Axillary hidradenitis.

The magnitude of the social, economic, and medical problems confronting patients with chronic suppurative axillary hidradenitis is not generally recognized. Nonoperative treatment is disappointing. Total excision of all apocrine-bearing axillary tissue with primary closure is the treatment of choice. Operative treatment can be safely accomplished even when draining sinuses are present. Twenty-six patients representing 47 operated axillae are presented.

Lidocaine is not necessary in liposuction.

Lidocaine is an integral part of most wetting solutions used in liposuction. Although the Physician's Desk Reference states that the permissible dose of lidocaine is 7 mg/kg, doses as high as 75 mg/kg have been used in liposuction. Lidocaine is used in the wetting solution even when the procedure is performed under epidural or general anesthesia. The justification for this is a reduction in postoperative pain. This study compared the pain between paired, mirrored sides of 10 patients when lidocaine was used on only one side. There was no statistically significant difference between the postoperative pain at 5, 30, 60, and 120 minutes and on the first postoperative day. Because there was no difference in pain whether or not lidocaine was used, and because lidocaine is potentially toxic and lethal, this study concludes that lidocaine is not necessary in liposuction.

Quality-of-life outcomes after cosmetic surgery.

Cosmetic surgery is an increasingly common medical procedure whose benefits to patients have not been quantified objectively. The purpose of this study was to prospectively examine long-term quality-of-life outcomes for patients undergoing elective cosmetic surgery. In this prospective, correlational study of 105 consecutive patients undergoing elective cosmetic surgery, the parameters of quality-of-life index, depression, social support, and coping were determined preoperatively and at 1- and 6-month intervals postoperatively. The data from the four study instruments were analyzed using Pearson correlation and repeated measures of multivariate analysis of variance for differences in each variable over time. The multivariate analysis of variance quality-of-life index scores for patients improved from baseline preoperative mean levels of 3.24 to a mean of 2.56 at 1 month, and then to 2.11 (f = 518.5, p = < 0.0001) at 6 months postsurgery. Mean scores for depression [determined by using the Center for Epidemiologic Studies Depression Scale (CESD)], improved from 11.2 preoperatively to 6.5 at 1 month, and to 6.3 (f= 79.3, p = < .0001) at 6 months after surgery. Surgical intervention produced no significant differences between preoperative and postoperative ways of coping and social support scores. Cosmetic surgery produces positive psychological benefits by significantly improving quality-of-life outcomes that persist long term, without adversely affecting social support and ways of coping.

Use of vascular clips to approximate skin grafts.

During excisions of acute burn wounds, attention to aesthetic detail often is secondary to the goal of rapid gross coverage. Expeditious approximation of adjacent skin grafts has long presented a problem to surgeons. Some surgeons simply place the grafts next to each other, relying on the intervening areas to "scar in". Others use staples to hold grafts together. These staples, however, can become buried under healed grafts and can cause "foreign body" reactions in the months and years ahead. In addition, staples cause bleeding beneath the newly placed grafts, contributing to hematoma formation. Still other surgeons suture or tape adjacent pieces of skin graft together, a tedious exercise. The cosmetic result of these techniques is often less than optimal resulting in the unfortunately familiar "patchwork quilt" appearance of grafts interweaved among scars. Vascular clips have proven to be useful for holding adjacent pieces of skin graft together.

Mafenide-induced pseudochondritis.

Wound infections following burns of the ear can result in the devastating complication of chondritis, requiring resection of cartilage. To prevent this, it has become common practice to dress the burned ear with mafenide acetate. We have observed six hypersensitivity reactions to the mafenide that occurred following several weeks of continuous use of the drug. The reaction mimics chondritis, causing edematous, erythematous, pruritic ears with a profuse serous exudate. There is no associated fever, systemic signs, or pain on motion of the cartilage. Treatment consists of stopping the mafenide. Recovery occurs within 72 hours. Differentiating between chondritis, with its required surgical and antibiotic treatment, and a hypersensitivity reaction is necessary to avoid further iatrogenic injury.

A case study of respiratory disease in a veal calf operation.

An outbreak of respiratory disease occurred in a central Alberta veal operation, after production capacity had been increased fourfold. Mortality rate reached 24.6% despite agressive antibiotic therapy. A review of the records revealed a cyclical disease pattern in each room. Weekly cleaning of occupied calf rooms was correlated with the disease pattern. Aerosols generated by a high pressure sprayer appeared to trigger transmission of respiratory pathogens in malnourished neonatal calves.DISEASE OCCURRENCE DECREASED AND PROFITABILITY INCREASED SIXFOLD AFTER THE INTRODUCTION OF THE FOLLOWING MEASURES: 1) discontinuing the use of the high pressure washer in the occupied calf rooms, 2) feeding calves a better quality milk replacer with supplemental milk for the poorest calves, 3) sale-yard calf purchases were abandoned in favor of direct buying.

Fatal herpesvirus infection in commercial rabbits.

Acute mortality occurred in two unrelated rabbitries. In the rabbits examined, an unidentified herpesvirus caused lesions that have not been reported previously in this species. The primary lesions were multifocal hemorrhagic dermatitis on the face and back, localized pneumonia, and severe splenic necrosis. Large eosinophilic, intranuclear inclusion bodies that were observed in tissue sections of skin, spleen, and lung were identified as herpes-like viral particles by electron microscopy, and herpesvirus was cultured on rabbit kidney cells. Intramuscular injection of tissue culture fluid containing virus resulted in mortality and severe illness in two seven-week-old domestic rabbits four and six days postinfection, respectively. The gross and microscopic lesions were reproduced and herpeslike viral inclusions were observed in skin lesions. Herpesvirus was recovered from lung, trachea, spleen, liver, and from the thigh muscle at the site of inoculation. The experimental infection also activated severe pasteurella septicemia. The herpesvirus isolate needs further characterization.

Abdominoplasty combined with total abdominal hysterectomy.

Twenty patients who underwent total abdominal hysterectomy combined with abdominoplasty are described here, along with the criteria used for their selection. No patients suffered pulmonary embolus, significant infection, or other serious complications. Combining the procedures shortened the convalescent period and reduced the total cost. In carefully selected cases it appears that these two procedures can be combined safely.

Fine tuning of the skin edges in the closure of surgical wounds. Controlling inversion and eversion with the path of the needle--the right stitch at the right time.

A primary objective in closure of surgical wounds is accurate apposition of epithelial edges in a manner that will return the tissues to as near normal a condition as possible. This article describes types of suture techniques that enable the surgeon to control the tendency of wound edges to either invert or evert. Accurate approximations and esthetically pleasing results are reached by using the appropriate pass of the needle and path of the suture to control tendencies to inversion and eversion.

Fingerstick felons.

Blood drawing through the fingerstick technique is growing in popularity. Generally considered harmless, it is widely used both in hospitals and at home for monitoring blood glucose concentrations. We report 2 cases of hand infections requiring surgery that resulted from fingerstick blood glucose concentration determinations in immunosuppressed patients. This potentially serious side effect of using the fingerstick technique may be minimized by drawing the blood from the volar forearm or from other areas of the body.

Skin graft survival--the bacterial answer.

An in vitro wound model was created to determine the mechanism by which bacteria cause skin graft failure. A wound surface was simulated by a human fibrin clot. Staphylococcus aureus or group A streptococcus was incubated over the clot. Either saline, human plasminogen, aprotinin, or epsilon-aminocaproic acid (EACA), or a combination of these, was added to the tubes. After 30 hours, the tubes were examined for the presence of the clot. The supernatant was then examined for the presence of fibrin degradation products (FDP). S. aureus was incapable of destroying the fibrin clot without the presence of plasminogen in the culture media. Group A streptococcus was capable of some clot degradation, but this was markedly improved in the presence of plasminogen. High FDP levels correlated with the destruction of the clot. Both aprotinin and EACA were capable of preserving the fibrin clots. In this study we carefully controlled the chemical and bacterial milieu on a simulated wound.