Repeated skin expansion to resurface a massive thigh wound.

We report here a patient who sustained posttraumatic skin and soft-tissue loss of the right thigh. Replacement of approximately 750 cm2 of split-thickness skin graft with adjacent skin serially expanded and advanced demonstrates the applicability of this technique to cover large tissue defects. Despite infection and exposure, we believe that expansion can proceed safely on an outpatient basis, providing that systemic toxicity does not develop and the exposure does not mechanically preclude expansion.

Carburetor priming: a cause of gasoline burn.

Burns as a result of priming carburetors with gasoline resulted in 4% of all burn admissions to the Oregon Burn Center from 1980-1982. The burns most frequently involved the head and neck and upper extremities. Although most of them involved less than 10% of the total body surface area, half of all the injuries included areas of full-thickness tissue loss. This type of preventable accident inflicts substantial morbidity and may be a major financial burden. Professional and public awareness of the risk of serious gasoline burns incurred during carburetor priming should decrease its incidence.

Blunt traumatic rupture of the abdominal wall musculature.

Only 38 cases of blunt traumatic rupture of the anterior abdominal wall musculature have been described in the literature to date. We describe a patient who sustained a complete transection of the right and a partial disruption of the left rectus abdominis muscle as well as multiple associated injuries secondary to blunt, crushing trauma. Postoperatively, he experienced several complications and developed a ventral and right flank hernia. The former was repaired with a rectus abdominis muscle flap and polypropylene mesh. The flank hernia was initially repaired with polypropylene mesh and a recurrence was repaired with latissimus dorsi fascia.

Inadvertent intraradial arterial injection of cocaine.

Injection of a chemical irritant into the radial artery at the wrist causes acute discoloration of the skin, edema, and pain in the hand. Subsequent damage due to vasospasm, endarteritis, particulate embolization, and vascular thrombosis may result in ischemic contractures, amputations, and other functional hand deficits. Injection of a street cocaine preparation into the radial artery of a 22-year-old man produced a constellation of signs and symptoms similar to that described for other irritants. Current thoughts with regard to the pathophysiology and treatment of these injuries are reviewed.

Severe soft tissue infection of the face and neck: a classification.

Successful treatment of severe soft tissue infections of the face and neck necessitates early recognition followed by aggressive medical and surgical therapy. These infections often spread via tissue planes, and it is essential that all areas of necrosis be exposed, debrided, or excised according to tissue planes. A classification of soft tissue infection based upon tissue plane involvement is proposed as an aid to diagnosis and treatment. In addition, a protocol for management of these infections is presented.

Glycerine injection and crystal formation in the larynx: a negative study.

Glycerine as a vehicle may be injected alone or with Teflon to reposition a lateral lying paralyzed vocal cord. During the study of a particular patient, crystal formation was observed in laryngeal tissues injected with glycerine. It was hypothesized that glycerine metabolized to oxalic acid crystals via the glyoxylic acid pathway. To confirm this proposition, the gluteus muscle of guinea pigs was injected with glycerine, and at weekly intervals submitted for ordinary and polarized light microscopic examination. The formation of crystals after glycerine injection was not found in the guinea pig. Similarly, no foreign material or crystals were found after centrifuging the stored glycerine.