Postoperative care

2021 ◽  
pp. 235-242
Author(s):  
Usman Latif ◽  
Tyler Concannon ◽  
Andrew Frazier
Keyword(s):  
Postoperative Care ◽  
Wound Care ◽  
Recovery Period ◽  
Operating Time ◽  
Surgical Techniques ◽  
Bone Allograft ◽  
Normal Activity ◽  
Postoperative Recovery ◽  
Short Period

This chapter discusses postoperative recommendations, including ambulation, wound care, antibiotic guidelines, and follow-up interval, for patients who have undergone open surgical SIJ fusion versus minimally invasive (MIS) SIJ fusion. Postoperative care varies widely based on the surgical approach. In particular, patients undergoing MIS are less likely to be admitted, ambulate sooner, have a shorter period of less stringent restrictions, and have faster wound healing with fewer complications. These benefits are due to a variety of factors including shorter incision length, less tissue disruption, decreased operating time, and less blood loss. This benefit is most pronounced with approaches that do not involve the use of hardware. Patients undergoing open surgery typically progress through a 4- to 5-month phased plan of progressive physical therapy. In contrast, patients undergoing MIS, particularly percutaneous SIJ fusion with bone allograft, are able to ambulate immediately and have a short period of mild restrictions followed by return to normal activity. The advent of new surgical techniques and less invasive solutions for SIJ fusion is leading the way to an easier postoperative recovery period for patients.

Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease

2017 ◽  
Vol 83 (10) ◽  
pp. 1045-1049 ◽  
Author(s):  
Farees Ricky Tavangari ◽  
Jennifer Amy Lee ◽  
David Garza ◽  
Talar Tejirian
Keyword(s):  
Postoperative Care ◽  
Recurrent Disease ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Surgical Techniques ◽  
Complete Healing ◽  
Skin Closure ◽  
Chronic Abscess ◽  
Healing Wounds

Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.

scholarly journals Gracilis Myocutaneous Flap: Adding to the Armamentarium of Complex Sacrococcygeal Defect Reconstruction

2019 ◽  
Vol 52 (02) ◽  
pp. 246-249
Author(s):  
K. Preetha Rani ◽  
J. Satish Kumar ◽  
V. Singaravelu ◽  
Fernandes Deyonna
Keyword(s):  
Myocutaneous Flap ◽  
Recovery Period ◽  
Postoperative Recovery ◽  
Skin Closure ◽  
Uneventful Postoperative Recovery ◽  
Vram Flap ◽  
Reconstructive Option ◽  
Vertical Rectus Abdominis Myocutaneous ◽  
Gracilis Myocutaneous Flap

Abstract Background With increasing radicality of rectal cancer surgeries, the postoperative defects are becoming more complex. This demands an ideal reconstructive option with minimal morbidity to the patient. Although vertical rectus abdominis myocutaneous (VRAM) flap is the commonly used flap, gracilis myocutaneous flap is increasingly being performed to avoid morbidity associated with VRAM flap. Results We share our experience about two of our patients treated for rectal malignancy with pelvic exenteration who were reconstructed immediately with pedicled gracilis myocutaneous flap. Both the patients had an uneventful postoperative recovery period and were discharged on postoperative day 10. During follow-up period both patients had a healthy flap with no evidence of recurrence. No perineal hernias or gross dehiscence of skin closure occurred. Conclusion Gracilis myocutaneous flap has its own place with unique advantages adding to the armamentarium of reconstructive options for complex perineal defects, thereby avoiding the morbidity associated with VRAM flap. It stands as a reliable alternative in patients where VRAM cannot be used.

scholarly journals Neutralized Chemical Matricectomy with the Winograd Method in the Management of Ingrowing Toenail

2014 ◽  
Vol 1 (2) ◽  
pp. 55-59
Author(s):  
Sanjay Agarwala ◽  
Anshul Shyam Sobti ◽  
Ganesh Mohrir
Keyword(s):  
Functional Limitation ◽  
Normal Activity ◽  
Deep Infection ◽  
Postoperative Recovery ◽  
Asia Pacific ◽  
Average Return ◽  
Surgical Methods ◽  
Good Cosmetic ◽  
High Level

ABSTRACT Background Ingrowing toenail is a common condition provoking pain, inflammation and functional limitation. Many surgical methods have evolved over the years for its treatment. The most important aspect of treatment of this problem is to prevent recurrence. The purpose of this paper was to study the effectiveness of combining the standard Winograd technique with neutralized chemical matricectomy to reduce the chances of recurrence and expedite postoperative recovery. Materials and methods Between 2006 and 2013, 33 patients (18 males, 15 females); with mean age 37.39 years (range 16 to 65 years) with 38 ingrowing toenails were treated with the standard Winograd technique combined with phenol matricectomy. The patients were evaluated in subsequent follow-ups for postoperative relapse, pain score (VAS) and time return to daily activities and ability to wear footwear and overall satisfaction. The mean follow-up period was 3.57 years (range 2 to 7 years). Results A total of 94.73% patients were satisfied with the overall outcome. The average return to normal shoe-wear was 1.54 weeks and the average return to normal activity was 1.18 weeks. Recurrence was seen in two patients (5.26%), 5 and 6 months after surgery. Four patients had delayed healing. None of the patients had any deep infection or neurovascular complications. Conclusion The Winograd technique when combined with neutralized phenol matricectomy is associated with a very low recurrence and infection rate. It allows early postoperative recovery and good cosmetic results with a high level of patient satisfaction. How to cite this article Agarwala S, Sobti AS, Mohrir G. Neutralized Chemical Matricectomy with the Winograd Method in the Management of Ingrowing Toenail. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):55-59.

scholarly journals Myomectomy by vaginal route

2004 ◽  
Vol 132 (1-2) ◽  
pp. 18-21 ◽  
Author(s):  
Zagorka Milovanovic ◽  
Dusan Stanojevic
Keyword(s):  
Operating Time ◽  
Surgical Techniques ◽  
Posterior Wall ◽  
Postoperative Recovery ◽  
Surgical Instruments ◽  
Prospective Clinical Study ◽  
Vaginal Route ◽  
Operative Blood Loss ◽  
Operative Trauma ◽  
Vaginal Myomectomy

In recent years, the development of new surgical techniques in uterus myoma treatment have reduced operative trauma significantly. Our objective was to present operative technique-vaginal myomectomy, making a prospective clinical study where we have evaluated the operative and postoperative period after intentive diagnosis. The result of our study shows the feasibility of myomectomy by entering the peritoneum through the posterior vaginal fornix, using traditional and cheap surgical instruments and thus avoiding the trauma of laparatomy, minimal operative blood loss, reduced operating time and postoperative recovery. In our opinion, vaginal myomectomy could be useful for the treatment of selected cases with fundal or posterior wall uterine myomas.

Mid-term outcomes of surgical treatment in fractures in patients with osteopetrosis

2020 ◽  
Vol 102-B (8) ◽  
pp. 1082-1087
Author(s):  
Şeyhmus Yiğit ◽  
Hüseyin Arslan ◽  
Mehmet S. Akar ◽  
Mehmet A. Şahin
Keyword(s):  
Operating Time ◽  
Surgical Techniques ◽  
Femoral Shaft ◽  
Hereditary Disease ◽  
Medullary Canal ◽  
Bony Union ◽  
Elastic Nail ◽  
Children And Young Adults ◽  
Closed Fractures

Aims Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. Methods This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. Results The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. Conclusion Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082–1087.

scholarly journals Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Giovanni Romeo ◽  
Alberto Bianchi ◽  
Vincenzo Cerbone ◽  
Matteo Maria Parrini ◽  
Francesco Malerba ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Bone Allograft ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Metallic Implant ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Medial Cuneiform ◽  
Forefoot Varus

Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

scholarly journals Holding It Together�Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Karuna Dahlberg ◽  
Maria Jaensson ◽  
Ulrica Nilsson ◽  
Mats Eriksson ◽  
Sigrid Odencrants
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Recovery Period ◽  
Day Surgery ◽  
Postoperative Recovery ◽  
Mobile App ◽  
Care Organization ◽  
Next Of Kin ◽  
Qualitative Interview Study

BACKGROUND There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery. OBJECTIVE The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery. METHODS This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis. RESULTS A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin. CONCLUSIONS It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Head Injury ◽  
Brain Tumour ◽  
Severe Head Injury ◽  
Case Reports ◽  
Subsequent Development ◽  
Malignant Brain Tumour ◽  
Tumour Development ◽  
Short Period ◽  
The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

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