J Trauma
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Three consecutive successful repairs of innominate artery tears caused by blunt trauma are reported. Attention is called to the fact that the innominate artery is the second most common site of great vessel injury in this setting. ⋯ Median sternotomy, with a cervical extension if necessary, is the incision of choice. Successful repair is the usual outcome.
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A young man hit by a car while riding his motorcycle presented with reversible hypotension, a compression fracture of C6, fractures of the left femur and of ribs 9-12 on the right, and right hemothorax. A falsely negative peritoneal lavage delayed laparotomy, which, when done, demonstrated two right diaphragmatic rents with bleeding into the right chest from a severe liver injury. Presentation of this case demonstrates that while peritoneal lavage is an excellent way to exclude intraperitoneal hemorrhage following blunt abdominal trauma, false-negative results may occur in the setting of hemorrhage with diaphragmatic rupture.
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Allograft skin lyophilised in 98% glycerol is an effective overlay for widely expanded autografts. The technique was evaluated clinically on a total of 58 sandwich grafting procedures in a group of 39 patients with extensive third-degree burns. Forty-five grafting operations performed within 10 days postburn all resulted in an epithelialisation rate of at least 75% within 5 weeks. ⋯ The absence of allograft viability did not impair its function as an autograft overlay. The apparent attenuation of allograft antigenicity conferred by the action of 98% glycerol may have contributed to the results achieved. The process of cadaver skin preservation in 98% glycerol is simple and inexpensive.