Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 8 Articles
Successful wound care involves optimizing patient local and systemic conditions in conjunction with an ideal wound healing\nenvironment. Many different products have been developed to influence this wound environment to provide a pathogen-free,\nprotected, and moist area for healing to occur. Newer products are currently being used to replace or augment various substrates\nin the wound healing cascade. This review of the current state of the art in wound-healing products looks at the latest applications\nof silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative\npressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications,\nand hyperbaric oxygen as an adjunct in wound healing. With the abundance of available products, the goal is to find the most\nappropriate modality or combination of modalities to optimize healing....
Objectives. To describe trends and category of disabilities caused by Buruli ulcer disease. Design. This retrospective study was set up\r\nto quantify information on the disability trends caused by Buruli ulcer (BU) using data on patients attending BU and chronic ulcer\r\nclinics from 2004 to 2009, at Global Evangelical Mission Hospital, Apromase. Methods. Data was retrieved from the WHO BU1\r\nform, case registry book, surgical theatre register, and BU patientsâ�� records book of the hospital. Disability was measured as the\r\nincapability of patients to perform one or more daily activities due to his/her state of BU disease before treatment. Results. A total\r\nof 336 positive BU cases comprising 181 males (53.9%) were recorded of which 113 (33.6%) cases of disabilities were identified.\r\nA mean age of 52.5 (�±1.32) years was recorded. For the trend of disabilities, the year 2009 recorded the highest (N = 34, 31.0%).\r\nThe lesions were mostly located at the lower limbs (N = 65, 57.5%) region of the patients. Lesions with diameter >15 cm were the\r\nmajor (59.3%) category of lesions. Conclusion. Trend of disability reveals proportional increase over the years from 2004 to 2009.\r\nContracture at the knee and ankle joints was the commonest disability recorded...
Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful\r\nappearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal\r\ntendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to\r\nbe corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity\r\nand intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous\r\nsurgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just\r\nas important as surgical technique....
Background. The goals of this project were to evaluate the current perspective on letters of recommendation and to assess the need\nfor, and acceptance of, a more standardized letter of recommendation (LOR). Methods. An eight-question survey was distributed\nto plastic surgery program directors. A five-point Likert scale was selected as a means of quantifying the participantsâ�� responses\nto the survey. Results. Twenty-eight of 71 program directors (39.4%) completed the survey. The majority of participants felt that\ncurrent LOR did not offer a realistic way to compare applicants (mean �± SD, 2.9 �± 0.8). While most agreed that increasing the\nobjectivity of LOR would be valuable in comparing applicants (mean �± SD, 4.1 �± 0.9), the overall average response to whether\na more standardized letter format would improve the resident selection process remained only slightly better than neutral\n(mean �± SD, 3.5 �± 1.2). Most of the chairmen supported the notion that familiarity with the author of the LOR strengthened\nthe recommendation (mean �± SD, 4.5 �± 0.6). Conclusion. The majority of plastic surgery program directors would like more\nobjectivity in comparing applicants but are ambivalent about a standardized letter of recommendation....
This is a paper reviewing the National Health Service (NHS) agenda in relation to the use of Negative Pressure Wound Therapy\r\n(NPWT) in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on\r\npatients� satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost\r\neffectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence\r\nto support its usage in chronic wounds with potential positive outcomes on finance and patients� satisfaction. However, the NHS\r\nsystem shows significant variations in the availability and implementation of this useful tool, depending on care providers and\r\nresources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound\r\nmanagements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing\r\nthe NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability\r\nand indication of this tool to assure equal opportunities for different patients in different areas in the country....
Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic\r\nScalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of\r\nthis study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical\r\ninstruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery\r\nbetween March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used\r\nin 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group), and in\r\nthe other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group). The following\r\nparameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower\r\nin the HS group), blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of\r\nthe Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps....
Diabetic foot ulcerations are historically difficult to treat despite advanced therapeutic modalities. There are numerous modalities\ndescribed in the literature ranging from noninvasive topical wound care to more invasive surgical procedures such as primary\nclosure, skin flaps, and skin grafting. While skin grafting provides faster time to closure with a single treatment compared to\ntraditional topical wound treatments, the potential risks of donor site morbidity and poor wound healing unique to the diabetic\nstate have been cited as a contraindication to its widespread use. In order to garner clarity on this issue, a literature review was\nundertaken on the use of split-thickness skin grafts on diabetic foot ulcers. Search of electronic databases yielded four studies that\nreported split-thickness skin grafts as definitive means of closure. In addition, several other studies employed split-thickness skin\ngrafts as an adjunct to a treatment that was only partially successful or used to fill in the donor site of another plastic surgery\ntechnique.When used as the primary closure on optimized diabetic foot ulcerations, split-thickness skin grafts are 78% successful\nat closing 90% of the wound by eight weeks....
Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap.\nHowever, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery.With the introduction\nof perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time\nconsuming, and with minimal donor site morbidity.When local perforator flap is designed as propeller and rotated to 180 degree,\ndonor site is closed primarily and increases reach of flap, thus increasing versatility. Material andMethods. From June 2008 toMay\n2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator\nof posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm Ã?â?? 3.5 cm to 7 cm Ã?â?? 5 cm. Results. One\npatient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which\nsubsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily\nin all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for\ndistal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique\nis convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result....
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