摘要:

BackgroundCurrent use of Integra, the collagen-based dermal analogue, requires a two-step grafting procedure to achieve wound closure with an “ultrathin” autograft.MethodsA one-step operative procedure of meshed composite skin graft (MCSG) using Integra as a dermal template for a meshed split thickness autograft was developed in rats. The silicon layer of Integra was removed, the resulting dermal analogue was meshed (1:1.5), expanded, and placed on excised full thickness wound and covered with a meshed (1:1.5 or 1:6) split thickness autograft. Grafted wounds were dressed with BioBrane, Vaseline gauze, silver-impregnated nylon, or silver-nylon and direct current (SNDC). At scheduled intervals up to 3 months postgrafting, wounds were examined for epithelialization, collagen deposition and fibrosis, hair growth, and contraction. The results of wound closure and healing following the one-step procedure were compared with the outcome of the two-step grafting procedure where application of meshed Integra (step one) was followed in 14 days by removal of the silicon layer and application of the meshed autograft (step two).ResultsThe one-step procedure applied to meshed autograft/Integra (1:1.5/1:1.5) composite graft accelerated wound closure by 6–19 days when compared with the two-step procedure. At 3 months postgrafting, the contraction of the healed wound dressed with SNDC, BioBrane, or Vaseline gauze was reduced by 13–16% following the one-step procedure compared with the two-step procedure (p< 0.05). The one-step procedure allowed the expansion of the autograft layer to 1:6 while achieving wound healing results similar to grafting with 1:1.5 meshed autograft layer using the two-step grafting procedure.ConclusionSingle-step application of meshed, thin, split thickness autograft over meshed Integra-derived dermal substitute allows more rapid wound closure with less contraction and more efficient use of graft donor skin than can be obtained with the commonly used two-step grafting procedure.

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThe ability to rapidly and accurately triage, evacuate, and utilize appropriate interventions can be problematic in the early decision-making process of trauma care. With current methods of prehospital data collection and analysis, decisions are often based upon single data points. This information may be insufficient for reliable decision-making. To date, no studies have attempted to utilize data at multiple time points for purposes of enhancing prediction, nor have studies attempted to synthesize prediction models with data reflecting both large-vessel venous and arterial injuries. Therefore, we performed a retrospective study to examine the potential utility of dynamic neural networks in predicting mortality using highly discretized uncontrolled hemorrhagic shock data.MethodsOne hundred forty-three swine with either grade V liver injuries or 2.8-mm aortotomies had hemodynamic data collected every minute throughout injury and resuscitation. The independent variables used as inputs to the polynomial neural networks (PNNs) included systolic blood pressure and mean arterial pressure (MAP). These inputs were used to predict mortality in individual swine 1 hour after injury using data up to 20 minutes after injury. Survival models were compared based on discrimination power (DP), i.e., where specificity equals sensitivity, and area under the receiver operating characteristic (ROC) curve (c-statistic). The Hosmer-Lemeshow (H-L) statistic was used to measure model calibration.ResultsThe best PNN model predicted mortality at 60 minutes utilizing data from injury to 20 minutes after injury. This model produced a ROC area of 0.919, a DP of 0.857, and a H-L value of 16.47. A DP of 0.857 means that 85.7% of the survivors are correctly predicted to survive, and 85.7% of the nonsurvivors are predicted to die. MAP of survivors and nonsurvivors were graphed for comparative purposes. As this graph illustrates, the use of MAP alone cannot discriminate survivors from nonsurvivors.ConclusionThis study demonstrates that PNN models can effectively harness the dynamic nature of uncontrolled hemorrhagic shock data, despite utilizing data from large-vessel arterial and venous injuries. Utilizing the dynamic nature of hemorrhagic shock data in PNNs may ultimately allow the development of novel decision assist devices.

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundDespite many studies addressing potential impact of helicopter transport on trauma mortality, debate as to the efficacy of air transport continues.MethodsThis retrospective study combined trauma registry data from five urban Level I adult and pediatric centers. Logistic regression assessed effect of helicopter transport on mortality while adjusting for age, sex, transport year, receiving hospital, prehospital level of care (Advanced Life Support vs. Basic Life Support), ISS, and mission type (scene vs. interfacility).ResultsThe study database comprised 16,699 patients. Crude mortality for Air (9.4%) was 3.4 times (95% CI, 2.9–4.0,p< 0.001) that of Ground (3.0%) patients. In adjusted analysis, helicopter transport was found to be associated with a significant mortality reduction (odds ratio, 0.76; 95% CI, 0.59–0.98;p= 0.031).ConclusionThe results of this study are consistent with an association between helicopter transport mode and increased survival in blunt trauma patients.

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2002

数据来源: OVID