[Microbial contamination of gunshot wounds to the face and neck].
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Biomedical subjects
Publications and source records attributed to M B Shvyrkov.
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Preserved cadaveric orthotopic grafts, osteocartilagenous autotransplants from the rib, ceramic, plastic, carbon, and titanium explants, etc. are used for osteoplasty of the condylar process. Osteoplasty based on distraction osteogenesis was used in 3 patients for osteoplasty of the condylar process and mandibular head with good results.
Dosed distraction of bone regenerate is paralleled by distraction of soft tissues (skin, muscles, nerves, etc.), which is particularly obvious during liquidation of medium-sized and extensive mandibular defects. Such distraction of soft tissues leads to their regeneration and growth. However regeneration of soft tissues is paralleled by dystrophic processes, which are never observed in bone regenerate. Dosed distraction can be used in repair of combined bone and soft tissue defects and deformations of the face of different etiology.
The author criticizes the traditional strategy of sparing treatment of gunshot wounds of the face involving the bones, formulated as long ago as in 1943, and suggests radical primary surgical treatment of such wounds. The author used such treatment with good results during 4 years in Afghanistan war.
We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.
Examinations including tasks presented as tests were carried out in 319 fourth-year students of dental surgery. This method for assessing the knowledge and skills of students proved to be highly objective.
Analysis of the results of examinations in oral surgery making use of tests in 319 fourth-year students showed that such a method of assessing students' knowledge is highly objective.
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Thirty three patients with 0.5 to 4.5 cm gunshot defects of the mandible were treated. The ends of the fragments of the bone were initially compressed, then distracted with the help of a compression-distraction device. The immature callus was distracted at a rate of 0.25 mm four times a day. During the process of distraction the defects of bone and soft tissues are replaced. Lack of soft tissue, which make insertion of a free bone graft impossible, is the main indication for an osteoplasty by local tissues.
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The osteoinductive activity of bone matrix demineralized in acid metabolites of glycolysis and Krebs cycle have been studied in rats. The highest osteoinductive effect was reached during the demineralization in oxaloacetic acid, the lowest one--in the malic acid. The regulatory role of glycolysis metabolites and Krebs Cycle in posttraumatic osteogenesis is under discussion.
Optimal conditions are developed for two methods of simultaneous recording of 45Ca and 32P-radiation in the bone and other tissues. Both methods are compared from the standpoint of their efficiency. The calculation method for the 32P hard beta-radiation in the presence of 45Ca in one tissue specimen by the liquid scintillation counter is 5-10 times as efficient as that by the gas-discharge counter with the filter. The method for recording the low-energy 45Ca beta-radiation in the combination with 32P in one tissue specimen by the end-window gas-discharge counter and filter is more efficient to some extent that the calculation in the liquid scintillation counter.
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White rat experiments have demonstrated that bone matrix osteoinductive activity (the matrix ability to induce ectopic osteogenesis) is in direct proportion with the transplant mass in cases when this mass is within 0 to 0.16% b. m. A higher transplant mass is not associated with elevated osteoinductive activity. When the transplant masses are equal, their osteoinductive activities are in proportion with their sizes. These regularities should be borne in mind when choosing the transplant mass and shape.