1/3. Treatment of soft tissue defects in pediatric patients using the V.A.C. system.Twenty-seven consecutive pediatric patients presenting to the orthopaedic surgery or plastic surgery services were reviewed after completion of wound care with the vacuum Assisted Closure (V.A.C.) system. Each patient presented with complex soft tissue wounds requiring coverage procedures. patients with acute wounds and wounds present after nonsuccessful attempts at surgical closure (dehisced incisions and failed flaps) were treated. All soft tissue defects healed without extensive coverage procedures using the V.A.C. system. In the majority of patients, use of the V.A.C. system produced a profuse bed of granulation tissue over all exposed bone, tendon, joint, and/or hardware, which could be covered with split thickness skin graft. Other patients were treated successfully with delayed primary closure, local flap advancement (one patient underwent a pedicled cross-leg flap), or by secondary intention. Use of the V.A.C. device is valuable in increasing the rate of granulation tissue formation and healing of extensive soft tissue injuries in pediatric patients. This vacuum system aids in the debridement of necrotic tissue and local soluble inflammatory mediators that may inhibit the proliferation of granulation tissue. These improvements in the local wound environment seem to accelerate wound healing compared with traditional methods. Before the development of the V.A.C. system, a minimum of nine patients within this group would have required free tissue transfer to obtain adequate coverage. The V.A.C. device seems to permit earlier coverage with local tissue or split-thickness skin grafting techniques, thereby decreasing the need for extensive microvascular tissue transfers in pediatric patients.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/3. A new method of skin-graft stabilization: the Reston technique.We describe a new staple-on dressing technique for skin-graft stabilization, using gas-sterilized polyurethane foam as bolster material. The method has all the attributes of a satisfactory skin-graft dressing: compression to prevent hematoma and seroma, resistance to shear forces, splinting properties, and protection from the outside environment. Although we have not completed a randomized, prospective study, skin-graft "take" appears to be excellent in most cases. The technique is cost effective, and application requires a fraction of the time required for a traditional bolster dressing.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/3. Ring avulsion injuries in a field environment.Two soldiers are reported who sustained ring avulsion injuries while performing duties as part of Operation Provide Promise in croatia (former yugoslavia). These traction injuries inflicted on a ringed finger can present difficult diagnostic and treatment challenges in the field environment. They also can result in long-term disfigurement and disability. Due to the type of work performed and the equipment used by soldiers in the field environment, they are at particular risk for ring avulsion injuries. However, with appropriate education and precautions, these risks can be minimized.- - - - - - - - - - ranking = 6keywords = environment (Clic here for more details about this article) |