J Trauma
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Open tibial fractures complicated by limb-threatening vascular injuries present an infrequent but difficult management problem. Twenty-three cases were reviewed with an ultimate amputation rate of 61% (22% primary, 39% delayed). Crush injuries, segmental tibial fractures, and revascularization delays of greater than 6 hours were associated with a bad outcome. Guidelines for primary amputation (crushing injuries, delay in revascularization, segmental tibial fractures) are proposed and implications of limb salvage are reviewed.
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Comparative Study
Comparison of blood serum iodine levels with use of Iodoplex and povidone iodine ointment.
Concentrations of iodine were assayed in burn patients, who were covered with Iodoplex ointment up to 30% of their body surface. The iodine levels in the serum were found to be in linear proportion to the area treated with an increase of 30 micrograms iodine per 100 ml of serum for 1% of TBSA. The maximal levels were reached within 24 hours of applying the Iodoplex ointment and decreased quickly following its discontinuation. Concentrations of the iodine were much lower than those found after treatment with povidone iodine, a fact which indicates that using Iodoplex in second-degree burns and donor sites entails fewer possible complications due to high levels of iodine in the serum than with povidone iodine.
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Case Reports
Aortic gunshot injury and paraplegia: preoperative definition with arteriography and computerized axial tomography.
Computerized axial tomography provided the diagnosis for an evolving paraplegia in a patient with a gunshot wound of the descending thoracic aorta. Successful surgical management of the aortic injury and considerations regarding the paraplegia are presented. We do not advocate arteriography and computed tomography routinely in major vascular injuries; however, in clinically stable patients with a high suspicion of associated injuries, use of both can be useful.
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Autotransfusion is an accepted adjunct to the treatment of massive bleeding associated with intra-abdominal trauma. We describe a case of massive air embolism during autotransfusion for a gunshot wound to the vena cava. Treatment required thoracotomy and direct aspiration of air. The patient recovered without sequelae.