J Trauma
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From 1981 through 1985, 220 consecutive patients with presumed vascular injuries in the lower extremities underwent operation at the Ben Taub General Hospital. More than 81% of injuries were due to penetrating wounds, and blunt and iatrogenic injuries accounted for the remainder. A preoperative emergency center arteriogram was performed in 63.2% of patients, and physical examination alone prompted operation in 36.8%. ⋯ Venous repair was most commonly accomplished by lateral venorrhaphy (48.8%), ligation (19.7%), or insertion of a conduit (18.1%). Postoperative infection in closed wounds, in wounds left open because of the magnitude of injury, and in adjacent fractured bone occurred in 13% of patients. Late amputations were necessary in only four patients, three of whom had infection as the cause.
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Standard management of axillary burn contractures has been scar release and the use of skin grafts, despite the common problem of incomplete graft take, prolonged splinting, extended physical therapy, and recurrent contractures. A recent development in plastic surgery has been the "super flap" or fasciocutaneous flap. A series of axillary burn contractures released with the latissimus dorsi fasciocutaneous flap has been reported by Tolhurst. Our series of ten patients confirms that the latissimus dorsi fasciocutaneous flap is the treatment of choice for the release of severe axillary burn contractures.
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Effective field triage of trauma victims requires identification of patients at risk of dying and their rapid transport to hospitals capable of treating severe injuries. Identification of these patients at the accident scene can be difficult since prehospital personnel receive little training in structured triage decision making. ⋯ Results showed that with physician input in the triage process, patients chosen for helicopter transport to the trauma center had a significantly higher median level of injury severity than patients triaged to the trauma center without physician involvement. The results have implications for controlling overtriage of patients to trauma centers.
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In an attempt to define optimal management, we have studied the outcome of 29 isolated tibial arterial injuries during the past 4 years. Twenty-five patients suffered blunt and four had penetrating trauma. Twenty-seven patients had preoperative arteriography which showed at least one interrupted tibial artery. ⋯ Bypass with autogenous vein was mandatory for success. Our experience has shown that most tibial arterial trauma will require immediate repair for success. Delayed repair was more difficult and was associated with substantial limb loss.
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This study evaluates our experience with surgical treatment of burns in the elderly. Forty-two patients more than 59 years old were treated from 1982 to 1986. The mean age was 73, and the mean TBSA burned was 29%. ⋯ The complication rate was 33%, with partial graft loss (14%) being the most frequent. The average hospital stay was 27 days in Group I and 45 days in Group II. Only 25% of the patients required nursing home assistance at discharge.