J Trauma
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Soft-tissue injuries and defects associated with severe fractures of the tibia treated with the Hoffmann external fixator were reviewed. Of 84 cases of open tibia fractures (classified as Gustilo's Type II and III), 54 patients with 55 injured limbs required soft-tissue reconstruction other than skin grafts or small rotational flaps. These 55 cases were constructed with 37 local musculocutaneous flaps (20 gastrocnemius, 17 soleus and other smaller muscle flaps), 15 free musculocutaneous flaps (14 latissimus dorsi, and one tensor fascia lata), and three medial gastrocnemius cross leg flaps. ⋯ There was a nonunion rate of 25.45% (14 cases) at 18 months postinjury. The Hoffmann external fixator has allowed bony stabilization and has not precluded the subsequent soft-tissue reconstruction or bone grafting. Muscle and musculocutaneous flaps, both local and free, have been employed in the reconstruction of the leg with minimal interference from the Hoffmann device.
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The mechanism of upper extremity trauma in three patients from a round hay baler is analyzed in relation to previously described experimental models of wringer or roller injury. One patient sustained an avulsive injury with typical tearing of the soft tissues. Thermal insult from roller friction heat and the duration of exposure were significant factors determining the extent of tissue injury in the other two patients.
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This study reviews the recent experience with popliteal artery injuries at the Massachusetts General Hospital. Twenty-two patients suffered 24 injuries. The overall limb salvage was 83%. ⋯ Arterial repair includes thrombo-embolectomy in distal arteries. If necessary, reverse saphenous vein is grafted. When operation is unsuccessful, revision should be performed.
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To appraise the ability of each to improve wound healing in zone-of-stasis burns (i.e., burns becoming progressively more ischemic early postburn), 1) an antithromboxane (dipyridamol PO immediately postburn), 2) burn-wound cooling, 3) their combination, or 4) no treatment was administered to burned guinea pigs half of which had burn blisters removed immediately postburn (PB). In all groups with blisters removed whole-thickness or very deep partial-thickness skin loss occurred. In all groups with blisters intact complete reversal of ischemia occurred without necrosis and, while dipyridamol and cooling each diminished stasis early PB, only cooled wounds showed any improved retention of hair follicles at 3 weeks PB. In this model, therefore: 1) blister removal eliminated any therapeutic effect of cooling or dipyridamol; 2) in burns with blisters intact, absorbed heat appeared at least as detrimental to healing as stasis, and 3) some of the beneficial effects of cooling appeared unrelated to prevention of stasis.
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Short-term storage of a patient's harvested skin is clinically desirable for numerous reasons. Previous experience in our center using a skin storage solution of saline with a high concentration of antibiotics resulted in poor graft viability and an unsatisfactory clinical outcome. This report defines an improved method of storage which allows longer storage time, yielding viable skin and results in subsequent graft acceptance on the patient. ⋯ In contrast 11/16 autografts which had been stored in the RPMI-1640 solution for 5 to 22 days (median, 11 days) were successful takes when regrafted to patients. Graft loss was observed in five cases due to the following reasons: inability to immobilize graft (one); poor vascular bed (two); and bacterial infections (two). These data are in agreement with results reported in a separate paper, demonstrating the effectiveness of RPMI-1640 as a storage medium for maintaining viable human skin grafts which were subsequently transplanted to athymic nude mice.(ABSTRACT TRUNCATED AT 250 WORDS)