Management of the burned hand. 1970.
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Burns↗
Biomedical subjects
J A Boswick
Publications and source records attributed to J A Boswick.
Snow blower injuries to the hand.
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Accidents, Home↗
Cephalosporin therapy in intraabdominal infections. A multicenter randomized, comparative study of cefotetan, moxalactam, and cefoxitin.
Three broad-spectrum cephalosporins (cefotetan, moxalactam, and cefoxitin) proved effective in this randomized, prospective trial for treatment of 303 surgical patients with moderately severe regional peritonitis.
Bacterial Infections↗
Comprehensive rehabilitation after burn injury.
Comprehensive rehabilitation of patients after burn injury requires the organized application of sound, recognized principles. The basic concerns are the prevention of loss of joint motion, loss of muscle mass, and the prevention of anatomic deformities. Important considerations are starting the rehabilitative program as early as possible after injury and avoiding techniques that unduly immobilize the patient or parts of the body. The use of early active motion to the patient and all movable joints, along with appropriate positioning while at rest, is crucial to a successful program. Passive exercising along with the use of restraints and splints is necessary in certain patients.
Burns↗
Identification and antibiotic susceptibility of bacterial isolates from burned patients.
We retrieved bacterial blood isolates from 397 adult burned patients admitted over a 7-year period. Sixty-two patients (15.6 per cent) developed true-positive bacterial blood cultures (judged non-contaminants), and of these 30 (48.4 per cent) expired. Pseudomonas aeruginosa (24 isolates), Staphylococcus aureus (19) and Klebsiella pneumoniae (19) were the most frequent isolates. In vitro susceptibilities of 149 isolates were determined to 12 antibiotics (gentamicin, amikacin, ticarcillin, piperacillin, mezlocillin, azlocillin, cefazolin, cefotaxime, ceftazidime, cefoperazone, thienamycin and ticarcillin-clavulinic acid) using agar diffusion assay. Thienamycin proved the most active agent (97 per cent of isolates susceptible). Cefoperazone was the most active cephalosporin (95 per cent susceptible). Twenty-eight organisms demonstrated multiple drug resistance; patients with such organisms had a 71 per cent mortality. Thienamycin was the most active agent against such isolates (27/28 susceptible). Susceptibilities of all 149 isolates to combinations of antibiotics were calculated, assuming no synergism or antagonism; some combinations of third-generation cephalosporins with the newer penicillins may prove to be as effective as combinations including aminoglycosides.
Adolescent↗
Topical cerium nitrate prevents postburn immunosuppression.
Suppression of cell-mediated immunity (CMI) follows a major thermal injury and is associated with an increased incidence of serious infections. Adult female CF-1 mice received a 20% full-thickness steam burn and were then treated with various topical antimicrobial creams in an attempt to alter the course of postburn immunosuppression. Topical agents included cerium nitrate (CE), silver sulfadiazine (SSD), mafenide (SML), silver nitrate (AG), and a mixture of CE and SSD (CE-SSD). CMI was determined in vivo by measuring ear swelling in response to 2,4-dinitrofluorobenzene (DNFB) challenge in previously sensitized mice. The usual nadir in CMI (ear swelling) when mice were sensitized at day 14 postburn did not occur in burned mice treated with CE or CE-SSD, AG was only modestly effective, and SML or SSD failed to restore CMI. These studies suggest that topical CE may have potential as an immunomodulator in the treatment of burns.
Animals↗
Isolated high median nerve injuries.
High median nerve injuries are commonly associated with injury to the brachial artery and decreased sensibility typical for the pattern of innervation. Loss of motor function is to the interphalangeal joint of the thumb and index finger. Nerve suture was always successful in restoring some degree of sensibility. The return of action to the forearm flexors occurred in a predictable fashion 6-13 months after nerve suture.
Adolescent↗
The effects of perfusion on an amputated extremity.
The amputated hindquarters of adult female rats were infused with solutions of lactated Ringer's, Collins hypertonic renal perfusate, and dextran-dextrose on a washout and continuous basis. The perfusate was analyzed for energy compounds and breakdown products and the muscle tissue examined histologically. Intermittent perfusion or injection under pressure led to marked edema in a 4-hour period and was abandoned in favor of a system that perfused the part at 120 to 150 cm H2O. The model perfused with Collins gained an average of 1.35 gm, that with lactated Ringer's 2.35 gm, and that with dextran-dextrose lost 2.35 gm. Pressure graphs of the various solutions indicated that the vascular bed reacts more physiologically to Collins solution and dextran-dextrose than to lactated Ringer's. Histologic sections of the muscle biopsies confirmed this. The release of ATP and hypoxanthine with lactated Ringer's suggests that it is the most damaging of the perfusates. These findings support the results of the pressure graphs and histologic studies. A potential for replantation of amputated limbs that contain muscle when the cold ischemia time may exceed 6 hours is suggested by the data presented.
Amputation, Surgical↗
Control of vasospasm following trauma and microvascular surgery.
Vasospasm may result in marked reduction of blood flow through injured or revascularized tissues. Neurogenic vasoconstriction is mediated through sympathetic pathways which may be blocked by long-acting local anesthetics resulting in optimal intravascular pressures and elevated flow. An experimental study performed on normal human volunteers has shown that distal sympathetic blockade using Bupivacaine protects the digital circulation against vasospasm elicited by a strong stimulus for a minimum of 7 to 8 hours. A catheter, placed adjacent to the median or ulnar nerve at the wrist level after digital microvascular reconstruction, facilitates continuous Bupivacaine sympathetic blockade. This technique has been used clinically and appears to improve the circulation of replanted or revascularized tissues and protects against vasospasm caused by a variety of stimuli.
Blood Pressure↗
Microsurgical repair of peripheral nerve injuries in the upper extremity.
Microsurgical techniques have been used for peripheral nerve repair at the University of Colorado since 1975. The authors prefer a modified fascicular repair. The rationale is discussed, surgical technique described, and a preliminary review of functional results presented.
Adolescent↗
Accidental hydrofluoric acid burns of the hand.
A case report of accidental hydrofluoric acid burns that involve dermal tissue of the hand is presented. Prompt medical treatment for this accident resulted in minimal disfigurement and minimal paresthesia and disability. Protocols for essential treatment and precautions for personnel working in dental laboratories where hydrofluoric acid is used have been discussed.
Burns, Chemical↗
The epidemiology of cold injuries.
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Adolescent↗
The role of soft tissue reconstruction in flexible implant arthroplasty of the metacarpophalangeal joint.
In 116 hand metacarpophalangeal joint arthroplasties of the flexible type, the operative technique did not include reconstruction of capsular or ligamentous structures, but employed meticulous relocation of the common extensor tendons, and a modification of the metacarpal osteotomy plane and shape. A closely supervised program of splintage and therapy was instituted postoperatively. This series does not vary significantly with respect to range of motion or recurrence of ulnar drift (seen only when patients failed to wear splints as directed) in comparison to other reports. The results, therefore, fail to support the concept that radial capsular and ligamentous reconstruction is an essential part of this procedure.
Arthroplasty↗
Traumatic false aneurysm of the hand in hemophilia.
An unusual case of traumatic false aneurysm following a puncture wound in the hand of a hemophiliac, despite Factor VIII replacement, demonstrates the necessity for careful evaluation of such patients when there is profuse and continued bleeding. Following surgical repair of the false aneurysm and the ulnar proper digital nerve of the thumb 17 days postinjury the patient had an uncomplicated recovery. Partial arterial laceration, the underlying pathology of this lesion, may be demonstrated by arteriography or surgical exploration.
Adult↗
Staged reconstruction of flexor tendons with a silicone rod and a "pedicled" sublimis transfer.
We report the results in 11 cases of secondary flexor tendon reconstruction, employing a silicone rubber rod and a sublimis/profundus tenorrhaphy in the first stage, then hinging out the sublimis tendon on the profundus motor at the second stage. Achievement of a healed proximal tenorrhaphy before the second stage allows (1) inspection of the proximal tenorrhaphy (with assessment of its location, apperance, and strength) and (2) early postoperative motion in a controlled range (with greater confidence in the proximal tenorrhaphy, as rupture after free tendon grafting is not uncommon. The functional results attained were comparable to those in other series of secondary flexor tendon reconstructions.
Adult↗
Common problems in clinical replantation and revascularization in the upper extremity.
The restoration of viability to damaged or amputated tissues may be associated with a variety of unique situational and technical problems. The replantation surgeon must be aware of the many pitfalls which can occur in the care of these serious injuries in order to make appropriate decisions and execute the techniques of microsurgery effectively. The care of these patients begins with an accurate assessment of the injury and the potential functional restoration which can be achieved. It ends following a long rehabilitative and reconstructive effort to maximize ultimate function. All phases of this care are the responsibility of the replantation surgeon who must identify and attempt to solve these unique problems as they arise.
Anesthesia↗
The irrigation jet: an aid in microvascular surgery.
Techniques for manipulating and positioning blood vessels during microvascular surgery which utilize a jeweler's forceps tend to inflict significant trauma to the wall and to the intima of the vessel. An irrigation jet device was designed which allows atraumatic positioning of the vessel, gentle and controlled dilation , and better visualization. With this device rat arteries and veins with an external diameter of 0.6 mm. were joined. Upon examination 3 weeks later, over 95 percent remained patent. In addition, vessels of 0.2 to 0.4 mm. were anastomosed successfully with a long-term patency rate of approximately 50 percent. The device has been found to be useful in clinical replantation and revascularization problems in man.
Animals↗
The influence of experimentally induced anemia on the patency of microvascular anastomoses.
Anemia, secondary to blood loss or hemodilution, causes reduction of blood viscosity and has been assumed to favor the long-term patency of microvascular anastomoses. This assumption was tested by performing arterial and venous anastomoses on rat vessels measuring 0.3 to 0.8 mm. in external diameter. A group of rats rendered experimentally anemic (whose blood viscocity was lowered by 37 percent) showed no higher patency rates when the involved vessels were examined 3 weeks later than did a control group. The hypothesis that anemia favors higher patency rates was not substantiated.
Anemia↗