Biomedical subjects
S R Lewis
Publications and source records attributed to S R Lewis.
Hats for the newborn infant.
The efficacy of a Gamgee-lined hat in reducing the rate of fall in rectal temperature of infants during the first 30 minutes of life was studied. The trial, which included 211 infants, was randomised, prospective, and controlled. One hundred and seven infants were exposed to overhead radiantheaters. Of these, only 30 had normal deliveries, so the analysis was confined to the infants who were not subjected to radiant heat, and in this group no conclusions were drawn about the efficacy of a hat or a radiant heater. In the 104 infants not subjected to radiant heat, body weight, initial rectal temperature, the application of hat, the environmental temperature, and the duration of exposure while naked were all found to influence measureably the rate of fall in rectal temperature during the first 30 minutes. Gamgee-lined hats should be routinely used to minimise heat loss, especially in small infants exposed at birth, during surgical operations, and during investigations necessitating prolonged exposure.
Outpatient breast surgery under intercostal block anesthesia.
During the past 3 years, we have performed various breast operations in 320 patients under local anesthesia, using intercostal nerve block. The amount of local anesthetic solution required has been about 20 ml 1% lidocaine for blocking both sides, and an additional 24 ml of 0.5% lidocaine during the surgery. This dosage is well within safe limits. We have found that various breast operations, ranging from augmentation mammaplasty to a staged reconstruction after mastectomy, can be done with this method of anesthesia. The complications attributable to the nerve block were nil in our series.
Ten years of experience in managing patients with burn contractures of axilla, elbow, wrist, and knee joints.
An analysis of 625 patients who had sustained burns across the axillae, elbows, wrists, or knee joints indicates that the use of splints and pressure across these joints will not only greatly decrease the incidence of contractures but will also reduce the frequency and need for release operations. However, these appliances must be used for at least 6 months (longer, if possible), if substantial benefits are to be obtained.
Migration of silicone gel after the "squeeze technique" to rupture a contracted breast capsule. Case report.
While the squeeze capsulotomy is a simple and effective method for managing capsular contracture around a breast implant, with extreme force the rupture of the prostheses can occur. With the concomitant use of a pressure dressing and breast massage, there was distant migration of the extravasated gel in one case, so this should be considered as a potential complication of this technique.
Hand deformities in patients with snakebite.
Over the past 25 years, 83 patients have been treated at our hospitals for poisonous snakebites of the hand. Prior to 1970, polyvalent antivenin was used, either alone or in conjunction with cryotherapy, steroids, or incision and suction methods. Hand deformities, due to tissue necrosis, were encountered in 15 of 22 patients (68%) treated by these methods. In contrast, excisional therapy, without the use of polyvalent antivenin, was the sole method of treatment in 61 patients seen since 1970. The incidence of hand deformity in them was 8.2%. We have concluded that early excision of the envenomated tissues will not only curtail systemic toxicity from the injected venom, but will also minimize the extent of local tissue damage.
Use of muscle flaps in treatment of osteomyelitis of the tibia.
Explore the source record for details and available documents.
Burn injuries of the eyelids.
Burns of the eyelid and surrounding structures are relatively uncommon in spite of a high incidence of thermal injuries involving the face. The etiologic factors, circumstances that precipitated the injury, and the anatomical features unique to the eyelid and adnexal area may conceivably account for the low incidence. The basic aims in reconstructing deformities must include primarily measures of protecting corneal exposure and relieving epiphora. Early reconstruction of other deformities such as epicanthal folds, palpebral stenosis, and missing eyebrows and eyelashes should be discouraged because of frequent recurrence of deformities due to contracting scars and scar hypertrophy.
Retrobulbar hemorrhage.
Retrobulbar hemorrhage is a rare complication of orbital trauma or surgery. Although the process is usually self-limiting, infrequently visual impairment may result. Various methods for relieving the associated intraocular hypertension (caused by the extraocular compression posteriorly) have been suggested. The effectiveness of some remains questionable. To reassess the effectiveness of conservative management of this problem, we reviewed the medical records of all 10 patients who had had retrobulbar hemorrhage at our institution during the past 8 years. Additionally, we did an experimental study on rabbits to evaluate the visual effects of a transient but abnormally high intraorbital pressure. The results are reported.
Burn alopecia.
Our experience in managing 117 patients with burn alopecia are presented. Most often we used staged excisions of the scarred scalp areas, and by this means we could cover up to 15 percent of the scalp. When the alopecia involved the anterior portion of the scalp, however, a rotational scalp flap was needed to restore the anterior hairline and/or sideburns. For those with burn alopecia of more than 60 percent of the scalp surface, no surgical treatment was effective; the women would often cover their scalps with hairpieces, but the men in our series preferred not to do so.
Thumb reconstruction in the severely burned hand.
The standard techniques have generally been adequate for thumb reconstruction in the severely burned hand. The basic principles of preservation of length, prevention of malposition and contracture by appropriate splinting, early motion, and early skin coverage are all applicable. The nature of the tissue changes wrought by the burn wound, however, frequently necessitates certain modifications in the approach to surgical reconstruction. We have described these and our methods used in handling 9 specific cases.
Relative hypoxemia during rhytidoplasty.
The results of blood gas analyses in 24 patients who had a rhytidoplasty under local anesthesia indicated that a moderate degree of hypoxemia can be elicited in these patients when they have had standard doses of the usual sedatives. While the acid-base abnormalities were generally corrected spontaneously, the extent of the hypoxemia can be aggravated further by the additional use of diazepam during the operation. Therefore, over-sedation of such a patient during the operation, without a secured airway, must be avoided. Additionally, we recommend deep breathing at frequent intervals, with or without supplemental oxygen through a high flow system.
Reconstruction of eyelids and eyebrows in burned patients.
The records of 283 consecutive patients treated for facial burns were reviewed. Eighteen percent of these patients had significant deformities of the eyelids or adnexal structures and underwent surgical correction. Our experience in managing these patients is presented and discussed.
Prevention and management of contractures in patients with burns of the neck.
Two hundred patients with neck burns were analyzed to determine the incidence of contractures. It was found that only 8 per cent of patients with second degree burns had contractures, all of which were mild. Both the overall incidence of cervical contractures in patients with third degree neck burns and their severity can be decreased by the use of a custom-formed isoprene splint. Splinting should begin as soon as possible after the burn and continue until scar maturation is complete.
Burned hands.
Hand involvement is common in patients with severe burns. Our experience indicates that almost one-third of the patients admitted to the Shriner's Burns Institute and The University of Texas Medical Branch Hospitals with burns exceeding 30 per cent of the body surface had concomitant burns of the hand. Our approach in managing the burned hand during the acute phase of unjury, as well as during secondary reconstruction of the deformities, is presented and discussed.