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Biomedical subjects

D H Parks

Publications and source records attributed to D H Parks.

12 recordsLinked to original sources
PubMed1990

Academic consequences of a trauma system failure.

Houston is served by only two trauma centers: Hermann Hospital (University of Texas Medical School at Houston [UTMSH]), and Ben Taub General Hospital (Baylor College of Medicine). In mid-1988, Hermann Hospital, prompted by a shortage of ICU nurses and +8.0 million/yr of uncollectible trauma charges, began to divert critically ill and injured patients to the already overburdened Ben Taub General Hospital. The academic consequences to UTMSH included a severe loss of clinical experience by the surgical residents and medical students and a severe reduction in faculty-generated billing. The lost billing from the trauma service and the other clinical services approximated +8.0 million/yr. This equated to an +13.5 million decrease in the anticipated billings for the year. Alternative revenue sources were not apparent. Other centers with a heavy trauma system commitment are at risk to suffer similar unsettling academic sequelae as our trauma systems fail.

Academic Medical Centers↗
PubMed1990

Nasal surgery complications.

This study examines the incidence of serious complications in nasal surgery and discusses the diagnosis and management of these complications. The authors review 259 consecutive cases performed between January 1, 1983, and August 31, 1988. One-hundred and ninety-five patients had septorhinoplasties, 29 had septoplasties, and 35 had rhinoplasties. Thirteen of these cases involved serious complications as follows: hemorrhage (5), perforation (4), infections (3), and pneumocephalus (1). All the patients with these serious complications had associated septal and/or turbinate surgery. The diagnosis and management of these complications will be discussed. In this small series of nasal surgery patients, the incidence of serious complications was 5.0 percent, with no fatalities reported. The higher incidence of serious complications occurred when associated septal and/or turbinate surgery was required. Awareness of these complications is essential because of the increasing number of patients presenting to plastic surgeons for nasal surgery in whom associated septal and/or turbinate surgery is necessary.

Adolescent↗
PubMed1990

Timing of burn therapy in the pediatric patient.

The physician embarking on the long-term management of burned children must have a very strong and honest relationship with the patient and family or guardians and must use all available resources, including physical and occupational therapists, social workers, and others, over the course of the effort. There is rarely an end-point in the rehabilitation of a burned child, and the surgeon must be aware of the effects of growth, have state-of-the-art knowledge of reconstructive techniques, and ideally have adequate experience to predict the effects of therapy over many years. This experience often can be gained only from senior surgical colleagues who have the advantage of experience following years of observing wounds heal and operations mature. The timing of many facets of pediatric burn care is, in many ways, abstract and based on intense clinical acumen and physical examination. However, it is imperative that the physician develop a treatment timetable based on the principles of contemporary burn care.

Burns↗
PubMed1989

Post-trauma reconstruction with free tissue transfer--analysis of 442 consecutive cases.

We reviewed 442 consecutive free flaps performed between July 1979 and December 1987 in 423 trauma patients. The ages ranged from 2 to 76 years. There were 339 males and 84 females. Soft-tissue coverage was the most frequent (56.3%) indication, followed by unstable wound, extensive bone loss, chronic osteomyelitis, insensate scar, loss of specialized tissue, and contour deformity. Most of the reconstructed defects (72.4%) were located in the lower extremity and the great majority (42.3%) involved the lower third of the leg. Motor vehicle accidents were the main (45.6%) cause of the defects followed by motorcycle injuries (28.6%), industrial accidents (15.1%), farming accidents (3.6%), and gunshot wounds (3.3%). Seventeen types of free vascularized cutaneous, myocutaneous, muscular, osseous, osteocutaneous, fascial, fasciocutaneous, sensate, and specialized tissue transfers were used. The latissimus dorsi free flap was the most frequently performed tissue transfer. Only 2.3% of the flaps were done within the first 48 hours post-trauma, although 76.5% of the transfers were completed within the first 2 weeks after injury. The overall success rate was 96.4% and the incidence of re-exploration was 14.7%. Free tissue transfers provide a very reliable method for dealing with difficult reconstructive problems in trauma patients.

Adolescent↗
PubMed1989

Primary skin closure in large myelomeningoceles.

Numerous reconstructive methods have been described for the soft tissue closure of large myelomeningoceles. Recent advances in techniques of soft tissue expansion provide yet another reconstructive option. Tissue expansion allows for primary closure of the defect with surrounding tissue, resulting in minimal donor site morbidity. This report illustrates the technique of tissue expansion in the closure of a large myelomeningocele.

Humans↗
PubMed1979

Ultrastructural evidence for the presence of "fibroclasts" and "myofibroclasts" in wound healing tissues.

We have observed, by light and electron microscopy, fibroblast-like cells which appear to be involved in collagen fiber and filament degradation. These cells are most prominent in the dermis of mature hypertrophic scars which were clinically observed to be in the remodeling phase of wound repair. Total incorporation of collagen filaments within cellular vacuoles, as seen by TEM, appears to precede the enzymatic degradation of the collagen. Cytoplasmic contractile bundles and/or collagen filament remnants found within residual lysosomes were also seen in many of these cells. Evidence of structural reorganization within the tissue was observed by means of SEM. These cells appear to be similar to osteoclasts in function: thus we propose to name them "fibroclasts" and "myofibroclasts."

Adolescent↗
PubMed1979

Outpatient breast surgery under intercostal block anesthesia.

During the past 3 years, we have performed various breast operations in 320 patients under local anesthesia, using intercostal nerve block. The amount of local anesthetic solution required has been about 20 ml 1% lidocaine for blocking both sides, and an additional 24 ml of 0.5% lidocaine during the surgery. This dosage is well within safe limits. We have found that various breast operations, ranging from augmentation mammaplasty to a staged reconstruction after mastectomy, can be done with this method of anesthesia. The complications attributable to the nerve block were nil in our series.

Ambulatory Care↗
PubMed1977

Management of burns.

An overview of the management of the acutely burned patient has been described. Adherence to the sound principles of early resuscitation, appropriate nutrition, wound management, and rehabilitation can provide hope for many of the victims of this tragic injury. Complications encountered throughout the burn illness present unique and perplexing problems for the physician, who must utilize all the clinical wisdom and facility available in the management of such complex problems.

Anesthesia↗
PubMed1977

Late problems in burns.

In summary, the commonest late physical complications of the burn injury have been reviewed and an approach to their management described. An understanding of the pathophysiology of the conditions is invaluable in planning one's approach to these problems. The techniques to control and correct chronic wound and hypertrophic scar and contractural deformities have been described. We present only a brief summary of the techniques found most reliable in the management of a large group of burned children over many years.

Axilla↗