powerpoint presentation · roswell park cancer institute arterial po2 and perfusion rate and ......
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Wounds
Michael J. Langworthy MD
Orthopaedic Trauma/Recon
Chairman of Orthopaedic Surgery
Southcoast Health System
Virus Bacteria
Host Wound
Risk For Patient
Risk For You
Genomic Breakdown
Only 60 percent of your
DNA is actually Human
Bacteria outnumber your
cells 10 to one
Commensal Bacteria
When commensals
detect harmful bacteria
they trigger and recruit
inflammatory cells to the
fight
Bacterodes in the gut
produces vit K.
Lactobacillus kills
Listeria
Staph epi can kill Staph
Aureus
40-60% of surgical site infections can be
prevented.
Surgical Site Infections
40% of all hospital-associated infections.
3% of post-operative patients
Twice as likely to die as other post-operative patients.
60% more likely to end up requiring admission to ICU
Odom-Forren etal. Nursing 2006 Odom-Forren etal. Nursing 2006
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Clip
Timing
Temp
Glucose
Porcine Vivarium
Sadahib Thailand 1999
20 animals
Anesthetized/IRB
Control incisions on right side closed with tweezers.
Investigational incisions on left closed with no touch technique.
Results at 24 hours revealed 5/20 wounds closed with tweezers grew Step/Staph/Coli.
INFLAMMATION
• TWO FUNCTIONS
•DEFENSIVE AGAINST INFECTION
•LINKS INJURY TO CELL GROWTH
INFLAMMATION
• PMNs
• LYMPHOCYTES
• LARGELY DEAL WITH INFECITON
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PMN uses GLUCOSE +O2---
SUPEROXIDE RADICAL, H ION
+ and Lactic Acid
• MAINSTAY OF BACTERIAL KILLING
Hydrogen ion
Lactic acid
Hydrogen ion
• REDUCES NAD+ TO NADH
Lactic acid
NADH----ADPR
REDUCED ADENINE
DIPHOSPHORIBOSE
• LEADS TO SYNTHESIS OF COLLAGEN
• RELEASE OF COLLAGEN
• CRITICALLY DEPENDENT ON PO2
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ARTERIAL PO2 AND
PERFUSION RATE
• CONSTITUTE MAJOR SOURCE OF IMMUNITY TO INFECTION
Fever
Good or bad?
All mammals get fever
Reptiles head for hot rocks
Evans et al
Evaluated temperature influence on WBCs
Mice temp elevated to 103 degree
Doubled the number of WBCs migrating into lymph
tissue
Heat also increases density of sticky molecules on
the surface of blood vessels and lymph nodes.
Roswell Park Cancer Institute
ARTERIAL PO2 and
PERFUSION RATE and
a LITTLE FEVER
• CONSTITUTE MAJOR SOURCE OF IMMUNITY TO INFECTION
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Increase Perfusion
HOAP
• Hydration
• Oxygen
• Antibiotics
• Pain Control
Host
Wound
Bacteria
Clinical Orthopaedics and Related Research
Langworthy etal, 2004
AGING AND SUBCHONDRAL
BONE
Subchondral Density
Subchondral Thickness
Calibration Stepwedge
AGING AND SUBCHONDRAL
BONE Density
Lateral Tibia Medial Tibia
p=0.02
N=38 N=59 N=33 N=38 N=59 N=33
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Rabbit Subchondral Bone Viability
12 New Zealand White Rabbits with grafts devoid of soft tissue
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Increase Perfusion
HOAP
• Hydration
• Oxygen
• Antibiotics
• Pain Control
Host
Wound
Bacteria
Amputation
ABSOLUTE INDICATIONS
RELATIVE INDICATIONS
Anatomically inspected complete disruption of the posterior tibial nerve
Polytrauma that precludes attempted limb salvage
Limb ischemia time > 6h
Severe ipsilateral foot trauma
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Vascular Compromise
• The more distal the arterial repair the
higher the delayed amputation rate.
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Medicine and Science and
Research...oh my
