J Trauma
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Randomized Controlled Trial Comparative Study
Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure.
The options for abdominal coverage after damage control laparotomy or abdominal compartment syndrome vary by institution, surgeon preference, and type of patient. Some advocate polyglactin mesh (MESH), while others favor vacuum-assisted closure (VAC). We performed a single institution prospective randomized trial comparing morbidity and mortality differences between MESH and VAC. ⋯ MESH and VAC are both useful methods for abdominal coverage, and are equally likely to produce delayed primary closure. The fistula rate for VAC is most likely due to continued bowel manipulation with VAC changes with a feeding tube in place-enteral feeds should be administered via nasojejunal tube. Neither method precludes secondary abdominal wall reconstruction.
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Exchange nailing of ununited fractures with or without bone grafting is the most acceptable procedure for nonunion with previously implanted intramedullary nails. Though excellence of this procedure has been well documented for diaphyseal, noncomminuted fractures of long bones, its acceptability for distal femoral, metaphyseal-diaphyseal junctional fractures, and humeral locations is doubtful. A method of obtaining stability at fracture site is described wherein locking compression plates are applied over the ununited fracture with bone grafting without removal of the underlying nail. ⋯ Locking compression plating of ununited fracture with preexisting intramedullary nails has predictable good results for specific indications.
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Review Case Reports
Unusual dislocation of the elbow in a child--review of literature.
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Venous air embolism (VAE) or fat embolism (FE) may occur in similar clinical settings such as after multiple injuries or total hip replacement. We designed this study to observe the differences between VAE and FE in routine intraoperative monitoring methods, transesophageal echocardiography (TEE), and fatal volume in pigs. ⋯ Large extensive echogenic masses on TEE, "bubble-like" sounds, "drum-like" murmurs, and "mill-wheel" murmurs were more likely associated with VAE. All of fat emboli were fine on TEE. Paradoxical embolism and cutaneous petechiae were more common in FE. Fatal volume of fat is lower than that of air.