Influence of restraining devices on patterns of pediatric facial trauma in motor vehicle collisions.

In the Commonwealth of Pennsylvania, it is required that all children under the age of 4 years be restrained by an infant seat or car seat appropriate for their age and weight. Furthermore, all individuals riding in the front seat must be restrained by a seatbelt. This study examined the relationship between patterns of facial injuries and the use of restraining devices in the pediatric population. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission included trauma patients who were admitted to the Intensive Care Unit, those who died during hospitalization, those who were hospitalized for more than 72 hours, or those who were transferred in or out of the receiving hospital. A subset of 412 pediatric patients, 15 years of age or younger, was analyzed for patterns of facial injury and the presence or absence of restraining devices. Restraining devices were categorized as a car seat or a seatbelt. Statistical analysis was performed using chi-square and Fisher\u27s exact tests. Of the 412 pediatric patients, only 17 children were restrained with a car seat and 121 were wearing a seatbelt. A total of 30 children sustained facial fractures, and 50 children suffered facial lacerations. There was a statistically significant increase in the incidence of facial fractures with increasing age of the child (p \u3c 0.001). Of children with facial fractures, 70 percent of those 5 to 12 years old and 90 percent of those 13 to 15 years old were unrestrained (p = 0.166). In conclusion, despite legislation mandating the use of restraints, a large proportion of children involved in motor vehicle collisions were unrestrained. Furthermore, there seems to be a direct relationship between the age of a child and the incidence of facial fractures sustained in motor vehicle collisions

The protruding premaxilla and minimal median alveolar cleft: an unusual problem with a 12-year follow-up.

This case of a bilateral complete cleft lip with minimal alveolar cleft illustrated that recession of the protruding premaxilla will occur following lip closure even if no cleft of the secondary palate or other void exists

Infected Meme Implants: Salvage Reconstruction with Latissimus Dorsi Myocutaneous Flaps and Silicone Implants.

Polyurethane-coated breast implants are used more frequently in recent years both in augmentation and reconstruction. Postoperative infection may lead to serious complications with formation of foreign body granulomas. A case is presented with such a complication that required multiple operations and wide excision of reconstructed breasts necessitating major myocutaneous flaps to salvage the breasts

Detection of a relatively radiolucent foreign body in the hand by xerography.

A case is presented in which a piece of wood, broken off in a hand, failed to show on a conventional radiograph and was clearly discernible on a xerogram

The Parascapular Fasciocutaneous Flap for Release of the Axillary Burn Contracture.

Major disturbances of shoulder function secondary to axillary burn contracture require some form of surgical release if conservative therapy has been unsuccessful. Any area large enough to need extensive skin grafts should be considered for reconstruction using a parascapular fasciocutaneous flap. This flap, which may be elevated easily, provides an option for single-stage correction of the deformity without the need for long-term rehabilitation or splinting

Free Temporoparietal Flap in Burn Reconstruction.

A series of 12 patients with deep burns resulting in exposed bones, joints, and tendons, in whom temporoparietal free flaps were used for reconstruction, are presented. Flap loss was 8.3%; good and satisfactory results were achieved in 91.7% of healed defects. Patients with large total body surface area burns are severely compromised, and the use of free flaps requiring prolonged periods of anesthesia and surgery should be a judicious decision. Prior to the availability of free flaps, most of these patients are left with chronic wounds and compromised functional results. Although our experience is limited, we think that in well-selected cases a one-stage reconstruction with free tissue transfer is expeditious, safe, and economical

Staged Reconstruction of Abdominal Wall Defects After Intra-Abdominal Catastrophes.

Advances in surgical intensive care have improved survival in patients with major traumatic or infectious intra-abdominal insults. Patients who recover are often left with massive abdominal wall defects. Sufficient autogenous tissue may not be available for reconstruction and synthetic mesh followed by skin grafting can lead to unaesthetic results or complications. We report on four patients with abdominal wall defects and their reconstruction after intra-abdominal injury. Treatment involved local wound care to stimulate granulation tissue, which is eventually skin grafted to close the wound. Patients are then allowed to make a full recovery. Soft-tissue expanding prostheses are placed during a second operation and inflated over subsequent weeks. Finally, the skin graft is excised, a polytetrafluoroethylene patch is placed into the fascial defect, and the expanded skin is used to achieve wound closure

How Accurate is Pulse Oximetry in Patients with Burn Injuries?

Pulse oximetry is a noninvasive method of measuring arterial oxygen saturation. The value of oximetry in patients with burn injuries has been questioned because of a theoretic inaccuracy in the presence of carboxyhemoglobin. We studied pulse oximetry in 27 intubated patients with burn injuries to determine the accuracy of the method and then to determine whether oximetry could replace indwelling catheters presently used for arterial blood gas analysis. Oximeter and arterial blood gas saturation data correlated closely, with a coefficient of 0.820. The pulse oximeter predicted adequate ventilation in 78% of patients with a readout of 99% or above. The arterial PO2 was greater than or equal to 90 torr in 90% of patients with oximetric readouts greater than or equal to 98% and in 10% of patients with readouts less than 95%. Pulse oximetry is an accurate adjunct in the management of patients with burn injuries and in addition provides continuous real-time data not available with arterial blood gas sampling