- Email: [email protected]
Treatment of subungual haematoma
Volume 3 Number 1
69
ABSTRACTS
2. Before re-assembling any tyre rim and fitting a new tyre, all the parts must be carefully checked for damage, rust, or corrosion and replaced if found defective. 3 The rim and ring must be locked in the closed position before the tyre is inflated. 4. Only accurate and tested gauges must be used to ensure correct air pressure. 5. The mechanic should stand well to the side of the wheel as the tyre is being inflated. BAUTISTA, B. N., KERNAHAN, D. A., and VISTNES, L. M. (1971), ' T r u c k Tyre-rim lnjury--a New Trauma Entity ', Plastic reconstr. Surg., 47, 117.
Gunshot Wound of the Head with Pneumocranium Drs. Gardner and Shannon describe an unusual complication of gunshot wound of the head. The patient, who was aged 36, was admitted with a compound fracture of the right frontal region with torn brain tissue exuding from the wound. He was unconscious and had a left hemiplegia. After excision of the damaged brain tissue there was a cavity 8 cm. in depth and 4 cm. in diameter, and the wound was left open. Five days later the patient recovered consciousness and cerebrospinal fluid drainage ceased on the tenth day. Six weeks after injury, sequestrectomy of the exposed outer table of the frontal bone was done. This exposed a large cavity. One week later radiography showed an extensive pneumocranium. Application of an elastic rubber band around the neck resulted in obliteration of most of the air cavity within 24 hours. On three occasions the patient removed the rubber band and each time the brain retracted. Four weeks after applying the venous congestive band the expanded brain was adherent to the dura and did not contract any more. Eventually the ulcer closed in, leaving a thin scar. The hemiplegia persisted. GARDNER, W. J., and SHANNON, E. W. (1971), ' Pneumocranium from Gunshot Wound of Brain', J. Ant. reed. Ass., 214, 2333.
Brain-stem Lesions The brains of 106 persons dying shortly after acute injury of the head were examined after fixing them with 10 per cent formol-saline for 2 weeks. None had suffered penetrating injury. Thirty-two brains showed primary lesions which were characterized by being asymmetrical and tegmental in distribution. Haemorrhagic and ischaemic lesions were found in the mid-brain and torn neurones with retraction bails were found in the medulla oblongata, and particularly in the olivary nuclei. Most of the deaths occurred within 12 hours. In most cases the force responsible had struck the occiput and there was bruising of the cerebellum. In the few cases in which the neck was struck, the lesions in the brain were primary. Death occurred mostly in the second 12 hours when there was no primary lesion; primary lesions were found only once in a person that had had a lucid internal. Sixty-three brains showed secondary lesions, 3 showed both primary and secondary lesions, and 14 showed neither. Secondary lesions were typically paramedian and symmetrical and were found in distorted brain-stems. CROtOn'TON, M. R. (1971), ' Brain-stem Lesions due to Closed Head Injury ', Lancet, 1, 669.
HAND INJURIES
Practical Aspects of Skin-grafting Increasing understanding of the value of early skin closure of defects by free skin-grafts has made this procedure part of the repertoire of the accident surgeon. Although the procedures are essentially simple, surgical technique and the choice of suitable donor sites are important. Errors in judgement and technique may have serious consequences and leave permanent unnecessary disfigurement. This carefully written and well illustrated paper gives excellent surgical guidance. CORT, D. F., and HERnERT, D. C. (1971), 'Practical Aspects of Skin Grafting', Br. J. Hosp. Med., 5, 462. Treatment of Subungual Haematoma Painless trephining of the nail by a red hot paperclip is described. WEE, G. C., and SHIEnER, W. (1970), 'Painless Evacuation of Subungual H a e m a t o m a ' , Surgery Gynec. Obstet., 131,531. Flap for Soft-tissue Adduction Contracture of the Thumb A triangular flap based proximally on the radial aspect of the proximal phalanx of the index finger is used to form the floor of the newly created cleft made by a simple incision between the thumb and the index finger and excision of the deep scar. The secondary defect on the side of the index finger is covered with a split-skin graft. Six cases have been treated in this way. Two cases are illustrated in detail. SPINNER, M. (1969), ' F a s h i o n e d Transpositional Flap for Soft Tissue Adduction Contracture of the Thumb ', Plastic reconstr. Surg., 44, 345. Reconstruction of Amputated Finger-tips Amputation of a finger-tip at the level of the fingernail presents the surgeon with a difficult decision. The potential for finger-nail growth remains, yet the bed and supporting tissues have been damaged or lost. Initial soft-tissue replacement (for preference by a palmar or thenar flap) often leaves a finger that is functionally and aesthetically unsatisfactory as the growing nail is not firmly adherent to the newly attached skin. The author describes a method of selective ' defatting ' of the pedicle of the flap to deal with this deformity and to restore the normal gentle curve of a finger-pad. Occasionally a nail-bed graft from the big toe may be required to complete the repair. A typical case is fully illustrated. BEASLEY, R. W. (1969), ' Reconstruction of Amputated Finger-tips ', Plastic reconstr. Surg., 44, 349. High-pressure Injection Injuries of the Hand The authors review the aetiology, clinical course, and treatment of high-pressure injection injuries of the hand and describe a personal series of 12 cases seen over a period of 8 years. Immediate and adequate d6bridement, decompression, and evacuation of the offending material should be carried out. Copious saline irrigation of the wound is recommended rather than the use of grease solvents which add further injury to the tissues. Antibiotics should be given systemically and tetanus prophylaxis is prudent. Some late cases may benefit from staged
69
ABSTRACTS
2. Before re-assembling any tyre rim and fitting a new tyre, all the parts must be carefully checked for damage, rust, or corrosion and replaced if found defective. 3 The rim and ring must be locked in the closed position before the tyre is inflated. 4. Only accurate and tested gauges must be used to ensure correct air pressure. 5. The mechanic should stand well to the side of the wheel as the tyre is being inflated. BAUTISTA, B. N., KERNAHAN, D. A., and VISTNES, L. M. (1971), ' T r u c k Tyre-rim lnjury--a New Trauma Entity ', Plastic reconstr. Surg., 47, 117.
Gunshot Wound of the Head with Pneumocranium Drs. Gardner and Shannon describe an unusual complication of gunshot wound of the head. The patient, who was aged 36, was admitted with a compound fracture of the right frontal region with torn brain tissue exuding from the wound. He was unconscious and had a left hemiplegia. After excision of the damaged brain tissue there was a cavity 8 cm. in depth and 4 cm. in diameter, and the wound was left open. Five days later the patient recovered consciousness and cerebrospinal fluid drainage ceased on the tenth day. Six weeks after injury, sequestrectomy of the exposed outer table of the frontal bone was done. This exposed a large cavity. One week later radiography showed an extensive pneumocranium. Application of an elastic rubber band around the neck resulted in obliteration of most of the air cavity within 24 hours. On three occasions the patient removed the rubber band and each time the brain retracted. Four weeks after applying the venous congestive band the expanded brain was adherent to the dura and did not contract any more. Eventually the ulcer closed in, leaving a thin scar. The hemiplegia persisted. GARDNER, W. J., and SHANNON, E. W. (1971), ' Pneumocranium from Gunshot Wound of Brain', J. Ant. reed. Ass., 214, 2333.
Brain-stem Lesions The brains of 106 persons dying shortly after acute injury of the head were examined after fixing them with 10 per cent formol-saline for 2 weeks. None had suffered penetrating injury. Thirty-two brains showed primary lesions which were characterized by being asymmetrical and tegmental in distribution. Haemorrhagic and ischaemic lesions were found in the mid-brain and torn neurones with retraction bails were found in the medulla oblongata, and particularly in the olivary nuclei. Most of the deaths occurred within 12 hours. In most cases the force responsible had struck the occiput and there was bruising of the cerebellum. In the few cases in which the neck was struck, the lesions in the brain were primary. Death occurred mostly in the second 12 hours when there was no primary lesion; primary lesions were found only once in a person that had had a lucid internal. Sixty-three brains showed secondary lesions, 3 showed both primary and secondary lesions, and 14 showed neither. Secondary lesions were typically paramedian and symmetrical and were found in distorted brain-stems. CROtOn'TON, M. R. (1971), ' Brain-stem Lesions due to Closed Head Injury ', Lancet, 1, 669.
HAND INJURIES
Practical Aspects of Skin-grafting Increasing understanding of the value of early skin closure of defects by free skin-grafts has made this procedure part of the repertoire of the accident surgeon. Although the procedures are essentially simple, surgical technique and the choice of suitable donor sites are important. Errors in judgement and technique may have serious consequences and leave permanent unnecessary disfigurement. This carefully written and well illustrated paper gives excellent surgical guidance. CORT, D. F., and HERnERT, D. C. (1971), 'Practical Aspects of Skin Grafting', Br. J. Hosp. Med., 5, 462. Treatment of Subungual Haematoma Painless trephining of the nail by a red hot paperclip is described. WEE, G. C., and SHIEnER, W. (1970), 'Painless Evacuation of Subungual H a e m a t o m a ' , Surgery Gynec. Obstet., 131,531. Flap for Soft-tissue Adduction Contracture of the Thumb A triangular flap based proximally on the radial aspect of the proximal phalanx of the index finger is used to form the floor of the newly created cleft made by a simple incision between the thumb and the index finger and excision of the deep scar. The secondary defect on the side of the index finger is covered with a split-skin graft. Six cases have been treated in this way. Two cases are illustrated in detail. SPINNER, M. (1969), ' F a s h i o n e d Transpositional Flap for Soft Tissue Adduction Contracture of the Thumb ', Plastic reconstr. Surg., 44, 345. Reconstruction of Amputated Finger-tips Amputation of a finger-tip at the level of the fingernail presents the surgeon with a difficult decision. The potential for finger-nail growth remains, yet the bed and supporting tissues have been damaged or lost. Initial soft-tissue replacement (for preference by a palmar or thenar flap) often leaves a finger that is functionally and aesthetically unsatisfactory as the growing nail is not firmly adherent to the newly attached skin. The author describes a method of selective ' defatting ' of the pedicle of the flap to deal with this deformity and to restore the normal gentle curve of a finger-pad. Occasionally a nail-bed graft from the big toe may be required to complete the repair. A typical case is fully illustrated. BEASLEY, R. W. (1969), ' Reconstruction of Amputated Finger-tips ', Plastic reconstr. Surg., 44, 349. High-pressure Injection Injuries of the Hand The authors review the aetiology, clinical course, and treatment of high-pressure injection injuries of the hand and describe a personal series of 12 cases seen over a period of 8 years. Immediate and adequate d6bridement, decompression, and evacuation of the offending material should be carried out. Copious saline irrigation of the wound is recommended rather than the use of grease solvents which add further injury to the tissues. Antibiotics should be given systemically and tetanus prophylaxis is prudent. Some late cases may benefit from staged