SUMMARYA 2-year-old child presented with pharyngeal perforation following a peroral injury with a toothbrush. Direct force applied to an object such as a toothbrush in the mouth may cause either superficial or penetrating injury within the oropharynx. A high index of suspicion is sometimes necessary to identify a pharyngeal perforation and if this is diagnosed we would advocate admission to hospital, restriction of oral intake, intravenous fluids and antibiotics, with close observation to ensure that healing occurs without development of further complications.
FOR the purposes of this work during the period mentioned, only men suffering from wounds of the upper and lower limbs have been admitted t o the C.C.S. Of these, 60.8 per cent have been entered on the research list as being cases suitable for immediate or early suture.Patients suffering severely from shock and loss of blood, Who are not in a condition to bear a thorough cleansing operation, and whose tissues may have lost much of their normal power of resisting infection, are not as a rule suitable subjects for primary suture, though they may sornetirnes be fit for closure of their wounds after the lapse of a few days. Patients Who show signs of already established infection of the tissues surrounding the wound must also be rejected ; these form a large class, and include the majority of men whose arriva1 at the C.C.S. has been delayed beyonrt twenty-four hours. Multiple wounds are seldom suitable, not only on account of the lengthy operation involved, but because of the likelihood of one failure causing infection of other wounds. Trivial wounds, and clean through-and-through bullet wounds without damage to main vessels or nerves, are also best left alone. Patients considered unsuitable for the research list are treated by us in the usual way, and evacuated to the base when they have sufficiently recovered.Patients whose wounds have been sutured are kept here till their wounds have healed, or until the treatment has definitely failed. We have, as far as possible, limited Our investigations to primary suture a t the time of operation, and to delayed primary suture, which may take place a t any subsequent time before granulations have formed.Secondary suture, by which we mean suture after granulations have formed, we have reserved chiefly for wounds with virulent infections such as those in which primary suture has failed on account of the presence of haemolytic streptococci. We feel that secondary suture is better investigated a t the base and in England, where so much important work has already been undertaken in this direction.Reference to the figures in Part II will show that the vast majority of the wounds which we have dealt with were infected before operation. Success in primary suture must, therefore, depend on early operation, whereby the infected area may be more or less thoroughly removed before sufficient time has elapsed to allow of infection penetrating into the surrounding tissues.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.