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Biomedical subjects

G T Rodeheaver

Publications and source records attributed to G T Rodeheaver.

At least 127 records · Page 7Linked to original sources
PubMed1978

Airless paint gun injuries: an update.

The airless paint gun delivers paint at pressures approximating 3,000 psi. Paint accidently injected into the skin under this pressure causes a devastating injury which is a result of the paint material, the level of bacterial contamination, and the pressure at which the paint is delivered. The time interval between injury and treatment seems a critical determinant of outcome. Decompression of the closed vascular compartments of the hand must be begun immediately to release the underlying tissue distended by the injected paint. Judicious wound debridement must be performed. Immediate antibiotic treatment is indicated in all patients. Studies seem to indicate that steroids limit the severity of inflammatory response. A regimen of hydrocortisone sodium succinate, 100 mg IV, administered immediately before surgery should be followed by a seven-day tapering course of oral prednisone starting with 40 mg on the first postoperative day. Recent safety measures and consumer warnings through the Consumer Product Safety Commission may reduce the number of airless paint gun injuries.

Adrenal Cortex Hormones↗
PubMed1978

Modification of the American Burn Association injury severity grading system.

This study evaluated the regional burn health care system of the Commonwealth of Virginia using the criteria for optimal care of the burn patient designated by the American Burn Association. The data base for this evaluation was hospital records of seven hospitals in Virginia. The major shortcoming of the designated criteria was the grading system for the severity of burn injury. Using the criteria designated by the American Burn Association, a large number of minor burn injuries were judged erroneously to be major burn injuries. A modification of the American Burn Association's injury severity grading system is proposed which more precisely identifies the minor burn injury.

Aged↗
PubMed1977

Rapid antibiotic disk sensitivities of burn eschar and infected wounds.

This study was undertaken to develop a more rapid antibiotic sensitivity test of the pathogens in soft tissue infections and burn wound eschar. The proposed rapid antibiotic sensitivity test was performed directly on the clinical specimen rather than on single strains of bacteria isolated from the tissue. By performing the antibiotic sensitivity tests directly on the tissue sample, the physician obtains the test results within seven hours after receiving the specimen rather than 38 to 52 hours later, the time delay encountered with the conventional technique. The modification used did not alter most of the standards advised by the Food and Drug Administration (3), since there was no inclusive change in medium, agar depth or antibiotic sensitivity disk. The changes in the Kirby-Bauer (1) test necessitated by using the clinical specimen did not alter significantly the interpretation of the antibiotic susceptibility. If clinically significant numbers of bacteria, 10(6)-10(9), were present, variations in the inoculum size did not appreciably change the results of the antibiotic susceptibility tests. If the incubation requirement for the standard Kirby-Bauer (1) antibiotic susceptibility test was reduced to seven hours, it also did not significantly limit the accuracy of the test. As expected, the variable most difficult to standardize was the heterogeneous inoculum containing large numbers, 10(7), of different organisms. A zone of inhibition interpreted as sensitive with one organism was occasionally masked by the presence of the confluent growth of an organism in which the zone of inhibition was considered resistant. However, even in this instance, it is possible that mixed culture sensitivities may provide the most valid information in mixed infections, since they more closely simulate the real clinical situation.

Anti-Bacterial Agents↗
PubMed1977

Management of soft tissue injury.

The fate of a surgical wound is held in a delicate balance between the host's resistance to infection and the causal factors of infection. Considerable insight into this relationship between the host and pathogen can be gained from the results of quantitative bacteriologic measurements. Newer rapid slide techniques have been developed which provide the surgeon with this information within 20 minutes. In most soft tissue injuries, the wound bacterial count gives an accurate prediction of subsequent infection. Wounds combining greater than 10(5) bacteria per gram of tissue are destined to develop infection. When the bacterial count is below that level, the wounds will usually heal per primam without infection. This large number of bacteria required to elicit infection reflects the remarkable ability of soft tissues to resist infection. This state of high resistance to infection can be reduced by several factors which include circulatory embarrassment, tissue injury, dead space, and the presence of foreign bodies (dirt, sutures, drains, etc.). When treating soft tissue injuries, the surgeon must employ specific therapeutic modalities that allow the wound to heal per primam without infection. On the basis of experimental studies supported by clinical experience, the following treatment protocol for soft tissue injuries is recommended. Using strict aseptic technique, the wound must be first anesthetized with 1 per cent Xylocaine to permit painless sound cleansing. All wounds should be subjected to high pressure syringe irrigation to remove bacteria, foreign bodies, and blood clots. When necessary, debridement of all devitalized tissue should be performed with a stainless steel scalpel. Many wounds caused by sharp wounding agents contain no foreign bodies and few bacteria and exhibit considerable resistance to infection. In these wounds, primary closure can be initiated after irrigation without the development of infection. Wounds resulting from impact forces have a diminished resistance to infection and are susceptible to infection by low level of bacterial contamination. Immediate antibiotic treatment of patients with impact injuries subjected to meticulous debridement and cleansing will permit a safe primary closure. In wounds contacted by pus or feces, open wound management followed by delayed primary closure is usually indicated. Antimicrobial prophylaxis is also recommended for patients with such wounds. Ideal postoperative care of all traumatic wounds includes a surgical dressing and immobilization and elevation of the site of injury.

Anesthesia, Local↗
PubMed1977

Practical bacteriologic monitoring of the burn victim.

A comprehensive picture of the burn wound microflora is now possible as a result of recent technologic advances. The microflora of the burn wound can be characterized with respect to its number, type, location, and antibiotic sensitivity. These parameters can be measured in sufficient time to influence the decision of the burn surgeon. The microflora of the surface of the burn wound and the burn wound itself are examined separately by different sampling techniques. For the surface microflora, the gauze capillary techniques employed, while incisional biopsies are used to monitor the organisms in the burn wound. After sampling, suspensions of the specimens are created which in turn are subjected to direct microscopic measurement, quantitative culture procedures, and immediate antibiotic sensitivity testing. Histologic examination of the burn wound is performed concomitantly with this bacteriologic examination to determine the depth of bacterial invasion as well as to detect the presence of either mycotic or herpetic infections.

Animals↗
PubMed1977

Inhibition of nonspecific defenses by soil infection potentiating factors.

This study was undertaken to examine the effect of soil infection potentiating factors on the defense system of the tissue. Using an in vitro model, leukocyte phite. This damaging effect on leukocyte function was a result of an interaction between the leukocyte and the clay particles. Montmorillonite also interfered with nonspecific humoral defenses. Exposure of serum to clay rapidly eliminated its bactericidal bodies occurred without any damage to the serum opsonins.

Bacteria↗
PubMed1977

The role of implant porosity on the development of infection.

The role of implant porosity as a determinant of infection was studied. Standardized porous and nonporous polymethyl methacrylate implants were fabricated for this investigation. In rabbits, the premolded polymethyl methacrylate implants were placed under the paravertebral fascia, just superficial to the paravertebral muscle fascia, before inoculation with a measured number of staphylococci. The polymethyl methacrylate implants did not enhance the infection rate of the contaminated wounds. The presence of pores within the implants did not damage tissue defenses. Polymethyl methacrylate implants did not alter the success of antibiotic treatment. Antibiotics prevented the development of infection in wounds containing 10(6) organisms, even in the presence of an implant. When higher levels of organisms were delivered to the wound, antibiotic treatment had a negligible benefit in the implant and control wounds.

Animals↗
PubMed1977

Practical applications of skin biomechanics.

The biomechanical properties of skin have an important influence on plastic surgical decisions. They aid the surgeon in planning elective incisions, excisions, or scar revisions. They provide insight into the most appropriate method of coverage of skin defects as well as the design of an artificial skin substitute. Skin biomechanics can, in part, be characterized in vivo by either a skin extensiometer or by studying the deformation of skin defects. These methods indicate the magnitude and directional orientation of skin tensions which are dependent partly on the mechanical characteristics of the dermal fibers and partly on the pattern in which they are woven. The tensions to which the skin are subjected can be classified as either static or dynamic in origin. Static skin tensions are the natural tensions existing in skin. The magnitude of static tensions varies between individuals, at different sites in the same person, and in different directions in many sites. The dynamic tensions are caused by a combination of forces which are associated with joint movement, mimetic and other voluntary muscle activity, and gravity. Knowledge of these tensions allows the surgeon to align the operative site in the direction of maximal tension and to approximate the wound with the least amount of tension. As a consequence of this, the scar healing between the cut edges of the wound should be narrow and inconspicuous.

Biomechanical Phenomena↗
PubMed1976

Quantitative microbiology: its application to hand injuries.

Quantitative microbiologic analysis of civilian hand injuries has been accomplished in thirty-four patients. Most traumatic soft tissue injuries exhibited an insignificant level of contamination. The number of bacteria recovered from most of those wounds was comparable to that encountered in clean elective surgical hand cases. We now view most civilian hand wounds as clean wounds carrying a very low risk of infection. Our patients with traumatic hand injuries are considered candidates for immediate reconstruction, which includes vascular, bony, or neural repair as well as immediate implantation of Silastic rods in preparation for subsequent tendon grafting.

Bacteriological Techniques↗
PubMed1976

Cleansing the traumatic wound by high pressure syringe irrigation.

The purpose of this study was to examine the influence of the fluid dynamics of syringe irrigation on the efficacy of wound cleansing and the infection rate of experimental wounds. The pressure experienced by a surface following wound irrigation was directly proportional to the pressure within the syringe and the size of the needle. High pressure syringe irrigation effectively removed bacteria from the surface of the wound. This reduction in the wound bacterial count resulted in a decrease in the infection rate of tissues. Low pressure irrigation with an asepto syringe did not significantly cleanse the wound of its bacterial contaminants and had no demonstrable clinical merit. On the basis of these studies, high pressure syringe irrigation is being employed routinely in our emergency department for the care of traumatic wounds.

Animals↗
PubMed1976

Side-effects of high pressure irrigation.

This study was undertaken to identify side-effects of high pressure irrigation. Standardized surgical wounds made in Yorkshire pigs were subjected to high pressure syringe and pulsatile irrigation. As a result of these treatments, fluids were disseminated into the adjacent tissue of the wound, predominantly in a lateral direction. Bacteria did not accompany this disseminated fluid and apparently were filtered out by the surface tissues. This treatment results in a tissue injury which impairs its defenses, making the wound more susceptible to infection. However, the remarkable cleansing capacity of high pressure irrigation appears to outweigh this side-effect, since heavily contaminated wounds subjected to this treatment heal per primum without infection.

Animals↗
PubMed1975

Mechanical cleansing of contaminated wounds with a surfactant.

Mechanical cleansing of a wound with a sponge soaked in a surfactant has prevented the development of experimental wound infection. The surfactant utilized for wound cleansing is Pluronic F-68, a member of a family of block copolymers called Pluronic polyols. Long-term toxicity studies and clinical trials suggest that this surfactant is safe for human use. Pluronic F-68 is a nonionic detergent that does not have any intrinsic antibacterial activity. Although mechanical cleansing with saline-soaked sponges effectively removes bacteria, it damages the wound and impairs its resistance to infection. The severity of the damage to the skin exerted by the sponge can be correlated with its porosity. Sponges with a low porosity are abrasive and exert more damage to skin than do sponges with a higher porosity. The addition of Pluronic F-68 to even the most abrasive sponges ensures that the bacterial removal efficiency of the sponge scrub is maintained, while tissue trauma is minimized. This dual effect of the surfactant results in a dramatic reduction in the infection rate of contaminated wounds. On the basis of these results, a clinical trial with surfactant-soaked sponges would appear to be indicated.

Animals↗
PubMed1975

Wound cleansing by high pressure irrigation.

All traumatic wounds are contaminated to some degree by both soil and bacteria. Specific infection potentiating factors in soil impair the defenses of the tissue and invite infection. These factors are small in size and resist removal by low pressure irrigation. The efficiency of wound irrigation is markedly improved by delivering the irrigant to the wound under continuous high pressure. Irrigation of the wound with saline solution delivered at 15 pounds per square inch removed 84.8 per cent of the soil infection potentiating factors from the wound. The residual infection potentiating factors remaining in the wound did not significantly impair tissue defenses. On the basis of these experimental studies, clinical studies are now being initiated to test the therapeutic value of high pressure irrigation in traumatic wounds in humans.

Animals↗