DOCSLIB.ORG

A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study Steven D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study Steven D Archives of Health Science Research Article A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study Steven D. Jones Jr MD*1, Parker J. Prusick MD1, Bennie G. Lindeque MD PhD1 1Department of Orthopedic Surgery, University of Colorado Denver, 12631 E 17th Ave, Aurora, CO 80045, USA *Corresponding Author: Steven D. Jones Jr MD, Department of Orthopedic Surgery, University of Colorado Denver, 12631 E 17th Ave, Aurora, CO 80045, USA Abstract Background: Negative-pressure wound-therapy (NPWT) has become a mainstay of treatment for high-risk surgical wounds. In closed wounds, traditional NPWT utilizes surface level sponges alone to provide negative pressure. A technique that allows for deep dead-space management, while maintaining superficial negative pressure over a closed wound, may prove beneficial inhigh-risk patients. Purpose: A novel technique and prospective case series are described which incorporate deep hemovac drain tubings into a traditional NPWT device (Deep Inside-Out Vac; DIOV). Pilot data is needed to begin evaluating the efficacy of this technique. Methods: Fourteen patients were stratified by initial indication for DIOV placement. Group 1 patients underwent wide tumor resection, while Group 2 patients underwent extensive debridement for infection. Demographic, surgical, and microbiological data were recorded. Results: Eight patients were identified in Group 1. Six were identified in Group 2. Both demonstrated 50% positive culture rates at time of drain removal. Most common organisms were coagulase negative staphylococcus species. At final follow-up, all wounds were clinically healed. Conclusions: NPWT is an established augment in post-operative wound care. The DIOV may provide added benefit in wounds at high-risk for dead-space related complications. Contamination remains unfavorable, and further research is needed to determine this device’s efficacy. Level of Evidence: Level IV Introduction surgical site infections compared to treatment with standard surgical dressings Background (8.8% vs 13.0% in the standard dressing Negative-pressure wound-therapy group; relative risk 0.66) [18]. Surgical site (NPWT) has become a mainstay of infections are a common complication and treatment for complex and high-risk are known to increase patient morbidity surgical wounds over the last three decades. and substantially increase health care Orthopedic and General Surgical related costs. A 2009 systematic review subspecialties alike have utilized these found that surgical site infections often systems to improve wound healing and double healthcare costs, primarily due to decrease morbidity in select patients. A increased lengths of stay [4]. Techniques to recent 2020 Cochrane meta-analysis of over reduce these complications have been 40 randomized controlled trials (RCTs) studied extensively and numerous demonstrated with moderate-certainty modalities have been explored over recent evidence that NPWT results in fewer years. Archives of Health Science 1 A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study Traditional NPWT was first utilized drain hemovac tubing into traditional in the early to mid-1990s. The first NPWT over a closed surgical wound. The indications for these devices included open construct was termed the Deep Inside-Out fractures and chronic, high-risk, lower Vac (DIOV) and was designed to further the extremity wounds [9, 2]. As techniques and depth of dead-space management while technology have advanced, NPWT has preserving the benefits of negative pressure become a safe and established method for over a closed wound. Pilot data from culture improving surgical site related outcomes in results at time of DIOV removal was select patients [1, 14, 15]. The cost assessed to determine if this technique effectiveness of NPWT remains controversial, maintains the device as a closed, aseptic, though many studies have found it to be sealed system. cost-neutral, if not cost saving, in a majority of applications [12, 16, 28]. NPWT has Methods become a fundamental component of high- Approval from the University of risk surgical wound management at Colorado School of Medicine Institutional numerous academic institutions. Review Board was obtained for this Rationale prospective case series. The cases and In orthopedic oncology, dead-space subsequent microbiological analyses were management is a critical component of conducted at a single institution. All surgical success for wound healing. Wide-resections procedures were performed by a single, for tumor removal often create soft tissue board-certified, fellowship-trained cavities that are prone to seroma and orthopedic oncologic surgeon (author BL). hematoma formation. This concept also This author also serves as a bone sepsis and rings true in infectious cases requiring musculoskeletal infection specialist at the extensive debridement. Significant tissue manuscript’s host institution. loss for any reason(whether surgical, Device Components and Terminology infectious, or traumatic) can create a negative pressure void prone to adverse The NPWT system used included a fluid accumulation. V.A.C.™ device (Vacuum Assisted Closure; K.C.I. Licensing, Inc., San Antonio, TX) with Literature dating back to the 1940s black polyurethane ether sponges. The established that dead-space management is hemovac tubing was taken from standard a crucial component of post-operative 1/4th inch DAVOL drum-style drains wound success [21]. Post-operative seroma (Medivida Corp. International, Causeway and/or hematoma formation can place Bay, HK), which were packaged and opened unyielding pressure on overlying tissues sterilely at time of placement. The term and may increase the risk of wound “hemovac,” when used in this manuscript dehiscence [19]. NPWT has been proven to represents any blub- or drum-style closed be beneficial for dead-space management in suction drain that relies on stored potential both human and animal models [23, 24]. energy to maintain negative pressure across For superficial tissues, incisional NPWT its system. While there is colloquial use of devices alone are often adequate to prevent this term, it should be known that the term post-operative, fluid-related complications. HEMOVAC is a registered trademark of However, in deeper areas of dead-space Zimmer Biomet Holdings, Inc. (Warsaw, IN), (particularly in the thigh, groin, or in and would represent one specific brand of morbidly obese patients), superficial NPWT “hemovac” drain device. The preliminary alone may not be sufficient to mitigate the design for the DIOV comes from risks associated with deep space fluid Christopher J. Kleck MD at the University of accumulation. A technique that allows for Colorado School of Medicine. The device’s deep dead-space management, whilst initial use was for complex wound simultaneously maintaining negative management following spinal surgery. pressure over a closed wound, may provide added benefit in select patients at high-risk Patients and Indications for dead-space related complications. Fourteen patients were identified In this case series, we describe a and prospectively enrolled in this pilot novel technique for incorporating deep analysis. Patients were included if they Archives of Health Science 2 A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study received a DIOV drainage system following Microbiological data included pre- an orthopedic oncologic or infectious DIOV culture results (for Group 2 only) and debridement procedure. Patients were post-DIOV culture results for both groups at stratified into two groups based on their time removal. Specimen fluid was obtained procedure at time of DIOV placement: from the deep portions of hemovac tubing primary oncologic patients were placed in at time of removal via flush injection of 3cc Group 1, while infection debridement of sterile saline. Care was taken to ensure patients were placed in Group 2. While sterile techniques were used while Group 2 patients were known to have some specimens were gathered to minimize form of initial infection, all underwent serial iatrogenic contamination. Aerobic, debridements, and data gathered was from anaerobic, mycobacterial, and fungal agars the DIOVs placed at time of final were used in the microbiologic analyses. debridement. This presumes aseptic DIOV Microbiologic analyses were performed at a placement even in Group 2,as final single institution (University of Colorado debridement was determined after Hospital - Anschutz Medical Campus) with consecutive cultures were pan-negative, all cultures being held for at least 14 days. wounds were free of necrotic/ nonviable/ Regarding antibiotic use, all patients purulent material, and inflammatory in Group 1 received pre-incisional markers (i.e. c-reactive protein, white blood antibiotics per the standard orthopaedic cell count) were normalized or near normal. guidelines (typically a 1st generation The determination of final debridement was cephalosporin or lincomycin/ amino made by a single-surgeon (BL) in all cases. glycoside administered within 1 hour of Data Collected incision). Group 2 patients expectedly received a variety of antibiotic therapies. Demographic data obtained Details on antibiotic therapy were not included patient age, gender, and body mass included, as all therapies were felt to be index (BMI). Clinical data obtained similarly effective given the empiric-to- included diagnosis, procedure performed, narrow therapeutic model used at the host estimated blood
Load more

Recommended publications
  • Discover Products for Minimally Invasive Drainage Procedures
    Discover products for minimally invasive drainage procedures. Thal-Quick Lock Fuhrman Pleural/ Wayne Cook Chest Tube Pericardiocentesis Pneumopericardial Pneumothorax Chest Drain Valve Catheter Drainage Catheter Catheter MEDICAL Contents Pneumothorax catheters Wayne Pneumothorax Catheter Set and Tray – Seldinger ......................................................................................... 4 Wayne Pneumothorax Catheter Set – Trocar ............................................................................................................... 5 Cook Emergency Pneumothorax Set ........................................................................................................................... 6 Pneumothorax Set and Tray ........................................................................................................................................... 7 Richli Pneumothorax Catheter Set ................................................................................................................................ 8 Catheter Aspiration Set for Simple Pneumothorax .................................................................................................... 9 Multipurpose catheters Thal-Quick Chest Tube Set .......................................................................................................................................... 10 Thal-Quick Chest Tube Tray ......................................................................................................................................... 11
    [Show full text]
  • Wound Drain Tube Management
    CLINICAL PROCEDURE WOUND DRAIN TUBE MANAGEMENT TARGET AUDIENCE All Peter Mac medical and nursing staff. STATE ANY RELATED PETER MAC POLICIES, PROCEDURES OR GUIDELINES Clinical Handover Policy Wound Management Guideline Hand Hygiene Procedure Aseptic Technique Procedure Care of Underwater Drainage Procedure Care of Percutaneous Nephrostomy Catheters Procedure Nursing Services Patient Health Assessment Guideline Patient Identification and Procedure Matching Procedure Observation and Response Chart Procedure PURPOSE This procedure aims to provide the target audience with best practice based evidence available, along with expert opinion, in regards to the management of drain tubes within the hospital setting. PROCEDURE Indication Drain tubes can be inserted prophylactically to either prevent or remove the accumulation of fluid in a wound. They can also be therapeutically inserted to evacuate an existing collection of fluid in a wound. Fluid is removed in order to treat or prevent infection and promote wound healing and patient comfort. Drain tubes can also be used to diagnose postoperative complications such as an anastomotic leak or haemorrhage. Types of Drainage Tubes ExudrainTM A closed, active drain system, with a negative pressure of approximately 75mmHg and a reservoir of 100mL. http://vitalmedikal.com.tr/yeni/index.php?option=com_content&task=view&id=9&Itemid=3 BellovacTM A closed, active drain system, with a negative pressure of approximately 90mmHg and a reservoir of 220mL. http://surgery.astratech.com.au/Main.aspx/Item/459337/navt/68686/navl/83954/nava/83974 Surimex Fixvac A closed, active drain system, with a negative pressure of approximately Vacuum System 338mmHg. It has a resevoir of 600mL. Please note: the bottle will only half fill and therefore will need to be changed when half filled.
    [Show full text]
  • Chronic Non Congestive Glaucoma: with Special Emphasis on Therapy
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1934 Chronic non congestive glaucoma: with special emphasis on therapy W. Morrison University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Morrison, W., "Chronic non congestive glaucoma: with special emphasis on therapy" (1934). MD Theses. 339. https://digitalcommons.unmc.edu/mdtheses/339 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. CHRONIC NON-CONGESTIVE GLAUCOMA: WITH ESPECIAL EMPHASIS ON THERAPY -. w. HOWARD MORRISON CHRONIC NON CONGESTIVE GLAUCOMA: with especial emphasis on therapy INTRODUCTION AND HISTORY It is my intention herein to discuss chronic non­ congestive glaucoma only briefly as an entirety, so that a suitable back ground may be constructed for the more exhaustive perusal of the recent literature on the therapy in that particular type of glaucoma. Throughout this paper the terms chronic non-congestive glaucoma, Simple glaucoma and glaucoma simplex will all refer to the same condition. The term glaucoma is not the title of anyone Single disease but is a clinical label for a complex of symptoms. Over four centuries before the Christian era, Hippocrates described glaukos as among the known affections of the eye. The Greek word, glaukos, he used to describe the disease because he saw a gray green reflex from the pupil.
    [Show full text]
  • Products for Emergency Medicine and Trauma
    PRODUCTS FOR EMERGENCY MEDICINE AND TRAUMA MEDICAL Cook Medical offers a comprehensive selection of products for emergency medicine to aid in the resuscitation and treatment of your patients. Our devices have been engineered to provide you with minimally invasive solutions for the numerous issues critically ill or injured patients face, including airway obstruction, difficulty breathing, and loss of fluid. AIRWAY Airways are usually the initial focus in the resuscitation of a critically ill or injured patient, but sometimes conventional endotracheal intubation can be difficult or even impossible in individuals with a challenging anatomy or serious trauma. For these situations, Cook has developed a variety of emergency devices to help you obtain airway access. BREATHING Often the inability to maintain proper airway exchange may be a direct result of abnormal chest wall dynamics, such as a pneumothorax. Cook offers an extensive line of drainage catheters for removing both air and fluid from the pleural space. Available in straight and pigtail designs, these catheters are placed with either the Seldinger technique or by direct puncture. CIRCULATION Correcting circulation problems is another crucial step in emergency care, as the rapid replacement of fluid volume is imperative in the treatment of shock. Cook’s intraosseous infusion needles can be used to infuse drugs or fluids when intravenous access is not possible. Contents Difficult airway Intubation Frova Intubating Introducer .....................................................................................................................................
    [Show full text]
  • The Drainage of Subretinal Fluid: a Randomized Controlled Clinical Trial
    THE DRAINAGE OF SUBRETINAL FLUID: A RANDOMIZED CONTROLLED CLINICAL TRIAL BY George F. Hilton, MD INTRODUCTION AMONG THE MANY CONTROVERSIES IN RETINAL DETACHMENT SURGERY, NONE HAS been more persistent than the unresolved question of drainage versus nondrainage. The controversy has persisted for over 20 years, and more than 60 papers have been written on the subject; however, to date there have been no controlled studies. The ongoing interest in this problem is illustrated by a recent Jules Gonin Club symposium on the drainage of subretinal fluid. After numer- ous papers on the subject the final summary acknowledged: "We are still challenged by the question: To drain or not to drain.'"1 The interest in this question is enhanced by the fact that most retinal surgeons regard the procedure ofsubretinal fluid drainage as a potentially hazardous step. Martin2 has defined it as "the most dangerous part of a retinal detachment operation." Ferguson3 referred to it as "the most crucial point" in the operation, and Norton4 observed that "fluid drainage is the one aspect ofthe surgical procedure over which the surgeon has the least control and although complications are unusual, they can be disas- trous." Not all authors are equally impressed with the potential complica- tions ofdrainage. Chawla5 regarded this surgical step as "only one danger among equals," and Schepens6 wrote that "the rate of complications from correctly performed perforation for the release of subretinal fluid is less than 1%." This question was recently brought into focus by a pair of papers representing the two major schools of thought on the issue.
    [Show full text]
  • Family of Drainage Catheters and Accessories M•Drain® Catheters
    Family of Drainage Catheters and Accessories M•Drain® Catheters Mermaid Medical offers an extensive range of state-of-the-art M•Drain® catheters and accessories to physicians and hospitals globally. The M•Drain® catheter design is focused on enhanced patient care while providing physicians with improved ease of use. M•Drain® catheters can be used for a variety of drainage applications including abscess, nephrostomy, biliary, centesis and other multipurpose drainage applications. Catheter placement is performed using either a Single Step or Seldinger technique. M•Drain®, from Mermaid Medical, makes One-Stop-Shopping convenient and cost effective while preserving quality care and physician preference. The Family of Drainage Catheters and Accessories M•Drain® Single Step Drainage Catheter with locking and non-locking pigtails M•Drain® Single Step Drainage Catheter – Mini Locking Pigtail M•Drain® Nephrostomy Drainage Catheter M•Drain® Biliary Drainage Catheter M•Drain® Percutaneous Introducer Set M•Drain® Centesis Catheter ACCESS Needles M•Fixx™ Catheter Securement Device for Percutaneous Catheters M•Drain® Accessories Guidewires All Catheters Incorporate These Enhanced Design Features Large “skived” oval side holes promote increased flow and reduce clogging Slimline reinforced tapered tip with “Anti-Accordion” design for smooth entry Unique leak proof pigtail locking system to avoid mess and unnecessary catheter exchanges Internal diameter of hub and catheter match for maximum flow Centimetre markings to assist in accurate placement Echogenic
    [Show full text]
  • Maintaining the Drain
    GLOBAL EXCLUSIVE h NURSING CARE h WOUND CARE h PEER REVIEWED Maintaining the Drain Danielle Browning, LVMT, VTS (Surgery) Karen M. Tobias, DVM, MS, DACVS University of Tennessee Knoxville, Tennessee, United States d FIGURE 1 A closed-suction drain exit site is secured with a mattress suture, and a finger-trap suture around the tubing prevents slipping. After placement of a wound suture (Figure 1), the area can be cov- drain, there are specific steps ered with a small, sterile, nonadhesive dressing and an outer adhesive film or an needed to prevent nosocomial island dressing (Figure 2, next page). Drains should infection of the wound and always be placed exposure of the team and other Passive Drains Passive drains (eg, Penrose drains, Fig- using aseptic patients to infectious material. ure 3, next page) are gravity-dependent technique, and and allow fluid, which can be irritating Drains are often placed to allow removal to the periwound skin, to travel around exit sites should of fluid or air, to close dead space, and to and along the drain and through an always be kept prevent seroma formation. On rare occa- exit site in the skin.1 Before bandage sions, drains may be used to provide application, a thin layer of sterile, petro- covered. medications such as local anesthetics. latum-based ointment can be applied to Drains should always be placed using the clean, dry skin around (not on) the aseptic technique, and exit sites should exit wound to protect the area. Another always be kept covered. option is to coat the periwound skin with an acrylate polymer.
    [Show full text]
  • General Principles the Acetabular Index and Center-Edge Angles
    Troelson E-Appendix Page 1 of 14 E-Appendix General Principles The acetabular index and center-edge angles following reorientation should correspond as closely as possible to the normal anatomy (acetabular index angle, 0° to10°; center-edge angle, 30° to 40°). It is of equal importance that the surgeon obtain appropriate anteversion of the acetabulum. Assessment of the range of motion and joint stability at the end of the procedure will help the surgeon to evaluate the change in hip joint mechanics. This description of the minimally invasive approach will give the reader an understanding of soft- tissue mobilization, instrument handling, and the performance of the osteotomies. Understanding of the anatomy and utilization of fluoroscopy during surgery are the keys to a safe, minimally invasive periacetabular osteotomy. Pubic Osteotomy Subperiosteal access to the superior ramus of the pubic bone is gained with use of a periosteal elevator. It is important that the pubic osteotomy be performed medially on the superior ramus since the bone otherwise is too thick, making the osteotomy and mobilization difficult or impossible. A curved blunt retractor is placed in the obturator fossa behind the superior ramus of the pubic bone. It is important that this retractor be placed subperiosteally to protect the obturator artery and nerve. A splined retractor is then placed anterior and medial to the site of the osteotomy in order to retract the iliopsoas muscle medially and protect the iliac artery and vein and the femoral nerve (Fig. E1). The superior ramus is then osteotomized under direct visualization with use of a slightly curved osteotome.
    [Show full text]
  • STANDARDIZED PROCEDURE CHEST TUBE PLACEMENT (Adult)
    STANDARDIZED PROCEDURE CHEST TUBE PLACEMENT (Adult) I. Definition Chest tube insertion is a common therapeutic procedure used to provide evacuation of abnormal collections of air or fluid from the pleural space. Tube thoracostomy may be indicated for pleural effusions associated with malignancy, infection, or hemothorax in the post-surgical setting. In these situations, drainage is imperative to allow for lung re- expansion. II. Background Information A. Setting: The setting (inpatient vs outpatient) and population (adults vs pediatrics) for the Advanced Health Practitioner (AHP) is determined by the approval of the privileges requested on the AHP Privilege Request Form. This particular procedure is for adults only. B. Supervision The necessity of the procedure will be determined by the AHP in verbal collaboration with the attending physician or his/her designee. Direct supervision is necessary until competency is determined and the minimum number of procedures is successfully completed, as provided for in the procedure. After that time, the attending physician or his/her designee must be available. Designee is defined as another attending physician who works directly with the supervising physician and is authorized to oversee the procedures being done by the AHP. C. Indications 1. Pneumothorax (especially if it is large or progressive, or if the patient is symptomatic). 2. Tension pneumothorax. 3. Penetrating chest trauma. 4. Hemothorax. 5. Chylothorax 6. Empyema. 7. Drainage of pleural effusions. 8. Prevention of hydrothorax after cardiothoracic surgery. 9. Bronchopleural fistula D. Precautions/Contraindications 1. Anticoagulation of a bleeding dyscrasia. 2. Systemic anticoagulation. 3. Small, stable pneumothorax (may spontaneously resolve). 1 STANDARDIZED PROCEDURE CHEST TUBE PLACEMENT (Adult) 4.
    [Show full text]
  • BICAKCILAR-Catalogue.Pdf
    Medical Disposable Product Cataloguee 10th Edition 9ddhjg\m[lkYf\hjg\m[l kh][a^a[Ylagfka\]fla^a]\afl`] hjg\m[l[YlYdg_m]Yj]ZYk]\ mhgfl`]af^gjeYlagfYnYadYZd]lg :ÔYc[ÔdYjYll`]lae]g^ hmZda[Ylagf&:ÔYc[ÔdYjj]k]jn]k l`]ja_`llg\ak[gflafm]Yfqg^ l`]k]hjg\m[lkgjlg[`Yf_]Yfq km[`kh][a^a[Ylagfkoal`gmlhjagj notice. YEARS OF 58EXPERIENCE :ÔYc[ÔdYjakl`]d]Y\af_\akhgkYZd]e]\a[Yd\]na[]Yf\]d][ljg%e]\a[Yd]imahe]fl\]na[] eYfm^Y[lmj]jafLmjc]q&L`][gehYfqoYk^gmf\]\af)1-1&L`jgm_`l`]q]Yjk$:ÔYc[ÔdYj ZjYf\`Yk_Yaf]\oa\]Y[[]hlYf[]Yf\`Yk]klYZdak`]\YljY\alagfg^kmklYaf]\j]daYZadalq Yf\[mklge]jkYlak^Y[lagf& 9k:ÔYc[ÔdYj]ehdgq]]k$lg_]l`]joal`gmjZmkaf]kkhYjlf]jk$o]k]jn]gmj[mklge]jkZq eYfm^Y[lmjaf_Yf\kmhhdqaf_affgnYlan]$j]daYZd]Yf\]fnajgfe]flYddq^ja]f\dqe]\a[Yd \]na[]k&O]\ada_]fldqnYdm]gmjZjYf\Yf\alkZ]f]^allgkg[a]lq& Mission Gmjeakkagfaklgkmhhdqj]daYZd]Yf\Y[[]kkaZd]e]\a[Yd\]na[]k^gj\aY_fgkakYf\lj]Yle]fl g^`meYf\ak]Yk]Yf\aehjgn]e]flafimYdalqg^da^]& Vision O]Yk:ÔYc[ÔdYjYj]\]\a[Yl]\lghjg\m[]Yf\kmhhdqkeYjl$affgnYlan]$\an]jk]$kY^]Yf\ ][g%^ja]f\dqe]\a[Yd\]na[]klg_]l`]joal`gmjhYjlf]jkYkZ]af_l`]^ajkl[`ga[]g^e]\a[Yd hjg^]kkagfYdkYf\Zmq]jk&O]nYdm]gmjZjYf\k$afl]j]klg^[geemfalq$kljYl]_a[l`afcaf_ Yf\hjgh]jaf^gjeYlagfk`Yjaf_& Group Companies Gh]jYl]kafeYfm^Y[lmjaf_g^\akhgkYZd]e]\a[Yd\]na[]kYf\]d][ljg%e]\a[Yd]imahe]fl$ \akljaZmlagfg^e]\a[Yd\]na[]k^jged]Y\af_emdlafYlagfYdZjYf\k&EYfm^Y[lmjaf_akh]j^gje]\ afAklYfZmd=k]fqmjl^Y[adala]ko`]j]Yk\ge]kla[kYd]kYf\\akljaZmlagfakh]j^gje]\naY j]_agfYdkYd]kZjYf[`]kafÓklYfZmd$9fcYjY$Óreaj$KYekmf$9flYdqYYf\9\YfY&@]Y\imYjl]jk akafAklYfZmd& GLOBAL TIBBİ ÜRÜNLER SANAYİ VE TİCARET A.Ș.
    [Show full text]
  • A Comparative Study of the Use of Harmonic Scalpel Versus
    [Downloaded free from http://www.nigerianjsurg.com on Thursday, May 18, 2017, IP: 165.255.213.249] Original Article A Comparative Study of the Use of Harmonic Scalpel versus Unipolar Cautery in Modified Radical Mastectomy Pallavi Mittal, Ashwani Kumar, Sunmeet Kaur1, Paras Kumar Pandove, Rachan Lal Singla, Jagpal Singh Department of Surgery, Context: Oncosurgery is an emerging branch with the set goals of prolonging Government Medical College and Rajindra Hospital, the life and ensuring the best possible quality of life to the surviving patient. Patiala, Punjab, 1Medical The use of harmonic scalpel has proved to be beneficial in a variety of surgeries Student, All India Institute but its role in breast surgery is still controversial. Aims: We conducted this of Medical Sciences, Abstract study to compare the intraoperative and postoperative outcomes in modified New Delhi, India radical mastectomy using harmonic scalpel versus electrocautery. Subjects and Methods: Fifty female patients with confirmed diagnosis of breast carcinoma and planned for modified radical mastectomy were taken up for surgery. Twenty‑five patients were operated using harmonic scalpel (Group A) and another 25 were operated using unipolar cautery (Group B). Results: The mean operative time was significantly longer with harmonic scalpel when compared to that with electrocautery (140.40 ± 29.96 vs. 99.80 ± 24.00 min, P < 0.001). The smaller amount of drainage content (431.60 ± 145.94 vs. 594.20 ± 278.63, P = 0.013) and intraoperative blood loss (426.00 ± 76.54 vs. 502.00 ± 104.56, P = 0.005) in the group operated with the ultrasound harmonic scalpel was statistically significant.
    [Show full text]
  • Comparative Study of the Prevention of Seroma Formation in Immediate Breast Reconstruction with Latissimus Dorsi Myocutaneous Flaps
    ORIGINAL https://doi.org/10.14730/aaps.2020.02096 aaps Arch Aesthetic Plast Surg 2020;26(3):92-98 Archives of ARTICLE pISSN: 2234-0831 eISSN: 2288-9337 Aesthetic Plastic Surgery Comparative study of the prevention of seroma formation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps Seok Won Hong1, Da Woon Lee1, Background Latissimus dorsi (LD) flaps are often used in breast reconstruction proce- Hwan Jun Choi1, Eun Soo Park2, dures, but seroma formation is a frequent complication. To decrease the incidence of Jun Hyuk Kim1 seroma formation, fibrin sealants and/or quilting sutures have been proposed, with controversial results. The primary objective of this study was to assess the effective- 1 Department of Plastic and ness of the Harmonic scalpel in association with Tisseel and three-point deep dermal Reconstructive Surgery, Soonchunhyang sutures in reducing the incidence of this complication. University Cheonan Hospital, Soonchunhyang University College of Methods A retrospective study was conducted of 108 patients undergoing immediate Medicine, Cheonan; 2Department of unilateral breast reconstruction with LD flaps over a 3-year period (2016–2018) by a sin- Plastic and Reconstructive Surgery, gle surgeon. In the experimental group, 37 patients underwent the procedure with a Soonchunhyang University Bucheon Harmonic scalpel and three-point deep dermal sutures (a modified version of quilting Hospital, Soonchunhyang University sutures), and the other 71 received conventional electrocautery. Fibrin sealant was ap- College of Medicine, Bucheon, Korea plied to the donor site of all patents to reduce seroma formation. Results Statistically significant differences in the incidence of seroma were found be- tween the two groups.
    [Show full text]