Complications of total ischiectomy for the treatment of ischial pressure sores.

Five patients are reported, 4 of whom had total ischiectomies and the other an extensive partial ischiectomy. In each, recurrent ulcers, extending into the perineum, developed subsequently. One patient had a urethrocutaneous fistula as a result of his perineal ulcer, and he had to undergo an ileal loop diversion. Following a unilateral ischiectomy, the pressure is shifted to the opposite ischium, and this favors the development of another ischial pressure sore on the opposite side. After bilateral ischiectomy there is much more pressure on the perineum, and these patients may go on to develop a perineal pressure sore--particularly if there is a dislocated hip. Recurrent pressure sores which extend into the perineum are difficult to treat, and usually they appear to be related to a previous extensive removal of the ischia.

Thoracolumbar-sacral flaps in the treatment of sacral pressure sores.

The treatment of pressure sores is a challenging problem. A new flap is described to be added to the armamentarium of surgeons looking after these patients. This procedure is not presented as a panacea for the sacral pressure sores but as an additional technique that could be used in very large sacral pressure sores, particularly recurrent pressure sores following conventional procedures.

Early management of burned patients.

Evaluation of the burned patient in the emergency department and fluid resuscitation of burned patients are discussed in detail.

Zygomatic fractures in the emergency department: evaluation and treatment.

Diagnosis of zygomatic fractures in the emergency department is possible by history and clinical signs together with a routine series of facial bone x-ray films. Three case reports are submitted to illustrate this approach, one case with obvious clinical signs and x-ray findings and two "unclear" cases where either the physical findings or the x-ray findings were equivocal. There may be pain, tenderness, cheekbone displacement subconjuctive hemorrhage and numbness, enophthalmos, and blurred vision. A Water's view is recommended for x-ray films. Zygomatic fractures are best treated in five to seven days; eye signs indicate earlier treatment. To treat, expose the probable fracture site and reduce under direct vision. The zygoma can be immobilized by passing a Kirschner wire through the body of the zygoma medially towards and through the lateral wall of the nose and into the bony nasal septum.

Emergency care of the reimplantation patient.

Emergency care of the reimplantation candidate involves care of the patient as well as the severed part. The part should be cooled rapidly to 0-4 C (32-39.2 F) after gentle cleansing with normal saline solution or Ringer's lactate. The stump should be gently irrigated with normal saline and pressure dressing applied. The suitability of the reimplantation candidate, chances for survival of the amputated part, and likelihood of eventual rehabilitation should be evaluated.

Treatment of burns by exposure in an attempt to reduce cross infection.

The advantages of treatment with betadine and glycerol are: cost containment of agent and dressings, ease of observing wounds, reduction of direct nursing care and, most importantly, reduction of ward epidemics, especially Pseudomonas. Major disadvantages are increased time to grafting, potential psychological effects on patients and visitors upon viewing the wounds and the relatively minor pain during application.