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Vinod Kumar Srivastava

A wound generally heals with regular wound care, administration of appropriate antibiotic agents, and rest; however, even when treated, trophic ulcers can remain unhealed for years. The common causes for this are diabetic neuropathy, spina bifida, tabes dorsalis, leprosy, and peripheral nerve injury. 1 Eight cases of trophic ulcers in patients with spina bifida are reported here. These ulcers remained unhealed for 1 to 8 years, but healed within a few weeks after back surgery with release of a tethered conus medullaris. The fact that these wounds healed

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John K. Houten, Gila R. Weinstein, Michael J. Collins, and Daniel Komlos

risk of wound complications in patients who previously had or postoperatively need radiation therapy. 8 , 11 , 12 Specialized wound closure techniques, particularly muscle flap mobilization, serve to reduce tension at the wound edges and increase the bulk of vascularized tissue in the midline and have been successfully employed as salvage maneuvers to manage wound complications. 13 , 14 There has been recent interest in investigating whether such techniques have a prophylactic role in subgroups of patients who are known to be at increased risk for wound

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Michael E. Carey, Gurcharan S. Sarna, J. Bryan Farrell, and Leo T. Happel

I n combat, the head receives about 20% of all “hits” and head wounds account for approximately half of all single missile deaths. 4 The most comprehensive data on the surgical treatment of missile wounds to the brain come from neurosurgical series reported from various wars of the 20th century. Review of these neurosurgical statistics reveals no significant reduction in the neurosurgical mortality rate from wounds inflicted in World War II through the Vietnam experience: during World War II, the neurosurgical mortality rate for United States Army soldiers in

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Barry M. Zide, Fred J. Epstein, and Jeffrey Wisoff

paraspinous muscles below it. The paraspinous muscles are then released from the underlying bone ( Fig. 2 ). In the cephalic third of the wound, the fascia and underlying muscle (always kept together as a unit) are lax enough to close easily. In order to provide mobilization of caudal tighter zones, a vertical releasing incision is made about 2.5 cm from the medial wound edge bilaterally ( Fig. 3 left ). This extends through the fascia only to the muscle . The release must not be extended to the sacrum at this juncture. Traction is placed on the medial wound edge while

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W. Craig Clark, Michael S. Muhlbauer, Clarence B. Watridge, and Morris W. Ray

C raniocerebral gunshot wounds continue to constitute a dilemma for the neurosurgeon. Many of the published studies were either based upon high-velocity wounds treated in military practice, 4, 13, 20–22, 32–35 or gathered before computerized tomography (CT) played such an important role in neurosurgery. 26, 36 Consideration of this problem is further complicated in that most reported series involve either small numbers of patients or heterogeneous management policies; as a result, any conclusions are tenuous. 9 There has been tremendous interest in the

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Barry M. Zide, Jeffrey H. Wisoff, and Fred J. Epstein

. This high incidence of wound complications prompted the development of an alternative method of wound closure, which has evolved with experience. The problems encountered in the first 20 cases (see below) were overcome by changes in the manner of closure. Since the last 32 patients suffered only minor problems, our experience with this latter group will be used in presenting the technique as it is performed today. Summary of Cases Between June, 1982, and March, 1986, 58 patients with spinal cord tumors were operated on jointly by a plastic surgeon (B.M.Z.) and

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Joel B. Kirkpatrick and Vincent Di Maio

G unshot injuries to the brain are relatively common in civilian medical practice. In 1972, the vital statistics on mortality in the United States recorded 13,348 suicides by firearms and explosives, 13,383 homicides by firearms and explosives, and an additional 2442 accidental deaths due to firearm missiles. 49 A large percentage of these fatalities was caused by missile wounds to the brain from weapons commonly available to civilians, namely, relatively low-velocity handguns and rimfire rifles. The medical literature, however, largely ignores injuries from

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Charles F. Kieck and Jacques C. de Villiers

I n the 20th century, stab wounds of the skull (as opposed to penetrating missile wounds) have become somewhat of a rarity in western experience. In South Africa, however, with the mixture of first and third world societies and perhaps also because of very strict gun control laws, stab wounds of the skull are a rather common occurrence. In contrast, missile wounds are seen only rarely and then usually as a result of attempted suicide. Stab wounds may be obvious and fatal, but can also be very misleading. A trivial wound ( Fig. 1 ) in an asymptomatic patient

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Stephen J. Haines and Michael L. Goodman

fluid leukocytosis and inflammation of the wound, although with negative culture. 6 No infection occurred in cases with aspiration of wound fluid collections. All operations, except for tracheostomies, percutaneous radiofrequency rhizotomies, and those performed on patients already infected or receiving antibiotics for other reasons, were included in the study. Patients were followed for a minimum of 6 weeks postoperatively. In addition, we calculated the infection rate for the 12 months preceding adoption of the protocol, using the same definition of infection. In

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David G. Kline

T he British experience with gunshot wounds (GSW's) to the brachial plexus in World War II indicated that some upper trunk and posterior cord lesions recovered spontaneously. Resection and suture led to functional improvement only in lesions of the upper trunk or C-5 and C-6 spinal nerve roots; although neurolysis of other elements did help pain, it seldom improved outcome. 3, 14 The experience in the United States, although larger and analyzed in a more detailed fashion, revealed similar limitations to operations on the plexus. 4, 13 In the interim, several