636 Injury: the British Journal of Accident Surgery (1985) Vol. 16/No. 9

VASCULAR INJURIES

Venous injuries

with or without comminution, or Y-shaped. The authors quote reports of poor results of treatment without operation but report no such case of their own.

Nine major veins in upper limbs were ligated without causing complications. In the lower limbs (in which I2 major veins were injured) repair is preferable to ligation and should be accompanied by anticoagulant drugs and by fasciotomy if there is much swelling.

Niechajer I. (1985) Dislocated intra-articular fracture of the base of the 5th metacarpal. flast. Reconstr. Surg. 75. 4()h.

Fractures of the hamate

Ross S. E., Ransom K. J. and Shatney C’. If. (1YX.S) The management of venous injuries in blunt extremity trauma. .I. Trauma 25. 1 SO.

One fracture occurred during a golf shot. the other while playing tennis. In neither instance was there a recognizable injury. Both fragments were removed. There was no mention of damage to the deep branch of the ulnar nerve.

BURNS

Bray T. J., Swafford A. R. and Brown R. I,. (1085) Bilateral fracture of the hook of the hamate. /. Trcrumo 25. 173.

Complications of burn therapy Self-treatment by immersion in iced water for several hours added damage by cold to that caused by burning.

SHOCK

Purdue G. F., Layton T. R. and Copeland C. E. (10%) Cold injury complicating burn therapy. J. 7‘raunza 25. 167.

Anti-shock garments

Success of skin grafting Fat and dermis under burned skin took split skin grafts equally well.

This is not the first report of this complication of the use of inhatable trouser splints and questions the proper use of the appliance.

Deitch E. A. (1985) Prospective study of the effect of the recipient bed on skin graft survival after thermal injury. .I. Trauma 25, 118.

Godbout B., Burchard K. W., Slotman G. J. and Gann 0. S. (1984) Crush syndrome with death following pneumatic

antishock garment application. J. Truurna 24. 1052.

Wounds in burned tissue PLASTICS

Wounds made through burned tissue within 17 hours of burning healed without infection but those made after I2 hours were liable to become infected.

Silastic foam dressing

Ward H.. Ahrenholz D. H., Crandall H. and Solem L. D. (1085) Primary closure of wounds in burned tissue: ex- perimental and clinical study. J. Truuma 2.5. 125.

Silastic foam polymerized on the spot offered particular advantages in the dressing of skin grafts on irregular surfaces and in cavities, and was found to be self-sterilizing.

Groves A. R. and Lawrence J. C. (IYSS) Silastic foam dressing: an appraisal. Ann. R. Cdl. Surg. Engl. 67. 116.

ORGANIZATION AND ACCIDENT PREVENTION Free tissue transfers

Dealing with battle casualties A wise and sympathetic account of the difticulties confronting the conscript medical officer called upon to deal with battle casualties.

An ultrasound Doppler flow meter used during operation and a laser Doppler How meter (which is much more expensive) used after operation greatly improved confidence in the microvascular anastomosis at the time and afterwards.

Eiseman B. (1085) Preparing the civilian surgeon for com- bat casualty management. .I. Traurnu 25. 156.

Jones B. M. (1985) Predicting the fate of free tissue trans- fers. Ann. R. Coil. Surg. Engl. 67. 63.

HAND INJURIES

Metacarpal fractures

Suturing of abdominal wounds The stitches took longer to insert but did not have to be removed. Otherwise they produced results similar to those achieved with other suture materials, both absorbable and unabsorbable.

Twenty-three cases are described and operated on, usually with one Kirschner wire to hold the fragments together and one to hold the metacarpal in place. Fractures were oblique.

Fiennes A. G. T. W. (1985) Interrupted subcuticular poly- glactin sutures for abdominal wounds. Ann. R. Coil. Surg. Engl. 67. I2 I