Limits...
Methods of advanced wound management for care of combined traumatic and chemical warfare injuries.

Graham JS, Gerlach TW, Logan TP, Bonar JP, Fugo RJ, Lee RB, Coatsworth MA - Eplasty (2008)

Bottom Line: The potential for associated traumatic injuries is significant.All measured levels significantly exceeded established safety limits.If appropriate protective measures are taken, surgical decontamination is both effective and safe.

View Article: PubMed Central - PubMed

Affiliation: Medical Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA. john.s.graham1@us.army.mil

ABSTRACT

Objective: Chemical warfare agents are potential threats to military personnel and civilians. The potential for associated traumatic injuries is significant. Damage control surgery could expose medical personnel to agents contaminating the wounds. The objectives of this study were to demonstrate efficacy of surgical decontamination and assess exposure risk to attending personnel.

Methods: Weanling pigs were randomly assigned to 2 of 4 debridement tools (scalpel, Bovie knife, Fugo Blade, and Versajet Hydrosurgery System). Penetrating traumatic wounds were created over the shoulder and thigh and then exposed to liquid sulfur mustard (HD) for 60 minutes. Excisional debridement of the injuries was performed while vapors over each site were collected. Gas chromatography was used to measure HD in samples of collected vapors. Unbound HD was quantified in presurgical wound swabs, excised tissues, and peripheral tissue biopsies following solvent extraction.

Results: Excisional debridement produced agent-free wound beds (surgical decontamination). A significant amount of HD vapor was detected above the surgical fields with each tool. Apart from the Versajet producing significantly lower levels of HD detected over thigh wounds compared with those treated using the scalpel, there were no differences in the amount of agent detected among the tools. All measured levels significantly exceeded established safety limits. Vesicating levels of unbound HD were extracted from excised tissue. There was no measured lateral spreading of HD beyond the surgical margins.

Conclusions: There is significant occupational exposure risk to HD during surgical procedures designed to stabilize agent-contaminated wounds. If appropriate protective measures are taken, surgical decontamination is both effective and safe.

No MeSH data available.


Related in: MedlinePlus

Versajet™excision with gas capture funnel over field.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2481389&req=5

F1e: Versajet™excision with gas capture funnel over field.

Mentions: At the beginning of each surgical procedure, a rectangular (4.5 cm × 4.5 cm) area of skin centered over the wound was incised down to the subcutaneous tissue, using a no. 15 blade scalpel. The skin within this demarcated area was then excised using 1 of 4 surgical instruments: a no. 15 scalpel blade (Fig 1b), a Bovie® electrosurgical knife (Fig 1c), the Fugo Blade® M100 anterior capsulotomy unit (Fig. 1d), or the Versajet™ hydrosurgery system (Fig. 1e). Animals were randomly assigned to 2 of the 4 surgical tools (1 per wound). The Bovie® pad and hand piece were decontaminated and disposed of (in accordance with regulations governing disposal of HD-contaminated waste) after each excision. The Fugo Blade® was set on high-power mode with the intensity set on 10 of 10 and utilized a sharp-angled tip. Before each use, the hand piece was wrapped in a disposable plastic sheath to protect the instrument from HD contamination. The Versajet™ was set on high (power setting of 10 of 10). The hand piece with a 15°, 14-mm head was chosen because of the tangential nature of the excision. Five hundred milliliters of lactated Ringer's solution was used as the cutting/irrigating solution for each procedure. Each hand piece was decontaminated and disposed of after each excision.


Methods of advanced wound management for care of combined traumatic and chemical warfare injuries.

Graham JS, Gerlach TW, Logan TP, Bonar JP, Fugo RJ, Lee RB, Coatsworth MA - Eplasty (2008)

Versajet™excision with gas capture funnel over field.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481389&req=5

F1e: Versajet™excision with gas capture funnel over field.
Mentions: At the beginning of each surgical procedure, a rectangular (4.5 cm × 4.5 cm) area of skin centered over the wound was incised down to the subcutaneous tissue, using a no. 15 blade scalpel. The skin within this demarcated area was then excised using 1 of 4 surgical instruments: a no. 15 scalpel blade (Fig 1b), a Bovie® electrosurgical knife (Fig 1c), the Fugo Blade® M100 anterior capsulotomy unit (Fig. 1d), or the Versajet™ hydrosurgery system (Fig. 1e). Animals were randomly assigned to 2 of the 4 surgical tools (1 per wound). The Bovie® pad and hand piece were decontaminated and disposed of (in accordance with regulations governing disposal of HD-contaminated waste) after each excision. The Fugo Blade® was set on high-power mode with the intensity set on 10 of 10 and utilized a sharp-angled tip. Before each use, the hand piece was wrapped in a disposable plastic sheath to protect the instrument from HD contamination. The Versajet™ was set on high (power setting of 10 of 10). The hand piece with a 15°, 14-mm head was chosen because of the tangential nature of the excision. Five hundred milliliters of lactated Ringer's solution was used as the cutting/irrigating solution for each procedure. Each hand piece was decontaminated and disposed of after each excision.

Bottom Line: The potential for associated traumatic injuries is significant.All measured levels significantly exceeded established safety limits.If appropriate protective measures are taken, surgical decontamination is both effective and safe.

View Article: PubMed Central - PubMed

Affiliation: Medical Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA. john.s.graham1@us.army.mil

ABSTRACT

Objective: Chemical warfare agents are potential threats to military personnel and civilians. The potential for associated traumatic injuries is significant. Damage control surgery could expose medical personnel to agents contaminating the wounds. The objectives of this study were to demonstrate efficacy of surgical decontamination and assess exposure risk to attending personnel.

Methods: Weanling pigs were randomly assigned to 2 of 4 debridement tools (scalpel, Bovie knife, Fugo Blade, and Versajet Hydrosurgery System). Penetrating traumatic wounds were created over the shoulder and thigh and then exposed to liquid sulfur mustard (HD) for 60 minutes. Excisional debridement of the injuries was performed while vapors over each site were collected. Gas chromatography was used to measure HD in samples of collected vapors. Unbound HD was quantified in presurgical wound swabs, excised tissues, and peripheral tissue biopsies following solvent extraction.

Results: Excisional debridement produced agent-free wound beds (surgical decontamination). A significant amount of HD vapor was detected above the surgical fields with each tool. Apart from the Versajet producing significantly lower levels of HD detected over thigh wounds compared with those treated using the scalpel, there were no differences in the amount of agent detected among the tools. All measured levels significantly exceeded established safety limits. Vesicating levels of unbound HD were extracted from excised tissue. There was no measured lateral spreading of HD beyond the surgical margins.

Conclusions: There is significant occupational exposure risk to HD during surgical procedures designed to stabilize agent-contaminated wounds. If appropriate protective measures are taken, surgical decontamination is both effective and safe.

No MeSH data available.


Related in: MedlinePlus