1/6. Pneumonitis following grease gun injury.Grease gun trauma often involves subcutaneous injection of the grease because of the high pressures required for its industrial application. The case is presented of a man who developed a pneumonitis shortly after sustaining a grease gun injury, with injection of grease into his upper thigh associated with significant vascular damage. Pneumonitis has not previously been reported with this type of injury, and is likely to represent a systemic reaction to the local inflammatory response. Management of these injuries should incorporate early debridement with anticipation of underlying vascular trauma, and also an awareness of the potential systemic complications.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/6. Case studies of an infant, a toddler, and an adolescent treated with a negative pressure wound treatment system.Three pediatric case studies (infant, toddler, and adolescent) using negative pressure wound treatment system (NPWS) in a children's hospital are described. Each child had complex surgical wounds and different goals for the therapy. The infant had an ulcerating labial hemangioma surgically removed, and the NPWS was used to expedite granulation tissue in preparation for a split-thickness skin graft. The critically ill toddler required abdominal fasciotomies for compartment syndrome, and the NPWS was applied to reduce interstitial abdominal edema and manage the excessive wound drainage. The adolescent initially had surgery to correct a pectus excavatum; when the sternal wound became infected and required debridement, the NPWS was used to expedite wound healing. The results of the NPWS were positive. Although this therapy has been used more commonly in adults, these case studies demonstrate its efficacy in several different types of wounds and age groups of children. The wound, ostomy, continence nurse should include the NPWS in his or her treatment differential as a valuable option for pediatric patients.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
3/6. The use of negative-pressure therapy and skin grafting in the treatment of soft-tissue defects over the achilles tendon.Management of soft-tissue defects over the achilles tendon presents specific challenges to the plastic surgeon. Primary closure or local flaps are often not feasible repair options for such wounds, and many of these patients may be poor candidates for free-tissue transfer secondary to their comorbidity. In this case series, the use of negative-pressure therapy in the preoperative period to prepare the wound bed for placement of a split-thickness skin graft and in the immediate postoperative period as a dressing for the graft was successfully used in 3 patients with soft-tissue defects over the achilles tendon with exposed tendon. All 3 patients had stable wounds at 48 to 80 months postoperatively. Negative-pressure therapy and skin grafting was found to be a reliable method of repair that provided stable coverage for such wounds.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
4/6. Soft tissue injury in resistance welding.Electrical resistance welding is commonly used in industries where light sheet metal is bonded. The process uses a combination of heat and pressure to form the weld, which frequently results in the production of high-velocity metal-fragment projectiles. The process is described and case studies are presented to illustrate the nature of the injuries which occasionally result from these missiles. The difficulties in preventing these injuries and potential approaches for doing so are discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/6. Revascularisation versus reconstruction of degloving injuries of the heel: case report.The anatomy of heel vascularization implies that there is a high risk of necrosis if degloved soft tissue is only sutured back to its former position. Two patients who had sustained similar degloving injuries of the heel are presented. One of them was treated by primary revascularization and the other by secondary reconstruction with a dorsalis pedis flap. The postoperative outcome was investigated to show the value of the salvage operation. Dynamic pressure distribution gait analysis was performed barefoot and in the shoe to investigate postoperative weightbearing on the reconstructed areas. In contrast to the heel reconstruction with the dorsalis pedis flap, the revascularized original heel was stable without development of soft tissue lesions. The salvaged original heel tissue enabled a physiologic pressure distribution beneath the heel and a more physiological rollover process of the foot, comparable to the contralateral foot. In degloving injuries of the heel, revascularization of the soft tissue should be considered whenever possible.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/6. Profound natriuresis, extracellular fluid volume contraction, and hypernatremia with hypertonic losses following trauma.A young male sustained very serious head and soft tissue injuries in a motor vehicle accident (MVA). Three interesting problems developed in the sodium (Na) and water area in the second week in hospital. First, on day 11 after the MVA, his urine output increased to 3 liters per day; the urine osmolality was 1000 mOsm/kg H2O and Na and Cl were the principal urine osmoles. There appeared to be a salt wasting syndrome because he had a very large natriuresis (close to 900 mmol/24 hr) at a time when his central venous pressure was low. To help identify the nephron site responsible for a natriuresis with a high urine osmolality, additional studies were carried out in normal volunteers who took a loop or a thiazide diuretic on different occasions while ADH was acting. The pattern of natriuresis in the patient was similar to that after the thiazide but not the loop diuretic. The second problem concerned his hypernatremia (153 mM) because his urine was hypertonic and his intravenous therapy was isotonic saline. To explain hypernatremia while receiving more electrolyte-free water, we speculated that there was a water shift into cells resulting from particles generated and retained in his intracellular fluid. Given the large shift of water required, a lesion in muscle was suspected, a form of rhabdomyolysis. The third problem concerned the rate of catabolism of lean body mass. The metabolic consequences of generating these intracellular particles and the large amount of urea that was excreted could reflect a large degree of protein catabolism.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |