1/49. Wound closure using a skin stretching device.The recent development of an indexed tissue advancement system makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in one procedure. A case is presented in which serial excision of a previous split-thickness skin graft and tissue expansion to achieve wound coverage were performed in one sitting to close an 8cm defect on the lateral side of the patient's leg without subsequent wound separation or dehiscence.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/49. vacuum-assisted closure in the treatment of degloving injuries.Degloving injuries range from the occult, easily missed injury to obvious massive tissue damage. The serious nature of these wounds is exacerbated by mismanagement. It is generally accepted that the degloved tissue should be excised, defatted, fenestrated, and reapplied as a full-thickness skin graft. Dressings are required that provide gentle, evenly distributed pressure and avoid shear stress to the newly grafted skin. Numerous types of dressings have been devised but all are cumbersome and time-consuming. We have found the vacuum-Assisted Closure device to be a rapid, effective, and easy-to-use alternative to traditional methods. The authors examine their experience using a vacuum-assisted closure device to treat nine degloving injuries in 5 patients and discuss the important aspects in using this technique.- - - - - - - - - - ranking = 1.25keywords = closure (Clic here for more details about this article) |
3/49. Arterial embolization in the treatment of post-traumatic priapism.priapism is a prolonged penile erection not associated with sexual arousal. Two types of priapism have been described: the more common one is the "veno-occlusive" priapism and can be frequently observed as the consequence of an intracavernosal injection of vaso-active drugs for the treatment of erectile dysfunction. The less common type of priapism is known as "high flow" priapism and usually follows perineal or direct penile trauma. The clinical presentation in case of high flow priapism is quite typical: hystory of recent penile or perineal trauma followed, by the onset of a painless, incomplete and constant erection of the penis. A color-flow Doppler sonogram should be performed as first diagnostic step: this examination allows to identify the presence of patent cavernous arteries and prominent venous drainage with focal area of high flow turbulence along the pathway of one or both the cavernous arteries. An arterial blood sample taken from the corpora will confirm the diagnosis. At first, conservative therapeutical attempts can be suggested, with mechanical external compression of the perineum, the use of ice packs, corporeal aspiration and irrigation with saline. Besides, intracorporeal administration of alpha-agonists and methylene blue should be performed. Unfortunately, these conservative measures often result unsuccessful, and more invasive approaches must be considered. The radiological superselective transcatheter embolization of the proximal artery supplying arterial-lacunar fistula should be the present treatment of choice in these cases of high-flow priapism refractory to conservative and medical treatments. The first successful management of high flow priapism by selective arterial embolization was reported by Wear and coworkers in 1977. Autologous clots and gelatine sponge have been extensively used and become very popular as the embolic agent. More recently, platinum microcoils have been proposed with the aim to achieve more precise and selective embolization. In our single-case-experience on the treatment of high flow priapism by arterial embolization, we used the recently introduced tungsten microcoils. At the time of the follow-up, 2 months later, patient reported satisfactory intercourse with an approximately 75% of penile rigidity. By comparison with microsurgical ligature of the damaged vessel, selective embolization is, at least theoretically, a less invasive procedure, particularly with reference to the trauma caused to the erectile tissue. High-flow priapism is a fairly rare urological pathology which does not require immediate and emergency treatment (as is the case, instead, with venous-occlusive priapism), since the risk of post-ischaemic fibrosis is excluded thanks to the fact that oxygen is supplied to the cavernous tissue. Once the diagnosis has been established with certainty, therefore, the specialist has the necessary time at disposal to arrange for the most appropriate therapeutic steps. When, as is frequently the case, conservative measures prove ineffective, the current treatment of choice for cases of fistula of the cavernous artery would appear to be superselective embolization of the artery, provided same can be performed at specialized centres and by experienced personnel.- - - - - - - - - - ranking = 0.026125077860457keywords = drug (Clic here for more details about this article) |
4/49. Treatment and stabilization of complex wounds involving the pelvic bone, groin, and femur with the inferiorly based rectus abdominis musculocutaneous flap and the use of power color Doppler imaging in preoperative evaluation.The authors present case reports demonstrating the trilevel utility of the inferiorly based rectus abdominis musculocutaneous flap in the closure of complex wounds involving the pelvis, groin, and femur that had failed previously or were not amenable to traditional closure techniques. The use of the rectus abdominis flap was especially advantageous for achieving infection eradication and large dead space closure. Additionally they present the emerging technique of power color Doppler imaging as a valuable tool in preoperative flap planning. This technique is particularly useful in evaluating the candidacy for rectus abdominis musculocutaneous flap placement of patients with a prior history of abdominal surgeries, trauma, infection, irradiation, or other conditions that might compromise the patency of the deep inferior epigastric vessels.- - - - - - - - - - ranking = 0.75keywords = closure (Clic here for more details about this article) |
5/49. Recurrent posttraumatic urethrovaginal fistula: a new application for ASTRA.The authors describe the results of an application of the surgical technique called ASTRA (anterior sagittal transrectal approach) in the case of a 16-year-old girl with a posttraumatic urethrovaginal fistula. The young girl with a posttraumatic urethrovaginal fistula had recurrence after 4 surgical attempts at closure performed by the vaginal approach before it was definitively corrected with the ASTRA. Two years after the ASTRA operation the patient is well with a complete restitution of function confirmed by a voiding cystourethrogram and urodynamic and rectal manometric tests. The successful recovery confirmed that ASTRA may be an excellent method of treating the developmental or acquired anomalies of the perineal region.- - - - - - - - - - ranking = 0.25keywords = closure (Clic here for more details about this article) |
6/49. Traumatic arteriovenous fistulas. A follow-up study.Over the period 1958 to 1972 14 patients with traumatic arteriovenous fistulas were treated. The mean period from trauma to surgical closure of the fistula was 13.3 years. No form of reconstructive vascular surgery had been performed initially. The dominating symptom of arteriovenous fistula was a pulsating tumor with a marked thrill. Excision of the fistula and reconstruction of the artery and vein was performed in 11 patients. In 3 patients the fistula was first ligated resulting in early recurrence of the shunt. At follow-up 3-15 years postoperatively all fistulas were closed, but 5 patients had moderate symptoms.- - - - - - - - - - ranking = 0.25keywords = closure (Clic here for more details about this article) |
7/49. Treatment of hostile midline back wounds: an extreme approach.The basic principles of successful wound closure remain the same: careful preoperative evaluation, removal of underlying nonviable tissue, and well-vascularized soft-tissue coverage. Many complex or "hostile" back wound closures also require stabilization of the spine and a two-layered wound closure. The use of long arteriovenous fistulas with free tissue transfer provides an additional weapon for the treatment of these complex wounds.- - - - - - - - - - ranking = 0.75keywords = closure (Clic here for more details about this article) |
8/49. Transcatheter closure of a posttraumatic ventricular septal defect with an Amplatzer occluder device.Cardiac traumatization may lead to severe complications. Transcatheter closure of a postraumatic ventricular septal defect (VSD) was successfully done using an Amplatzer septal occluder in a man who had previously undergone surgery for myocardial fissure and mitral valve dysfunction. In selected cases, the percutaneous approach may be a valuable option to close muscular VSDs.- - - - - - - - - - ranking = 1.25keywords = closure (Clic here for more details about this article) |
9/49. Managing the pain of traumatic injury.Management of pain in the trauma patient is a complex issue requiring the ability to selectively match different injuries and patient situations with the most optimal pain management methods. Having an understanding of the various stages of trauma care helps clinicians to best support the goals of patient care while decreasing the detrimental effects of the stress response through good pain control interventions. When nurses have a good understanding of the various pain management interventions they are better able to assess the effectiveness, potential side effects, and goals of therapy. The following is a list of clinical pearls to help guide nurses to better manage the pain of traumatic injuries: Encourage your trauma team to standardize pain medications (particularly opioids). A protocol that uses a couple of opioids with varving routes of administration, onset, duration, mechanism of action, and side effects helps the team to become extremely familiar with them and better able to assess effectiveness and side effects. Frequent motor and sensory assessments are necessary in the injured-patient (especially with extremity and head injuries), and drug therapy choices must allow for a thorough baseline assessment and periodic checks to follow. patients with multiple rib fractures or flail segments (particularly elderly patients) and no contraindications deserve serious consideration for treatment with an epidural. When using various pain management techniques, the nurse needs to be prepared to treat complications if they should arise. Airway equipment, drugs (i.e., oxygen, opioid antagonists, pressors), and resuscitation means must be immediately available. nurses need to be extremely careful when receiving pain medication and other central nervous system depressant orders from various doctors involved in patients' care. If a pain management specialist is involved, all pain medication therapies should be supervised and ordered by that individual, particularly when spinal analgesia is employed. nurses must be knowledgeable regarding the effects of spinal medications (local anesthetics and opioids) at varying spinal levels so as to assess therapeutic as well as untoward effects. Institute a diligent bowel protocol when using opioids. Opioid administration combined with the immobility and altered nutrition often associated with trauma can easily result in constipation, abdominal distention, and bowel obstruction. It is not uncommon for epidural blocks to need supplementation with other drug therapy, and this should not be considered a failure of the epidural. Any addition needs to be ordered and closely supervised by one primary team of doctors. Use of nonopioid drugs, if not contraindicated should be considered in all trauma patients. This is especially true for patients sustaining trauma and being discharged to home within 24 hours. They need to be educated about the pain they can expect the next day and how to judge if it is normal and expected or possibly the sign of a missed injury or developing complication (i.e., compartment svndrome infection).- - - - - - - - - - ranking = 0.10450031144183keywords = drug (Clic here for more details about this article) |
10/49. Eosinophilic fasciitis associated with simple traumatism.Eosinophilic fasciiitis is an idiopathic and uncommon condition, a scleroderma-like disorder that predominantly affects the extremities and is characterized by marked thickening and inflammation of the fascia, associated with with peripheral blood eosinophilia, hypergammaglobulinemia, and characteristic histologic findings. A case is presented of a 75-year-old female patient who sought medical assistance for sudden occurrence of induration and erythema of both lower extremities one week after she had fallen from a one-meter height, with generalization of the signs. The diagnosis of eosinophilic fasciitis was made on the basis of histopathologic findings, and treatment with glucocorticoids, non-steroid anti-inflammatory drugs and antihistaminics was prescribed.- - - - - - - - - - ranking = 0.026125077860457keywords = drug (Clic here for more details about this article) |
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