Wound assessment and categorization.
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Burns↗
Biomedical subjects
G Rodeheaver
Publications and source records attributed to G Rodeheaver.
Production of experimental brain abscess in the rat.
Experimental evaluation of brain abscess has been inhibited by the lack of a simple and reproducible model in small animals. A stereotaxic headholder and slow infusion of 1 microliter of saline, containing a known number of bacteria, were used to produce brain abscess consistently in the rat. The natural history of the brain abscess produced by this technique closely simulated that found in the human clinical situation.
Animals↗
The influence of catabolism on immunocompetence in burned patients.
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Adolescent↗
Side-effects of topical proteolytic enzyme treatment.
The results of this study indicate that short term treatment of wounds with topical enzymes appears to be safe and is accompanied by no clinically significant side-effects. Topical wound treatment with this enzyme did not interfere either with healing of experimental wounds or the activity of the antibiotics. Wounds subjected to this enzyme treatment exhibited a normal capacity to resist infection, even though this enzyme interferred with leukocyte phagocytosis in vitro. The potential benefits of this treatment in experimental wounds as an adjunct to antibiotics considerably outweigh its damaging effects. Its clinical use in patients must await the results of carefully controlled clinical trials in which the efficacy of this treatment is evaluated.
Administration, Topical↗
Debridement: an essential component of traumatic wound care.
The harmful influences of devitalized tissue on wound defenses are documented and the importance of wound debridement in the care of the traumatic wound is stressed. All devitalized soft tissues damaged the host's defenses and encouraged the development of infection. The capacity of divitalized muscle, fat, and skin to enhance infection was comparable. The infection-potentiating effect of skin was enhanced by exposing it to a dry thermal injury. The mechanisms by which devitalized soft tissue enhanced infection are several. The devitalized soft tissue acts as a culture medium promoting bacterial growth. In addition, the devitalized tissue inhibits leukocyte phagocytosis of bacteria and subsequent kill. Finally, the anaerobic environment within the devitalized tissue may also limit leukocyte function.
Debridement↗
A new model for experimental brain abscess in rats and mice.
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Animals↗
Antimicrobial prophylaxis of contaminated tissues containing suture implants.
Neomycin sulfate was the only antibiotic tested that significantly reduced the incidence of infections around suture implant sites. The therapeutic efficacy of this antibiotic was related to the chemical and physical configuration of the sutures.
Animals↗
Nonoperative management of fingertip pulp amputation by occlusive dressings.
Nonoperative management of fingertip pulp amputations has been employed in eighteen adults. After wound cleansing and debridement, the wound was covered by an occlusive dressing. Healing of the amputated fingertip occurred within four weeks. The healed fingertip had an excellent sensory perception, normal range of motion and an acceptable cosmetic appearance. This satisfactory outcome was realized with less than ten days lost from work.
Aluminum↗
Influence of subcuticular sutures on scar formation.
The purpose of this study was to determine the influence of nonabsorbable and absorbable subcuticular sutures on the width of scars of the human skin. This study included seventeen patients undergoing partial laminectomy for radiculopathy secondary to herniated nucleus pulposis. The scar of each patient served as its only control with its superior and inferior portions being subjected to different closure technics. The most important determinant of scar width was the patient himself. The width of the scar varied from an almost imperceptible scar in one patient to a very wide scar in another. An additional determinant of scar width was the location of the scar. The width of the inferior half of the scar was wider than the width of the superior half of the scar. Subcuticular closure of the laminectomy scar did not alter the magnitude of scar formation.
Cicatrix↗
Mechanical performance of sutures in surgery.
In this study, we have compared the recommended configuration of a knot with specified sutures as ascertained by mechanical performance tests to that employed by a group of board-certified surgeons. Agreement between the surgeon and the results of the test was encountered in only one fourth of the instances. In another one fourth of the cases the surgeon overestimated the number of throws required for a knot to reach knot break. This additional suture material further handicaps the host's defenses, thereby inviting infection. Surgeons employed knots that untied without reaching knot break in the remaining half of the cases. The holding power of many of the knots that untied was substantially less than that of knots reaching knot break. On the basis of the study, it is recommended that results of the mechanical performance tests be made readily available to the surgeon so that his patient can receive maximal benefits from the knotted suture with the least damage to the host's defenses.
Evaluation Studies as Topic↗
A rapid technic for quantitating wound bacterial count.
An improved technic has been developed to predict rapidly the critical number of bacteria in tissues. This technic gave reliable and accurate measurements for wounds containing more than 2 X 10(5) organisms per gram of tissue. It is fortuitous that 10(6) bacteria is the critical number of bacteria that will induced clinical infection in experimental animals and humans. The rapid slide technic is now being utilized routinely in our medical center to determine graft bed receptiveness, predict the safety of wound closure, and monitor the course of burns.
Animals↗
Pharmacokinetics of a new skin wound cleanser.
Iodophors are effective germicidal agents that have prolonged antiseptic activity in contaminated wounds. A nontoxic surfactant, Pluronic F-68, has been used to formulate a safe and effective iodophor. The parameters necessary to regulate the activity of the iodophor were studied to develop a potent, yet safe bactericidal solution for use in human subjects. The parameters found to be most important were the pH of the solution and the concentration of sodium iodide. Lowering the pH of iodophors increased their stability and antiseptic activity. The free iodine in iodophor solutions prepared with a low pH is predominantly the highly biocidal diatomic iodine (I2). The concentration of iodide regulated the equilbrium of the dissolved iodine between its free and complexed form. Increasing the concentration of iodide in the iodophor lowered the amount of free iodine in solution and enhanced the concentration of the complexed iodide. It is the level of free iodine in an iodophor that determines its antiseptic activity. Low levels of free iodine yielded iodophors that had a slow bacterial kill rate but a prolonged duration of action. Manipulation of these variables permitted the generation of iodophors that varied considerably in their kill rates of bacteria and their duration of antibacterial activity. Iodophors tested in this study demonstrated a distinct superiority to noncomplexed iodine solutions (tincture and aqueous iodine solutions) as wound and skin cleansers.
Animals↗
The crush injury: a high risk wound.
A standardized experimental impact injury model was developed to produce soft tissue trauma that simulated impact injuries to soft tissue overlying the cranium. An aluminum impact instrument was constructed so as to deliver a measured amount of energy to a finite area of soft tissue over a fixed foundation. Impact injury resulted in readily demonstrable changes in the morphology of the tissue and its blood flow. As measured by the distribution of fluorescein dye, the blood flow to the impact site was considerably less than that to unwounded tissue. The magnitude of this reduction in blood flow to the site of injury was proportional to the level of energy absorbed by the tissue. The injury to skin resulting from the impact was restricted primarily to the subcutaneous tissue and panniculus carnosus. Loss of adipose tissue and necrosis of skeletal muscle fibers in these layers were associated with the development of a dense inflammatory infiltrate. The structural damage to the tissue and its reduced perfusion were correlated with the tissue's increased susceptibility to infection by bacteria delivered either by direct infection or as a result of a bacteremia. The magnitude of this damage to the host's defenses is, again, directly related to the amount of energy absorbed per unit area of soft tissue. Antibiotics did suppress the growth of bacteria in these experimental soft tissue impact wounds, even when treatment was delayed eight hours. While the therapeutic efficacy of antibiotics was readily apparent in soft tissue impact wounds, the degree to which they could suppress bacteria in these wounds was less than that encountered in the treated control wounds not subjected to impact.
Adipose Tissue↗
Proteolytic enzymes as adjuncts to antimicrobial prophylaxis of contaminated wounds.
When a tissue is injured, its vessels exhibit a marked increase in vascular permeability. Blood proteins, including fibrinogen, traverse the vessel walls and lead to the development of a surface coagulum. This inflammatory response continues until primary closure of the wound edges is accomplished. The thickness of the surface coagulum is roughly proportional to the time interval between wounding and closure. This coagulum encompasses the surface contaminants, preventing contact with either topical or systemic antibiotics. The presence of this surface coagulum limits the time in which antibiotic prophylaxis is effective. At three hours after injury, antimicrobial prophylaxis of contaminated wounds has no therapeutic value. Hydrolysis of the protein coagulum by proteolytic enzymes enhances the activity of the antibiotic in experimental wounds. The success of proteolytic enzymes as adjuncts to delayed antibiotic treatment can be correlated with the clot lysis activity of the enzymes in vitro. Travase, the most potent fibrinolytic enzyme, is the most effective adjunct to delayed antibiotic therapy of contaminated wounds. In contrast, the active enzymes found in Elase, which exhibit no significant clot lysis activity in vitro, do not potentiate the activity of antibiotics in wounds subjected to a delay in treatment. Travase prolongs the period of effective topical antibiotic action for at least eight hours in experimental contaminated wounds. The therapeutic merit of Travase is also apparent when the antibiotic is administered systemically. Travase shows promise as an adjunct to a variety of antibiotics that are effective against both gram-positive and gram-negative organisms. The results of these experimental studies support our belief that clinical studies support our belief that clinical studies should now be initiated to test the therapeutic value of Travase as an adjunct to antibiotics in heavily contaminated wounds subjected to an unavoidable delay in treatment.
Animals↗
A new filtered sump tube for wound drainage.
A new filtered sump tube has been designed for drainage of collections of fluids from wounds without the danger of infection by airborne contaminants. A two-staged filter has been attached to the vent lumen that removes particulate matter and bacteria from the air that passes through the filter. A clinical evaluation of this tube confirms the superiority of sump drainage as compared with closed suction drainage in the removal of fluids from wounds or cavities.
Abdominal Injuries↗
A more reliable gram staining technic for diagnosis of surgical infections.
The purpose of this study was to identify pitfalls in the Gram staining technic that limit its diagnostic value. In our clinical experience, gram-positive organisms were often decolorized too easily. Factors have been identified that alter the susceptibility of gram-positive organisms to decolorization in the Gram staining technic. The age of the bacterial culture, the preparation of the smear, the fixation technic, and the mordant have an important influence on the ease with which gram-positive organisms are decolorized. On the basis of these studies, a more reliable and reproducible Gram staining technic has been developed for the diagnosis of surgical infections.
Bacteria↗
Mechanical performance of surgical sutures.
A comprehensive analysis of the mechanical performance of sutures has been made to provide information concerning the reliability and security of knotted sutures. The tests utilized in this analysis were designed to be easily reproduced by other investigators. The construction of the knot and the knot performance analysis were undertaken utilizing an Instron Tensile Tester. The mechanical reliability of each knotted suture was determined by measuring the number of throws to reach knot break, the expected slippage of the knot when it reaches knot break, and the maximal holding force at knot break. On the basis of these measurements, recommendations are made for the use of a suture at operation.
Biomechanical Phenomena↗
Biology of infections of split thickness skin grafts.
The purpose of this study was to identify determinants of split thickness skin graft infection. The bacterial count of the experimental wounds was proportional to the incidence of infection in split thickness skin grafts. When the wound was heavily contaminated with 107 organisms, infection developed under most grafts. Graft take frequently occurred in wounds subjected to a lower level of inoculum. The importance of bacterial counts as a determinant of potential skin graft infection was also suggested by a clinical study. We now routinely use quantitative bacterial counts to identify the granulating wounds that are ready for grafting. The type of organism played no significant role in the development of infection.
Animals↗