J Trauma
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Controversy continues regarding the use of PTFE versus autogenous vein grafts in the repair of arterial injuries. This study was designed to evaluate the results of a large series of autogenous interposition vein grafts used for arterial trauma. The charts of 191 patients with 192 arterial injuries repaired with an autogenous vein graft were reviewed. ⋯ Eighteen patients (9.4%) required amputation; however, only eight (4.2%) of these cases were graft related. One patient died from non-graft-related multiple organ failure, establishing a mortality rate of 0.5%. Based on the data reported in this series, it is concluded that autogenous grafts continue to provide a safe, readily accessible, and effective means by which selected arterial injuries can be repaired.
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Case Reports
Management of blunt injuries of the axillary artery and the neck of the humerus: case report.
Axillary artery injury, a rare vascular complication of fracture of the humeral neck, is rendered unique by the concomitant subluxation of the humeral head. A coordinated vascular and orthopaedic surgical approach is necessary to reconstruct both the shoulder joint and the artery. The operative techniques chosen may determine long-term outcome.
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Pigs were used for studies of effects on the peripheral nervous tissue of pressure waves induced by impact and passage through the left thigh of high-energy missiles. The short-lasting pressure waves were demonstrated to move close to the speed of sound and to have a spectrum of high frequencies and large amplitudes. The sciatic nerve in the contralateral leg showed no hemorrhage or major deformation. ⋯ Similar changes, although less extensive, were noticed in the phrenic nerves as well as in unmyelinated axons in both sciatic and phrenic nerves. It is concluded that a high-energy missile hit in the thigh of a pig, caused structurally demonstrable dislocations of myelin sheaths, and disarrangement of cytoskeleton and endoplasmic reticulum in axons as well as other signs of damage. The changes may interfere with the normal functions of peripheral and autonomic nerves.
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A retrospective review of 79 frostbite cases over a 10-year period at a major Northern Canadian hospital was performed. Factors predisposing to frostbite injury and predictors of a poor outcome were sought. ⋯ At the time of injury, 53% of patients were under the influence of alcohol and 16% were suffering from psychiatric illnesses. Lower extremity frostbite, infection, and delay in seeking medical attention were factors found to be associated with a poor outcome.
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The operative records of 683 patients who required an exploratory laparotomy for trauma with the findings of a liver injury were reviewed. Of the 683 patients 18% (121) sustained severe liver injuries with difficult to control hemorrhage, and 82% of the deaths, in this group of severe liver injuries, were due to exsanguination. A critical analysis of the specific surgical techniques used for hemostasis was undertaken. ⋯ The survival rate for this group of patients was 86%. Vascular isolation of the liver was used 8.3% of the cases and was successful 40% of the time. An algorithm for the successful surgical control of hemorrhage from severe liver injuries including indications and contra-indications of specific surgical techniques is presented.