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sixth EDITION THE MONT REID SURGICAL HANDBOOK The University of Cincinnati Residents From the Department of Surgery University of Cincinnati College of Medicine Cincinnati, Ohio EDITOR-IN-CHIEF Wolfgang Stehr, MD FM_i-xxiv-X4895.indd 0iii 6/9/08 6:52:09 PM 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 THE MONT REID SURGICAL HANDBOOK, SIXTH EDITION ISBN: 978-1-4160-4895-4 Copyright © 2008, 2005, 1997, 1994, 1990, 1987 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: ((cid:2)1) 215 239 3804, (US) or (+44) 1865 843830 (UK); fax: ((cid:2)44) 1865 853333; e-mail: healthpermissions@elsevier. com. You may also complete your request on-line via the Elsevier website at http://www.elsevier.com/ permissions. Notice Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recom- mended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editor assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher Library of Congress Cataloging-in-Publication Data The Mont Reid surgical handbook / the University of Cincinnati residents from the Department of Surgery, University of Cincinnati College of Medicine ; editor-in-chief, Wolfgang Stehr. -- 6th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4160-4895-4 1. T herapeutics, Surgical--Handbooks, manuals, etc. I. Reid, Mont. II. Stehr, Wolfgang. III. University of Cincinnati. Dept. of Surgery. IV. Title: Surgical handbook. [DNLM: 1. Surgical Procedures, Operative--Handbooks. WO 39 M7575 2008] RD49.M67 2008 617.9--dc22 2008012874 Acquisitions Editor: Jim Merritt Developmental Editor: Greg Halbreich Senior Production Manager: David Saltzberg Design Director: Louis Forgione Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 FM_i-xxiv-X4895.indd 0iv 6/9/08 6:52:10 PM Contributors Steven R. Allen, MD Benjamin L. Dehner, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine Division of Urology Cincinnati, Ohio UC College of Medicine Cincinnati, Ohio Alexander J. Bondoc, MD Resident Gerald R. Fortuna, Jr., MD Department of Surgery Resident UC College of Medicine Department of Surgery Cincinnati, Ohio UC College of Medicine Cincinnati, Ohio Bryon J. Boulton, MD Michael D. Goodman, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Eric M. Campion, MD R. Michael Greiwe, MD Resident Resident Department of Surgery Department of Orthopaedic UC College of Medicine Surgery Cincinnati, Ohio UC College of Medicine Cincinnati, Ohio Ondrej Choutka, MD Resident Julian Guitron, MD Department of Neurosurgery Resident UC College of Medicine Department of Surgery Cincinnati, Ohio Section of Cardiothoracic Surgery Callisia N. Clarke, MD UC College of Medicine Resident Cincinnati, Ohio Department of Surgery UC College of Medicine Nathan L. Huber, MD Cincinnati, Ohio Resident Department of Surgery T. Kevin Cook, MD UC College of Medicine Resident Cincinnati, Ohio Department of Surgery UC College of Medicine Karen Lissette Huezo, MD Cincinnati, Ohio Resident Department of Surgery Bradford A. Curt, MD UC College of Medicine Resident Cincinnati, Ohio Department of Neurosurgery UC College of Medicine Cincinnati, Ohio v FM_i-xxiv-X4895.indd 0v 6/9/08 6:52:10 PM vi Contributors Lynn C. Huffman, MD Renee Nierman Kreeger, MD Resident Resident Department of Surgery Department of Anesthesia UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Thomas L. Husted, MD Ryan A. LeVasseur, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Angela M. Ingraham, MD Jaime D. Lewis, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Sha-Ron Jackson, MD Jocelyn M. Logan-Collins, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Mubeen A. Jafri, MD Christopher A. Lundquist, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Marcus D. Jarboe, MD Jefferson M. Lyons, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Andreas Karachristos, MD, PhD Rian A. Maercks, MD Transplant Fellow Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Dong-Sik Kim, MD Grace Z. Mak, MD Transplant Fellow Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio FM_i-xxiv-X4895.indd 0vi 6/9/08 6:52:10 PM Contributors vviiii Amy T. Makley, MD Shannon P. O’Brien, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Joshua M. V. Mammen, MD Brian S. Pan, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Colin A. Martin, MD Prakash K. Pandalai, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Rebecca J. McClaine, MD Charles Park, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Benjamin C. McIntyre, MD Parit A. Patel, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Kelly M. McLean, MD Jonathan E. Schoeff, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Stacey A. Milan, MD John D. Scott, MD Resident MIS Fellow Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Rajalakshmi R. Nair, MD Thomas W. Shin, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio FM_i-xxiv-X4895.indd 0vii 6/9/08 6:52:10 PM viii Contributors Wolfgang Stehr, MD Konstantin Umanskiy, MD Resident Resident Department of Surgery Department of Surgery UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Janice A. Taylor, MD Paul J. Wojciechowski, MD Resident Resident Department of Surgery Department of Anesthesiology UC College of Medicine UC College of Medicine Cincinnati, Ohio Cincinnati, Ohio Ryan M. Thomas, MD Resident Department of Surgery UC College of Medicine Cincinnati, Ohio Jonathan R. Thompson, MD Resident Department of Surgery UC College of Medicine Cincinnati, Ohio FM_i-xxiv-X4895.indd 0viii 6/9/08 6:52:11 PM Foreword To the sixth edition The Surgical Residency Training Program at the University of Cincinnati has a long history of transforming medical students into capable, competent, and compassionate surgical leaders. Paramount to effective surgical leadership is a continuous commitment to the renewal and refi nement of the scien- tifi c basis of clinical practice. Concrete evidence of our exceptional collective commitment is The Mont Reid Surgical Handbook. This sixth edition, com- posed on behalf of our residency and with faculty leadership and supervision, provides a comprehensive, user-friendly document to facilitate the state-of- the-art practice of surgery. The commitment and work ethic of these most exceptional resident authors are evident in the quality of every chapter. Having assumed the Christian R. Holmes Professor and Chair of the Department of Surgery at the University of Cincinnati College of Medicine in November 2007, I consider it a privilege to chair a department with such a great legacy. The Mont Reid Surgical Handbook, as much as any other achievement, is tangible evidence of our historical and ongoing commitment to excellence in the comprehensive missions of clinical service, education, and scholarship. Michael J. Edwards, MD, FACS Christian R. Holmes Professor of Surgery and Chairman of the Department of Surgery University of Cincinnati Medical Center Cincinnati, Ohio 2008 ix FM_i-xxiv-X4895.indd 0ix 6/9/08 6:52:11 PM Foreword To the fi rst edition Dr. Mont Reid was the second Christian R. Holmes Professor of Surgery at the University of Cincinnati College of Medicine. Trained at Johns Hop- kins, he came to Cincinnati as the associate of Dr. George J. Heuer, the initial Christian R. Holmes Professor, in 1922, and became responsible for the teaching in the residency. He assumed the Chair in 1931 and died in 1943, a great tragedy for both the city and the University of Cincinnati Col- lege of Medicine. He was beloved by the residents and townspeople. A very learned, patient man, he was serious about surgery, surgical education, and surgical research. His papers on wound healing are still classics and can, to this day, be read with profi t. It was under Mont Reid that the surgical residency fi rst matured. In his memory, the new surgical suite built in 1948 was named the Mont Reid Pavillion. Part of the surgical suite is still operational in that building, as are the residents’ living quarters. The Mont Reid Handbook is written by the surgical residents at the University of Cincinnati hospitals for residents and medical students and thus is appropriately named. It represents a compilation of the approach taken in our residency program, of which we are justifi ably proud. The residency program as well as the Department refl ect a basic science physiological approach to the science of surgery. Metabolism, infection, nutrition, and physiological responses to the above as well as the physiological basis for surgical and pre-surgical interventions form the basis of our residency program and presumably will form the basis of surgical practice into the twenty-fi rst century. We hope that you will read it with profi t and that you will use it as a basis for further study in the science of surgery. Josef E. Fischer, MD Christian R. Holmes Professor of Surgery and Chairman of the Department of Surgery University of Cincinnati Medical Center Cincinnati, Ohio 1987 xi FM_i-xxiv-X4895.indd 0xi 6/9/08 6:52:11 PM Preface To the fi rst edition We can only instill principles, put the student in the right path, give him methods, teach him how to study, and early to discern between essentials and non-essentials. Sir William Osler The surgical residency training program at the University of Cincinnati Medical Center dates back to 1922 when it was organized by Drs. George J. Heuer and Mont R. Reid, both students of Dr. William Halsted and gradu- ates of the Johns Hopkins surgical training program. The training program was thus established in a strong Hopkins mode. When Dr. Heuer left to as- sume the chair at Cornell University, Mont Reid succeeded him as chairman. During Reid’s tenure (1931–1943), the training program at what was then the Cincinnati General Hospital was brought to maturity. Since then, the training program has continued to grow and has maintained the tradition of excellence in academic and clinical surgery which was so strongly advocated by Dr. Reid and his successors. The principal goal of the surgical residency training program at the University of Cincinnati today remains the development of exemplary academic and clinical surgeons. There also is a strong tradition of teaching by the senior residents of their junior colleagues as well as the medical students at the College of Medicine. Thus, the surgical house staff became very enthused when Year Book Medical Publishers asked us to consider writing a surgical handbook which would be analogous to the very suc- cessful pediatrics handbook, The Harriet Lane Handbook (now in its 11th edition). We readily accepted the challenge of writing a pocket “pearl book” which would provide pertinent, practical information to the students and residents in surgery. The six chief residents for 1985–1986 served as editors of this handbook and the contributors included the majority of the surgical house staff in consultation with other specialists who are involved in the direct care of surgical patients and the education of residents and medical students. The information collected in this handbook is by no means exhaustive. We have attempted simply to provide a guide for the more effi cient management of prevalent surgical problems, especially by those with limited experience. Therefore, this is not a substitute for a comprehensive textbook of surgery, but is rather a supplement which concentrates on those things that are important to medical students and junior residents on the wards, namely the initial management of common surgical conditions. Much of the information is infl uenced by the philosophies advocated by the residents and faculty at the University of Cincinnati and thus refl ects a certain bias. In areas of con- troversy, however, we have also provided other views and useful references. xiii FM_i-xxiv-X4895.indd 0xiii 6/9/08 6:52:11 PM xiv Perioperative Care The index has been liberally cross-referenced in order to provide a rapid and effi cient means of locating information. This handbook would not have been possible without the enthusiastic support and advice of our chairman, Dr. Josef E. Fischer, whose commitment to excellence in surgical training serves as an inspiration to all of his residents. We would also like to acknowledge the invaluable advice provided by several of the faculty members of the Department of Surgery: Dr. Robert H. Bower, Dr. James M. Hurst, and Dr. Richard F. Kempczinski. The authors gratefully acknowledge the helpful input of Dr. Donald G. McQuarrie, Profes- sor of Surgery at the University of Minnesota, for his review of each chapter in the handbook. Also we would like to thank Mr. Daniel J. Doody, Vice President, Editorial, Year Book Medical Publishers, for his patience and guid- ance in the conception and writing of this fi rst edition of The Mont Reid Handbook. None of this would have been possible were it not for the word process- ing expertise and herculean efforts of Mr. Steven E. Wiesner. His assistance in the typing and editing of the manuscript was invaluable. Finally, this handbook is the result of the cumulative efforts of the surgical house staff at the University of Cincinnati as well as those residents who preceded us and taught us many of the principles that are so advocated in this book. We wish to thank all those who worked so diligently on this manuscript in order to make the fi rst edition of The Mont Reid Handbook a reality. Michael S. Nussbaum, MD Editor-in-Chief Cincinnati, Ohio 1987 FM_i-xxiv-X4895.indd 0xiv 6/9/08 6:52:11 PM