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INTRODUCTION TO THE ATLAS

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Each preceding chapter has figures, tables, and drawings that aid the author and the editors in imparting and clarifying the messages of the chapter. In this edition of TRAUMA, the editors have devoted a special section to an atlas. It is not intended to include an exhaustive artistic rendering of every operation, but, rather, to focus on procedures that are commonly used in major trauma operations, along with related anatomical drawings. Some procedures that may have been commonly practiced in the past but are rarely currently done are not included. However, a few relatively infrequently used concepts and procedures have been included in this section because of sufficient need to clarify the opinions of the editors. The art has been kept in as simple a form as possible, so it is expeditiously available when needed for a quick refresher in anatomy, anatomical relationships, and/or surgical approach in the "heat of battle."

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HEAD AND NECK

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FIGURE 1

ICP Coronal

An “ICP bolt” is inserted through a skull bone into the space around the brain where blood and fluid accumulate following trauma. This device permits continuous ICP monitoring.

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FIGURE 2

ICP Lateral

From a lateral perspective, this shows an ICP bolt inserted into the space around the brain via the skull bone to facilitate continuous ICP monitoring.

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FIGURE 3

Burr Hole

The ideal location of a cranial burr hole depends on the anticipated injury in the three skull bones.

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FIGURE 4

Steps in Performing a Lateral Parietal Craniectomy

A.  The exact location and size of the skin flap vary, depending on extent of the wound but must not extend to the midline at the top of the skull.

B.  Skin clips are placed for hemostasis, and burr holes elevate the skull bone flap.

C–D.  The bone flap is removed, the dura mater is opened to expose and release an epidural hematoma, and bleeding vessels are ligated. In the absence of significant brain swelling, the skull plate is reattached once hemorrhage is controlled and other necessary procedures have been accomplished. With significant brain swelling, the dura is closed, sometime using dural substitutes, and the bone flap is not replaced at initial operation (decompressive craniotomy).

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FIGURE 5

Nasal Packing for Hemorrhage Control

A.  Under general or topical anesthesia, gauze impregnated with Vaseline to facilitate insertion is layered into a bleeding nasal ...

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