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Wound geometry and the kinetics of wound contraction
CURRENT LITEPIIATURE Abstracts
Postoperative Toxic Shock Syndrome. Oldfield EC. Arch Surg 118:791, 1983
Morrison
a
total parotidectomy with facial nerve preservation should be performed. Radiation therapy has been advocated by others but appears to have no place in the management of Warthin’s tumor.-TrM KABOT
VA,
Toxic shock syndrome (TSS) is characterized by high temperature, headache, confusion, conjunctival hyperemia, scarlatiniform rash, subcutaneous edema, vomiting, watery diarrhea, and oliguria. It has been classically described in the premenopausal woman in a menses-related setting. Recently, however, similar cases have been reported in association with postoperative wound infections and not menses. This publication describes the clinical syndrome and presents three cases of TSS in the postsurgical setting, one resulting in the patient’s death. Common to all three was fever and multiseptum involvement in combination with cutaneous erythroderma. Pathogenesis is postulated as being secondary to the absorption of one or more staphylococcal exotoxins into the circulation by way of inflamed or traumatized mucous membranes or from a focal soft tissue site, resulting in a diffuse toxic vasculitis. It appears that beta-lactamaseresistant antibiotics are only useful in minimizing risks of recurrences. Optimal antibiotic dosage and duration of therapy are unknown. It is now apparent that TSS needs to be included in the differential diagnosis of fever in the postoperative setting.-MARK SILVERBERC
Reprint requests to Dr. Chapnik: Ear, Nose and Throat ASSOciates, 99 Avenue Road, Suite 207, Toronto M5R 2G5, Canada.
Laryngeal Injury Following Short-Term Intubation. Peppard SB, Dickens JH. Ann Otol Rhino1 Lagyngol92:327, 1983 Endotracheal intubation for anesthesia may lead to a number of complications, including sore throat, hoarseness, broken teeth, abrasions, lacerations, and even esophageal perforation, tracheal rupture or cricoarytenoid dislocation. In this study, indirect laryngoscopy was performed on 475 patients immediately following extubation after surgery. Patients were also questioned on subjective pre- and postoperative laryngopharyngeal symptoms. Of the 475 patients, 30 were found to have traumatic lesions, including hematoma (25), lacerations (3), and vocal cord paralysis (2). Subjectively, sore throat was the most common complaint overall, while hoarseness was the most common complaint in the traumatically injured patients. No correlation could be drawn between the injured and uninjured group with respect to tube size, length of intubation, sex, age, smoking history, or ease of intubation as described by the anesthetist.-ROBERT A. STRAUSS
Reprint requests to Dr. Morrison: Department of Internal Medicine, Naval Regional Medical Center, Portsmouth, VA 23708.
The Controversy of Warthin’s ryngoscope 93:695, 1983
Tumor.
Chapnik J. La-
Reprint requests to Dr. Peppard: 540 East Cantield Avenue, Detroit, MI 48201.
The controversies regarding Warthin’s tumor (papillary cystadenoma lymphomatosum) include its classification, pathogenesis, and treatment. In the past, vague classifications of salivary gland tumors have led to the misdiagnosis and subsequent mismanagement of Warthin’s tumors. Recent classifications regard Warthin’s tumor as a benign salivary gland neoplasm in its own subcategory. There is much controversy about the tumor’s pathogenesis. The epithelial component is generally regarded as a neoplastic transformation of parotid duct cells. Which specific duct cell becomes neoplastic is debatable. The intercalated duct cells, stem reserve cells, oncocytes, myoepithelial cells, and striated duct cells have all been implicated. The lympocytic infiltrate, which is the other main cellular component, has been regarded as either a cellular response to an epithelial neoplasm; a residual, normal lymph node involved in an area of epithelial neoplasia; or residual lymphoid tissue reacting to the epithelial component. Warthin’s tumor may arise from heterotopic salivary gland epithelium within nodes of the parotid gland, periparotid area, or neck. However, others have questioned whether the tumor is actually a neoplasm. It has been suggested that the tumor represents a delayed hypersensitivity tissue reaction initiated by striated duct epithelial metaplasia. Treatment of Warthin’s tumor presents a dilemma. Limited resection or superficial parotidectomy with facial nerve preservation has been advocated, since 90% of the tumors involve the superficial lobe. Some feel that superticial parotidectomy is associated with a high recurrence rate and advise that
Wound Geometry and the Kinetics of Wound Contraction. McGrath MH, Simon RH. Plast Reconstr Surg 72:66, 1983 The skin and subcutaneous tissue of rats were excised in the pattern of circles, large squares, and small squares to observe the kinetics of wound contraction, to mathematically describe that contraction, and to study the influence of wound geometry on contraction. Wound contraction is described as occurring in three phases: a preexponential or plateau phase (first six days), an exponential phase (day six through day 39) and a postexponential phase. The mathematical description of contraction during the exponential phase is described as A = Be-” + Ao where A is area, Ao is the area remaining after contraction is completed, B is the area that will undergo contraction, k is a contraction rate constant, and t is any given time. It was found that regardless of size or shape, the contraction rate constant was the same within age- and species-matched animals and that in the exponential phase, differently shaped wounds of the same size contract at the same rate. It was found that shape exerted an effect before the onset of contraction and that size is determined by shape through peritIIeter.-BRADLEY WRIGHT Reprint requests to
Dr. McGrath: College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032.
341
Postoperative Toxic Shock Syndrome. Oldfield EC. Arch Surg 118:791, 1983
Morrison
a
total parotidectomy with facial nerve preservation should be performed. Radiation therapy has been advocated by others but appears to have no place in the management of Warthin’s tumor.-TrM KABOT
VA,
Toxic shock syndrome (TSS) is characterized by high temperature, headache, confusion, conjunctival hyperemia, scarlatiniform rash, subcutaneous edema, vomiting, watery diarrhea, and oliguria. It has been classically described in the premenopausal woman in a menses-related setting. Recently, however, similar cases have been reported in association with postoperative wound infections and not menses. This publication describes the clinical syndrome and presents three cases of TSS in the postsurgical setting, one resulting in the patient’s death. Common to all three was fever and multiseptum involvement in combination with cutaneous erythroderma. Pathogenesis is postulated as being secondary to the absorption of one or more staphylococcal exotoxins into the circulation by way of inflamed or traumatized mucous membranes or from a focal soft tissue site, resulting in a diffuse toxic vasculitis. It appears that beta-lactamaseresistant antibiotics are only useful in minimizing risks of recurrences. Optimal antibiotic dosage and duration of therapy are unknown. It is now apparent that TSS needs to be included in the differential diagnosis of fever in the postoperative setting.-MARK SILVERBERC
Reprint requests to Dr. Chapnik: Ear, Nose and Throat ASSOciates, 99 Avenue Road, Suite 207, Toronto M5R 2G5, Canada.
Laryngeal Injury Following Short-Term Intubation. Peppard SB, Dickens JH. Ann Otol Rhino1 Lagyngol92:327, 1983 Endotracheal intubation for anesthesia may lead to a number of complications, including sore throat, hoarseness, broken teeth, abrasions, lacerations, and even esophageal perforation, tracheal rupture or cricoarytenoid dislocation. In this study, indirect laryngoscopy was performed on 475 patients immediately following extubation after surgery. Patients were also questioned on subjective pre- and postoperative laryngopharyngeal symptoms. Of the 475 patients, 30 were found to have traumatic lesions, including hematoma (25), lacerations (3), and vocal cord paralysis (2). Subjectively, sore throat was the most common complaint overall, while hoarseness was the most common complaint in the traumatically injured patients. No correlation could be drawn between the injured and uninjured group with respect to tube size, length of intubation, sex, age, smoking history, or ease of intubation as described by the anesthetist.-ROBERT A. STRAUSS
Reprint requests to Dr. Morrison: Department of Internal Medicine, Naval Regional Medical Center, Portsmouth, VA 23708.
The Controversy of Warthin’s ryngoscope 93:695, 1983
Tumor.
Chapnik J. La-
Reprint requests to Dr. Peppard: 540 East Cantield Avenue, Detroit, MI 48201.
The controversies regarding Warthin’s tumor (papillary cystadenoma lymphomatosum) include its classification, pathogenesis, and treatment. In the past, vague classifications of salivary gland tumors have led to the misdiagnosis and subsequent mismanagement of Warthin’s tumors. Recent classifications regard Warthin’s tumor as a benign salivary gland neoplasm in its own subcategory. There is much controversy about the tumor’s pathogenesis. The epithelial component is generally regarded as a neoplastic transformation of parotid duct cells. Which specific duct cell becomes neoplastic is debatable. The intercalated duct cells, stem reserve cells, oncocytes, myoepithelial cells, and striated duct cells have all been implicated. The lympocytic infiltrate, which is the other main cellular component, has been regarded as either a cellular response to an epithelial neoplasm; a residual, normal lymph node involved in an area of epithelial neoplasia; or residual lymphoid tissue reacting to the epithelial component. Warthin’s tumor may arise from heterotopic salivary gland epithelium within nodes of the parotid gland, periparotid area, or neck. However, others have questioned whether the tumor is actually a neoplasm. It has been suggested that the tumor represents a delayed hypersensitivity tissue reaction initiated by striated duct epithelial metaplasia. Treatment of Warthin’s tumor presents a dilemma. Limited resection or superficial parotidectomy with facial nerve preservation has been advocated, since 90% of the tumors involve the superficial lobe. Some feel that superticial parotidectomy is associated with a high recurrence rate and advise that
Wound Geometry and the Kinetics of Wound Contraction. McGrath MH, Simon RH. Plast Reconstr Surg 72:66, 1983 The skin and subcutaneous tissue of rats were excised in the pattern of circles, large squares, and small squares to observe the kinetics of wound contraction, to mathematically describe that contraction, and to study the influence of wound geometry on contraction. Wound contraction is described as occurring in three phases: a preexponential or plateau phase (first six days), an exponential phase (day six through day 39) and a postexponential phase. The mathematical description of contraction during the exponential phase is described as A = Be-” + Ao where A is area, Ao is the area remaining after contraction is completed, B is the area that will undergo contraction, k is a contraction rate constant, and t is any given time. It was found that regardless of size or shape, the contraction rate constant was the same within age- and species-matched animals and that in the exponential phase, differently shaped wounds of the same size contract at the same rate. It was found that shape exerted an effect before the onset of contraction and that size is determined by shape through peritIIeter.-BRADLEY WRIGHT Reprint requests to
Dr. McGrath: College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032.
341