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SECTION ONE PHYSIOLOGIC ASPECTS OF THE MANAGEMENT OF TRAUMA1

1．BASIC FACTORS IN WOUND HEALING＆Warner F．Bowers，Colonel，MC，U．S1

Biophysical Factors＆Elbert DeCoursey，Brigadier General，MC，U．S1

Chemical Factors7

Bacterial and Immunologic Factors10

Mechanical Factors13

2．A．WOUND HEALING IN SPECIALIZED TISSUES＆Warner F．Bowers，Colonel，MC，U．S19

Hollow Viscera19

Bone and Cartilage20

B．REACTION TO INJURY AND REPAIR IN PERIPHERAL NERVE＆Barnes Woodhall，M．D21

Definitions21

The Classical Reaction to Injury－Wallerian Degeneration22

The Acute Reaction of Peripheral Nerve to Injury22

Late Repair of Peripheral Nerve Injury23

C．MUSCLE AND TENDON＆Warner F．Bowers，Colonel，MC，U．S26

D．THE HEALING OF BLOOD VESSELS＆Gerald H．Pratt，M．D26

Termination28

Injury to Veins29

E．SEROUS AND SYNOVIAL SURFACES＆Warner F．Bowers，Colonel，MC，U．S29

3．A．HEALING OF WOUNDS DUE TO SPECIAL AGENTS SONIC，THERMAL，CHEMICAL AND ELECTRICAL INJURIES＆George K．Lewis，M．D31

Injuries Produced by Sound Waves31

Injuries Thermal in Origin31

Chemical Injury32

Electric Burns32

Repair of Electrical Wounds34

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

Introduction35

Vascular System37

Skin37

Nerve38

Muscle38

Bone40

Pathogenesis40

Healing41

C．PATHOLOGY OF IONIZING RADIATION＆Elbert DeCoursey，Brigadier General，MC，U．S42

4．RESPONSES OF THE BODY TO A WOUND45

A．Normal Battle Reaction＆Warner F．Bowers，Colonel，MC，U．S45

B．Metabolic Response and Wound Shock＆Jonathan E．Rhoads，M．D48

Nature and Significance of Metabolic Response48

Components of Metabolic Response49

Management of the Metabolic Response51

Potassium Depletion and Hypoalkalemic Alkalosis52

Nature of Wound Shock52

Clinical Manifestations of Wound Shock53

Dynamic Nature of Wound Shock53

Systemic Pathology Consequent to Wound Shock54

Experimental Shock54

C．Wound Shock＆Fiorindo A．Simeone，M．D58

General Considerations58

Etiologic Classification of Shock62

Pathology of Wound Shock63

Experimental Shock66

The Nature of Wound Shock74

5．WOUND INFECTIONS＆W．A．Altemeier，M．D．，J．Giuseffi，M．D．，and J．M．Stevenson，M．D80

General Considerations80

Early Infections82

Staphylococcal82

Streptococcal83

Necrotizing Fasciitis87

Mixed Infections87

Anaerobic Cellulitis88

Clostridial Myositis (True Gas Gangrene)91

Tetanus95

Diphtheritic Infection98

Chronic Burrowing Ulcers98

Chronic Progressive Cutaneous Gangrene99

Later Infections and Related Complications99

Dead Tissue Remaining or Developing After Debridement99

Granulating Wounds100

Septic Blood Clots and Hematomas100

Retained Foreign Bodies and Missiles100

Infected Rigid-Walled Cavity101

Dressing Technic101

SECTION TWO REGIONAL WOUND SURGERY105

6．CRANIOCEREBRAL TRAUMA＆Donald D．Matson，M．D107

First Aid107

Preparation for Operation108

Operation109

Postoperative Care112

Special Types of Craniocerebral Wounds113

Complications119

7．PENETRATING WOUNDS OF THE SPINAL CORD＆Eldridge Campbell，M．D．，and Arnold Meirowsky，M．D121

Introduction121

Organization of Neurosurgical Care－Evacuation125

General Measures128

Indication for Neurosurgical Intervention137

Operative Method of Laminectomy142

8．PERIPHERAL NERVE WOUNDS＆Barnes Woodhall，M．D．，and Frank Nulsen，M．D150

Management in the Forward Area150

Definitive Management151

Postoperative Program158

9．EARLY AND LATE CARE OF THE TRAUMATIC MAXILLOFACIAL WOUND＆Bernard N．Soderberg，Colonel，MC，U．S162

Early Care163

Methods of Definitive Repair177

10．EYE WOUNDS＆Frederick Harbert，Captain，MC，U．S．N191

First Aid191

Ocular Adnexa192

Abrasions193

Contusions and Penetrating Wounds194

Burns198

Foreign Bodies202

Enucleation and Evisceration208

Circulatory Trauma209

11．NECK WOUNDS＆Manuel E．Lichtenstein，M．D210

First-Aid Instructions210

The Lightly Wounded210

The Seriously Wounded211

Injuries to the Air Passages211

Injuries to the Vessels212

Injuries to the Cervical Cord215

Foreign Bodies215

Injuries to Pharynx and Esophagus215

Wounds of the Neck Adjacent to Mandible，Chest，Axilla or Head216

Concomitant Injuries217

12．THORACIC WOUNDS＆James H．Forsee，Colonel，MC，U．S220

Cardiorrhaphy231

Cardiac Arrest234

Summary234

13．ABDOMINAL WOUNDS＆Robert M．Zollinger，M．D．，and Howard D．Sirak，M．D237

First Aid237

Definitive Treatment238

Operative Procedure240

After-care245

Wound Complications247

14．WOUNDS OF PERINEUM，RECTUM AND BUTTOCKS＆Frank B．Berry，M．D．，and Robert H．Wylie，M．D251

Anatomy251

Anatomic Relationships253

Important Blood Vessels and Nerves253

Examination of the Patient254

Treatment254

Complications256

15．VASCULAR WOUNDS＆Gerald H．Pratt，M．D261

First Aid261

Control of Hemorrhage261

Resuscitation of the Patient264

General Therapy264

Evacuation264

Operative Technics265

Blood Replacement265

Types of Injuries to the Artery265

Decision as to Operation266

Exploration－Incision Site266

Ligation267

Surgical Repair of Arterial Laceration269

Blood Vessel Grafts272

Analogous Vein Grafts273

Homologous Grafts274

Prognosis in Extremity Injuries275

Ancillary Procedures275

Surgical Treatment of Arteriovenous Fistulas or Aneurysms275

Surgical Treatment of Traumatic Arterial or So-called False Aneurysm279

Long Vein Grafts to Increase Arterial Supply to Ischemic Extremities282

Care After Operations on the Blood Vessels282

Anticoagulants Given by Injection284

Oral Anticoagulants286

Program to Initiate Anticoagulant Therapy288

External Care of the Limb After Vascular Operation289

16．FRACTURES OCCURRING IN WAR WOUNDS＆Mather Cleveland，M．D295

Emergency Immobilization of Fractures for Transportation295

Treatment of the Compound Fracture at the Mobile Hospital in a Theater of Operations296

Immobilization of Fractures for Evacuation297

Skeletal Traction300

Fractures of Long Bones Which Cannot Be Benefited by Skeletal Traction301

Internal Fixation in Compound Fractures301

Bone Replacement in Compound Fractures with Loss of Bone Substance302

Case Histories of Compound Fractures of Long Bones303

17．WOUNDS OF THE HAND＆Oscar S．Reeder，Colonel，MC，U．S．A．F312

Incidence312

Classification of Hand Injuries312

Problems in Treatment312

Treatment of Battle Injuries315

Initial Surgery316

Reparative Surgery321

Treatment of Nonbattle Injuries326

Closed Fractures and Dislocations327

Surface Wounds329

Puncture Wounds330

Incised，Lacerated and Crushed Wounds330

Reconstructive Surgery of the Hand336

Basic Considerations337

Sequence of Procedures337

Tendon Transfers339

Rehabilitation341

18．AMPUTATIONS＆Leonard T．Peterson，M．D345

Indications345

First Aid346

Initial Amputations346

Traction for Transportation351

Reparative Phase352

Late Amputation354

Levels of Amputation356

Lower Extremity356

Upper Extremity358

Management of the Amputation Stump359

Prosthetic Fitting360

Management of the Patient361

19．WOUNDS OF JOINTS＆Oscar P．Hampton，Jr．，M．D363

Hip Joint368

Knee Joint370

Ankle Joint384

Shoulder Joint386

Elbow Joint386

Wrist Joint388

20．GENITO-URINAEY WOUNDS＆James C．Kimbrough，M．D390

Kidney390

Ureter397

Bladder402

Neurogenic Bladder Due to Injuries of the Central Nervous System410

Urethra and External Genitalia429

Wounds of the Urethra429

Wounds of the Penis434

Wounds of the Scrotum436

Injuries of the Testes and the Spermatic Cord436

21．COLD INJURIES＆Harris B．Shumacker，M．D440

Frostbite441

Trench Foot443

Immersion Foot and Immersion Hand444

Prevention444

Treatment445

General Principles of Treatment447

Specific Methods of Therapy452

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．S457

Immediate Treatment458

Triage of Burns459

Early Definitive Care459

Functional Positioning463

Conversion to a Closed Wound463

Burns of the Face467

Burns of the Hands468

Burns of the Respiratory Tract468

Chemical Burns468

Electric Burns470

Anesthesia for the Burn Patient471

Nutrition in Burns472

Psychosomatic Aspects of Burn Care472

SECTION THREE MILITARY CONSIDERATIONS IN WOUND MANAGEMENT477

23．SURGICAL IMPLICATIONS OF THE EVACUATION AND THE DISTRIBUTION OF WAR CASUALTIES＆Warner F．Bowers，Colonel，MC，U．S479

24．CLASSIFICATION AND NOMENCLATURE OF WOUNDS＆Robert H．Holmes，Lieutenant Colonel，MC，U．S485

General Description and Definitions of War Wounds485

The Wounding Agent487

The Circumstances of Wounding488

Lightly and Seriously Wounded489

Simple and Complex Wounds490

Penetrating and Perforating Wounds490

Anatomicotopographic Surface Regions491

Burns493

25．WOUND BALLISTICS＆Carl M．Herget，Ph．D494

Preliminary Explanations494

Wounding495

Size of Entrance and Exit Wounds505

Wound Contamination506

Protection from Wounding506

26．MANAGEMENT OF THE WOUNDED SOLDIER511

A．General Considerations＆Frank E．Hagman，Colonel，MC，U．S511

Transportation511

Hemorrhage511

Control of Pain512

Antibiotic Administration513

Splinting Fractures513

Dressing514

Position of the Patient During Evacuation514

Emergency Restoration of Blood Volume514

Thirst and Dehydration514

Examination of the Patient514

B．Replacement Therapy in Wound Shock＆Harold A．Zintel，M．D515

Estimation of Blood Loss516

Administration of Blood517

Rate of Administration of Blood518

＂Substitutes＂for Whole Blood518

Plasma Volume Expanders520

Isotonic Infusions of Water520

C．Burn Shock－Its Pathologic Physiology and Treatment＆William H．Amspacher，Colonel，MC，U．S．A．，and Eric Reiss，Captain，MC，A．U．S522

D．Kidney Damage Consequent to Wound Shock＆Carl W．Walter，M．D527

Pathology527

Pathologic Physiology528

Clinical Picture528

Therapy529

Summary532

E．Specific Effects of Wounds of the Thorax＆Howard K．Gray，M．D532

Pneumothorax533

＂Stove-in＂Thorax536

Hemothorax536

Cardiac Tamponade536

F．Specific Effects of Craniocerebral Wounds＆Robert C．Greenwood，Lieutenant Colonel，MC，U．S537

Mechanics537

Metabolism540

Physiology542

Pathology544

Clinical Effects of Craniocerebral Trauma548

Recognition of Surgical Conditions550

Focal Effects552

Late Effects of Craniocerebral Trauma553

G．General Response to Wound Complications＆Curtis P．Artz，Major，MC，U．S560

Response of the Body to Infection560

Surgical Septicemia562

Wound Disruption563

Acute Dilatation of the Stomach564

Fat Embolism566

Deep Venous Thrombosis567

Pulmonary Embolism and Infarction571

27．GENERAL WOUND MANAGEMENT＆Oral B．Bolibaugh，M．D574

Treatment in the Divisional Area576

Treatment in the Army Area578

Mobile Army Surgical Hospital and Evacuation Hospital578

Mobile Army Surgical Hospital578

Reparative Phase of Treatment581

Delayed Primary Wound Closure582

Internal Fixation of Fractures585

Reconstruction Phase of Wound Surgery586

SECTION FOUR STUDY METHODS AND RESEARCH PROBLEMS587

28．STUDY METHODS AND RESEARCH PROBLEMS＆Warner F．Bowers，Colonel，MC，U．S589

Introduction589

Measuring and Evaluating Wound Healing589

Methods of Presentation of Data589

Control Procedures590

Hiatuses in Current Knowledge591

INDEX593