J Trauma
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To evaluate the effect which cooling of burn wounds has upon dermal microvascular circulation, standard 10% BSA dorsal guinea-pig scald burns were created. In treated animals, the dorsal burned region was immersed in a circulating ice-water bath (0-3 degrees C) for 30 minutes at various time intervals postburn (10,20,30, and 60 minutes after scald). India-ink perfusion was used to determine the level of dermal vessel patency at 2, 4, 8, 24, 72, and 96 hours after burning. ⋯ Those not treated until 60 minutes after burning had dermal perfusion essentially the same as control animals. 133Xe dermal washout studies were performed at 8 and 24 hours and corroborated these findings. Grossly, burn wounds cooled by 30 minutes after burn had markedly better healing than control animals and animals cooled 60 minutes after burning. We believe these data support the early use of cold water treatment of partial-thickness burn wounds, as demonstrated in this experimental study.
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The rare traumatic condition of intra-articular dislocation of the patella in a 12-year-old boy is described, suffered in a fall, when he landed in a hole with his knee bent. Closed reduction by manipulation under general anesthesia failed because the upper pole of the patella was locked deeply in te intercondylar space. Operative reduction using a parapatellar incision in which the patella was levered into position without opening the capsule was followed by functional recovery.
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The pathogenicity of several strains of Pseudomonas aeruginosa for burned rats (3 degrees scald burns, 20% body surface) following topical application of the bacteria to the burn within 1 hour after burning was established. Following this, it was demonstrated that purposeful infection of such 3 degrees scald burns of rats by a strain of Ps. aeruginosa of low virulence (JB-77) protects the rats from the lethal effect of subsequent (48-hour) topical contamination of the burn by a highly virulent strain of Ps. aeruginosa (VA-134) (p less than 0.001). This finding was confirmed in a similar experiment beginning with germfree rats. ⋯ S.). When burned rats were given the low virulence strain of Ps. aeruginosa by gavage right after burning, there was not protection to subsequent (48 hours) challenge by topical application of the highly virulent strain of Ps. aeruginosa to the burn (11/12 vs 12/12 dying). Our finding that purposeful infection of a 3 degrees burn of rats (conventional and also germfree) by a strain of Ps. aeruginosa of low virulence protects from the lethal effect of subsequent (48-hour) topical contamination of the burn by a highly virulent strain of Ps. aeruginosa is due, we believe, to direct bacterial interference between the two strains of pseudomonas.
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Selective management of 465 patients with stab wounds limited to the posterior abdomen is reviewed. Celiotomy was based primarily on clinical findings. Tenderness not localized to the area of injury and absent or rare bowel sounds best identified patients with serious injuries. ⋯ Six per cent had "nonessential' celiotomies. The overall morbidity was 11%, and mortality rate, 1.1%. Selective management of posterior abdominal stab wounds is a prudent and reliable approach.
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A case of shotgun pellet embolization to the middle cerebral artery is presented. Embolization occurred approximately 36 hours following successful resuscitation of blood pressure, respirations, and neurologic function in a 21-year-old man who had sustained a massive chest wound. ⋯ In all cases of shotgun trauma to the chest cerebral embolization of pellets should be considered at any sign of neurologic change and skull films obtained. Surgical intervention is necessary before cerebral infarction.