A Case of a Patient Who Successfully Achieved Early Wound Closure by Local Negative Pressure Wound Therapy (NPWT) against Compromised Wound Healing after Arterio-Venous Graft Infection

The primary treatment strategy for arterio-venous graft (AVG) infection includes appropriate antibiotic use and removal of the infected graft. It is well known that patients with hemodialysis are likely to experience compromised wound healing, which often leads to various postoperative complications. Negative pressure wound therapy (NPWT) is a non-invasive procedure that promotes wound healing by sealing the wound under negative pressure. Although NPWT is practically accepted in general surgery, there are only a few reports of this strategy to the vascular access operation for patients with hemodialysis due to the possibility of severe bleeding. In the present report, we report a case of a patient who successfully achieved safe and early wound closure by NPWT against compromised wound healing after AVG infection.

Early detection of complications in pancreas transplants by microdialysis catheters, an observational feasibility study

Background Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged. Methods To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1–2 hours. Results Nine patients with graft venous thrombosis had significant lactate and lactate–to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas. Conclusions Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging.

AN EXCEPTIONAL CASE OF A POSTERIOR PURE OPEN DISLOCATION OF THE ELBOW WITH RUPTURE OF THE BRACHIAL ARTERY

Pure open dislocation of the elbow remains a very rare entity, being associated with a complete rupture of the brachial artery make it more exceptional, the therapeutic strategy is very discussed. The vascular repair is essentially based on a venous graft which can be collected from different sites, the second challenge is to reduce and maintain the stability of the elbow.The course ofthis different operatory times represents the real challenge in front of that type of traumas. We report a case of a young man admitted in the emergency room with an open pure elbow dislocation with rupture of the brachial artery, treated by a venous graft and reparation of the elbow capsular with an elbow immobilization by an ulno-humeral pin and with a satisfactory evolution in a long term.

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

Domino-liver transplantation represents a rare chance to expand the donor liver pool. Fear of putting both donor and recipient at disadvantage has meant that the procedure has not been applied universally. A modification of the original technique which allows both safe procurement of the graft as well as safe implantation of the reconstructed graft in the domino-graft recipient using a 180° rotated, adequately trimmed, free iliaco-caval venous graft is described in detail.