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Biomedical subjects

L H Engrav

Publications and source records attributed to L H Engrav.

At least 55 records · Page 3Linked to original sources
PubMed1981

Minor burns: guidelines for successful outpatient management.

Minor burns are not necessarily trivial. They often involve dynamic or cosmetically important body areas, and outpatient treatment is not always indicated. Hospitalization is usually necessary for the very young or the elderly; those with deep partial-thickness or full-thickness burns; those with burns of the hand, face, foot, or perineum; those who are alcoholics, demented, or economically deprived; and those who have another illness or injury. Hospitalization is mandatory in cases of suspected child abuse or neglect. Superficial partial-thickness burns can be managed in a variety of ways, including application of biologic dressings and synthetic skin coverings. Most deep partial-thickness burns and all full-thickness ones should be considered for early excision and grafting. All but the most superficial burns require maintenance of joint function and long-term follow-up.

Adult↗
PubMed1980

Sepsis of the cheek over a subcutaneous forehead flap.

In two cases, a temporal flap was folded medially and passed through a subcutaneous tunnel superficial to the parotid gland. In both cases sepsis developed at the point at which the flap entered the mouth. In one case a spontaneous perforation occurred and the other required drainage. If one elects to fold the flap medially and pass it superficial to the zygomatic arch, the route described by Lewis and Remensnyder, i.e., deep to the masseter, is preferable.

Aged↗
PubMed1978

Diagnostic peritoneal lavage: fourteen years and 2,586 patients later.

During a fourteen year period, diagnostic peritoneal lavage was 98.5 per cent accurate in determining the presence or absence of blunt intraabdominal injuries among 2,586 patients. Of these, 69.4 per cent had a negative lavage and 29.2 per cent a positive lavage. Six patients (0.2 per cent) had a false-positive lavage. Thirty-two patients (1.2 per cent) had a false-negative lavage; however, all but one of these patients underwent exploratory laparotomy on the basis of clinical acumen or other diagnostic tests.

Abdominal Injuries↗
PubMed1976

Delayed rupture or delayed diagnosis of rupture of the spleen.

Delayed rupture of the spleen was seen in only six of 302 patients undergoing splenectomy for splenic injury following blunt abdominal trauma. Only one of these six patients was asymptomatic for two days following the accident. This is an incidence of 2 per cent delayed rupture as compared with the 15 per cent quoted in the literature. An aggressive approach to the diagnosis of intra-abdominal injury has helped to eliminate the delay in recognition of rupture of the spleen. Peritoneal lavage has accurately identified those patients with intra-abdominal injury. We conclude that delayed rupture of the spleen is, in reality, usually a delay in diagnosis of splenic rupture.

Adolescent↗
PubMed1975

Diagnostic peritoneal lavage in blunt abdominal trauma.

Diagnostic peritoneal lavage is accurate and safe. It leads to fewer unnecessary laparotomies than if clinical examination alone is used and nearly eliminates deaths from undiagnosed abdominal injuries. Persons with clinical abdominal findings, shock, altered sensorium, and severe chest injuries after blunt trauma should undergo the procedure.

Abdominal Injuries↗
PubMed1975

Experimental effects of heparin or magnesium sulfate on the patency of microvascular anastomoses.

Partial amputations of the hind legs were done in 44 rats. The femoral arteries and veins were repaired by microvascular techniques. The systemic use of heparin, the local use of magnesium sulfate, and the combined use of the two drugs, were evaluated as to their influence on preventing thrombosis in these microvascular anastomoses. No benefit could be demonstrated from the use of these drugs.

Amputation, Surgical↗
PubMedDate not supplied

Cones of skin occur where hypertrophic scar occurs.

Hypertrophic scarring is devastating for the patient, however the pathophysiology and treatment remain unknown after decades of research. The process follows deep dermal injury, occurs only on certain body parts, does not occur in the early fetus or in animals, and is a localized event. This suggests that an anatomic structure in human, deep dermis may be involved. The dermis is a matrix perforated by cones containing many structures including skin appendages and fat domes. We hypothesized that studying the cones might reveal a structure related to scarring. We examined tangential wounds from various body parts on human cadavers along with skin histology from various human body parts, the early fetus, partial thickness burns, hypertrophic scars, and two other species-rats and rabbits. We found that the cones may in fact be the structure. They exist where hypertrophic scar occurs-cheek, neck, chest, abdomen, back, buttock, arm, forearm, dorsal hand, thigh, leg, dorsal foot, helix and ear lobe. They do not exist where hypertrophic scar does not occur-scalp, forehead, concha, eyelid, palm, early fetus, and in rat, or rabbit. It also became apparent that the cones have been omitted from most considerations of skin histology. We suggest that the cones need to be studied in relation to hypertrophic scarring and restored to skin diagrams.

Adult↗
PubMedDate not supplied

Partial excision of residual burn lesions.

Most burn victims have unattractive residual lesions, which may include hypertrophic donor sites, unsightly skin grafts, hypertrophic scars, and mature scars with altered pigmentation or texture. Some of these lesions can be treated by total excision in one or more stages or they can be reconstructed utilizing grafts, flaps, Z-plasties, or tissue expansion. But frequently these procedures are either not indicated or not elected by the patient. In such a situation, the only surgical option is partial excision, with the goal of making the lesion less conspicuous and more easily concealed by clothing. Whether or not such partial excisions are worthwhile is the obvious question. We could not find an answer in the literature and therefore decided to review our own experience. Between 6/30/81 and 3/12/86, 92 such procedures were performed and followed in 25 patients. Partial excision of hypertrophic donor sites, unsightly skin grafts, and hypertrophic scars did yield improved appearance in most patients. However, partial excision of mature scars, ie, areas of altered pigmentation or texture, did not have the same success. We continue to treat the first three types of lesions in this fashion but no longer include the latter.

Adolescent↗
PubMedDate not supplied

Molten metal burns to the lower extremity.

In this study of ten consecutive patients sustaining molten metal injuries to the lower extremity who were treated with excision and grafting, treatment with compression Unna paste boot was compared with that with conventional dressing. Hospital stay was decreased from 12.2 days in the conventional dressing group (five patients) to 6.4 days in the Unna group (five patients). Ambulation was initiated on postoperative day (POD) 2.2 in the Unna group, compared with POD 8.0 in the conventional dressing group. Return to work was on POD 44.8 in the Unna group versus POD 86.3 in the conventional dressing group. Treatment of molten metal injuries to the lower extremity with Unna paste compression dressing resulted in shorter hospital stay, earlier ambulation, and more rapid return to work.

Accidents, Occupational↗
PubMedDate not supplied

Determinants of donor site infections in small burn grafts.

Studies indicate no advantage to the early use of systemic antibiotics in patients with burns, but the use of prophylactic antibiotics during excision is still being questioned. The records of 213 patients who required excision and who had less than 20% total body surface area burned were reviewed. We investigated risk factors associated with donor- and graft-site infections and whether or not perioperative antibiotics influenced the incidence of infections. Statistically significant increases in donor-site infections occurred when patients did not receive perioperative antibiotics, when the excision was large, and when the time between injury and excision was prolonged. Age, burn size, or type of dressing did not influence the development of infections. A risk of graft infections in those patients who were not receiving perioperative antibiotics existed, but it was not significant. The time between injury and excision and the actual size of the excision influence the development of donor-site infections. However, perioperative antibiotics seem to decrease the risk of these infections.

Adult↗
PubMedDate not supplied

Infection control in a burn center.

No consensus has been reached on the ideal isolation technique to prevent hospital-acquired infection in the patient with burns. This study reports four 2-month consecutive periods of microbial surveillance in a burn center intensive care unit. Phase I, the first period of surveillance, demonstrated a unit-acquired colonization rate of 63%, with the marker organisms appearing at 4 to 8 days. Direct observation of isolation technique showed a 51% error rate. A mandatory educational session reviewing the high colonization rates, observed breaks in isolation technique, and principles of infection control failed to decrease the colonization rates as measured in phase II. A simplified isolation technique was adopted, which led to a decrease in unit-acquired colonization, from 63% to 33% in phase III from phase I values (p = 0.0514); and to a significant delay in inception, from 7.8 to 21 days, in those colonized with Pseudomonas aeruginosa (p less than 0.05). The simplified isolation technique decreased isolation costs over a 6-month period from $53,000 to $30,000. To confirm the decrease colonization rates from phase I to phase III, a fourth 2-month surveillance period was undertaken 6 months later. Phase IV demonstrated similar results to those of phase III.

Burn Units↗
PubMedDate not supplied

Treatment of fourth-degree hand burns.

Fourth-degree hand burns are rare but devastating injuries. They cannot be grafted readily but often require flaps and amputation, and impairment is significant. We report our 10-year experience (1981 to 1990) with deep hand burns to characterize our treatment and outcome. A total of 25 patients (35 hands) were treated. Eight local flaps, nine distant flaps, and two free-tissue transfers were performed. Eleven hands were treated with K-wire immobilization and grafting. Thirty-three amputations were done. Postburn function was evaluated in 25 salvaged hands. Eleven hands had good outcomes, whereas seven had moderate sequelae and seven were severely affected. Patients who were treated with flap coverage of exposed tendons and joints had better functional outcomes than those treated with delayed closure with immobilization and grafting. The excellent outcomes in the flap coverage group justifies the added commitment of technical and therapeutic resources that this treatment requires.

Adult↗
PubMedDate not supplied

Skeletal and dental disturbances after facial burns and pressure garments.

Pressure garments alter facial growth. We conducted a prospective study of facial growth in children wearing such garments to quantify these skeletal and dental disturbances. Three children with total face masks and three children with devices covering the lower face were studied. Panoramic and cephalometric radiographs were obtained at the start of treatment, approximately 6 months later, and at the end of the treatment. Clinical examinations were performed to document occlusal status and subsequent changes. Total face masks affected maxillary horizontal growth more than vertical growth. Mandibular growth changed from the normal anterior and inferior direction to a more inferior direction. With partial face masks, the most notable change was increased proclination of anterior teeth. Facial growth and the position of anterior teeth appear to be affected by the combination of the extent of the burn and skin graft and the type of pressure garments worn during the time of rehabilitation.

Burns↗