Chapter 6: Plastic Surgery. - Famona Site

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with the shark. In addition the victim may drown, or swallow so much water that resuscitationis complicated, whereas it would have been easier to treat only the injuries.Clinical PresentationThe injuries are easily visible. Shock and signs of drowning should be looked for. Thisdemands a critical clinical assessment. There is usually no need for special investigations asthe emergency on the beach or river bank is treated first. Special investigations will comelater.Treatment- Prevention comes first, i.e. shark nets are often used.- Life savers are usually taught the first-aid measures for accidents of this nature.- Many a death has been caused by hasty transporting of a patient to hospital beforeproper "first-aid" measures were taken. Whenever possible, a doctor should be summoned.Once in hospital, a more detailed assessment of the patient should be made. Intensiveanti-shock treatment must be given. Wound cleansing (copious irrigation) should be done.Debridement, laparotomy and fracture treatment can then be done when the patient is in amore stable condition.Proceed as follows:- Remove devitalized or dead tissue.- Remove lacerated bowels widely and do an exteriorization.- Skin grafting can be done to cover exposed bone, nerves, tendons and joints.- If in doubt about a wound, don't close, rather do secondary suturing.- Several wound inspections in theatre may have to be undertaken.AntibioticsProphylactic antibiotics should be used. Cultures from shark wound bites and mouthsof sharks, especially the great white shark, have grown a vairety of vibrio species, viz. V.alginolytica, V. fluvialis and other genera. These species are sensitive to the tetracyclines andchloramphenicol antibiotics. The cephalosporin and aminoglycosides have also been usedsuccessfully. In addition, prophylaxis for tetanus should be given.PrognosisSwimmers, anglers and even herdboys bitten by crocodiles are usully fit, healthypeople. Once they reach the hospital, the chances of recovery are usually very good dependingon the extent of the bite.ComplicationsThe most serious is death. Others include shock, haemorrhage, drowning, infectionsand disfigurement.30
Insect BitesThere are many smaller insects and arthropodes which bite humans. To name a fewcommon ones:Spiders- Paralysis may result from a spider bite.- Local tissue necrosis and haemolysis have been caused by spider bites.- Abdominal crisis and respiratory failure may result.- Spider anti-venom is available for treatment.Scorpion BitesIn hot climates these are commonly seen at night. Pain, spasms, paralysis and evencardiac and respiratory arrests have occurred. Treatment is by a firm bandage and applicationof ice, sometimes for up to two hours.TicksThe most important effect of tick bite is paralysis - ascending type. Treatment consistsof removing the thick including the teeth.MosquitoesMalaria is well known in this country. Awareness of the disease is the keystone ofdiagnosis, prevention and treatment.CommentBitesG S Fehrsen- When there is a minor injury to a finger like a skin laceration which is becomingpainful and showing signs of early infection, a first-aid treatment of dipping the finger for 10minutes at atime in the hottest water one can tolerate with intervals of about three times, willoften cure that infection.- I think that it is impractical to give prophylactic antibiotics that are based onbacterial isolates. In the first place one is unlikely to isolate bacteria, and secondly very fewpeople will wait for bacterial culture before giving prophylactic antibiotics. In general,prophylactic antibiotics should be based on probabilities and risk.- I just wondered what the cost would be of giving Hepatitis B immune serum globulintyo all the people presenting with human bites. In addition one would have to mention thepossibilities of developing AIDS in the same breath today.31
Page 1 and 2: C J Mieny, U Mennen: Principles of
Page 3 and 4: SkinThe anatomy of the blood supply
Page 5 and 6: BoneAttempts are made to remove as
Page 7 and 8: Brain: DebridementThe regeneration
Page 9 and 10: Chapter 6.2: Closure of Wounds and
Page 11: Skin OverlapWhy, when simple suture
Page 14 and 15: diameter of a vessel becomes a sign
Page 16 and 17: CommentClosure of Wounds and Materi
Page 18 and 19: Facial Human BitesIn the head regio
Page 20 and 21: After irrigation, removal of devita
Page 22 and 23: Sites Bitten by DogsThese include:-
Page 24 and 25: Injury Type- large wounds (lacerati
Page 26 and 27: Snake BitesBy definition snake bite
Page 28 and 29: Following poisonous snake bites:- t
Page 32 and 33: - I think the fact that with minor
Page 34 and 35: Gas gangrene has often erroneously
Page 36 and 37: Diagnosis and Special Investigation
Page 38 and 39: Surgical DebridementTimely surgery
Page 40 and 41: PrognosisIn spite of remarkable adv
Page 42 and 43: symptoms of the disease. The incuba
Page 44 and 45: Prophylaxis After Trauma- Prompt an
Page 46: - Assisted ventilation and administ
Page 49 and 50: are deep with superficial areas aro
Page 51 and 52: Diagnosis and Special Investigation
Page 53 and 54: Blood/Plasma/ColloidsThese are usua
Page 55 and 56: Early excision and skingrafting of
Page 57 and 58: DiagnosisWound swabs are often not
Page 59 and 60: Early excision of deep localized in
Page 61 and 62: The use of 1% copper sulphate solut
Page 63 and 64: - Massively increased metabolic rat
Page 65 and 66: - the fascial plexuses both deep to
Page 67 and 68: Full Thickness Skin GraftsThese gra
Page 69 and 70: Random FlapsThese are skin flaps mo
Page 71 and 72: very largely on the experience of t

Chapter 6: Plastic Surgery. - Famona Site

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