Frostbite in the prairies: a 12-year review.

A 12-year retrospective review of inpatient frostbite injury was undertaken in three tertiary hospitals serving a northern prairie population of 650,000. In the 125 patients identified, the mean age was 41 years, with a range of 3 to 90 years. Predisposing factors were alcohol consumption (46 percent), psychiatric illness (17 percent), vehicular trauma (19 percent), vehicular failure (15 percent), and drug use (4 percent). Profound hypothermia with a core temperature less than 32 degrees C was present in 12 percent. Anatomic distribution was 19 percent upper extremity, 47 percent lower extremity, 31 percent combined upper and lower extremity, and 3 percent facial or trunk only. Factors correlating with amputation of parts (p < 0.05) were duration of exposure, lack of proper attire, remote site of injury, presence of wound infection, and delay in seeking treatment. Prophylactic systemic antibiotics did not decrease the incidence of wound infection. Comparison with nine other civilian series revealed striking similarities in the patient populations.

Reconstruction of the atrophic mandible.

Because atrophy of the jaws in edentulous patients is a major health problem, how best to reconstruct the atrophic mandible is a dilemma that frequently confronts the medical and dental professions. After loss of the natural dentition, the reduction of the residual ridges is progressive, irreversible, and cumulative. The cause and pathogenesis of mandibular atrophy is discussed. In the evaluation of a patient, the amount of residual bone at the symphysis should be measured on the lateral cephalometric radiograph as an aid to treatment planning. This measurement allows the degree of atrophy to be classified as minor, moderate, or severe. The current techniques to rehabilitate the edentulous mandible, including relative and absolute heightening techniques and implants, are reviewed with illustrative examples. A modification of a previous absolute heightening osteotomy technique utilizing pedicle bone flaps, is presented.

Facial sinuses from dental pathosis.

Sinus tracts presenting on the face may be the result of dental pathosis. This etiologic possibility should be ruled out before such lesions are treated by prolonged antibiotic therapy or surgical excision. The diagnosis can often be confirmed by a good clinical intraoral examination supplemented by appropriate radiographs. Four cases are presented in which treatment of the underlying pathology resulted in resolution of the sinus tract.

Frostbite in Saskatoon: a review of 10 winters.

In a review of 101 patients suffering from frostbite who were admitted to hospitals in Saskatoon during 10 winters, it was found that alcohol consumption was a contributing factor in 39 patients and a motor vehicle accident or breakdown in 33 others. Sixty-six patients underwent primary treatment in Saskatoon, the other 35 were referred for management of demarcated gangrene. Two hospitalized patients died, both of causes unrelated to the frostbite. The preliminary results of bone scanning with radioactive technetium methylene diphosphonate in frostbitten patients suggest that this is not a good prognostic indicator of the ultimate extent of tissue loss until 5 days have elapsed from the time of exposure. The lesion appeared to decrease in extent and increase in depth over a 3-week period. The mainstays of treatment remain rapid rewarming and adequate delay before conservative débridement or amputation. The delay allows healing of partial-thickness injuries and demarcation of full-thickness injuries. One third of patients receiving primary care in Saskatoon required amputation.

Concomitant treatment of developmental jaw deformities with rhinoplasty.

The purpose of this paper is to emphasize the importance of a complete assessment of facial profile and dentition in selected patients who seek rhinoplasty or correction of developmental jaw anomalies. To offer these individuals the optimum result, it is mandatory to have close liaison with an orthodontic colleague. At times it may be necessary for the surgeon to urge orthodontic care even though this was not contemplated by the patient. The orthodontist will prepare occlusion and study models of the teeth. X-ray examination includes a Panorex projection and cephalometric radiography. The surgeon should be familiar with the rudiments of skeletal analysis, as it facilitates joint discussion of the proposed treatment. Soft tissue profile, photographs, and clinical examination complete the assessment. A wafer splint is an important adjunct for accurate placement of the occlusion at the time of surgery. Three patients are presented to illustrate the advantage of combined treatment planning. The end result in each has been enhanced. In maxillary protrusion, simultaneous osteotomy and rhinoplasty have halved the surgical procedures required.

Emergency wound care.

The purpose of this article is to emphasize facets of wound closure which are confusing and not always recognized. Many physicians concern themselves with the type of suture to be used when a clean cut edge and closure without tension are far more important aspects. One should also be aware that a method of wound closure suitable in the vascular head and neck region may not be adaptable to a lower limb site such as the ankle. If this short treatise can leave the reader with two or three principles of emergency wound care, then the journal space allotted is justified.