J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized trial of absorbable staple fixation of skin grafts for burn wound coverage.
A prospective randomized trial of absorbable versus metal skin staples for securing skin grafts to excised burn wounds was performed in 20 patients. The absorbable staples were easy to use and efficacious in securing the skin grafts, except to edematous fatty tissue. ⋯ A decrease of 61.4 minutes of the most significantly painful portion of the postoperative dressing change (i.e., staple removal) would have been avoided by using absorbable staples. The overall cost of using the absorbable staples for small burns was comparable with metal staples; however, the cost difference was significantly greater for large burns.
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Review Case Reports
Successful nonoperative management of secondarily infected pulmonary pseudocyst: case report.
Pulmonary contusion is a frequent sequelae of blunt chest trauma. If significant shear forces are encountered during energy transfer to the chest wall, pulmonary laceration may result. ⋯ However, secondary infection of a posttraumatic laceration often leads to serious complications that may be lethal. We report a case of a secondarily infected pulmonary laceration resulting from blunt trauma that was successfully treated by computerized tomogram-guided drainage and review the literature on this unusual complication.
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The demographics and outcome of patients with gunshot wounds to the head over the past 10 years at Chicago's Cook County Hospital was examined. The study group consisted of 476 consecutive patients admitted to this urban level I trauma center with a diagnosis of penetrating craniocerebral missile injury. All patients followed a protocol that included aggressive surgical management when indicated. ⋯ A large proportion of this violence is most likely attributable to gang activity. Factors correlating with poor outcome included hypotension, apnea, bihemispheric injuries, or ventricular penetration. Although aggressive surgical and medical management improves the outcome of these patients, much more stringent preventative measures are required to control this violent epidemic.
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Pulmonary embolism in reamed femoral nailing has been reported and discussed over recent years. Does an unreamed nailing technique with a solid nail prevent this rare but serious complication of intramedullary fixation? In an animal model in rabbits, we studied the pathophysiologic impact on pulmonary function and the impact on hemostasis of reamed and unreamed nailing of intact femora and tibiae, and of femoral fracture in relation to intramedullary pressure. No statistical difference of PaO2, PaCO2, and PCO2et was found in the femur whether a reamed or unreamed procedure was performed. ⋯ Intramedullary pressure was increased in all animals with perioperative impairment of pulmonary function (375 to 676 mbar). Analysis of the hemostatic results showed a significant difference of platelet activation in reamed versus unreamed nailing of the femur 1 hour after nailing (p < 0.01) and a significant decrease of fibrinogen and antithrombin III (p < 0.001/p < 0.01) in reamed femoral nailing. We conclude that unreamed nailing of the femur with a solid rod may also cause bone marrow embolization with alteration of pulmonary function as long as an important increase of the intramedullary pressure is generated during the nailing procedure.(ABSTRACT TRUNCATED AT 250 WORDS)