Surgery Of TraumaPDF电子书下载

SECTION ONE PHYSIOLOGIC ASPECTS OF THE MANAGEMENT OF TRAUMA 1

1．BASIC FACTORS IN WOUND HEALING＆Warner F．Bowers，Colonel，MC，U．S 1

Biophysical Factors＆Elbert DeCoursey，Brigadier General，MC，U．S 1

Chemical Factors 7

Bacterial and Immunologic Factors 10

Mechanical Factors 13

2．A．WOUND HEALING IN SPECIALIZED TISSUES＆Warner F．Bowers，Colonel，MC，U．S 19

Hollow Viscera 19

Bone and Cartilage 20

B．REACTION TO INJURY AND REPAIR IN PERIPHERAL NERVE＆Barnes Woodhall，M．D 21

Definitions 21

The Classical Reaction to Injury－Wallerian Degeneration 22

The Acute Reaction of Peripheral Nerve to Injury 22

Late Repair of Peripheral Nerve Injury 23

C．MUSCLE AND TENDON＆Warner F．Bowers，Colonel，MC，U．S 26

D．THE HEALING OF BLOOD VESSELS＆Gerald H．Pratt，M．D 26

Termination 28

Injury to Veins 29

E．SEROUS AND SYNOVIAL SURFACES＆Warner F．Bowers，Colonel，MC，U．S 29

3．A．HEALING OF WOUNDS DUE TO SPECIAL AGENTS SONIC，THERMAL，CHEMICAL AND ELECTRICAL INJURIES＆George K．Lewis，M．D 31

Injuries Produced by Sound Waves 31

Injuries Thermal in Origin 31

Chemical Injury 32

Electric Burns 32

Repair of Electrical Wounds 34

B．PATHOLOGY OF LOCAL COLD INJURY＆Robert B．Lewis，Lieutenant Colonel，U．S．A．F．(MC) 35

Introduction 35

Vascular System 37

Skin 37

Nerve 38

Muscle 38

Bone 40

Pathogenesis 40

Healing 41

C．PATHOLOGY OF IONIZING RADIATION＆Elbert DeCoursey，Brigadier General，MC，U．S 42

4．RESPONSES OF THE BODY TO A WOUND 45

A．Normal Battle Reaction＆Warner F．Bowers，Colonel，MC，U．S 45

B．Metabolic Response and Wound Shock＆Jonathan E．Rhoads，M．D 48

Nature and Significance of Metabolic Response 48

Components of Metabolic Response 49

Management of the Metabolic Response 51

Potassium Depletion and Hypoalkalemic Alkalosis 52

Nature of Wound Shock 52

Clinical Manifestations of Wound Shock 53

Dynamic Nature of Wound Shock 53

Systemic Pathology Consequent to Wound Shock 54

Experimental Shock 54

C．Wound Shock＆Fiorindo A．Simeone，M．D 58

General Considerations 58

Etiologic Classification of Shock 62

Pathology of Wound Shock 63

Experimental Shock 66

The Nature of Wound Shock 74

5．WOUND INFECTIONS＆W．A．Altemeier，M．D．，J．Giuseffi，M．D．，and J．M．Stevenson，M．D 80

General Considerations 80

Early Infections 82

Staphylococcal 82

Streptococcal 83

Necrotizing Fasciitis 87

Mixed Infections 87

Anaerobic Cellulitis 88

Clostridial Myositis (True Gas Gangrene) 91

Tetanus 95

Diphtheritic Infection 98

Chronic Burrowing Ulcers 98

Chronic Progressive Cutaneous Gangrene 99

Later Infections and Related Complications 99

Dead Tissue Remaining or Developing After Debridement 99

Granulating Wounds 100

Septic Blood Clots and Hematomas 100

Retained Foreign Bodies and Missiles 100

Infected Rigid-Walled Cavity 101

Dressing Technic 101

SECTION TWO REGIONAL WOUND SURGERY 105

6．CRANIOCEREBRAL TRAUMA＆Donald D．Matson，M．D 107

First Aid 107

Preparation for Operation 108

Operation 109

Postoperative Care 112

Special Types of Craniocerebral Wounds 113

Complications 119

7．PENETRATING WOUNDS OF THE SPINAL CORD＆Eldridge Campbell，M．D．，and Arnold Meirowsky，M．D 121

Introduction 121

Organization of Neurosurgical Care－Evacuation 125

General Measures 128

Indication for Neurosurgical Intervention 137

Operative Method of Laminectomy 142

8．PERIPHERAL NERVE WOUNDS＆Barnes Woodhall，M．D．，and Frank Nulsen，M．D 150

Management in the Forward Area 150

Definitive Management 151

Postoperative Program 158

9．EARLY AND LATE CARE OF THE TRAUMATIC MAXILLOFACIAL WOUND＆Bernard N．Soderberg，Colonel，MC，U．S 162

Early Care 163

Methods of Definitive Repair 177

10．EYE WOUNDS＆Frederick Harbert，Captain，MC，U．S．N 191

First Aid 191

Ocular Adnexa 192

Abrasions 193

Contusions and Penetrating Wounds 194

Burns 198

Foreign Bodies 202

Enucleation and Evisceration 208

Circulatory Trauma 209

11．NECK WOUNDS＆Manuel E．Lichtenstein，M．D 210

First-Aid Instructions 210

The Lightly Wounded 210

The Seriously Wounded 211

Injuries to the Air Passages 211

Injuries to the Vessels 212

Injuries to the Cervical Cord 215

Foreign Bodies 215

Injuries to Pharynx and Esophagus 215

Wounds of the Neck Adjacent to Mandible，Chest，Axilla or Head 216

Concomitant Injuries 217

12．THORACIC WOUNDS＆James H．Forsee，Colonel，MC，U．S 220

Cardiorrhaphy 231

Cardiac Arrest 234

Summary 234

13．ABDOMINAL WOUNDS＆Robert M．Zollinger，M．D．，and Howard D．Sirak，M．D 237

First Aid 237

Definitive Treatment 238

Operative Procedure 240

After-care 245

Wound Complications 247

14．WOUNDS OF PERINEUM，RECTUM AND BUTTOCKS＆Frank B．Berry，M．D．，and Robert H．Wylie，M．D 251

Anatomy 251

Anatomic Relationships 253

Important Blood Vessels and Nerves 253

Examination of the Patient 254

Treatment 254

Complications 256

15．VASCULAR WOUNDS＆Gerald H．Pratt，M．D 261

First Aid 261

Control of Hemorrhage 261

Resuscitation of the Patient 264

General Therapy 264

Evacuation 264

Operative Technics 265

Blood Replacement 265

Types of Injuries to the Artery 265

Decision as to Operation 266

Exploration－Incision Site 266

Ligation 267

Surgical Repair of Arterial Laceration 269

Blood Vessel Grafts 272

Analogous Vein Grafts 273

Homologous Grafts 274

Prognosis in Extremity Injuries 275

Ancillary Procedures 275

Surgical Treatment of Arteriovenous Fistulas or Aneurysms 275

Surgical Treatment of Traumatic Arterial or So-called False Aneurysm 279

Long Vein Grafts to Increase Arterial Supply to Ischemic Extremities 282

Care After Operations on the Blood Vessels 282

Anticoagulants Given by Injection 284

Oral Anticoagulants 286

Program to Initiate Anticoagulant Therapy 288

External Care of the Limb After Vascular Operation 289

16．FRACTURES OCCURRING IN WAR WOUNDS＆Mather Cleveland，M．D 295

Emergency Immobilization of Fractures for Transportation 295

Treatment of the Compound Fracture at the Mobile Hospital in a Theater of Operations 296

Immobilization of Fractures for Evacuation 297

Skeletal Traction 300

Fractures of Long Bones Which Cannot Be Benefited by Skeletal Traction 301

Internal Fixation in Compound Fractures 301

Bone Replacement in Compound Fractures with Loss of Bone Substance 302

Case Histories of Compound Fractures of Long Bones 303

17．WOUNDS OF THE HAND＆Oscar S．Reeder，Colonel，MC，U．S．A．F 312

Incidence 312

Classification of Hand Injuries 312

Problems in Treatment 312

Treatment of Battle Injuries 315

Initial Surgery 316

Reparative Surgery 321

Treatment of Nonbattle Injuries 326

Closed Fractures and Dislocations 327

Surface Wounds 329

Puncture Wounds 330

Incised，Lacerated and Crushed Wounds 330

Reconstructive Surgery of the Hand 336

Basic Considerations 337

Sequence of Procedures 337

Tendon Transfers 339

Rehabilitation 341

18．AMPUTATIONS＆Leonard T．Peterson，M．D 345

Indications 345

First Aid 346

Initial Amputations 346

Traction for Transportation 351

Reparative Phase 352

Late Amputation 354

Levels of Amputation 356

Lower Extremity 356

Upper Extremity 358

Management of the Amputation Stump 359

Prosthetic Fitting 360

Management of the Patient 361

19．WOUNDS OF JOINTS＆Oscar P．Hampton，Jr．，M．D 363

Hip Joint 368

Knee Joint 370

Ankle Joint 384

Shoulder Joint 386

Elbow Joint 386

Wrist Joint 388

20．GENITO-URINAEY WOUNDS＆James C．Kimbrough，M．D 390

Kidney 390

Ureter 397

Bladder 402

Neurogenic Bladder Due to Injuries of the Central Nervous System 410

Urethra and External Genitalia 429

Wounds of the Urethra 429

Wounds of the Penis 434

Wounds of the Scrotum 436

Injuries of the Testes and the Spermatic Cord 436

21．COLD INJURIES＆Harris B．Shumacker，M．D 440

Frostbite 441

Trench Foot 443

Immersion Foot and Immersion Hand 444

Prevention 444

Treatment 445

General Principles of Treatment 447

Specific Methods of Therapy 452

22．BURNS＆Curtis P．Artz，Major，MC，U．S．A．Eric Reiss，Captain，MC，A．U．S．John H．Davis，Captain，MC，A．U．S．Jerry A．Stirman，First Lieutenant，MC，A．U．S．William H．Amspacher，Colonel，MC，U．S 457

Immediate Treatment 458

Triage of Burns 459

Early Definitive Care 459

Functional Positioning 463

Conversion to a Closed Wound 463

Burns of the Face 467

Burns of the Hands 468

Burns of the Respiratory Tract 468

Chemical Burns 468

Electric Burns 470

Anesthesia for the Burn Patient 471

Nutrition in Burns 472

Psychosomatic Aspects of Burn Care 472

SECTION THREE MILITARY CONSIDERATIONS IN WOUND MANAGEMENT 477

23．SURGICAL IMPLICATIONS OF THE EVACUATION AND THE DISTRIBUTION OF WAR CASUALTIES＆Warner F．Bowers，Colonel，MC，U．S 479

24．CLASSIFICATION AND NOMENCLATURE OF WOUNDS＆Robert H．Holmes，Lieutenant Colonel，MC，U．S 485

General Description and Definitions of War Wounds 485

The Wounding Agent 487

The Circumstances of Wounding 488

Lightly and Seriously Wounded 489

Simple and Complex Wounds 490

Penetrating and Perforating Wounds 490

Anatomicotopographic Surface Regions 491

Burns 493

25．WOUND BALLISTICS＆Carl M．Herget，Ph．D 494

Preliminary Explanations 494

Wounding 495

Size of Entrance and Exit Wounds 505

Wound Contamination 506

Protection from Wounding 506

26．MANAGEMENT OF THE WOUNDED SOLDIER 511

A．General Considerations＆Frank E．Hagman，Colonel，MC，U．S 511

Transportation 511

Hemorrhage 511

Control of Pain 512

Antibiotic Administration 513

Splinting Fractures 513

Dressing 514

Position of the Patient During Evacuation 514

Emergency Restoration of Blood Volume 514

Thirst and Dehydration 514

Examination of the Patient 514

B．Replacement Therapy in Wound Shock＆Harold A．Zintel，M．D 515

Estimation of Blood Loss 516

Administration of Blood 517

Rate of Administration of Blood 518

＂Substitutes＂for Whole Blood 518

Plasma Volume Expanders 520

Isotonic Infusions of Water 520

C．Burn Shock－Its Pathologic Physiology and Treatment＆William H．Amspacher，Colonel，MC，U．S．A．，and Eric Reiss，Captain，MC，A．U．S 522

D．Kidney Damage Consequent to Wound Shock＆Carl W．Walter，M．D 527

Pathology 527

Pathologic Physiology 528

Clinical Picture 528

Therapy 529

Summary 532

E．Specific Effects of Wounds of the Thorax＆Howard K．Gray，M．D 532

Pneumothorax 533

＂Stove-in＂Thorax 536

Hemothorax 536

Cardiac Tamponade 536

F．Specific Effects of Craniocerebral Wounds＆Robert C．Greenwood，Lieutenant Colonel，MC，U．S 537

Mechanics 537

Metabolism 540

Physiology 542

Pathology 544

Clinical Effects of Craniocerebral Trauma 548

Recognition of Surgical Conditions 550

Focal Effects 552

Late Effects of Craniocerebral Trauma 553

G．General Response to Wound Complications＆Curtis P．Artz，Major，MC，U．S 560

Response of the Body to Infection 560

Surgical Septicemia 562

Wound Disruption 563

Acute Dilatation of the Stomach 564

Fat Embolism 566

Deep Venous Thrombosis 567

Pulmonary Embolism and Infarction 571

27．GENERAL WOUND MANAGEMENT＆Oral B．Bolibaugh，M．D 574

Treatment in the Divisional Area 576

Treatment in the Army Area 578

Mobile Army Surgical Hospital and Evacuation Hospital 578

Mobile Army Surgical Hospital 578

Reparative Phase of Treatment 581

Delayed Primary Wound Closure 582

Internal Fixation of Fractures 585

Reconstruction Phase of Wound Surgery 586

SECTION FOUR STUDY METHODS AND RESEARCH PROBLEMS 587

28．STUDY METHODS AND RESEARCH PROBLEMS＆Warner F．Bowers，Colonel，MC，U．S 589

Introduction 589

Measuring and Evaluating Wound Healing 589

Methods of Presentation of Data 589

Control Procedures 590

Hiatuses in Current Knowledge 591

INDEX 593