SUMMARYTwo groups, each of 50 patients over the age of 40 years, underwent elective operation at two district general hospitals in Essex. The incidences of calfvein thrombosis on routine lZ5I-fibrinogen scans after operation were 16 and 18 per cent respectively. The incidence in comparable samples of patients from three metropolitan teaching hospitals was about 33 per cent. (Kakkar, 1969) and in the Chelmsford group of hospitals in Essex, observed a remarkable difference in incidence between the two. We therefore conducted a prospective investigation of the problem in the district general hospitals at Chelmsford and Billericay.
SELECTION OF PATIENTSFor a comparable series, every patient over the age of 40 years coming in for elective operation under general anaesthesia and who was likely to stay in the hospital for at least 5 days afterwards was investigated. Fifty patients were studied in each hospital.Those who were to have operations on the legs were excluded.
METHODSWe followed the method described by Negus and others (1968)~ but used a portable isotope-localization monitor* which gives readings comparable to the standard laboratory equipment. In view of the obvious advantages, this model was used for routine scanning in all the patients. Every patient was examined before operation clinically as well as with the * Model 235 manufactured by D. A. Pitman, England. ultrasonic flow detector,t and Lugol's iodine was used to block the thyroid. At the beginning of the operation 100 pc. in I mg. of 1861-fibrinogenS were injected intravenously. If there was evidence of thrombosis
I11considerable time. The need to exclude haemolytic streptococci from skin-grafts initially prompted the use of erythromycin (penicillin is seldom feasible in these patients because of sensitivity reactions). When the combination with chloramphenicol proved effective in controlling the minor flora of the wounds, its use became standard. Occlusive pressure dressings were introduced to prevent wound infections which otherwise inevitably followed seepage of tissue fluids or blood through the dressings. Pressure further assists by reducing the amount of oedema in the skin flaps.
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