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Biomedical subjects

L S Nichter

Publications and source records attributed to L S Nichter.

At least 37 records · Page 2Linked to original sources
PubMed1991

Expanding the limits of composite grafting: a case report of successful nose replantation assisted by hyperbaric oxygen therapy.

A successful nose replantation assisted by hyperbaric oxygen therapy is presented, with a brief discussion of the possible mechanisms and a brief literature review of the use of hyperbaric oxygen in tissue preservation and replantation. Although it is not certain that the hyperbaric oxygenation ensured the survival of the replanted nose in this 2-year-old girl, there was documented change in graft appearance during the initial hyperbaric oxygen treatment. A 1-month, 1-year, and 2-year follow-up is included.

Child, Preschool↗
PubMed1989

Efficacy of debridement and primary closure of contaminated wounds: a comparison of methods.

Proper management of highly contaminated traumatic wounds frequently requires delayed primary closure of healing by secondary intention to prevent subsequent infection. This animal study compares the efficacy of various wound debridement methodologies to prevent infection following primary closure of treated contaminated wounds. Forty-four Sprague-Dawley rats with uniform, paravertebral incisions were studied. Each wound was inoculated with a standard amount of Staphylococcus aureus bacteria and allowed to remain open for two hours. Each wound was treated before wound closure by one of four debridement methods: (1) surgical scrubbing, (2) high-pressure irrigation, (3) ultrasonication, or (4) soaking. The control animals' wounds were closed without debridement. At 7 days, each animal was evaluated for the presence of gross infection and wound induration. Ultrasound, with a 25% incidence of gross infection, compared with irrigation (75%), scrubbing (82%), and soaking (89%) provided significant protection from subsequent abscess formation. The control group uniformly developed infection (100%). The average amount of induration after ultrasonication (1.35 +/- 0.56 cm) was also significantly less than irrigation (2.07 +/- 0.75 cm), scrubbing (1.95 +/- 0.34 cm), and soaking (1.73 +/- 0.22 cm). Our data demonstrate that ultrasonic wound debridement has exciting potential as a new debridement technique for contaminated traumatic wounds.

Animals↗
PubMed1989

An unusual complication of an open-head injury: coccidioidal meningitis.

A case of coccidioidal meningitis following an open-head injury is presented. A 6-year-old boy was ejected from a motor vehicle as it was driven over a cliff, resulting in a severe open-skull fracture with grossly contaminated wounds. The accident occurred in an area in which coccidioidomycosis is endemic, and the causative agent, Coccidioides immitis, is found in high concentration in the soil. In addition to fracture reduction, the child received a course of intrathecal and intravenous amphotericin and achieved a satisfactory clinical response.

Amphotericin B↗
PubMed1989

Intralesional corticosteroid therapy for infantile hemangiomas.

Intralesional corticosteroid injections were performed in 31 hemangiomas in 30 infants aged 1 to 10 months at first injection. One to five injections were given, spaced 6 weeks apart. Lesions were located throughout the head and neck region, except one that was on the buttock. A mixture of betamethasone acetate and triamcinolone acetonide was used. Four lesions (13 percent) virtually disappeared, ten (32 percent) showed greater than 50 percent reduction in volume, ten (32 percent) showed definite but less than 50 percent reduction in volume, and seven (23 percent) showed little or no decrease in size. None showed further growth. All injections were performed without anesthesia, and there were not significant complications. We conclude that intralesional corticosteroid injections are safe and effective in properly selected infants with hemangiomas.

Betamethasone↗
PubMed1988

Cost of treating advanced leg ischemia. Bypass graft vs primary amputation.

We compared the hospital costs of 94 patients undergoing femoropopliteal bypass grafts with those of 53 patients undergoing primary amputation. The total cost of uncomplicated bypass surgery averaged +20,300, compared with +14,000 for uncomplicated below-knee amputation. However, including the cost of prosthesis and rehabilitation, the total cost of primary amputation was +20,400, equivalent to that of the bypass operation. Complications requiring revision of a bypass graft increased hospitalization by 4.5 days with the total cost rising to +28,700; complications that ended with major amputation added 15 hospitalization days and had an average cost of +42,200. In contrast, complicated below-knee amputation cost +40,600 and added 12.5 hospitalization days. There is therefore no cost-benefit in primary amputation when compared with arterial reconstruction, and cost should not be used to deny a patient the opportunity for limb salvage.

Amputation, Surgical↗
PubMed1988

Improving micrograft patency.

To help clarify many of the controversial issues affecting early microvascular graft patency, a series of experiments was performed comparing the relative importance of graft material used alone and in conjunction with antiplatelet agents. Using a rat carotid model employing 1 cm micrografts with 1 mm luminal diameter, this study demonstrated that 1) untreated 1 mm polytetrafluoroethylene (PTFE) and human umbilical vein (HUV) micrografts have unacceptably low patency rates; 2) treatment with the antiplatelet agents indomethacin, ibuprofen, and aspirin significantly improved micrograft patency; 3) differences in patency among the three agents were not significant; and 4) PTFE had higher patency rates than HUV, although this difference did not achieve significance.

Animals↗
PubMed1988

Ultrasonic wound debridement.

Current management of hand injuries includes debridement by abrasive scrubbing with anti-bacterial detergents, surgical excision, or pressure irrigation. A rat model with a contaminated laceration was used to study the efficacy of ultrasonic debridement to diminish bacterial counts and particulate matter in open wounds. Ultrasonic debridement of hand wounds has several advantages over the current methods of wound debridement. These include a technically simple procedure that is effective in the removal of particulate matter and the reduction of bacterial counts (p less than 0.005). In addition there was no blood loss and no detectable damage of viable tissues as evaluated by electron microscopy. This technique may prove to be a significant advance in the early management of hand wounds.

Animals↗
PubMed1988

Computer-assisted burn care.

The use of a computer does not take the thought process out of burn care. Rather, it provides constant user reinforcement while emphasizing key elements of burn care management.

Burns↗
PubMed1988

Bony and soft tissue reconstruction and rehabilitation following traumatic hemipelvectomy, exsanguination and cardiac arrest.

Survival following traumatic hemipelvectomy in the child with subsequent local flap coverage of wounds has been previously described. The use of axial skin flaps and thigh and rectus abdominis musculocutaneous flaps for coverage of hemipelvectomy defects following tumor extirpation has also been noted in the literature. The use of muscle flaps to salvage otherwise nonvital bone and to eradicate osteomyelitis with subsequent wound closure has also been thoroughly demonstrated both clinically and experimentally. The use of musculocutaneous flaps to revascularize otherwise nonviable bone of the pelvis and thus maintain the pelvic girdle integrity, however, has not to our knowledge been previously reported. We recently had an opportunity to treat such a case, which we herein describe.

Amputation, Traumatic↗
PubMed1988

Radionuclide-labeled red blood cell imaging of vascular malformations in children.

Vascular malformations, particularly in the absence of cutaneous changes, can be difficult to distinguish from other soft tissue masses in children. We have used technetium-99m-labeled red blood cell scintigraphy to study 47 lesions in 43 children. Thirty-nine lesions showed increased flow and were, therefore, diagnosed as vascular malformations. Subsequent biopsy of 10 of these lesions confirmed that diagnosis. The other 29 lesions with increased flow were followed for 10 months to 5 years and the clinical course was consistent with vascular malformation in every case. Eight lesions showed no increased flow on technetium scan. One of these subsequently proved to be a hemangioma. The others have turned out not to be vascular malformations. Therefore, in our experience, the technetium-99m-labeled red blood cell scan has had 98% sensitivity and 100% specificity in diagnosing vascular malformations in children.

Adolescent↗
PubMed1988

Efficacy of verapamil in the salvage of failing random skin flaps.

Verapamil is a calcium channel blocker that inhibits mast cell degranulation, platelet aggregation, and neutrophil function and is a potent vasodilator. The efficacy of verapamil (20 mg/kg/day) to salvage a standard failing random skin flap in the rat was studied. In this study verapamil failed to benefit skin flap survival. The results are analyzed and presented.

Animals↗
PubMed1988

Dermabrasion of traumatic tattoos: simple, inexpensive, effective.

In this article we describe the use of an electrosurgical cautery tip scratch pad for the treatment of traumatic (adventitious) tattoos. This inexpensive item is available in most surgical operating rooms. The pad is flexible yet firm and obviates the need for power equipment. Most important, the technique is simple, easy to learn, and highly effective.

Blast Injuries↗
PubMed1988

The use of wall suction as a lipoaspirator.

Hospital wall suction, standard tubing, and liposuction cannulas have been used successfully for liposuction. Benefits include convenience, simplicity, cost effectiveness, and reduction of effluent dispersion. Our experiences indicates that hospital wall suction can be used as an efficacious lipoaspirator.

Humans↗
PubMed1988

Massive subgaleal hematoma resulting in skin compromise and airway obstruction.

Subgaleal hematomas following minimal trauma, haircombing, and hair pulling by playground swings have been described. Recently a case was reported that progressed to otic hemorrhage and upper facial edema. We present a case (of a previously unreported nature) of a subgaleal hematoma that resulted in airway obstruction, massive edema of the entire face and neck, and limited epidermolysis of facial skin.

Airway Obstruction↗
PubMed1988

Hair-thread tourniquet syndrome .

We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. Patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.

Clothing↗