By H. Cole. Northwestern Michigan College.
The scalp should be considered the first choice in infants and small children and when excision and grafting of face burns are considered buy 1.5 mg lozol free shipping. The following are some of the principles for successful harvesting of scalp donor sites: 1 buy cheap lozol 2.5 mg on-line. Infiltrate the area to be harvested with 1:200,000 epinephrine solution. Provide enough tension to facilitate the harvest by achieving a flat surface. The head should be fixated by an assistant to allow control and good exposure 6. A scrubbed anesthetist should hold the endotracheal tube and protect the airway (Fig. Apply epinephrine-soaked (1:10,000) Telfa dressings when harvesting is completed. When the scalp is not an option as a donor site (either due to concomitant scalp burns or lack of parent or patient’s consent), the buttocks are the second choice in small children who are still in diapers. For older children, the thigh or back provides the surgeon with plenty of skin grafts. It is more painful to harvest than the scalp, but it is easy to dress and care for, and it heals properly in few days. Infiltration of subcutaneous epinephrine solutions should be considered to obtain good hemostasis, although it is not necessary to use tumescent technique to provide good tension. An assistant should hold the limb in good position and the muscles should be positioned in tension. The thigh is then serially harvested until enough quantity of skin grafts has been obtained. Epinephrine-soaked Telfa dressings are then applied to the donor site and the thigh is dressed after 10 min.
It is hoped by the author that this current edition will provide a useful resource for all primary care physicians seeing children with orthopedic problems purchase 1.5 mg lozol with mastercard. Tom Campbell for a yeoman effort in medical illustration and visual reproduction generic 1.5 mg lozol, and the entire Audio-Visual Department at Children’s Hospital Medical Center of Akron; Mrs. Allison Allen for clerical and typographical assistance of a monumental nature; Mrs. Scott Weiner for his contribution in Chapter 6 on malignant soft tissue and bone lesions; Dr. Brad Weiner for his contribution in Chapter 5 on backache and disc discase; and to the many primary care physicians who helped catalyze this effort. Chapter 1 Basic considerations in grow ing bones and joints A mind that can comprehend the principles, will devise its own methods. The growth plate Although there are clear and distinct structural differences between very young and mature bones, the structure that most clearly separates them is the physis or growth plate. Anatomically situated beneath the epiphysis and above the metaphysis and diaphysis, its role in our maturing process is a noble work of nature. Not only does it afford us eventual height and body mass, it contributes to our Figure 1. The upper cellular layer(s) of the growth plate are in a resting (germinal) stage, waiting to be converted into actively reproducing cells (chondrocytes) that will add to our eventual height by replicating in a longitudinal fashion (Figure 1. These cells also are responsible for producing the matrix in which they are embedded, most particularly the collagen that binds to the protein polysaccharide produced by these cells. This zone of proliferation is best conceived as an anabolic zone, where positive events are happening, both to elongate our bones and to build strength for the growth plate apparatus. Its tightly bound cells and matrix allow for considerable resistance to stress. The Basic considerations in growing bones and joints 2 next zone closer to the metaphysis is the zone of hypertrophy.
J Bone Joint Surg Am 84:420–424 nous or bony component is an important part of the 8 discount 1.5 mg lozol visa. It is useful to define the extent of the injury purchase lozol 2.5mg, another cause of snapping hip. Clin Pediatr 31:562–563 determine joint involvement and assess fragment 9. J Ultrasound Med both imaging methods when investigating tendon 21:753–758 10. Pelsser V, Cardinal E, Hobden R, et al (2001) Extraarticular and ligament disorders in children. Farley FA, Kuhns L, Jacobson JA, et al (2001) Ultrasound examination of ankle injuries in children. J Pediatr Orthop 21:604–607 Inflammatory Disorders 53 4 Inflammatory Disorders David Wilson CONTENTS problem. The fractious and unwell child may resist this examination and it can prove very difficult to 4. However, the hip is a common site and serves to illustrate the range of possible diagnoses and the potential assis- 4. The same principles Introduction apply to all the other joints of the body. Inflammatory conditions of joints normally present with pain, swelling and dysfunction. However, the diagnosis is not so easy in infants for whom the presentation may be that the parents 4. Careful Irritable hip is the clinical syndrome that most com- physical examination may be required to locate the monly affects children between the age of four and ten years. It is most often due to transient syno- vitis which is a self-limiting condition for which no cause has been found. Wilson, FRCP, FRCR other potential causes some of which require urgent Department of Radiology, Nuffield Orthopaedic Centre, NHS medical attention if serious consequences are to be Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK 54 D. The list of possible causes of an irritable although it is likely that clinical examination is just hip includes: as sensitive.
