The history of wound healing dates back thousands of years before Christ to the Ancient Egyptians. Detailed tomb and temple hieroglyphics depict wound treatments of that era. Through the historic milestones set forth by Hippocrates (400 BC) to Lister (1800s), current theory of wound management and trends have evolved. During ...

In the past, minimal recommended therapy for vulvar melanoma was radical vulvectomy with bilateral inguinal-femoral lymphadenectomy, regardless of lesion size, thickness, or depth of invasion. In the last decade, several authors and investigators have questioned the need for radical surgery in all patients and have used a variety of microstaging ...

Family physicians are naturally concerned with the work effects or causes of their patients' health problems. As occupational risk factors have become better understood, however, a new specialty of occupational medicine has been recognized by the Royal College of Physicians and Surgeons in 1984, two years after the Canadian Board ...

Arrow wounds represent an unusual class of wounds rarely seen by most death investigators. Although the edged, broadhead-tipped arrow produces a wound usually characteristic of archery/crossbow weapons, the plain, field-tipped arrow wound can be confused with gunshot injuries in those cases in which powder residue or firearm projectiles or fragments ...

Non-healing mid-sternotomy wounds are a persistently difficult problem. The numerous methods that have been employed to manage these wounds are costly in terms of patient discomfort and length of hospital stay. We present a method to manage a complicated sternotomy that uses an omental flap with an immediate, split-thickness skin ...

Ovarian cancer represents a formidable challenge to physicians. Early symptoms are nonspecific, and are usually attributed to disorders of the upper gastrointestinal tract. Especially important is suspicion of this neoplasm in its early stage. This article discusses the epidemiology, clinical features, evaluation, and treatment of early carcinomas of the ovary.

The authors describe a technique for reinforcing sternal wound closure that is recommended for high-risk wounds and for use after sternal dehiscence.

Improper postoperative pelvic radiation of 5,000 rad in five weeks results in poor patient tolerance, unacceptable complications, and increased local recurrence. Preoperative or postoperative low-dose pelvic radiation results in better tolerance; however, in patients with resectable adenocarcinoma of the rectum and rectosigmoid, low-dose radiation improves neither the local failure rate ...

Gunshot wounds to the lower extremity consist of three types: 1) low velocity, 2) high velocity, and 3) shotgun wounds. High velocity wounds are generally seen in military practice, whereas low velocity wounds are of concern in civilian practice. Adequate management of the gunshot wound necessitates a rigid protocol consisting ...

Selective management of 473 patients with stab wounds limited to the posterior abdomen was reviewed. This group was composed of predominantly young, healthy men. Laporotomy was based primarily on clinical findings. Tenderness, not localized to the area of injury, or absent or rare bowel sounds best identified patients with serious ...

Four types of nonadherent dressing materials (rayon/polyethylene dressing, cotton nonadherent film dressings, fine mesh gauze petrolatum dressings, and commercial petrolatum emulsion dressings) were applied on small full-thickness skin defects on the backs of 12 Beagles. At 7 days, the wounds treated with the petrolatum-containing dressings had more contraction than wounds ...

Family medicine residents across Canada represent a unique body of physicians with exciting and different training experiences. Some 30 residents from each of the 16 university-administered Canadian family medicine programs meet twice annually as a subcommittee of the Canadian Association of Internes and Residents (CAIR), to exchange ideas and discuss ...

Attempts to terminate a pregnancy by self-inflicted gunshot-wounds is a new mechanism whereby women sustain gunshot wounds of the pregnant uterus. Two patients with self-inflicted gunshot wounds of the gravid uterus in an attempt to induce abortion are presented. The conservative management of such wounds is discussed.

Debate surrounds the natural history and appropriate management of Hürthle cell neoplasms of the thyroid. Some of the uncertainty stems from difficulty in the differentiation of benign from malignant lesions. We report the presentation, management, and outcome of patients with invasive Hürthle cell carcinoma who were examined at this institution ...

The American Civil War marked the last time more soldiers died from disease than from enemy bullets and the beginning of medical science's movement beyond folklore and superstition. The wound management techniques described that were practiced just a little more than a century ago provide a dramatic and sharp counterpoint ...

This paper reviews the attitude of 131 surgeons to the performance of a second sternotomy incision and assesses 144 severe hemorrhages that occurred as the sternotomy was being done. Eighty-eight percent of the hemorrhages occurred in situations in which the pericardium had not been closed at the first operation. From ...

Wound treatment practices of the Aztecs are discussed. The use of concentrated maguey sap (Agave ssp.) was widely dispersed and has persisted in folk medicine. A possible reason may be that it is effective. Laboratory analysis of maguey syrup indicates that its utilization as a remedy by ancient and modern ...

Originally presented as the first George McQuitty Memorial Lecture in Calgary, this article reviews the progress of family medicine since the inception of the first residency training programs in 1966, and speculates on its future.

This article summarizes impressions after ten years of fulltime teaching in a department of family medicine. Both positive and negative experiences are assessed, including views on teaching, medical school admissions, and the acceptance of training in family medicine. Concern is expressed for the longterm future of family medicine residency programs.

Data collected from prescriptions in family practice are useful for interpractice comparison because these data are more precise than morbidity data. Interpractice comparisons of prescribing are an attractive alternative for continuing medical education.Drug prescribing patterns are influenced by the characteristics of the practice population, physician factors and external factors. Any ...

Polyurethane moisture-vapor permeable film (MVPF), a new product for the management of superficial wounds, was studied in an uncontrolled clinical trial in 50 pediatric patients. MVPF was used in the management of skin graft donor sites, partial thickness burns, traumatic abrasions, decubitus ulcers, intravenous skin sloughs, and a variety of ...

Fifty incisional hernias were managed by excision of all scar tissue and approproximation of the abdominal wall using continuous doubled nylon inserted with a generous suture length: wound length ratio. There were no major recurrences and only 4 minor ones. The method is theoretically sound and should be more widely ...

We describe our experience in the use of a Silastic foam dressing in 17 patients undergoing radical excision of hidradenitis suppurativa whose wounds were allowed to heal by granulation. Axillary excisions were carried out in 9 patients and perineal excisions in 8 patients. The technique permits adequate excision of the ...

We have presented our experience in light of current practice in the management of malignant melanoma. Central to considerations of adequate management is the question of precise definition of the extent of the disease as determined by histologic evaluation, determination of the depth of penetration and assessment of the extent ...

The patient with unstable angina (angina of recent onset, of changing pattern or occurring at rest) is at high risk of myocardial infarction and sudden death. Patients with simple angina of recent onset can generally be managed out of hospital. Those with progressive angina or angina at rest should be ...

The best management of acute laryngeal fractures is an approach which promotes healing by primary intention and does not require the use of a lumen keeper or core mold. This presenentation outlines the theoretical considerations and practical steps which make it possible to achieve these goals. The basic emphasis is ...

The characteristics of shotgun ammunition and ballistics are discussed to give an understanding of how shotgun wounds differ from all other types of civilian penetrating wounds. Five case examples of shotgun injuries to blood vessels involving the neck and extremities are presented to highlight problems encountered and to point out ...

Nonoperative management of fingertip pulp amputations has been employed in eighteen adults. After wound cleansing and debridement, the wound was covered by an occlusive dressing. Healing of the amputated fingertip occurred within four weeks. The healed fingertip had an excellent sensory perception, normal range of motion and an acceptable cosmetic ...

Carcinoembryonic antigen (C.E.A.) estimation has been used in the preoperative assessment of colorectal carcinoma patients and has been shown to give a useful guide to the presence of metastatic disease and ultimately to a poor prognosis if the serum concentration is 100 ng/ml or more. C.E.A. has been shown to ...

Oral potassium permanganate has been used in the management of terminal carcinoma in three patients. Symptomatic improvement occurred in all three, with elimination of oral foetor in one patient and diminished requirement of analgesics in the other two. The mental state of each patient was improved and normal activities were ...

Superficial wounds resulting from athletic injury are common in sports medicine. Although such wounds can be quite painful, they are usually merely inconvenient to the athlete. If improperly managed, however, superficial wounds may heal slowly and cause unnecessary scar tissue proliferation at the wound site. Scar formation causes the wound ...

Effective management of vulnerable wound margins and fragile skin in the area peripheral to wounds is challenging. Maceration by chronic wound exudate and skin stripping, as a result of removing traditional or adhesive dressings, are common causes of damage to peri-wound skin. This article identifies the potential causes of macerated ...

This article explores the management of surgical cavity wounds. The effectiveness of healing depends on wound assessment and constant re-evaluation of the management strategy adopted. Management strategies should be holistic and take into account the wound bed and local and systemic barriers to healing, as well as patients' thoughts and ...

The routine use of drainage devices for wound management is relatively uncommon because of the extensive range of dressings available. However, there is an almost equally large range of wound drainage devices with different designs and properties from which to choose. Large, complex wounds with a fistula draining small bowel ...

Selecting the correct dressing for a wound can be complicated as there are so many products from which to choose. The selection process is made easier once the healthcare professional has performed a holistic assessment. This article discusses some of the principles of wound management and the efficacy of Askina ...

Topical honey treatment has been shown to possess antimicrobial properties, promote autolytic debridement, stimulate growth of wound tissues to hasten healing, and to start the healing process in dormant wounds, stimulating anti-inflammatory activity that rapidly reduces pain, oedema and exudate production. This article provides an overview of the use of ...

Since maggots were reintroduced into modern wound management practice, published papers have described their mode of action in the treatment of wounds such as pressure sores and leg ulcers (Thomas et al, 1996a; Thomas et al, 1996b), diabetic ulcers (Jones and Thomas, 2000; Johnson, 1999; Murray and Benbow, 1999; Rayman ...

Excessive exudate is a common characteristic of malignant fungating wounds. This article explores the problems this causes for patients and looks at how to manage them. It critically reviews five key studies that used qualitative and quantitative methods to analyse data on the performance of various dressings as a means ...

An understanding of how wounds heal is vital to any practitioner involved in wound management, and an understanding of how dressings function and perform while on a patient's wound is important in the decision-making process of dressing selection. This article outlines the interim results of an international multi-centre clinical in-market ...

Wound assessment offers practitioners a framework upon which to base clinical decisions aimed at maximizing healing potential. It relies heavily on basic observational skills to detect often subtle differences between a healing and non-healing wound and focuses on the difficulties in identifying clinical signs of wound infection. Part one of ...

This article discusses best practice in the management of skin tear injuries in older people. It considers what a skin tear wound is, examines skin tear classification systems currently available and discusses management and treatment of these wounds as well as strategies to prevent the recurrence of skin tears in ...

Silver (Ag) has been thought to improve wound healing and reduce instances of associated infections for many years. There are centuries-old records of silver being used in wound treatment, but the past two decades in particular have seen an increasing clinical application of silver-impregnated wound dressings and as such, have ...

This article explores the role of hydrogels in wound management. Methods of debriding necrotic/sloughy wounds are considered and the benefits of using a hydrogel are discussed. The article focuses upon Aquaform Hydrogel, investigating the evidence of its efficacy, and concluding with an evaluation of the product which resulted in a ...

Exu-Dry is a relatively new product that is designed to manage a variety of exuding wounds. It is a one-piece, multilayer, highly absorbent, non-adherent wound dressing. It is unique in construction, and incorporates a non-adherent wound contact layer which, it is suggested, makes dressing changes less painful and traumatic. This ...

Hydrocolloid dressings were first used in wound management in the 1960s. They provide the optimal environment for wound healing, i.e. a moist environment, constant wound temperature and infrequent dressing changes, and can be used on wounds in various stages of healing. As a result they are a popular treatment option ...

Honey was commonly used to treat wounds until the introduction of antibiotics. However, increasing numbers of antibiotic-resistant bacteria mean that alternative treatment options, such as honey, are receiving renewed interest. This article provides an overview of the use of honey in wound management and reviews the evidence to support its ...

Hypergranulation (or overgranulation) is an excess of granulation tissue beyond the amount required to replace the tissue deficit incurred as a result of skin injury or wounding. An infrequent but not rare consequence of wounding, the dearth of reliable evidence on the subject of hypergranulation has led to widely varying ...

The potential for charcoal cloth in wound management relates to its well demonstrated ability to adsorb small gas molecules. Charcoal has become increasingly used to contain odour and is especially useful in the management of fungating lesions. This article looks at CliniSorb activated charcoal odour control dressing (distributed by CliniMed) ...

The reality of wound management in clinical practice leaves a lot to be desired in relation to dressing selection and use. Maureen Benbow highlights some of the problems currently being encountered in relation to good wound management practice and illustrates good practice with a particularly difficult case study. A basic ...

VACUTEX is a new rapid capillary action dressing comprising three layers: two 100% polyester filament outer layers, and a 65% polyester and 35% cotton woven inner layer. The outer surfaces are fused in such a way as to prevent micro fibres shedding within the wound bed. No two wounds are ...