J Trauma
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Twenty-six individuals with second- and third-degree burn wounds have been grafted with cultured allogeneic epidermal cells. These epidermal cell grafts were grown in culture from cadaver skin according to a technique which we have developed. After being grafted with cultured allogeneic epidermal cells, superficial wounds, e.g., donor sites, healed within 7 days, compared to 14 days for mirror image control sites. ⋯ The cultured cells produced rapid healing in 11 of the 12 patients with deep second-degree burn wounds. The deep second-degree wounds grafted with cultured allogeneic epidermal cells healed with results which were comparable to the deep second-degree wounds which were autografted. Grafts of cultured allogeneic epidermal cells placed on full-thickness, or third-degree burn, wounds did not grow well.
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Ninety-four cases of percutaneous tracheostomy and six cases of percutaneous cricothyroidotomy are reported in this study. There was one death attributable to the use of the device. A complication rate of 14% is reported. ⋯ Autopsies on 14 of these patients are discussed. Long-term followup, that is for 1 year and more, is reported in 19 cases. Advantages of the percutaneous technique over the standard dissection technique are detailed.
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Injuries to the larynx and cervical trachea are uncommon, making the development of treatment protocols and subsequent data analysis in any one hospital difficult. This prompted a review of our experience with emphasis on variables related to long-term morbidity. The records of 20 patients with laryngotracheal injuries seen at the Montreal General Hospital from January 1974 to December 1984 were reviewed. ⋯ Computerized tomography of the upper airway facilitates definitive surgical repair. Long-term followup is essential. Laryngeal trauma remains a major challenge.
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From January 1982 through December 1983, 83 severely injured and hypovolemic patients were immediately resuscitated with uncrossmatched packed red cells. Seventy-four patients received 250 units (3.3 units/pt) of Group O red blood cells (TOB), and nine patients received 27 units of type-specific blood (TSB) (3.0 units/pt). Additionally, 53 units of TSB were transfused to the TOB group in the interval between TOB immediate transfusion and the availability of fully crossmatched blood. ⋯ Two patients developed positive hepatitis screens, and there was one clinical case of hepatitis observed. None of the 'DIC' cases were related to incompatible blood transfusion. We conclude that for immediate trauma resuscitation, TOB is safe and TOB has additional advantages over TSB or Type O whole blood transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Performance of surgery for trauma is an important part of residency training, yet what constitutes an adequate exposure to trauma surgery is ill defined. A retrospective review of records at a metropolitan receiving hospital was carried out for the academic year 1981-1982. Of the 50,902 patients treated in the Emergency Room more than one third were seen by a surgical resident. ⋯ An adequate education in trauma must be based on a large experience in the nonoperative resuscitation, diagnosis, and treatment of trauma victims. Nevertheless, the number of cases performed as operating surgeon provides a useful means of evaluation experience in trauma. Thirty cases are suggested as an appropriate level of exposure to the surgery of trauma, yet only one third of applicants to the American Board of Surgery attained this level.