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Biomedical subjects

D J Wainwright

Publications and source records attributed to D J Wainwright.

11 recordsLinked to original sources
PubMed1995

Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns.

Scarring and contracture are major long-term sequelae of meshed split-thickness autografting for full-thickness skin injury. In the absence of dermis, mature fibroblasts secrete collagen in the altered pattern of scar. This case report illustrates the use of an acellular dermal matrix processed from human allograft skin (AlloDerm) in the treatment of a full-thickness burn injury. The processing technique results in an acellular dermal matrix with normal collagen bundling and organization and an intact basement membrane complex. In these patients, AlloDerm exhibited a high percentage 'take' and supported an overlying meshed split-thickness skin autograft, applied simultaneously. The clinical observations of 'take' were confirmed with histological and electron-microscopic evaluation of biopsies which demonstrated host cell infiltration and neovascularization of the AlloDerm. No specific immune response was detected, either by histology or by lymphocyte proliferation assay. By providing a dermal replacement, the grafted dermal matrix permitted the use of a thin, widely meshed autograft from the donor site, without the undesirable scarring and contracture at the wound site that commonly results from this technique. If effective, this approach would markedly reduce the amount of donor skin required for split-thickness autografts in full-thickness burn injuries.

Adult↗
PubMed1994

Changing patterns in the epidemiology and treatment of zygoma fractures: 10-year review.

A ten year retrospective review of 259 zygoma fractures is presented to highlight changes in epidemiology and treatment. Motor vehicle-related trauma resulted in a majority of the injuries (80.6%), with a high incidence of multiple facial fractures (43.2%). The number of zygomatic and other facial fractures decreased over the duration of the study (by 50.0% and 20.1%, respectively, p < 0.05), perhaps reflecting lowered speed limits and the increased use of seat belts. The proportion of fractures receiving open reduction and internal fixation (ORIF) remained relatively constant (46.3%). At present, miniplate fixation is the preferred surgical treatment, accounting for 61.5% of cases in 1988 and 1989. There was a trend toward the use of multiple fixation sites and more frequent use of the lateral maxillary buttress (20.0% increase over the study period). The need for orbital floor exploration decreased by almost half, possibly reflecting improved preoperative radiologic evaluation. Despite the recent popularity of cranial bone grafting for facial reconstruction, silicone rubber was the preferred material for orbital floor repair (59.6% of cases). Although overall surgical complications were few (1.5%) there was a high incidence of associated ocular injuries (36.3%).

Adolescent↗
PubMed1994

The treatment of nasal valve obstruction.

The purpose of this study is to present the authors' experience with nasal valve obstruction and their management scheme. Between July 1, 1988 and June 30, 1991, 27 patients were seen for nasal valve obstruction. There were 17 males and 10 females, with a median age of 39.2 years. The internal valve alone was involved in 14 patients, the external valve was involved in 2 patients, both valves were involved in 11 patients, and significant septal deviation was seen in 15 patients. Nasal valve obstruction resulted from previous surgery in 13 patients, from trauma in 8 patients, and from a "narrow nose" in 4 patients. Twenty-four patients were treated successfully, while 3 patients, seen early in the series, failed to improve. All patients were followed for a minimum of 1 year. Surgery in the nasal valve is done through an open approach and involves a systematic approach to all the structures surrounding the nasal valve. Surgical repositioning and cartilage grafting are used to reconstruct the nasal valve.

Adult↗
PubMed1992

Hydrofluoric acid burns.

Hydrofluoric acid is widely used in both industrial and household settings. The acid may cause insidious burns that can be very destructive. If the burns are not treated appropriately, the continued action of the free fluoride ion leads to liquefaction necrosis of the affected soft tissues, bony erosion and, ultimately, potentially lethal hypocalcemia. Immediate and copious irrigation, followed by topical, subcutaneous or intra-arterial administration of calcium carbonate, minimizes the extent of injury. In major exposure to hydrofluoric acid, management includes serum electrolyte and electrocardiographic monitoring, as well as aggressive repletion of calcium deficiency.

Burns, Chemical↗
PubMed1992

The surgical applications and implications of cultured human epidermis: a comprehensive review.

Replacement of skin has long been the ultimate task for surgeons facing skin-resurfacing challenges such as thermal burns and chronic ulcerations. Autologous skin grafts have been the "gold standard" for wound closure, but in patients who are massively burned, the availability of normal skin is the limiting factor. In the past 15 years the technique of in vitro cultivation of human epidermis has been developed in an attempt to deal with the problem of extensive skin loss. Although the technique is costly and arduous, grafting patients who are severely burned with cultured epidermal autografts has proved to be a life-saving measure where few alternatives exist. Cultured allografts have promoted rapid healing and pain relief in patients with chronic ulcers. Although longer follow-up is necessary, recent evidence suggests that cultured epidermis provides a wound cover that is just as durable and esthetically acceptable as conventional split-thickness skin grafts. This article reviews the development and applications of epidermal cell culture.

Animals↗
PubMed1988

The role of three-dimensional computed tomography in the management of maxillofacial trauma.

Open reduction and internal fixation of facial fractures demand a detailed understanding of the three-dimensional pattern of injury. This is difficult if not impossible to obtain with present radiographic methods. The purpose of this study was to define the role of three-dimensional computerized tomography (3DCT) in surgical management of facial fractures. The two-part investigation: 1) compared the diagnostic accuracy of 3DCT with conventional CT and plain film studies; and 2) examined the clinical usefulness of 3DCT to surgeons. Twenty-four acute trauma patients suspected of having facial fractures were examined radiographically with analysis of every facial bone and specific facial regions. Particular attention was directed to the course of the fracture lines and the number, size, and displacement of fracture fragments. The surgeons were then asked to conceptualize the reported and the personally observed radiographic information and document their impressions on preprinted diagrams of the facial skeleton. They also completed questionnaires designed to indicate whether patient management would be influenced by the 3DCT. The radiographic findings were correlated with intraoperative observations. The 3DCT provided superior definition of fracture lines (especially horizontal) and the extent of comminution was better appreciated. This additional information improved the surgeons' ability to plan placement of interfragmentary wires and/or plates. Surgeons were also able to more accurately predict those patients requiring immediate bone grafting. Large, life-size 3D images of the facial skeleton made intraoperative conceptualization of the injury pattern easier. The accuracy of the 3DCT images corroborated the intraoperative findings in all cases. The following conclusions are offered: 1) The diagnosis of most mandibular fractures can be made equally well with conventional and 3DCT techniques. 2) Improved diagnosis of fracture lines and the specific patterns of comminution in midface fractures is made possible with 3DCT. 3) If open reduction and internal fixation is the mode of treatment, 3DCT is desirable because the added information makes preoperative planning more accurate and thereby facilitates surgical intervention.

Facial Injuries↗
PubMed1986

Effect of steroids in maxillofacial surgery.

Thirty-six pediatric patients (age range, 6 to 18 years; mean, 15 years) undergoing mandibular and/or maxillary osteotomies were examined in a randomized double-blind study to determine objectively whether steroids are therapeutic in such operations. Dexamethasone or a saline placebo was administered immediately preoperatively (0.5 mg/kg) and for 48 hours postoperatively (0.25 mg/kg/day). Standardized surgical techniques and fluid administration were used. Photographs of the patient taken on admission and 24 hours postoperatively were compared by three independent observers familiar with maxillofacial surgery to rate facial swelling. Mean intubation period (until an audible leak around the endotracheal tube was present), time until oral intake was satisfactory, and facial swelling ratings were compared between the two groups. The results seemed better for the patients receiving steroids but the difference was not significant. This study did not confirm the subjective belief of many surgeons that steroid administration reduces facial swelling after maxillofacial surgery.

Adolescent↗
PubMed1984

A technique of distraction osteosynthesis in the hand.

Moderate digital lengthening may be accomplished with a step osteotomy that preserves attached sleeves of periosteum. A new external fixation apparatus, the Mini-H-Fixator, allows gradual distraction and solid bone fixation after surgery and facilitates this operation. The advantage of this procedure is that it results in rapid bone formation in the osteotomy gaps, obviating the need for bone grafting.

Adult↗
PubMedDate not supplied

Posttraumatic stress disorder in electric burn patients.

It was hypothesized that burn injuries electric in origin may have a poor prognosis for rehabilitation and return to work. Ten electrically injured burn patients were compared to seven patients whose burns were nonelectric, after all 17 had shown clinically significant emotional problems during rehabilitation. Results of psychological tests from both groups were also compared to results in three other groups: psychiatric, chronic pain, and blepharospasm patients. Results indicated that patients with electric burns had the most severe psychopathologic symptoms and the least likelihood of returning to work. Only the factor of educational background was predictive of degree of psychological distress, prognosis for returning to work, and response to psychological intervention. Results are discussed within a one-trial aversive conditioning paradigm potentially unique to electric injuries.

Adult↗
PubMedDate not supplied

Structured exercise circuit program for burn patients.

A 10-station structured exercise circuit was developed for burn patients. This conditioning program was designed to accelerate overall functional mobility. The effectiveness of this structured exercise program (SEP) was examined with respect to length of hospitalization, number of outpatient occupational/physical therapy visits required over a three-month period following discharge, and number of days required to return to work post-discharge. Results showed no change in hospitalization. There was, however, a significant decrease in the number of outpatient therapy visits required post-discharge and an earlier return to work date for those patients enrolled in the SEP.

Adult↗