Cefazolin-based Antimicrobial Prophylaxis May Reduce Surgical Site Infections in Patients Undergoing Peripheral Vascular Bypass Surgery

ABSTRACT:Ischemic monomelic neuropathy (IMN) is a little-known, painful axonal neuropathy, secondary to vascular occlusion or steal phenomenon. It typically occurs after vascular bypass, hemodialysis fistulization, or diabetic microvascular disease in the absence of significant clinical features of ischemia. There is limited literature to assist in the characterization and diagnosis of this condition. We describe three patients with IMN with no surgical or peripheral vascular disease history who exhibited spontaneous, persistent foot pain, edema numbness, and weakness with denervation on needle electromyogram in a distal lower leg peripheral nerve distribution. Occlusive disease was found in all patients on angiogram, requiring vascular bypass surgery.

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Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

International Journal of Angiology ◽

10.1055/s-0040-1720970 ◽

2020 ◽

Author(s):

Ahmed Mousa ◽

Ossama M. Zakaria ◽

Mai A. Elkalla ◽

Lotfy A. Abdelsattar ◽

Hamad Al-Game'a

Keyword(s):

Severity Score ◽

Vein Graft ◽

Bypass Surgery ◽

Age Groups ◽

Vascular Injuries ◽

Peripheral Vascular ◽

Group Iii ◽

Mangled Extremity ◽

Group I ◽

End To End

AbstractThis study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 40.5 and 49%, respectively. On the other hand, 10.5% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma (p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury (p = 0.001). The MESS has a significant correlation to both age groups I and II (p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

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Faculty Opinions recommendation of Preoperative pulse pressure and major perioperative adverse cardiovascular outcomes after lower extremity vascular bypass surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717598014.793052925 ◽

2012 ◽

Author(s):

Praveen Neema ◽

Satyajeet Misra

Keyword(s):

Lower Extremity ◽

Pulse Pressure ◽

Bypass Surgery ◽

Cardiovascular Outcomes ◽

Vascular Bypass

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Feasibility study on retinal vascular bypass surgery in isolated arterially perfused caprine eye model

Eye ◽

10.1038/eye.2011.197 ◽

2011 ◽

Vol 25 (11) ◽

pp. 1499-1503 ◽

Cited By ~ 6

Author(s):

Y Chen ◽

W Wu ◽

X Zhang ◽

W Fan ◽

L Shen

Keyword(s):

Feasibility Study ◽

Bypass Surgery ◽

Eye Model ◽

Vascular Bypass

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Trends in orthopaedic antimicrobial prophylaxis in the UK between 2005 and 2011

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960047038 ◽

2013 ◽

Vol 95 (7) ◽

pp. 495-502 ◽

Cited By ~ 12

Author(s):

RS Aujla ◽

DJ Bryson ◽

A Gulihar ◽

GJ Taylor

Keyword(s):

Orthopaedic Surgery ◽

Methicillin Resistant Staphylococcus Aureus ◽

Elective Surgery ◽

Antimicrobial Prophylaxis ◽

Trauma Surgery ◽

Surgical Site Infections ◽

Freedom Of Information ◽

Infection Rates ◽

Freedom Of Information Act ◽

The Uk

Introduction Antimicrobial prophylaxis remains the most powerful tool used to reduce infection rates in orthopaedics but the choice of antibiotic is complex. The aim of this study was to examine trends in antimicrobial prophylaxis in orthopaedic surgery involving the insertion of metalwork between 2005 and 2011. Methods Two questionnaires (one in 2008 and one in 2011) were sent to all National Health Service trusts in the UK using the Freedom of Information Act. Results In total, 87% of trusts that perform orthopaedic surgery responded. The use of cefuroxime more than halved between 2005 and 2011 from 80% to 36% and 78% to 26% in elective surgery and trauma surgery respectively. Combination therapy with flucloxacillin and gentamicin rose from 1% to 32% in elective and 1% to 34% in trauma surgery. Other increasingly popular regimes include teicoplanin and gentamicin (1% to 10% in elective, 1% to 6% in trauma) and co-amoxiclav (3% to 8% in elective, 4% to 14% in trauma). The majority of changes occurred between 2008 and 2010. Over half (56%) of the trusts stated that Clostridium difficile was the main reason for changing regimes. Conclusions In 2008 a systematic review involving 11,343 participants failed to show a difference in surgical site infections when comparing different antimicrobial prophylaxis regimes in orthopaedic surgery. Concerns over C difficile and methicillin resistant Staphylococcus aureus have influenced antimicrobial regimes in both trauma and elective surgery. Teicoplanin would be an appropriate choice for antimicrobial prophylaxis in both trauma and elective units but this is not reflected in its current level of popularity.

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