J Trauma
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Seven patients with cardiac rupture from blunt trauma were encountered at the University Hospital, University of Alabama School of Medicine, in a 15-year period. Five of seven patients survived, including three with left atrial injuries and one each with right ventricular and left ventricular injuries. ⋯ Successful management demands a high index of suspicion of cardiac injury, prompt diagnosis, and immediate median sternotomy. After repair of the heart the incision should usually be extended to allow exploratory laparotomy.
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Fracture of the sesamoid bones of the hallux is rare. A case of fracture of the medial sesamoid bone is presented. ⋯ Complete relief of pain was followed by the patients' return to full athletic activity. The diagnostic criteria and indications for operation are discussed briefly.
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A young male patient with traumatic lung cyst, a rare lesion of blunt chest trauma, is presented. Compression of an elastic thorax with narrowing or closure of the airway produces a bursting or shearing force that creates an intrapulmonary cavity. The cyst may be filled with blood and is often associated with pulmonary contusion. ⋯ Patients with traumatic lung cyst should be watched for respiratory distress, but the clinical course is usually uncomplicated, and the lesion completely resolves in 2 to 4 months. There are two indications for surgical treatment: infection in the cavity that is unresponsive to a trial of appropriate antibiotic therapy, and a cavity that does not progressively become smaller. In the patient presented, lobectomy was done 9 days postinjury and the cyst removed, and his subsequent recovery was without problems.
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A major factor limiting survival following extensive thermal injury is insufficient availability of donor sites to provide enough skin for the required grafting procedures. While 3:1 expanded mesh autograft have aided greatly in better utilization of available sites, a 6:1 or greater expanded mesh graft is often accompanied by significant loss of the graft. A technique has been developed in which widely meshed autograft (6:1 or greater) is covered by a 1.5 or 3:1 expanded mesh allograft to provide better take. ⋯ Rejection of the allograft was not associated with acute inflammation or loss of autograft. The ultimate cosmetic appearance and function was acceptable in all. This new technique appears to offer significant advantages for the grafting of extensively burned patients with limited donor sites.