Biomedical subjects
Publications and source records attributed to D T Gault.
Three babies who developed infection in their median sternotomy wounds are reported. In one child, a retrosternal abscess was drained and in the other two cases, the wounds dehisced. The wound cavities were filled with a rectus abdominis myocutaneous island flap and in each case, the wounds healed primarily. Early flap repair resolved the infection, shortened the hospital stay and provided protection to the exposed mediastinum.
The intracranial volume of 104 children with craniosynostosis was measured. Premature fusion of skull sutures is thought to deny the growing brain room to expand, but contrary to traditional teaching the intracranial volume of such children is often within normal limits.
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Intraoperative perforation of surgical gloves is common. Nine hundred and forty surgical gloves were tested after 100 consecutive plastic surgical operations, each involving a surgeon, a variable number of assistants and a scrub nurse. In the first 52 operations, single gloves were used and 21.5% of the staff were found to have a perforated glove. In the second 48 operations, double gloves were used by all members of the surgical team and the number with perforations (of both inner and outer gloves) was reduced to 9%. Most perforations occurred on the dorsum of the hand and fingers and on the thumb tip, especially in the non-dominant hand. The risk of acquiring AIDS due to glove perforation is low but the consequences of such an event could be lethal.
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This is a report of five patients who sustained untidy division of flexor tendons in zones 1 and 2, associated with overlying soft tissue loss. Contrary to traditional teaching, the tendon injuries were repaired primarily, and the tissue loss was made good with a cross-finger flap. At final evaluation, three cases were assigned excellent grades and two cases fair grades by Kleinert criteria. This unexpectedly favourable outcome may be due to a quality of the inner surface of the cross-finger flap and/or to staggering of the skin and tendon suture lines.
Traditional silicone prostheses have been found to be inflexible, heavy, and of poor color match when used on the limbs. Ten patients distressed by contour deformities on their limbs after the wide excision of malignancies or following trauma were fitted with a light-weight prosthesis whose special features include a flexible foam backing, an outer tinted skin, and finely feathered edges that draw the eye away from the margins of the defect. The prosthesis sticks dependably to the skin and is particularly effective when worn under stockings or tights. When reviewed, all patients were continuing to use the device. It is a useful alternative to surgical reconstruction in such patients.
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67 patients with 176 repaired flexor tendons have been reviewed after a mean follow-up interval of 26.4 months. After repair, mean grip strength was 74.5%, mean finger flexion pressure 76.8% and mean finger pinch pressure 74.7% of that of the opposite uninjured hand or digit. For 16 patients with repaired flexor pollicis longus tendons, mean key pinch was 78.7%. Grip strength was reduced after injury to tendons alone, but was especially reduced when there was concomitant damage to the median or ulnar nerves.
67 patients with 176 repaired flexor tendons have been reviewed after a mean interval of 26.4 months. 160 tendons to 100 fingers, and 16 flexor pollicis longus tendons were repaired. When evaluated by Buck-Gramcko criteria, the functional results in 92% of the fingers and 69% of the thumbs were graded as excellent or good. Patients with partially divided tendons fared no better than those whose tendons were completely divided. The results of repair in the little finger were less satisfactory than in other fingers.
Twenty-six patients who sustained significant burn injuries as a result of striking underground electric cables are reviewed. This study sets out to highlight why such injuries occur and to recommend preventive measures to those digging in the London area. There were three deaths in this series.
Changes in serum cholinesterase (also known as pseudo- or non-specific cholinesterase) activity have been measured in 20 patients after thermal injury. In 19 patients a marked fall was noted at around day 5 post-burn, and recovery to normal levels was variable and in some cases prolonged. A variety of symptoms, for example, dyspnoea and confusion, have been attributed to lowered serum cholinesterase activity and some workers have gone so far as to advocate blood transfusion to treat such a condition (Price et., 1970; Frohlich, 1977). In this study we found 13 patients (65 per cent) with such symptoms coexisting with a low serum cholinesterase activity. However, we do not believe these symptoms were directly attributable to the low enzyme activity for the following reasons: In only three of the 13 patients were symptoms observed at times when the lowest cholinesterase activity was recorded. A conventional explanation for these symptoms was available, except in three cases with abdominal distension. In six cases no symptoms were observed despite very low cholinesterase levels.
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The long term results of flap cover in 28 cases of exposed metalwork are presented. The patients fall into two groups; those with exposure of plates after internal fixation of fractures (14), and those with exposed knee or elbow prosthetic joints (14). The average duration of metal exposure at the time of referral was 6.4 weeks. In the majority of cases, cover was achieved by local muscle or fasciocutaneous flaps. The average duration of follow-up was 20 months. Metalwork was covered and preserved in 16 cases (57%). The remainder had persistent discharging sinuses or overt sepsis despite survival of the overlying flap. The results of this series are discussed in relation to the pre-operative microflora and the duration of metal exposure.
Two cases of metastatic tumour at the nasal tip are described. Both originated from a primary tumour of the bronchus. In each case the lesion was the first sign of an otherwise silent neoplasm.
Seven cases of presumed Toxic Shock Syndrome (TSS), occurred in burned children admitted to the Regional Burn Unit at St Andrew's Hospital, Billericay. Four patients died, and three caused concern. 30 per cent of Staphylococcus aureus isolates available for retrospective study were found to be toxin producing. On reviewing children in this age group admitted between September 1982 and April 1984 we feel that a form of TSS has occurred commonly, in some cases where the burned area was less than 5 per cent. Certain recommendations are made.
An unusual complication of radical neck dissection is presented. Necrosis of the anterior half of the tongue developed gradually within the first week of bilateral neck dissection. The patient had previously received radiotherapy.