Biomedical subjects
Publications and source records attributed to R F Edlich.
An athlete with talotibial exostoses with entrapment of the deep peroneal nerve is presented. This diagnosis was made by history, physical and roentgenographic examinations, bone scan, and isokinetic exercising. Treatment of this condition involved surgical excision of the boney exostoses.
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The design and material properties of a surgical wire have been enhanced to improve its performance in surgery. One blunt end of the wire has been honed to a point to decrease the axial compressive force required to penetrate tissue. In addition, its sharp end has been work hardened to increase its yield strength. The mechanical performance of this wire has been characterized by a series of in vitro experiments and a clinical trial.
Pseudofolliculitis barbae is a common cutaneous infection occurring in the bearded area of the face of black men. The infection is caused by ingrown hairs that produce an inflammatory foreign body reaction characterized by papules and pustules at the point of hair penetration that may result in permanent scarring, usually in grooved patterns, and occasionally in keloids. The purpose of this article is to describe the successful treatment of a patient with pseudofolliculitis with keloids that was based on the pathophysiology of the disease and the biology of wound repair.
A special pig's foot holder has been developed for wound-repair teaching sessions. It has been designed to stabilize the pig's foot without obstructing the physician's view of the wound.
The epidemiology, pathology, and management of axillary hidradenitis suppurativa were examined in 11 patients with this disease. On the basis of this study, the following predisposing factors were incriminated in the epidemiology of the disease: predilection of the disease for women, obesity, hair removal by a safety razor, antiperspirants and deodorants, and local pyogenic infections distant from the axilla. Because antiperspirants do not effect transepidermal water loss of axillary skin, their potential deleterious effects are probably related to their chemical irritant effects on cut, nicked, or irritated axillary skin. Treatment of this disease will vary according to its severity. Incision and drainage are usually needed to treat the localized disease. Specific measures must also be instituted to prevent progression of the disease (eg, weight reduction, avoidance of safety razor and antiperspirants and deodorants, and control of localized pyogenic infections distant from the axilla). Management of the chronic phase of the disease is primarily excision of infected axillary skin.
Abdominal wound dehiscence was quantitatively studied in a rat model. Polybutester suture is a new monofilament nonabsorbable suture that has unique stress-strain properties that are potentially beneficial for abdominal wound closure. The abdominal volume at the moment of wound dehiscence was correlated with the extensibility of the suture material used for closure. Interrupted sutures of polybutester cut through the tissues at a mean abdominal volume of 212 +/- 3 ml. This volume was significantly (p less than or equal to 0.005) greater than the mean volumes reached with nylon (197 +/- 3 ml) or polyglycolic acid (187 +/- 4 ml). Closure of abdomens with continuous polybutester suture resulted in a mean rupture volume of 218 +/- 3 ml, which was significantly (p less than or equal to 0.005) greater than that achieved with the same suture employed as simple interrupted sutures (212 +/- 4 ml). The influence of width of tissue bite, suture size, and needle configuration was also evaluated.
Puncture wounds are common and challenging problems facing the physician. In general, puncture wounds can be classified into two distinct types. In one type, a child usually sustains a puncture wound of the foot. The other type of puncture wounds occur among hospital employees. These seemingly innocuous injuries may have serious sequelae that can be averted by prompt appropriate care of the wound. The fundamental trends of treatment of puncture wounds include cleansing the wound, débridement of any necrotic or devitalized tissue, and appropriate immunoprophylaxis.
Tetanus is produced by the action of the potent neurotoxin, tetanospasmin, which is elaborated during the growth of Clostridium tetani. The objectives of management of tetanus are to provide supportive care until the tetanospasmin that is fixed in tissue has been metabolized, to neutralize circulating toxin, and to remove the source of tetanospasmin. This disease, which is frequently fatal, is prevented by immunization.
This article is a collective review of all the prospective clinical studies that assessed the therapeutic value of antibiotics in minor soft tissue lacerations. This review critically evaluates each study that tests the hypothesis that antibiotic treatment reduces the incidence of infection. Even though the design of each of the studies was scientifically inadequate, important factors were identified that influenced the incidence of infection. On the basis of this collective review as well as other studies, indications for antibiotic therapy of minor soft tissue lacerations have been identified. Future clinical studies must be designed to test more precisely the validity of these recommendations.
Toxic epidermal necrolysis (TEN) is a symptom complex characterized by a devastating skin disorder, erosive involvement of two or more mucous membranes, and severe constitutional symptoms. The disorder shares features with erythema multiforme and is thought to be an expression of the syndrome. Although a wide range of etiologic factors have been incriminated in TEN, only a few cases have provided convincing evidence of a direct causal link. Most cases of TEN have been associated with drug administration.
Mammalian bites have reached epidemic proportions with more than one half million people being bitten by an animal or another person. Although the bite wound may initially appear to be innocuous, it may lead to severe complication that can be prevented by a timely and comprehensive treatment program that is outlined in this report. Our approach to these challenging injuries includes a complete evaluation of the injury, planned surgical intervention, antimicrobial therapy, immunoprophylaxis, and appropriate postoperative care.
New guidelines on tetanus prophylaxis in wound management have been prepared by the American College of Surgeons and are available in a poster format or in bulletins. The purpose of this study was to determine the impact of these educational brochures on tetanus prophylaxis in a hospital setting. The results of this study indicate that these informational brochures and posters had insignificant impact on the quality of prophylaxis against tetanus in our hospital. Innovative programs of information exchange and quality assurance are urgently needed to improve the delivery of health care.
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The purpose of this experimental study was to test the potential value of heat welding to cut the ends of knotted surgical sutures. This heat process resulted in knot security in a coated polyglactin suture with fewer throws than those needed for the same suture with knotted ends cut by scissors. Results of mechanical performance testing of the knotted sutures cut either by scissors or welding did not differ significantly. With refinements in the technical design of the heat source, suture welding may have important applications in surgery.
A new, improved drainage system has been specifically designed to provide either closed suction drainage for the ambulating patient or sump drainage for the patient confined to bed. This drainage system is made of silicone that has a hydrogel coating with a low coefficient of friction. This coating facilitates removal of the drain from the wound cavity and reduces the adherence of blood clots in the drainage system. A filter assembly is attached to the air vent lumen to remove particulate matter and bacteria from the air. Clinical evaluation of the filtered sump drainage system has confirmed its superiority over closed suction in its efficiency of removing fluids from the wound.
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