunt abdominal trauma, the spleen is the most common organ damaged, it is the most likely source of serious injury, and is associated with significant morbidity and mortality. The participants in this study were emergency department (ED) patients with splenic trauma determined via imaging study, surgical exploration, or autopsy. Patients were located using both the institution's trauma registry and discharge diagnoses (ICD-9 codes) involving splenic injury resulting from blunt trauma. ⋯ Complaints of pain resulting from traumatic injury and abdominal examination findings did not identify patients requiring urgent operative management. Hemodynamic instability, evidence of multiple injuries, abnormal laboratory parameters, and the requirement for blood transfusion in the ED identifies a patient population likely to require operative therapy of their splenic injury. Emergency physicians should consider early surgical consultation or urgent transfer to the regional trauma center in patients with these characteristics.
-
The American surgeon · May 1998
The prevalence and effect of alcohol and drug abuse on cohort-matched critically injured patients.
A prospective study was undertaken at a Level I trauma center to evaluate the prevalence of substance use among victims of major trauma, along with the impact on clinical outcome. Five hundred sixteen patients had urine toxicology and blood alcohol screens performed and correlated with pattern and severity of injury, hospital course, and outcome. Three hundred seventy-one patients (71%) screened positive for alcohol or drugs, or both. ⋯ Univariate analysis revealed patterns of alcohol/drug use varied among subgroups according to demographics (less use among patients older than 55 years, females and Asians; more drug use in blacks; more alcohol use in Hispanics), mechanism of injury (non-use in blunt trauma patients and use of both in penetrating trauma patients) and body region injured (non-use in head-injured patients). Septic complications and mortality were more correlative with severity of injury, but not with use or non-use of alcohol or drugs. We conclude that alcohol and drug use remains a major comorbid factor in major trauma, and that injury prevention efforts should include a strong focus on counseling regarding these lifestyle choices.
-
The American surgeon · Apr 1998
Review Case ReportsMeandering bullet in the pericardial sac: to remove or not to remove.
Patients with bullets in the pericardial sac without obvious myocardial injuries are rare, making it difficult to analyze the natural history and propose management approaches. We present the case of a meandering bullet in the pericardial sac and a review of the literature.