Canadian journal of surgery. Journal canadien de chirurgie
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The sequence of events occurring after fracture is now relatively well understood. Healing takes place in three phases--inflammatory, reparative and remodelling. ⋯ Factors that influence fracture healing are both local and systemic; the former include particularly the degree of local trauma and bone loss, the type of bone affected, the degree of immobilization and local pathologic conditions; the latter include age, hormones, local stress and electric currents. Natural processes of healing should be allowed to take their usual course and interference should be attempted only when there is demonstrable need or substantial advantages for the patient.
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Review
Results of minor foot amputations for ischemia of the lower extremity in diabetics and nondiabetics.
Results of 208 minor amputations were analyzed in 179 patients who had no food pulses. Wound healing was assessed at 3 months in relation to diabetes and previous vascular surgery. ⋯ Transmetatarsal amputation should be considered more often as a conservative amputation for gangrene of the toes. The absence of a palpable posterior tibial pulse is a contraindication to the Syme's amputation.
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In a 5-year period (1968 to 1973) 33 cases of vascular compartment syndrome were seen. Seven case reports illustrate various etiopathogenetic factors in the development of vascular compartment syndrome. ⋯ Mild cases may be treated by application of ice, elevation, and observation; for severe cases fasciotomy is the treatment of choice. Two techniques of fasciotomy are available: multiple skin incisions with fasciotomy between the incisions for single-compartment sydnromes and extensive skin incisions over the length of the fasciotomy for multicompartment syndromes or severe single-compartment syndromes.
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Through an artificially created carotid-cavernous fistula, the cavernous sinus of four suitable cadavers was perfused at a constant input pressure of 50 cm H20 at various levels of intracranial pressure. The flow rate fell 25% at an intracranial pressure of 50 mm Hg but could not be totally arrested even at the extremes of intracranial hypertension. The authors conclude that the cavernous sinus in man is not collapsible.