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Biomedical subjects

R F Edlich

Publications and source records attributed to R F Edlich.

At least 73 records · Page 4Linked to original sources

Evaluation of surgical tapes for wound closure.

The performance of four wound closure tapes was evaluated by a series of standardized tests. The tapes examined in this study were a nonwoven microporous tape, a nonwoven microporous reinforced tape, a gauze tape, and a polyurethane tape. The performance of these tapes was assessed by measuring their breaking strength, degree of elongation under loading, adhesion to skin, air and water vapor transmission, and bacterial growth under the tape. On the basis of these in vitro and in vivo studies, the nonwoven microporous tape is recommended for skin closure. This tape has a nonwoven microporous structure with an adhesive that aggressively adheres to the underlying skin. It is strong enough to resist breakage during clinical use and elongates sufficiently to prevent blister formation. Its microporous structure permits rapid air transmission in vitro and results in an environment that is antithetical to bacterial growth.

Air

Clavicular fractures and acromioclavicular joint dislocations in lacrosse: preventable injuries.

Clavicular fractures and acromioclavicular joint dislocations occur frequently in high school lacrosse players. This injury is restricted to attackmen who are struck in the clavicular region by the stick of the defensemen. The conventional foam shoulder pads with or without flexible plastic inserts worn by the attackmen did not protect them from this injury. On the basis of this clinical experience, a new protective shoulder pad containing high-density polyethylene over the clavicle and acromioclavicular joint has been designed and manufactured to prevent these injuries. Our initial experience with this new shoulder pad indicates that it will protect lacrosse players from clavicular fractures and acromioclavicular joint dislocations.

Acromioclavicular Joint

Prosthetic valve endocarditis developing after an infected scalp laceration.

This case report describes a 21-year-old man who developed prosthetic valve endocarditis (PVE) from an infected scalp laceration. Despite intravenous antibiotic therapy, the infectious process could not be controlled and the patient required replacement of the aortic valve. Our patient is the fourth case of late PVE occurring after a subcutaneous infection. In each case, antibiotic prophylaxis of infective endocarditis was not practiced. Current antibiotic regimens for prophylaxis of PVE are reviewed.

Adult

Evaluation of a new, improved surgical drainage system.

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.

Drainage

Innovations in skin suture removal.

A cutting forceps and suture removal scissors have been specially designed for removal of percutaneous sutures. Our clinical experience with these instruments indicate that they facilitate removal of percutaneous sutures in the surgical patient.

Dermatologic Surgical Procedures

Efficacy of burned surface area estimates calculated from charts--the need for a computer-based model.

An accurate estimation of burn surface area is needed to correctly calculate initial fluid resuscitation, nutritional requirements, prognosis, and comparisons of treatment protocols among burn centers. The following experiment was conducted to test the accuracy of physicians compared to a computer-assisted method. Twenty-seven physicians were asked to estimate the per cent of burned surface area from an adult patient diagram. Physicians were found to consistently overestimate the percentage of burned surface area. The average physician estimate was 42% compared to 29.6% calculated by a computer-assisted program. The degree of error between physician estimates and actual TBSA burned is significant and may critically affect patient management. Additional benefits of computer assistance include a permanent record of injury, burn wound trend analysis, and meaningful statistics involving morbidity, mortality, and comparative treatment protocols among burn centers.

Body Surface Area

Improving the accuracy of burn-surface estimation.

A user-friendly computer-assisted method of calculating total body surface area burned (TBSAB) has been developed. This method is more accurate, faster, and subject to less error than conventional methods. For comparison, the ability of 30 physicians to estimate TBSAB was tested. Parameters studied included the effect of prior burn care experience, the influence of burn size, the ability to accurately sketch the size of burns on standard burn charts, and the ability to estimate percent TBSAB from the sketches. Despite the ability for physicians of all levels of training to accurately sketch TBSAB, significant burn size over-estimation (p less than 0.01) and large interrater variability of potential consequence was noted. Direct benefits of a computerized system are many. These include the need for minimal user experience and the ability for wound-trend analysis, permanent record storage, calculation of fluid and caloric requirements, hemodynamic parameters, and the ability to compare meaningfully the different treatment protocols.

Body Surface Area

Clinical syndromes caused by staphylococcal epidermolytic toxin.

Coagulase-positive staphylococci of phage group II produce an epidermolytic toxin that results in a spectrum of diseases that include localized bullous impetigo, generalized scarlatiniform syndrome without exfoliation, and staphylococcal scalded-skin syndrome (SSSS). The mechanism of action of the toxin occurs at the level of the lower stratum granulosum, resulting in intraepidermal cleavage. Generalized exfoliative dermatitis, or SSSS, is one of the most severe infections characterized by generalized epidermolysis with desquamation. Generalized scarlatiniform syndrome is an erythematous rash without exfoliation. A localized infection that results in a bulla larger than 5 mm in diameter is bullous impetigo.

Bacterial Toxins

Lightning injuries.

Lightning causes more deaths than any other weather phenomenon. It is an electrical current that will choose the shortest paths between the contact points of the human body and may involve vital structures in its pathway. Almost every organ system can be injured by the electrical current of lightning. A broad spectrum of complications resulting from damage to the various organ systems has been reported. The sequelae peculiar to this specific type injury will dictate the choice of therapy.

Bone and Bones

Electric burns of the oral cavity.

Low-voltage electric burns are the leading cause of electric burn injury in childhood and can result in an injury to the oral cavity that can heal with a noticeable deformity. The mechanisms of burn injuries to the oral cavity are either due to the electric arc or current or both. Electric burns of the oral cavity can involve the lip, tongue, mucous membranes, and underlying bone. Therapy for these injuries should include management of systemic sequelae and treatment of the local burn injury. Our therapeutic approach to this injury is dictated by the pathophysiology of the electric burn of the oral cavity.

Burns, Electric

The trapezius musculocutaneous flap in head and neck reconstruction: potential pitfalls.

Defects resulting from bulky tumor resection of the head and neck region represent a reconstructive challenge. The trapezius musculocutaneous paddle flap based on the transverse cervical vessels is a useful tool for the reconstructive surgeon. Failure to recognize the variable anatomy is discussed in relation to other musculocutaneous flaps used for the purpose of head and neck reconstruction. The trapezius muscle has a variably located vasculature and diverse nomenclature. The knowledge of the variance of its anatomical vasculature is essential in the successful use of the trapezius musculocutaneous flap.

Arteries

Surgical cautery revisited.

A new hemostatic scalpel has been developed to control bleeding between the cut edges of wound tissue. The scalpel blade resembles conventional scalpel blades, except that it can be heated and its temperature controlled within narrow limits. Cutting is accomplished by the blade's sharp edges, and hemostasis results from the direct transfer of heat from the blade to the tissue. This experimental study has demonstrated that the hemostatic effect of the scalpel is associated with damage to the tissue's defenses against infection and impaired wound healing.

Animals

Evaluation of a new hydrogel coating for drainage tubes.

The performance of silicone drains has been improved by coating their surfaces with a hydrogel polymer. This hydrogel is formed by reacting polyvinylpyrrolidone with an isocyanate prepolymer. By absorbing water, the hydrogel creates a drain surface with a low coefficient of friction. The results of this experimental study demonstrate that the surface coating reduces the adherence of blood clots to the drain and facilitates its removal from the wound. On the basis of these and other experiments, the Food and Drug Administration has allowed the use of hydrogel for coating surgical drains for use in patients.

Animals

Bacteriologic evaluation of electric clippers for surgical hair removal.

Clipper blade assemblies for electric clippers used repeatedly without sterilization demonstrated high levels of bacterial contaminations that are potential sources of infection. A technique of sterilization of the clipper blade has been reported that eliminates the exogenous bacterial contamination.

Adolescent

Epidemiology of flame burn injuries.

This study examines the epidemiology of flame burn injuries in 173 patients treated in four regional burn centres. During this study, recurring and predictable burn accident scenarios were found identifying who was being burned, the circumstances surrounding the burn injury, the burn victim's response to the flame burn situation and the role of garments in the burn injury. This data base should now provide a sound basis for targeted educational programmes on the population that is prone to burn injury.

Accidents

Search for a nontoxic surgical scrub solution for periorbital lacerations.

The purpose of this study was to identify a skin wound cleanser that could be used safely to cleanse lacerations of the periorbital region. The irritation and toxicity to the eye of the commercially available skin wound cleansers were quantitated using numerical values and weights for the ocular lesions in experimental animals. Shur Clens did not elicit lesions in experimental animals or in a series of 20 patients with periorbital lacerations. On the basis of this study, Shur Clens is recommended as a safe skin wound cleanser for periorbital lacerations.

Animals