Search PubMed⌕ Search

Biomedical subjects

E A Luce

Publications and source records attributed to E A Luce.

At least 55 records · Page 3Linked to original sources
PubMed1988

The use of maggots in wound debridement.

Since antiquity, clinicians have observed that maggots can provide debridement of necrotic wounds, but the therapeutic use has declined since the advent of aseptic wound management and antibiotics. In certain difficult wounds, the use of maggots for debridement may have a role. If so, the larvae must be prepared prospectively to control the bacterial population of the insect's intestinal tract and integument. The mechanism of wound debridement by maggots includes the secretion of proteolytic enzymes and antibacterial substances. A case of infestation of a necrotic wound in a patient with cancer of the head and neck is presented including the entomological identification and description of the maggots.

Animals↗
PubMed1987

Frontal sinus fractures: guidelines to management.

The appropriate management of frontal sinus fractures is controversial. Experience with 78 frontal sinus fractures over a 9-year period was reviewed, and the fractures were classified into anterior wall, anterobasilar, and frontal skull fracture extensions. The presence of a concomitant CSF leak or an air-fluid level in the sinus was a diagnostic clue of posterior wall involvement. Ablation or obliteration of the fractured frontal sinus is not necessary. Primary reconstruction of the sinus and nasofrontal duct drainage constitute the preferred treatment. "Cranialization" of a severely damaged sinus is performed by excision of the posterior wall plugging of the nasofrontal duct and reconstruction of the anterior wall. Reconstruction of the anterior wall with primary bone grafting may be necessary in selected patients.

Accidents, Occupational↗
PubMed1986

Carcinoma of the lower lip.

Carcinoma of the lower lip is sufficiently common in occurrence that a practitioner should be cognizant of the requisite diagnostic and therapeutic guidelines. This article discusses the pertinent anatomy, the management of the local or primary lesion, and some prognostic criteria for surgical decisions directed toward the regional lymph nodes. Reconstruction is discussed from the standpoint of magnitude of the defect as a percentage of the total lip transverse diameter.

Carcinoma↗
PubMed1985

Wound closure of the myelomeningocoele defect.

Our experience with 74 neonates with myelomeningocoele is reported. Management in the first phase of the study period consisted of primary closure in 37 patients by wide undermining and skin advancement, marked by a high wound-complication rate. Latissimus dorsi muscle closure, either "reverse" or advanced, was performed in a transitional phase in 5 patients, characterized by increased operative time and blood loss. In the last portion of the study period, 32 patients were managed by immediate dural closure and skin grafts either simultaneously or on a delayed basis at 48 to 72 hours with a low incidence of graft loss, CSF leak, or sepsis. Back ulceration and follow-up in either the primary closure or the skin-grafted group has been infrequent.

Female↗
PubMed1984

The irradiated wound.

Radiation and its effects on normal tissue are important to an understanding of the alteration of healing that occurs in a radiated wound. The surgical management of irradiated tissue is discussed regarding surgical procedures in previously irradiated tissue and regarding management of the nonhealing irradiated wound, the radiation ulcer.

Carcinoma↗
PubMed1984

"True" high-tension electrical injuries.

A series of 48 patients with high-voltage electrical injuries managed over a six-month period was reviewed. The line voltage at the time of injury was recorded for 40 of the patients, with an average of 14,200 volts. The mean duration from injury to admission was 11 hours. The study group of 48 patients was readily divided into two subgroups: a majority (31) sustained a "true" high-voltage, prolonged contact electrical injury, and a smaller subgroup (17) sustained flash and clothing burns. There was no difference between the two subgroups in the magnitude of voltage exposure. However, patients in the "true" high-voltage subgroup sustained a wide variety of injuries to almost every organ system. Transient EKG abnormalities were noted in 16 patients. The occurrence of myoglobinuria and/or hemoglobinuria was nearly universal and was treated by volume expansion alone without bicarbonate or mannitol. Resuscitation of the "true" group required an average of 7 cc/kg/% BSA of Ringer's lactate. No incidence of acute tubular necrosis was observed. Initial debridement was almost always performed on patients in the "true" subgroup on the day of admission. Flap coverage and/or amputation was required in 70% of these 31 patients. Wound management required an average of 2.4 debridements and 2.2 wound closure procedures. There was no evidence of delayed or progressive tissue necrosis. The principles of resuscitation and aggressive operative management are discussed.

Adult↗
PubMed1983

Total abdominal wall reconstruction.

A patient had full-thickness loss of abdominal wall from clostridial myonecrosis. Initial care consisted of resuscitation, debridement, and transfer to a hyperbaric chamber facility. After control of sepsis, multiple enteric fistulas were managed by enterotomies, gastric and duodenal defunctionalization with closed-loop gastrojejunostomy, gastrostomy, and end jejunostomy. Good nutritional status was maintained with total parenteral nutrition over a three-month period. Total abdominal wall reconstruction was accomplished by rotation of bilateral tensor fascia lata musculocutaneous flaps. Reconstruction was successful as the patient was able to return to an active life.

Abdominal Muscles↗
PubMed1983

Loss of hand and forearm following Bier block: a case report.

Few complications have been reported with the use of the Bier block for intravenous regional anesthesia. The method requires little expert training and produces good analgesia in a bloodless field for a period of 1 to 1.5 hours. The loss of an upper extremity in a 25-year-old white woman who had the performance of a Bier block for removal of a ganglion cyst is reported. The block was performed with 200 mg of mepivacaine without epinephrine. Total tourniquet time was 25 minutes. The patient had prompt onset of pain and swelling followed by loss of motor and sensory function. Operative exploration revealed necrosis of the forearm compartments. Arteriography demonstrated thrombosis of the terminal branches of the radial and ulnar artery. Below elbow amputation was performed 1 week later. Essentially all complications reported with regional anesthesia have been related to the systemic pharmacologic effects of the local agent used. Loss of an upper extremity has not been reported. We postulate three possible mechanisms: (1) possible cannulation and injection of the radial artery, (2) an idiosyncratic allergic reaction to the anesthetic agent or the preservative, and (3) erroneous injection of a foreign substance into the forearm venous system. We conclude the last mechanism is the most likely cause in this patient.

Adult↗
PubMed1983

Breast reconstruction after mastectomy.

Radical mastectomy inflicts emotional as well as physical scars, and preoperative interviews with the reconstructive surgeon can help to ameliorate some anxiety. There is no evidence of risk to the patient from reconstruction of the breast. Reconstruction is best deferred for four to six months after mastectomy for several oncologic and psychologic reasons. Careful selection of patients is paramount. Reconstruction involves the correction of several functional and structural deficits. The end result has been enhanced by the silicone breast implant and the myocutaneous flap. Although the final result is usually not a cosmetic triumph, the reconstruction may serve to enhance the patient's self-image.

Age Factors↗
PubMed1983

The ordeal of Sigmund Freud. A postscript.

A number of questions about Freud's illness and treatment remain unanswered. The author ponders the duration of Freud's survival, the histologic diagnosis of the tumor, the contemporary management of this cancer, and the doctor-patient relationships involved.

History, 20th Century↗
PubMed1982

The pectoralis major island flap for coverage in the upper extremity.

From July 1, 1978, to July 1, 1980, 26 patients required pedicle flap coverage for acute skin loss defects in the hand and upper extremity. Eighteen patients had groin or abdominal flap coverage, and the pectoralis major island flap (PMIF) was used in eight patients. The circumstances of injury were approximately the same in both groups, consisting of a gunshot wound or electrical injury in over half of the cases. The PMIF was selected more often in proximal and dorsal injuries of the forearm and wrist and in older patients. Two of 13 groin flaps sustained partial necrosis, but none of the abdominal or PMIF flaps necrosed. The principle advantages of the PMIF in these selected cases was fourfold: (1) an extremity placed in a less dependent, sling-like position, (2) mobility, (3) reliability, and (4) a complete inset into the defect. The chest wall donor site defect, however, must be given some consideration.

Abdomen↗
PubMed1982

Tracheal stomal stenosis after laryngectomy.

Stenosis of the postlaryngectomy tracheal stoma remains a persistent problem. A retrospective study of 89 patients determined on overall incidence of 22 percent. The use of postoperative radiotherapy was associated with a higher incidence (36 percent) than preoperative radiotherapy (19 percent) and combined preoperative and postoperative radiotherapy (17 percent). Retention of the tracheal cannula for longer than 1 week was associated with a slightly increased incidence (25 percent) of stenosis. The technique of stomal construction was an important determinant of stoma stenosis. A simple circle of straight transection of the trachea had the highest incidence (29 percent) of stenosis, which could be reduced with a beveled technique (15 percent). The lowest incidence was seen with a primary plastic or flap construction technique (8 percent). The authors recommend the construction of a patulous stoma by a technique of beveling transection of the tracheal stump in combination with the use of interdigitation skin flaps.

Adult↗