Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Keloids Laceration or Myocardial Perforation 883

■Surgical excision

➣Alone

➣With immediate and periodic injection of intralesional corticos-

teroids into site

➣With postoperative silicone gel dressings

➣With intralesional interferon alfa-2b

➣With intralesional injection of 5-fluorouracil

➣With topical application of imiquimod

➣With radiotherapy immediately postop

■Possible success with 585-nm flashlamp pumped pulsed dye laser

follow-up

■Postop follow-up with adjunctive therapy such as intralesional

steroids, silicone gel dressings, pressure dressings, etc.

complications and prognosis

■Most common complication is recurrence.

■Frequent follow-up with adjunctive therapy may decrease risk of

recurrence.

■Postop wound infection is rare.

Laceration or Myocardial Perforation......................

JUDITH A. WISNESKI, MD

history & physical

■Hypotension

■Cardiac tamponade

■New heart murmur

tests

■Echo/Doppler – location of laceration

■MRI (pending stability of patient) – location of laceration

differential diagnosis

n/a

management

■Pericardiocentesis for tamponade

■Emergency surgical intervention for laceration repair

specific therapy

n/a