scholarly journals Damage control hip disarticulation: two-stage operation with index creation of a large medial flap for the septic hip

2020 ◽  
Vol 5 (1) ◽  
pp. e000502
Author(s):  
Christina Colosimo ◽  
Charles Fredericks ◽  
James R Yon ◽  
John C Kubasiak ◽  
Faran Bokhari ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hospital Discharge ◽  
High Mortality ◽  
Wound Care ◽  
Damage Control ◽  
Mortality Rates ◽  
Consecutive Series ◽  
Postoperative Wound ◽  
Hindquarter Amputation

BackgroundAlthough rarely performed, hip disarticulation (HD) is usually used for the patient with a non-viable leg who is also in extremis. HD was first used for trauma and infection; however, the technique was perfected during the age of hindquarter amputation for osteosarcomas. The operation performed by most surgeons today is still based on the oncological principles of high vessel control and ligation. When this approach has been used in the overwhelmingly infected or mangled extremity, it has resulted in high mortality rates. During the last 20 years, the concept of damage control operation has been embraced by emergency surgeons in all fields. We sought to extrapolate this concept and to apply it to the non-viable lower extremity.MethodsWe describe a new concept of damage control HD, review the technique and discuss our consecutive series of nine patients who underwent the procedure for trauma or necrotizing infection without flap dehiscence or mortality.ResultsAll patients survived to hospital discharge. At time of discharge or at follow-up, six of the nine patients were able to transfer to a wheelchair.DiscussionProper disarticulations for infection need to address these two operative and postoperative issues: damage control debridement with creation of sufficient flap size and thorough postoperative wound care.Level IV

scholarly journals Survival and factors predicting mortality after major and minor lower-extremity amputations among patients with diabetes: a population-based study using health information systems

2020 ◽  
Vol 8 (1) ◽  
pp. e001355
Author(s):  
Silvia Cascini ◽  
Nera Agabiti ◽  
Marina Davoli ◽  
Luigi Uccioli ◽  
Marco Meloni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Renal Disease ◽  
High Mortality ◽  
Chronic Renal Disease ◽  
Mortality Rates ◽  
Population Based ◽  
Term Survival ◽  
Factors Associated ◽  
Patients With Diabetes

IntroductionThe aim of the study was to identify the sociodemographic and clinical factors associated with death after the first lower-extremity amputation (LEA), minor and major separately, using data from regional health administrative databases.Research design and methodsWe carried out a population-based cohort study including patients with diabetes residing in the Lazio region and undergoing a primary amputation in the period 2012–2015. Each individual was followed up for at least 2 years. Kaplan-Meier analysis was used to evaluate long-term survival; Cox proportional regression models were applied to identify factors associated with all-cause mortality.ResultsThe cohort included 1053 patients, 72% were male, 63% aged ≥65 years, and 519 (49%) died by the end of follow-up. Mortality rates at 1 and 4 years were, respectively, 33% and 65% for major LEA and 18% and 45% for minor LEA. Significant risk factors for mortality were age ≥65, diabetes-related cardiovascular complications, and chronic renal disease for patients with minor LEA, and age ≥75 years, chronic renal disease and antidepressant drug consumption for subjects with major LEA.ConclusionsThe present study confirms the high mortality rates described in patients with diabetes after non-traumatic LEA. It shows differences between minor and major LEA in terms of mortality rates and related risk factors. The study highlights the role of depression as specific risk factor for death in patients with diabetes after major LEA and suggests including its definition and management in strategies to reduce the high mortality rate observed in this group of patients.

High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up

2000 ◽  
Vol 94 (3) ◽  
pp. 305-309 ◽  
Author(s):  
C. Kang'ombe ◽  
A.D. Harries ◽  
H. Banda ◽  
D.S. Nyangulu ◽  
C.J.M. Whitty ◽  
...  
Keyword(s):  
High Mortality ◽  
Mortality Rates ◽  
Tuberculosis Patients

V. Cause of Death

1991 ◽  
Vol 159 (S13) ◽  
pp. 30-33 ◽  
Author(s):  
C. Anderson ◽  
J. Connelly ◽  
Eve C. Johnstone ◽  
D. G. C. Owens
Keyword(s):  
Cause Of Death ◽  
High Mortality ◽  
Mentally Ill ◽  
Mortality Rates ◽  
Point Of View ◽  
Extensive Literature ◽  
Linkage Studies ◽  
Schizophrenic Patients ◽  
Large Groups

High mortality rates among schizophrenic patients from infectious diseases, particularly tuberculosis, pneumonia and gastro-enteritis, reported for periods up to the 1940s were shown not to be specific for schizophrenia, but were characteristic of the mental hospital population as a whole (Alstrom, 1942). Studies covering more recent times confirm the decline and virtual disappearance of mortality from tuberculosis (Baldwin, 1979), but an extensive literature continues to emphasise the relatively high mortality of the mentally ill, including those defined as schizophrenic (Innes & Millar, 1970; Tsuang & Woolson, 1977), and more recent record linkage studies (Herrman et al, 1983; Allebeck & Wistedt, 1986) have continued to show an excess of both natural and unnatural deaths. Long follow-up studies of reasonably large groups of well documented cases are relatively uncommon in this area and therefore the 532 cases in the Harrow study were carefully followed up from the point of view of the occurrence and cause of death.

Absorbable Intradermal Closure of Elective Craniotomy Wounds

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS490-ONS492 ◽  
Author(s):  
Sergio Paolini ◽  
Roberta Morace ◽  
Giuseppe Lanzino ◽  
Paolo Missori ◽  
Giovanni Nano ◽  
...  
Keyword(s):  
Wound Healing ◽  
Skin Infection ◽  
Wound Care ◽  
Bed Rest ◽  
Cerebrospinal Fluid Leakage ◽  
Consecutive Series ◽  
Oral Antibiotics ◽  
Superficial Skin ◽  
Closure Method

Abstract Objective: More and more commonly, craniotomies are being performed with minimal hair shaving to improve cosmesis and facilitate return to a normal life. In such patients, traditional sutures or metal staples are used for scalp closure. This practice requires suture removal, often perceived as a cause of discomfort by the patient. We investigate the safety and efficacy of intradermal sutures in a large, consecutive series of patients undergoing elective craniotomy. Methods: Wound healing complications were investigated in a consecutive series of 208 patients who underwent elective craniotomy during a 2-year period. In all patients, minimal shaving, performed by shaving a small strip of hair along the planned wound, was used. Scalp closure was achieved with only absorbable intradermal running sutures. All wounds were covered with sterile adhesive strips, which were kept in place for 24 hours postoperatively. Patients were followed for a mean follow-up period of 10.6 months (range, 1–23 mo). Results: All patients except two had satisfactory wound healing. One patient (0.48%) developed cerebrospinal fluid leakage, which responded to bed rest and lumbar drainage. Another patient (0.48%) had a superficial skin infection, which was successfully treated with topical wound care and oral antibiotics. Conclusion: The closure method described is safe and effective. The absence of visible sutures in the postoperative course reinforces the cosmetic advantage of no shaving and decreases discomfort associated with the removal of sutures or staples.

Surgical Treatment of Pressure Ulcers of the Heel in Skilled Nursing Facilities

2011 ◽  
Vol 101 (2) ◽  
pp. 167-175 ◽  
Author(s):  
Paul Y. Han ◽  
Ruben Ezquerro
Keyword(s):  
Lower Extremity ◽  
Pressure Ulcers ◽  
Wound Care ◽  
Nursing Home Residents ◽  
Complete Healing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Below The Knee ◽  
Leg Amputation

Background: Chronic nonhealing pressure ulcers of the heel in nursing homes are frequent occurrences among bedridden patients with lower-extremity contractures of varying degrees of severity. Conservative local wound care for these patients can be time consuming, ineffective, costly, and may only delay an eventual major leg amputation. This study evaluates the efficacy of limb salvage surgical procedures, partial calcanectomy, total calcanectomy, and excision of the entire calcaneus and talus, for heel ulcers. Methods: We performed a retrospective review of 57 nursing home residents who had chronic infected nonhealing pressure ulcers of the heel that we had treated over 12 years. Forty-three patients underwent partial calcanectomy, nine underwent total calcanectomy, and five underwent excision of the entire calcaneus and talus. Average postoperative follow-up was 15 months. Also included in this study are representative surgical cases. Results: Forty-three patients completed follow-up. Complete healing occurred in 25 patients (58%). Failure to resolve the heel ulcer owing to persistent infection, or recurrence was seen in 18 patients (42%) who eventually had a below-the-knee or above-the-knee amputation. All of the patients with heel pressure ulcers were found to have lower-extremity contractures. Conclusions: In the nonambulatory contracted patient with a heel ulcer, partial or total calcanectomy or excision of the entire calcaneus and talus offer a viable alternative not only for resolution of infection but also for prevention of limb loss. An aggressive plan must also be instituted to address the lower-extremity contractures in order to prevent recurrence. (J Am Podiatr Med Assoc 101(2): 167–175, 2011)

1497-P: Secular Trends in Incidence and One-Year Mortality Rates of Lower Extremity Amputation in People with Diabetes in Hong Kong between 2001 and 2016

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1497-P
Author(s):  
HONGJIANG WU ◽  
AIMIN YANG ◽  
ERIC S. LAU ◽  
RONALD C. MA ◽  
ALICE P. KONG ◽  
...  
Keyword(s):  
Hong Kong ◽  
Lower Extremity ◽  
Mortality Rates ◽  
Secular Trends ◽  
Lower Extremity Amputation ◽  
One Year ◽  
Extremity Amputation

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

scholarly journals Simultaneous Casualty Admissions—Do they Affect Treatment in the Receiving Trauma Center?

2021 ◽  
Author(s):  
Michel Paul Johan Teuben ◽  
Carsten Mand ◽  
Laura Moosdorf ◽  
Kai Sprengel ◽  
Alba Shehu ◽  
...  
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Ct Scanning ◽  
Mortality Rates ◽  
Trauma Centers ◽  
Simultaneous Treatment ◽  
Diagnostic Pathway ◽  
Injured Patients ◽  
The Impact ◽  
Mean Time

Abstract Background Simultaneous trauma admissions expose medical professionals to increased workload. The impact of simultaneous trauma admissions on hospital allocation, therapy, and outcome is currently unclear. We hypothesized that multiple admission-scenarios impact the diagnostic pathway and outcome. Methods The TraumaRegister DGU® was utilized. Patients admitted between 2002–2015 with an ISS ≥ 9, treated with ATLS®- algorithms were included. Group ´IND´ included individual admissions, two individuals that were admitted within 60 min of each other were selected for group ´MULT´. Patients admitted within 10 min were considered as simultaneous (´SIM´) admissions. We compared patient and trauma characteristics, treatment, and outcomes between both groups. Results 132,382 admissions were included, and 4,462/3.4% MULTiple admissions were found. The SIM-group contained 1,686/1.3% patients. The overall median injury severity score was 17 and a mean age of 48 years was found. MULT patients were more frequently admitted to level-one trauma centers (68%) than individual trauma admissions were (58%, p < 0.001). Mean time to CT-scanning (24 vs. 26/28 min) was longer in MULT / SIM patients compared to individual admissions. No differences in utilization of damage control principles were seen. Moreover, mortality rates did not differ between the groups (13.1% in regular admissions and 11.4%/10,6% in MULT/SIM patients). Conclusion This study demonstrates that simultaneous treatment of injured patients is rare. Individuals treated in parallel with other patients were more often admitted to level-one trauma centers compared with individual patients. Although diagnostics take longer, treatment principles and mortality are equal in individual admissions and simultaneously admitted patients. More studies are required to optimize health care under these conditions.

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