Prevention of Infections Associated With Combat-Related Eye, Maxillofacial, and Neck Injuries

Petersen, Kyle; Colyer, Marcus H.; Hayes, Donald F.; Hale, Robert G.; Bell, R. Bryan; Hospenthal, Duane R.; Murray, Clinton K.; Andersen, Romney C.; Calhoun, Jason H.; Cancio, Leopoldo C.; Cho, John M.; Chung, Kevin K.; Clasper, Jon; Conger, Nicholas G.; Costanzo, George P.; Crouch, Helen K.; Curry, Thomas K.; D’Avignon, Laurie C.; Dorlac, Warren C.; Dunne, James R.; Eastridge, Brian J.; Ficke, James R.; Fleming, Mark E.; Forgione, Michael A.; Green, Andrew D.; Holcomb, John B.; Hsu, Joseph R.; Kester, Kent E.; Martin, Gregory J.; Moores, Leon E.; Obremskey, William T.; Renz, Evan M.; Saffle, Jeffrey R.; Solomkin, Joseph S.; Sutter, Deena E.; Tribble, David R.; Wenke, Joseph C.; Whitman, Timothy J.; Wiesen, Andrew R.; Wortmann, Glenn

doi:10.1097/ta.0b013e318227ad9a

Cited by 18 publications

(15 citation statements)

References 49 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reconstruction of the scalp, skull, and underlying tissues is carried out for aesthetic repair [18], but also to prevent complications (e.g., infections) associated with open head injuries [19] and CSF leakage [20]. In some cases, the skull is reconstructed, i.e., cranioplasty [21], [22].…”

Section: Introductionmentioning

confidence: 99%

Immediate, but Not Delayed, Microsurgical Skull Reconstruction Exacerbates Brain Damage in Experimental Traumatic Brain Injury Model

Glover¹,

Tajiri²,

Lau³

et al. 2012

PLoS ONE

View full text Add to dashboard Cite

Moderate to severe traumatic brain injury (TBI) often results in malformations to the skull. Aesthetic surgical maneuvers may offer normalized skull structure, but inconsistent surgical closure of the skull area accompanies TBI. We examined whether wound closure by replacement of skull flap and bone wax would allow aesthetic reconstruction of the TBI-induced skull damage without causing any detrimental effects to the cortical tissue. Adult male Sprague-Dawley rats were subjected to TBI using the controlled cortical impact (CCI) injury model. Immediately after the TBI surgery, animals were randomly assigned to skull flap replacement with or without bone wax or no bone reconstruction, then were euthanized at five days post-TBI for pathological analyses. The skull reconstruction provided normalized gross bone architecture, but 2,3,5-triphenyltetrazolium chloride and hematoxylin and eosin staining results revealed larger cortical damage in these animals compared to those that underwent no surgical maneuver at all. Brain swelling accompanied TBI, especially the severe model, that could have relieved the intracranial pressure in those animals with no skull reconstruction. In contrast, the immediate skull reconstruction produced an upregulation of the edema marker aquaporin-4 staining, which likely prevented the therapeutic benefits of brain swelling and resulted in larger cortical infarcts. Interestingly, TBI animals introduced to a delay in skull reconstruction (i.e., 2 days post-TBI) showed significantly reduced edema and infarcts compared to those exposed to immediate skull reconstruction. That immediate, but not delayed, skull reconstruction may exacerbate TBI-induced cortical tissue damage warrants a careful consideration of aesthetic repair of the skull in TBI.

show abstract

Section: Introductionmentioning

confidence: 99%

Immediate, but Not Delayed, Microsurgical Skull Reconstruction Exacerbates Brain Damage in Experimental Traumatic Brain Injury Model

Glover¹,

Tajiri²,

Lau³

et al. 2012

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…On prophylactic basis, the aim is to prevent the infection of the surgical wound [11]. Regarding oral and maxillofacial region antibiotic prophylaxis ranges from penicillin-derivatives with -lactamase inhibitors to second or third generation cephalosporins, quinolones or clindamycin.…”

Section: The Need For Better Antimicrobial Targetingmentioning

confidence: 99%

“…Although most surgeons deal with them successfully and expeditiously, a vague and inadequate knowledge of the organisms involved persists [5,[11][12]30]. …”

Section: The Need For Better Antimicrobial Targetingmentioning

confidence: 99%

See 1 more Smart Citation

Novel Antimicrobial Agents for the Management of Maxillofacial and Neck Infections

Valasidis

Kyrgidis²,

Tzellos³

et al. 2012

PRI

View full text Add to dashboard Cite

Background: Maxillofacial and head & neck infections often jeopardize patients' lives. Regional intracranial spread to the cavernous sinus, but also to the mediastinum is common for those left untreated. The divergence of the upper peptic and respiratory tracts from the pharynx, the presence of the brain vasculature, the fine sensory instruments for vision, hearing and taste-smell, and the unique feature of mucosa directly attached to facial bones in the paranasal sinuses, oral cavity and external auditory meatus make this region the most exposed to infections in the human body. Special immune mechanisms have evolved in this area, however infections are still very common.Methods & Results: We review the unique pathophysiological features of maxillofacial and head & neck infections. We describe novel investigational anti-infective agents, and analyze their potential clinical utility with regard to mechanisms of action and site preference.Discussion: We emphasize on the need for more antimicrobial drug research and discuss on the current skews in pharmaceutical research and manufacturing practices that make new categories of antimicrobial drugs an exceptional entity. Drug patents may need to be expanded both longitudinally in terms of time period but also squarely, potentially including the drug class in the patent rather than the drug itself. Clinicians need to be aware of these limitations and prescribe antibiotics to their patients with parsimony.

show abstract

“…Infection is of particular concern in craniofacial reconstruction, where tissue defects are often exposed to bacteria not only from the external environment, but also from neighboring structures including the sinuses, nasal passages, and the mouth. 6-7 For instance, wound infection rates approaching 100% have been reported following gunshot injuries to the face. 8-9 …”

Section: Introductionmentioning

confidence: 99%

A rapid, flexible method for incorporating controlled antibiotic release into porous polymethylmethacrylate space maintainers for craniofacial reconstruction

et al. 2016

View full text Add to dashboard Cite

Severe injuries in the craniofacial complex, resulting from trauma or pathology, present several challenges to functional and aesthetic reconstruction. The anatomy and position of the craniofacial region make it vulnerable to injury and subsequent local infection due to external bacteria as well as those from neighboring structures like the sinuses, nasal passages, and mouth. Porous polymethylmethacrylate (PMMA) “space maintainers” have proven useful in staged craniofacial reconstruction by promoting healing of overlying soft tissue prior to reconstruction of craniofacial bones. We describe herein a method by which the porosity of a prefabricated porous PMMA space maintainer, generated by porogen leaching, can be loaded with a thermogelling copolymer-based drug delivery system. Porogen leaching, space maintainer prewetting, and thermogel loading all significantly affected the loading of a model antibiotic, colistin. Weeks-long release of antibiotic at clinically relevant levels was achieved with several formulations. In vitro assays confirmed that the released colistin maintained its antibiotic activity against several bacterial targets. Our results suggest that this method is a valuable tool in the development of novel therapeutic approaches for the treatment of severe complex, infected craniofacial injuries.

show abstract

Prevention of Infections Associated With Combat-Related Eye, Maxillofacial, and Neck Injuries

Cited by 18 publications

References 49 publications

Immediate, but Not Delayed, Microsurgical Skull Reconstruction Exacerbates Brain Damage in Experimental Traumatic Brain Injury Model

Immediate, but Not Delayed, Microsurgical Skull Reconstruction Exacerbates Brain Damage in Experimental Traumatic Brain Injury Model

Novel Antimicrobial Agents for the Management of Maxillofacial and Neck Infections

A rapid, flexible method for incorporating controlled antibiotic release into porous polymethylmethacrylate space maintainers for craniofacial reconstruction

Contact Info

Product

Resources

About