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Wounds, healing and tissue repair
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
After assessment, a thorough debridement is essential. Abrasions, ‘road rash' (following a fall from a motorbike) and explosions all cause dirt tattooing and require the use of a scrubbing brush or even excision under magnification. A wound should be explored and debrided to the limit of blood staining. Devitalised tissue must be excised until bleeding occurs, with the obvious exceptions of nerves, vessels and tendons. These may survive with adequate revascularisation subsequently or after being covered with viable tissue such as that brought in by skin or muscle flaps.
Mechanical and Physical Injury
Published in John M. Wayne, Cynthia A. Schandl, S. Erin Presnell, Forensic Pathology Review, 2017
John M. Wayne, Cynthia A. Schandl, S. Erin Presnell
Answer B is correct. Pictured is a male torso with numerous roughly parallel, somewhat linear abrasions. This pattern is characteristic of “road rash,” which occurs when a body surface is dragged or otherwise propelled across an abrasive surface. Of the choices, the most reasonable scenario would be that in which the individual was ejected from a vehicle and then traversed the road for some distance. The linear aspect of the abrasions is due to the directional inertia, while the extent of the abrasions provides some information regarding the surface area in contact with the abrasive surface (commonly a road).
Strategies for extremity reconstruction with exposed bones and tendons using acellular dermal matrices: concept of sequential vascularization
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
A 34-year-old male was hit by a motorcycle while riding a bicycle. He was admitted to the hospital and presented a soft tissue injury on the right foot; on the dorsal side lateral to the ankle with exposed bone and joint (Figure 1(A,B)). Patient was a smoker with no medical history. The wound was contaminated with significant amount of gravel and road rash. The patient was administered antibiotics upon admission, and the wound underwent 2 operative debridement procedures (Figure 1(C)). Following debridement, the resulting defects measured 15 × 8 cm with exposed underlying joint. IMBWM was applied to the wound in the operating room (OR) under general anesthesia, and was fixed in place using staples. The immediate post-operative dressing was a wound VAC, with black foam sponge, set at negative pressure of 125 mm Hg. The patient was discharged 2 days after placement of the matrix, with the outpatient wound VAC. Vascularization of the dermal matrix occurred sequentially (Figure 1(D)) and was achieved 9 weeks after placement (Figure 1(E)), at which time the silicone layer was removed. Matrix take was 100%. A STSG of 12/1000″ was applied to the neodermis, under general anesthesia. The patient was discharged the same day after grafting, with 5 days of outpatient wound VAC treatment. STSG take was 100%, 1 week after grafting (Figure 1(F)). There was no postoperative complication, and the reconstruction covered the exposed joint without flap treatment.