Biomedical subjects
Publications and source records attributed to R J Neimkin.
Nontraumatic clostridial infections are rare, but need to be diagnosed and treated early or high morbidity and mortality rates result. We believe that this is the first reported case of metastatic nontraumatic Clostridium septicum osteomyelitis. Early treatment with surgical debridement and parenteral antibiotics without hyperbaric oxygen was used. An associated occult rectal malignancy was discovered and treated.
In 11 patients (1 to 28 years of age) having elective surgical release of congenital or burn syndactyly in 1982-1983, we used the modified Cronin method of web reconstruction with double opposing, inverted V-shaped flaps and full-thickness skin grafts. Postoperatively, the hands were splinted for three weeks, at which time we changed the dressing, with the patient under anesthesia. The hands were then immobilized for an additional three weeks. At the last clinic visit (13 to 20 months postoperatively) the hands were evaluated for adequacy of web space reconstruction, cosmesis, and postoperative complications. There was one partial loss of a full-thickness skin graft, which required regrafting when the patient prematurely removed his dressing. One proximal interphalangeal joint contracture required splinting. The web space reconstruction was judged adequate in all hands, and all patients and parents were pleased with the cosmetic results. This method of reconstruction gives good results and its web space reconstruction is technically easier than other methods.
Irreducible palmar dislocation of the proximal interphalangeal joint in which the central slip remains intact is a rare injury. A noose formed by the extensor mechanism traps the condyle of the proximal phalanx. The collateral ligament is avulsed and the volar plate is disrupted. Closed reduction was unsuccessful in this case. Open reduction achieved a good result.
Continuous regional anesthesia through a catheter placed in the axillary sheath has been an effective method of brachial plexus neural blockade. This article confirms this observation and demonstrates that continuous axillary block is useful in replantation surgery to provide anesthesia and analgesia in addition to sympathetic blockade for up to 7 days after operation. This anesthetic technique may allow extensive revascularization or replantation procedures to be performed for patients who could not safely tolerate prolonged application of general anesthesia.
Double tourniquets linked to separate Freon cannisters and two mercury manometers have been effective in maintaining ischemia in over 1,000 consecutive hand surgery operations. The mercury manometers permit constant accurate monitoring of the tourniquet pressure. The cuffs are used alternately. Each is inflated for up to 1 hour in order to limit the duration of nerve compression deep to the cuff. If there is malfunction of either cuff, the other cuff may be inflated at once. This system has permitted sustained ischemia in the upper extremity for up to 3 1/2 hours at a constant tourniquet pressure with no permanent clinically apparent sequellae. There has been no permanent nerve injury, although patients with more than 2 hours of tourniquet time often note hypoesthesia or paresthesia for 1 or 2 days. The alternating double tourniquet linked to a mercury manometer permits up to 3 1/2 hours of continuous ischemia of the upper limb with little risk of nerve damage.
The teaching of surgical anatomy is an important aspect of an orthopedic training program. The fabrication of polyurethane bones by the authors' staff has proved to be a simple, inexpensive, and rapid means of duplicating bones, permitting the orthopedic surgeons to experiment with new surgical techniques as well as to teach surgical skills. Polyurethane bones may be purchased commercially but are much less costly and more instructive when made by staff members.