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Biomedical subjects

J F Reinisch

Publications and source records attributed to J F Reinisch.

At least 19 recordsLinked to original sources
PubMed1989

Efficacy of debridement and primary closure of contaminated wounds: a comparison of methods.

Proper management of highly contaminated traumatic wounds frequently requires delayed primary closure of healing by secondary intention to prevent subsequent infection. This animal study compares the efficacy of various wound debridement methodologies to prevent infection following primary closure of treated contaminated wounds. Forty-four Sprague-Dawley rats with uniform, paravertebral incisions were studied. Each wound was inoculated with a standard amount of Staphylococcus aureus bacteria and allowed to remain open for two hours. Each wound was treated before wound closure by one of four debridement methods: (1) surgical scrubbing, (2) high-pressure irrigation, (3) ultrasonication, or (4) soaking. The control animals' wounds were closed without debridement. At 7 days, each animal was evaluated for the presence of gross infection and wound induration. Ultrasound, with a 25% incidence of gross infection, compared with irrigation (75%), scrubbing (82%), and soaking (89%) provided significant protection from subsequent abscess formation. The control group uniformly developed infection (100%). The average amount of induration after ultrasonication (1.35 +/- 0.56 cm) was also significantly less than irrigation (2.07 +/- 0.75 cm), scrubbing (1.95 +/- 0.34 cm), and soaking (1.73 +/- 0.22 cm). Our data demonstrate that ultrasonic wound debridement has exciting potential as a new debridement technique for contaminated traumatic wounds.

Animals↗
PubMed1989

Intralesional corticosteroid therapy for infantile hemangiomas.

Intralesional corticosteroid injections were performed in 31 hemangiomas in 30 infants aged 1 to 10 months at first injection. One to five injections were given, spaced 6 weeks apart. Lesions were located throughout the head and neck region, except one that was on the buttock. A mixture of betamethasone acetate and triamcinolone acetonide was used. Four lesions (13 percent) virtually disappeared, ten (32 percent) showed greater than 50 percent reduction in volume, ten (32 percent) showed definite but less than 50 percent reduction in volume, and seven (23 percent) showed little or no decrease in size. None showed further growth. All injections were performed without anesthesia, and there were not significant complications. We conclude that intralesional corticosteroid injections are safe and effective in properly selected infants with hemangiomas.

Betamethasone↗
PubMed1988

The treatment of cutaneous vascular lesions with the Nd:YAG laser.

The Nd:YAG laser is well suited for the treatment of cutaneous vascular lesions. The characteristic properties of the Nd:YAG laser emissions in tissue are a high degree of penetration with low absorption by unpigmented tissue. The result is a coagulative effect on tissue containing hemoglobin with relative skin sparing. The Nd:YAG laser was used to treat 116 patients with a variety of cutaneous vascular lesions. Good to excellent results were obtained with a low complication rate for deep cavernous and capillary lesions, port wine stains, and minor vascular ectasias above the lower extremities. Minor venous ectasias and varicosities located on the lower extremities responded poorly. The Nd:YAG laser represents an efficacious tool for the treatment of difficult vascular lesions, with the exception of venous lesions of the lower extremities.

Facial Neoplasms↗
PubMed1988

Radionuclide-labeled red blood cell imaging of vascular malformations in children.

Vascular malformations, particularly in the absence of cutaneous changes, can be difficult to distinguish from other soft tissue masses in children. We have used technetium-99m-labeled red blood cell scintigraphy to study 47 lesions in 43 children. Thirty-nine lesions showed increased flow and were, therefore, diagnosed as vascular malformations. Subsequent biopsy of 10 of these lesions confirmed that diagnosis. The other 29 lesions with increased flow were followed for 10 months to 5 years and the clinical course was consistent with vascular malformation in every case. Eight lesions showed no increased flow on technetium scan. One of these subsequently proved to be a hemangioma. The others have turned out not to be vascular malformations. Therefore, in our experience, the technetium-99m-labeled red blood cell scan has had 98% sensitivity and 100% specificity in diagnosing vascular malformations in children.

Adolescent↗
PubMed1988

The use of wall suction as a lipoaspirator.

Hospital wall suction, standard tubing, and liposuction cannulas have been used successfully for liposuction. Benefits include convenience, simplicity, cost effectiveness, and reduction of effluent dispersion. Our experiences indicates that hospital wall suction can be used as an efficacious lipoaspirator.

Humans↗
PubMed1988

Massive subgaleal hematoma resulting in skin compromise and airway obstruction.

Subgaleal hematomas following minimal trauma, haircombing, and hair pulling by playground swings have been described. Recently a case was reported that progressed to otic hemorrhage and upper facial edema. We present a case (of a previously unreported nature) of a subgaleal hematoma that resulted in airway obstruction, massive edema of the entire face and neck, and limited epidermolysis of facial skin.

Airway Obstruction↗
PubMed1988

Hair-thread tourniquet syndrome .

We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. Patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.

Clothing↗
PubMed1987

A simple method for preventing misplaced electrocauterization.

A small segment of universally available and inexpensive rubber catheter can be easily fitted to insulate electrocautery tips. This technique can prevent numerous thermal injuries and potential litigation arising from accidently burning adjacent tissues. The routine use of this modification in the operating room can save time, anxiety, and potential litigation by preventing misplaced cauterization.

Electrocoagulation↗
PubMed1987

Scalp infections in black children: think kerion.

Treatment of tinea capitis consists of a 5-week course of griseofulvin. A 1-week course of a systemic corticosteroid may be considered in addition to griseofulvin therapy to accelerate the subsidence of inflammation in kerion lesions. Kerion is an inflammatory form of tinea capitis which may progress rapidly into a fulminant infection if untreated. This case report underscores the need for prompt recognition and appropriate treatment of this disorder.

Abscess↗
PubMed1985

Crescent mastopexy and augmentation.

We have defined a group of patients with a lesser degree of moderate breast ptosis whose ptosis correction is not adequately improved by augmentation alone but requires some elevation of the nipple-areola complex. We have selected the crescent excision mastopexy to provide this additional needed lift. Experience with 26 patients employing this technique has helped to define the indications and limitations for this approach. It seems to adequately provide the additional needed lift when nipple descent has been no more than 1.5 to 2 cm below the inframammary crease. Complications such as scar widening (46 percent) were reviewed, but seemed to be well tolerated by the patients.

Breast↗
PubMed1985

Flap physiology and the prediction of flap viability.

Skin flaps are classified as random, axial, musculocutaneous, or fasciocutaneous according to the anatomy by which the skin receives its blood supply. The delay phenomenon allows larger and more reliable skin flaps to be transferred but requires additional surgical procedures. Efforts to mimic the delay phenomenon by pharmacologic means have, unfortunately, been disappointing. The major recent advances in flap design and reliability have come from increased knowledge of the anatomy of skin circulation, specifically musculocutaneous and fasciocutaneous circulation. In an effort to accurately predict flap survival, various monitoring techniques have been tried. These include visual inspection of fluorescein, fluorescein photography, dermofluorometry, surface temperature readings, photoplethysmography, ultrasound Doppler flowmeters, laser Dopplers, and transcutaneous PO2 monitors. Fluorescein has proved to be consistent and reliable, and the dermofluorometer has the advantage of using smaller fluorescein doses that can be frequently repeated. The other monitoring devices each have additional advantages and disadvantages.

Animals↗
PubMed1984

Management of radiation wounds.

Radiation wounds caused by newer high-voltage radiotherapy techniques are very difficult to manage. Recent developments in flap design and transfer aid the surgeon in successfully treating these difficult problems.

Aged↗
PubMed1984

The use of the osteocutaneous groin flap in gunshot wounds of the hand.

Since 1972, the groin flap has been used as an excellent source of skin coverage for the hand. This flap can incorporate the underlying iliac crest to provide both soft tissue and vascularized bone for the reconstruction of complex hand injuries. Three patients who sustained gunshot wounds of the hand with loss of the thumb metacarpal and extensive soft tissue were treated with a groin flap that included the iliac crest. Bony union was rapid and thumb stability was excellent in all patients 3 months after initial reconstruction. The advantages of the osteocutaneous flap include the ability to: (1) supply vascularized bone to what is frequently a poor recipient bed for a bone graft, (2) reconstruct both soft tissue and bony defects simultaneously, and (3) be used in facilities without capability for microvascular surgery.

Adult↗
PubMed1983

The effects of streptokinase on ischemic flaps.

Prolonged ischemic periods may inhibit success in microsurgical procedures. Impairment of fibrinolytic activity could be a factor contributing to this problem. Ischemic epigastric flaps in the rat were used as a model to measure the potential of streptokinase to improve blood flow and tissue survival. A moderate but statistically significant improvement in flap survival was observed and is felt to be due to the enhancement of fibrinolytic activity previously impaired by ischemia. Saline irrigation alone in control animals was found to be detrimental to flap survival. Streptokinase might prove beneficial when dealing with an ischemic replant or free flap.

Animals↗