During a 33-month interval 106 consecutive renal transplants were performed. Prophylactic parenteral antibiotics, local wound irrigation with antibiotic solutions and drains were used. The over-all incidence of wound infection was 11.3 per cent. The true incidence in primary wounds was 8.4 per cent and in reopened wounds it was 21.7 per cent. Graft loss owing to infection was 33.3 per cent. Sepsis occurred in 25 per cent and death in 16.6 per cent of the patients with wound infection. The incidence of infections in hematomas was 27.5 per cent. The use of prophylactic measures contributed to a lower incidence of wound infection, while the use of drains and the occurrence of hematomas increased the incidence of infections.
Blunt subclavian artery injury has been uncommonly reported in the literature. Recent encounter with three such injuries prompted us to review our experience over the past 10 years uncovering only one additional case. These four cases and a review of pertinent literature form the basis for this article. Key clinical issues include a high index of suspicion in patients sustaining major blunt deceleration and rotational or direct injuries to the neck, thorax, and/or upper extremities. Prompt diagnosis remains obscured by the presence of severe associated injuries, the treatment of which requires prioritization. Arteriography is invaluable to elucidate injury because prompt vascular control is dictated by various approaches depending on the location. Expeditious surgical repair is indicated to prevent complications of hemorrhage, pseudoaneurysm, thromboembolism, and/or arteriovenous fistula. Long-term results appear to be good with major morbidity related to associated neurologic, soft tissue, and bony injuries.
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