摘要:

Controversy exists in the literature regarding the proper treatment of partial flexor tendon lacerations. In this study, a novel nonweighthearing canine model was developed in order to closely approximate human flexor tendon conditions. The relative effects of immobilization, early protected mobilization, tenorrhaphy, and no repair of flexor tendon healing were evaluated by paired comparisons of four experimental groups (24 animals). Parameters evaluated after a 35-day healing period included tendon excursion, breaking strength, energy absorption, and stiffness. The contralateral digit-matched profundus tendon served as a normal control. Eight additional animals were studied histologically and by scanning electron microscopy. Data analysis revealed statistically significant adverse effects on breaking strength, stiffness, and energy absorption when repaired by modified Kessler technique. Early motion improved excursion and stiffness significantly, and resulted in more nearly normal tendon morphology than immobilized tendons. Thus, we conclude that partial flexor tendon lacerations of 60% cross-sectional area are optimally treated without tenorrhaphy and with early mobilization.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

From 1978 through 1984, 22 patients with 20 penetrating and two blunt injuries to the proximal superior mesenteric artery were treated. Patients presented with exsanguinating hemorrhage (19), midline hematomas (two), or 'black bowel' (one). Two other patients developed 'black bowel' during operation. Direct cutdown through the mesentery was the approach in 11 patients, and three survived; a Mattox maneuver was used in ten patients, and three survived. Arteriorrhaphy was the repair performed in ten patients, and five survived. Complex bypass or grafting procedures were performed in nine patients, and two survived. Ten of 15 deaths were secondary to hemorrhagic shock; two of five late deaths were related to problems with the vascular repair in patients with multiple injuries. Interposition grafting near a major pancreatic injury may lead to catastrophic postoperative problems. Bypass grafts from the distal aorta should have retroperitoneal tissue coverage of the suture line.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Midline pancreatic injury from blunt trauma can be very subtle. Although nonoperative management usually results in early complications, chronic symptoms may develop 2 months to 2 years after injury. Four patients with pancreatic sequestrum demonstrated the need for ERCP in patients with epigastric pain developing late after injury, emphasizing the importance of early operation and complete exploration of pancreatic injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Early open reduction and internal fixation (ORIF) of extremity fractures in patients with multiple injuries has been demonstrated to be safe, improve survival, and decrease the incidence of respiratory failure. Complications leading to abandonment of planned operative fixation and death in several patients with pelvic fractures led us to initiate a policy of early ORIF of the disrupted pelvic ring.Early ORIF of the pelvis was performed in 15 multiply injured patients between May 1984 and August 1985. Patients ranged in age from 13 to 79 years, their Hospital Trauma Index-ISS scores ranged from 14 to 68, and number of preoperative transfusions ranged from 0 to 42. Types of fractures were A-P compression, two, lateral compression, one, vertical shear, seven, complex, two, and acetabulum with ring disruption, three. All patients were resuscitated, transported in pneumatic antishock garments, and evaluated by abdominal and pelvic CT scan (in two patients following celiotomy). Preoperative angiograms to assess retroperitoneal hemorrhage in eight patients resulted in identification and control of significant bleeding in five. The mean time from injury to pelvic stabilization was 38 hours. Seven patients underwent ORIF within the first 24 hours. In most cases simultaneous anterior and posterior internal fixation was performed with the patient in the lateral decubitus position. Excluding associated procedures, operative time averaged 5.1 hours. Intra-operative transfusions averaged 4 units (range, 0—11).Rigid fixation was achieved in all patients. Most patients were out of bed by the third postoperative day. No patient developed respiratory failure. Two patients developed wound infections. Modification of our technique has avoided this complication in the latter part of this series.We conclude that an aggressive approach including expeditious preoperative angiography, embolotherapy when indicated, and early ORIF of the pelvis and other skeletal injuries is safe and offers significant advantages in the acute management of multiply injured patients with pelvic ring disruption. The assessment of long-term functional results requires further study.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The value of endotracheal intubation and internal stabilization in severe chest injuries is well known. Recent reports have proposed that many such patients can be managed without intubation. To determine which patients need intubation we reviewed 140 patients with three or more rib fractures who presented to our hospitals from 1 January 1979 through 31 December 1983: 119 nonintubated patients (Group A); 13 patients intubated on admission (Group B); five patients intubated after hospital day 1 (Group C); and three patients intubated questionably on admission (Group D).The purpose of this report was to identify the factors which indicated severe pulmonary injury necessitating intubation. The need for intubation was correlated with five risk factors: 1) initial respiratory rate of over 25 min; 2) pulse greater than 100 min; 3) systolic blood pressure less than 100 mm Hg; 4) poor initial arterial blood gas; 5) the presence of other injuries.There was no correlation between severity of pulmonary injury and number of fractures, bilateral and/or segmental fractures, flail chest, contusion of lung, or age of patient. There was a greater percentage of complications and deaths in intubated patients (Groups B, C, and D).Group C patients all had poor initial blood gases and were erroneously not intubated early, even though 60% of them had three or more risk factors, as did Group B patients. Only 4% of patients who did not need intubation (Group A) had three or more risk factors. Group D patients were intubated without apparent indication. They had good initial blood gas levels and only one risk factor. Patients with fractured ribs and three or more risk factors should probably be intubated; those with less than three risk factors may not need to be intubated. However, the latter need aggressive pulmonary care and close monitoring.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Ninety-seven traumatized patients had blood samples taken immediately upon admission before any resuscitation. Microaggregate (MA) formation was measured by the screen filtration pressure (SFP) technique. Plasma fibronectin levels (Fn) were measured by immunoturbimetric assay. An Injury Severity Score (ISS) was calculated for each patient. The results show a highly significant correlation between severity of trauma, amount of MA formation, and amount of Fn depletion. We conclude that the highly significant correlation between MA formation and Fn depletion following trauma suggests a role for the reticuloendothelial system (RES) in the clearance of MA that form following trauma. Further, enhancement of RES clearance of MA may be possible by purified Fn or cryoprecipitate administration early in the treatment of trauma patients, thereby preventing the adverse sequelae of end organ MA deposition.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We studied 47 hospitalized motorcyclists admitted through the Massachusetts General Hospital emergency room during a 1-year period. Four factors were studied: 1) hospitalization charges, 2) hospitalization lengths, 3) medical insurance profiles, and 4) patterns of injuries.The mean hospitalization charges were $15,114. The total hospital charges for this group of patients were nearly $700,000. These figures excluded the costs of subsequent admissions, surgeons' fees, rehabilitation, vocational training, legal suits, and loss of wages. Sixteen per cent of the charges were uncollectable. Forty-six per cent of the patients were uninsured. The average hospitalization was 22 days. The mean age was 22 years and 90% of patients were less than 30 years old. Eighty-five per cent of the patients sustained at least one fracture. Lower extremity fractures occurred in 60%, open fractures in 55%, and tibia fractures occurred in 33% of the patients. Associated head, chest, or abdominal injuries occurred in 40% of the patients. Patients with multiple fractures, open fractures, and grade 3 open tibia fractures had substantially higher hospital bills.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Serum phosphate (S-P) and 2,3-diphosphoglycerate (2,3-DPG) were monitored for 10 days after severe burn trauma in 16 patients treated with total parenteral nutrition, including supplementation with 25—75 mmol phosphate daily. Phosphate metabolism was previously shown to be disturbed in patients with severe burns, and hypophosphatemia has been reported to disturb oxygen transport by reducing synthesis of 2,3-DPG in the red cells. In this study, S-P was decreased in the first post-trauma week because of a negative phosphate balance the first 4 post-trauma days, but 2,3-DPG remained at normal concentrations. These findings indicate that posttraumatic disturbance in red-cell phosphate metabolism may be prevented by administration of phosphate and that such supplementation is important in the metabolic management of severely injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Nitrogen losses in the urine are derived from amino acid oxidation, and the increased loss of urinary nitrogen during stress indicates accelerated amino acid oxidation. This study compared isoleucine and valine oxidation by traumatized rats with that by pair-fed control rats. Seventy rats received bilateral hind limb fractures and were fed an oral liquid diet ad libitum, and 70 healthy rats were pair-fed with the trauma group. Daily food intake, body weight, and 24-hr urinary nitrogen were monitored for each animal, and isoleucine and valine oxidation were measured on days 1 through 7 postinjury using five rats from each group for each amino acid. Amino acid oxidation was determined from the percentage of dose appearing in the breath during 4 hours following a single injection of C-14 labeled amino acid. Anesthesia had a pronounced effect on all parameters on day 1, and the its effects were dissipated by day 2. Skeletal trauma produced elevated urinary nitrogen losses that lasted for 5 days and peaked on day 3. Valine and isoleucine oxidation were increased for 5 days, and the peak increase occurred on day 3 posttrauma. These data show that isoleucine and valine oxidation parallel excessive urinary nitrogen excretion after skeletal trauma and that isoleucine and valine, like leucine, contribute to the increased urinary losses after trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Burns involving face, hand, dorsum of foot and areas around joints are regarded as burns of special parts. Because of the structural characteristics we emphasize the importance of preserving subeschar adipose tissue and using large sheets of skin graft in these parts of body during the resurfacing procedures. Thirty-one cases with 56 sites of deep burns were observed. The results were good. Followup in three typical cases is reported in detail in this article. Preserving subeschar healthy fatty tissue can ensure high graft take rate, early functional recovery, and immediate as well as long-range curative effect. So one must carefully judge the cutting depth of eschar excision. We prefer grafting debrided facial wounds with sheets of skin according to regional units. The minimal width of circular grafts around ankle and wrist is discussed. For wrist, the recommended minimal width is 4 cm; for ankle, it is 5 cm.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID