Arch Surg Chicago
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of hair-removal methods on wound infections.
The influence of preoperative shaving v clipping on wound infection rate was studied in 1,013 patients undergoing elective operations at a single hospital. Patients were prospectively randomized to be either shaved or clipped the night before or the morning of operation. ⋯ For each 1,000 patients treated, a savings of approximately $270,000 could be realized if the AM clipper method replaced shaving for preoperative hair removal. Preoperative shaving is deleterious, and the practice should be abandoned.
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Within a 24-month period, 454 patients were admitted with burns (average size, 33% of the total body surface [TBS]). Wound infection developed in 19, who subsequently were treated with subeschar antibiotics. The average burn size in those 19 patients was 63% of the TBS, with an average full-thickness injury of 47%. ⋯ The five surviving patients (average burn size, 59% TBS) underwent excision of infected tissue, with split-thickness cutaneous autograft closure of the burn wound, after the course of subeschar antibiotic infusion. All surviving patients were infected with Pseudomonas aeruginosa. Subeschar infusion of semisynthetic penicillins, therefore, is an effective adjunct in the care of the patient with Pseudomonas burn-wound infection.
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Opsonic fibronectin modulates reticuloendothelial (RE) uptake of nonbacterial particulates, as well as some bacterial strains, and may thus play an important role in host defense against sepsis after burn injury. We evaluated the relationship between burn injury, sepsis, and opsonic fibronectin levels in rats, as well as the ability to reverse the acute opsonic deficiency after burn injury by administration of purified opsonic fibronectin. ⋯ The in vitro serum opsonic deficit was partially correctable (from 2.2% to 6.7% of the injected dose per 100 mg), while in vivo RE functional deficits could not be corrected. We conclude that the acute postburn deficiency in opsonic fibronectin is amenable to repletion therapy; however, many additional factors may contribute to acute RE failure after burn injury.
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Although most surgeons prefer primary closure of gastroschisis, staged closure is most commonly needed because of marked visceroabdominal disproportion. We have modified the usual primary fascial closure by introducing postoperative muscle paralysis through the use of a nondepolarizing neuromuscular blocking agent. The result was a higher percentage of patients amenable to primary closure. ⋯ Primary fascial closure was possible in 20 cases (69%). In 17 of the 20 patients, postoperative paralysis was induced for two to three days to avoid the complications associated with increased intraabdominal pressure. Postoperative complications were few.
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Comparative Study
Prevention of postoperative peritoneal adhesions: efficacy of povidone.
The appearance and severity of peritoneal adhesions after simple laparotomy and after adhesiolysis were studied in a rabbit model. Adhesions were induced by direct abrasion with latex glove and dry gauze; control rabbits had abrasion only. ⋯ Results showed a significant reduction in the number of adhesions and in the severity of adhesions after treatment with povidone. This study supports the further investigation of the efficacy of povidone in preventing postoperative peritoneal adhesions.