Trauma And Amputation Surgery

Trauma and Amputation Surgery
   

• Jabor O.B., Bosse MF, Hudson MC et al (Carolinas Med. Ctr., Charlotte NC, Univ of North Carolina at Charlotte)
  Does Bacteremia Occur During High Pressure Lavage of Contaminated Wounds.
  Clin Orthop 347: 117-121. 1998
       
  This study on 20 dogs investigates the risk of bacteremia secondary to high pressure lavage of contaminated wounds.
     
  The dogs were divided randomly into 4 groups. In groups A and B, the wound was contaminated with 1.4  x 10 ⁹ staphylococcus aureus and were followed 75 minutes later with high pressure lavage or bulb syringe irrigation. Groups C and D underwent the same treatment but without contamination.
     
  No detectable bacteremia occurred in the contaminated wounds.  However bacteremia was detected in 18 of 20 control dogs.  High pressure lavage reduced bacterial levels by 70% and bulb irrigation by 44%.
    
  It is concluded that high pressure lavage reduced wound bacteria more consistently than bulb irrigation did.
       

• Davis KD, Kiss ZHT, Luo L, et al (Univ of Toronto)
  Phantom Sensations Generated by Thalamic Microstimulation.
  Nature 391: 386-387, 1998.
     
  Thalamic neuronal responses and stimulation induced sensations were analysed in patients with postamputation pain to gain better understanding of the thalamic mechanisms underlying phantom sensations.
      
  Thalamic mapping demonstrated an unusually large thalamic stump representation.
      
  More research is needed to further define the electrode activity in the thalamus and to assess potential pharmacologic or stereotactic interventions.
        

• KJ Janjua, M Sugrue, SA Deane (Liverpool Hosp, Australia) 1998.: Prospective Evaluation of Early Missed Injuries and the Role of Tertiary Trauma Survey.   Injury Infect Crit Care 44: 1000-1007.
       
  Many trauma patients have missed injuries even after primary and secondary trauma survey.  These assessments cannot be regarded as definitive. A tertiary trauma survey is needed to reduce the rate of missed diagnosis.
        
  The study identifies factors responsible for missed diagnosis.
         

• SA Gould, EE Moore, DB Hoyt, et al
  The First Randomized Trial of Human Polymerized Haemoglobin as a blood substitute in Acute Trauma and Emergent Surgery
  J Am Coll Surg  187: 113-122, 19998
     
  Polymerized haemoglobin appears to be safe and clinically useful blood substitute in patients with acute blood loss. Although the use of Polymerized Haemoglobin is associated with reduciton in Red Blood Cell Haemoglobin, it preserves total haemoglobin and reduces requirement for allogenic blood.
     
  Advantages : Safe and Effective Blood Substitute  because of :-
     
  1.                 Immediate availability

  2.                 Compatibility with all blood types

  3.                 Freedom from transfusion reactions

  4.                 Freedom from transmission of hepatitis, AIDS and other blood borne diseases

  Biologically inert-hence no immune reactions and no potentiation of infection.