Prevention of stomal complications

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20745-e20745
Author(s):  
M. V. Phadke
Keyword(s):  
Wound Healing ◽  
Deleterious Effect ◽  
Rectus Sheath ◽  
High Rate ◽  
Tube Lumen ◽  
Stomal Complications ◽  
Round Opening ◽  
Bacterial Migration ◽  
A Minor

e20745 Background: Ileostomy/Colostomy operations are associated with a high rate of infections and complications resulting in increased morbidity, mortality and litigation. Pathogenesis of each complication and role of Nature was observed. Technique of stomal maturation was modified. Surgeon must maintain control over the stoma at all times. Primary maturation of stoma is unnecessary and potentially harmful. Opening stomal lumen in O.R. is unscientific and allows bacteria to contaminate stomal and main wounds. Methods: Concept was evolved by serendipity in April 1986. Since then it has been used on all patients requiring an Ileostomy or Colostomy. Bacterial migration is prevented by keeping the lumen obstructed. Iatrogenic obstruction of small/large intestine has no deleterious effect on post-operative course. Obstructed bowel is brought out of opening at proposed site of stoma. Mesenteric corner of obstructed stoma is always above the skin. Anti-mesenteric surface is pulled out till the anti-mesenteric corner becomes the apex of a conical stoma. Serosa is sutured to a round opening in the rectus sheath. Stoma is covered by an appliance with a transparent pouch. Peristalsis starts in about 48–72 hours. When obstructed stoma bulges, it is opened with electrocautery as a minor bedside procedure. Diet is started. Peristalsis pushes mucosal cuff which protrudes, everts and auto-grafts over angiogenesis. This is based on Delayed-Primary (DP) wound healing. Mucosal cuff comes in contact with dermis of skin opening at stomal site completing Self-Maturation (SM). During SM, mucosal tube separates from serosal tube. Peristalsis continues to exert its effect on serosal tube but not on mucosal tube. Lumen of stoma remains concentric. Results: 65 Colostomies and 15 Ileostomies were performed using DPSM technique. Infection and complications were prevented. Minor complications were handled easily. Patient satisfaction was excellent. Conclusions: Primary maturation of stoma is unnecessary and potentially harmful and should be replaced by DPSM. It can be performed in all types of stoma construction, end or loop, temporary or permanent. It prevents infection and complications in all patients. No significant financial relationships to disclose.

New “sutureless” technique of ileostomy and colostomy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15132-e15132
Author(s):  
M. V. Phadke ◽  
L. H. Stocks ◽  
Y. G. Phadke
Keyword(s):  
Wound Healing ◽  
Foreign Body Reaction ◽  
Rectus Sheath ◽  
Single Layer ◽  
Emergency Operation ◽  
Operation Technique ◽  
Sutureless Technique ◽  
Round Opening ◽  
Mesenteric Vessels ◽  
Tissue Trauma

e15132 Purpose: Purpose is to prevent infection and subsequent complications following construction of either an Ileostomy or a colostomy in an elective or emergency operation. Technique is based on delayed-primary wound healing and established principles of basic sciences. Methods: Discovered by serendipity in 1986 during an Ileostomy, procedure was used for all stomata. Stomal (proximal) end of bowel (small/large) was left obstructed with staples and brought out at proposed site of stoma. Mesenteric corner was brought above skin opening. A cone was formed by lifting anti-mesenteric corner of bowel as apex of the stoma by pulling anti-mesenteric surface of bowel. Length of the stoma was determined by thickness of the abdominal wall. Serosa was sutured circumferentially to a round opening in rectus sheath starting below the mesenteric corner leaving an arc to accommodate the mesenteric vessels. This neutralized pulling effect of peristalsis on mesenteric corner of stoma and protects mesentery under skin reducing the chances of thrombosis of mesenteric vessels. Stoma was covered in OR using an appliance with transparent pouch. Obstructed stoma prevented immediate contamination of stomal and main wounds by feces. Postoperatively, serosal surface was covered by angiogenesis, making the stomal wound refractory to infection. When peristalsis returned, bulging stoma was opened using electro-cautery as a bedside procedure. Mucosal cuff protrudes and everts on angiogenesis over a single layer of serosa. Cuff progresses with peristalsis and grafts over a bed of granulation tissue. Margins of cuff adhere with dermis of skin opening completing self-maturation of stoma. Absence of sutures reduced tissue trauma and eliminated foreign body reaction resulting in better wound healing. This new scientific technique was named “DELAYED-PRIMARY SELF-MATURATION (DPSM)”. Results: 63 Colostomies and 17 Ileostomies were performed using DPSM. Infection in stomal and/or main wound was prevented. Subsequent complications were prevented. Conclusions: DPSM prevents infection and complications associated with Ileostomy and Colostomy operations. It is technically easier and more scientific than a conventional stoma. This technique is recommended for all cases requiring end/loop, temporary/permanent types of intestinal stomas. No significant financial relationships to disclose.

The Effect of Path Length and Display Size on Memory for Spatial Information

2012 ◽  
Vol 59 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Katherine Guérard ◽  
Sébastien Tremblay
Keyword(s):  
Path Length ◽  
Potential Role ◽  
Spatial Information ◽  
Recall Performance ◽  
Minor Role ◽  
Length Effect ◽  
Serial Memory ◽  
Fixed Reference ◽  
A Minor

In serial memory for spatial information, some studies showed that recall performance suffers when the distance between successive locations increases relatively to the size of the display in which they are presented (the path length effect; e.g., Parmentier et al., 2005) but not when distance is increased by enlarging the size of the display (e.g., Smyth & Scholey, 1994). In the present study, we examined the effect of varying the absolute and relative distance between to-be-remembered items on memory for spatial information. We manipulated path length using small (15″) and large (64″) screens within the same design. In two experiments, we showed that distance was disruptive mainly when it is varied relatively to a fixed reference frame, though increasing the size of the display also had a small deleterious effect on recall. The insertion of a retention interval did not influence these effects, suggesting that rehearsal plays a minor role in mediating the effects of distance on serial spatial memory. We discuss the potential role of perceptual organization in light of the pattern of results.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

The role of angiopoetic factors in wound healing among patients with diabetes treated with negative-pressure wound therapy

Leczenie Ran ◽  
2015 ◽  
Vol 11 (4) ◽  
pp. 171-178
Author(s):  
Beata Mrozikiewicz-Rakowska ◽  
Joanna Kania ◽  
Ewelina Bucior ◽  
Adriana Nowak ◽  
Tomasz Grzela ◽  
...  
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Patients With Diabetes

Role of iron in wound healing

Leczenie Ran ◽  
2013 ◽  
Vol 10 (2) ◽  
pp. 41-45
Author(s):  
Ewa Rojczyk-Gołębiewska ◽  
Marek Kucharzewski ◽  
Katarzyna Wilemska-Kucharzewska ◽  
Artur Pałasz
Keyword(s):  
Wound Healing

THE ROLE OF ANTHROPONYMS IN THE SEMANTIC FIELD OF ARTISTIC WORKS

2019 ◽  
Vol 2019 (29) ◽  
pp. 66-77
Author(s):  
Lidiya Derbenyova
Keyword(s):  
Literary Work ◽  
Main Theme ◽  
Semantic Field ◽  
New Meanings ◽  
Minor Part ◽  
The One ◽  
A Minor ◽  
And Storage ◽  
Horizon Of Expectations

The article explores the role of antropoetonyms in the reader’s “horizon of expectation” formation. As a kind of “text in the text”, antropoetonyms are concentrating a large amount of information on a minor part of the text, reflecting the main theme of the work. As a “text” this class of poetonyms performs a number of functions: transmission and storage of information, generation of new meanings, the function of “cultural memory”, which explains the readers’ “horizon of expectations”. In analyzing the context of the literary work we should consider the function of antropoetonyms in vertical context (the link between artistic and other texts, and the groundwork system of culture), as well as in the context of the horizontal one (times’ connection realized in the communication chain from the word to the text; the author’s intention). In this aspect, the role of antropoetonyms in the structure of the literary text is extremely significant because antropoetonyms convey an associative nature, generating a complex mechanism of allusions. It’s an open fact that they always transmit information about the preceding text and suggest a double decoding. On the one hand, the recipient decodes this information, on the other – accepts this as a sort of hidden, “secret” sense.

Crucial role of physiotherapy in treating COVID-19 patients

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 967-971
Author(s):  
Poonam Thakre ◽  
Waqar M. Naqvi ◽  
Trupti Deshmukh ◽  
Nikhil Ingole ◽  
Sourabh Deshmukh
Keyword(s):  
Public Health ◽  
Distress Syndrome ◽  
Public Health Problem ◽  
Public Health Emergency ◽  
High Rate ◽  
Major Public Health Problem ◽  
Front Line ◽  
The Many ◽  
Sixth International

The emergence in China of 2019 of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) previously provisionally names 2019-nCoV disease (COVID19) caused major global outbreak and is a major public health problem. On 30 January 2020, the WHO declared COVID19 to be the sixth international public health emergency. This present pandemic has engrossed the globe with a high rate of mortality. As a front line practitioner, physiotherapists are expected to be getting in direct contact with patients infected with the virus. That’s why it is necessary for understanding the many aspects of their role in the identification, contains, reduces and treats the symptoms of this disease. The main presentation is the involvement of respiratory system with symptoms like fever, cough, sore throat, sneezing and characteristics of pneumonia leads to ARDS(Acute respiratory distress syndrome) also land up in multiorgan dysfunction syndrome. This text describes and suggests physiotherapy management of acute COVID-19 patients. It also includes recommendations and guidelines for physiotherapy planning and management. It also covers the guidelines regarding personal care and equipment used for treatment which can be used in the treatment of acute adult patients with suspected or confirmed COVID-19.

Role of topical insulin therapy as an adjunct in the management of pressure ulcer

2020 ◽  
Vol 2 (3) ◽  
pp. 01-03
Author(s):  
Ravi Chittoria
Keyword(s):  
Wound Healing ◽  
Insulin Therapy ◽  
Pressure Ulcer ◽  
Healing Rate ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Established Method ◽  
Wound Bed Preparation ◽  
Wound Healing Rate

Pressure ulcer or pressure sore is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. Various adjunctive methods are used for wound bed preparation before definitive reconstruction plan is made. Here we describe our experience in the role of insulin therapy as an adjunct in the management of pressure sores.

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