The impact of infection on length of stay in adult burns: A scoping review.

BACKGROUND: The disruption to the immune system and profound metabolic response to burn injury gives rise to a unique susceptibility to infection. Indeed, infection is one of the most frequently encountered post-burns complications placing significant burden on patients and healthcare system. Advancements in burn care have led to marked improvements in burn-related mortality and morbidity; however, scarce hospital resources hamper adequate burn-related care, and patient length of stay (LOS) in hospital is an important drain on such resources. The aim of this review was to assess and evaluate the existing literature relating to the impact of infections on LOS in hospitalised, adult burn patients. METHODS: Electronic searches were performed in Medline and Embase. Eligible studies were those reporting on LOS and infection in adult burn populations. Articles published before 2000 were excluded to ensure that the analysis was focused on contemporary literature that reflects current, clinical management of burn patients. RESULTS: Nineteen studies (54,397 burn patients) were included in the review. All studies were retrospective, with the majority undertaken in North America (14 studies). The mean age range was 38-67 years and the majority of patients were male. Inhalation injury was recorded in eleven studies. The most common types of infection included pneumonia, blood stream infections (BSI) and burn wound infections. Overall, there was a trend towards a positive association between infection and LOS. CONCLUSION: The results of this scoping review provide an overview of the existing literature on the relationship between infection and LOS in adult burn populations. However, significant gaps remain in knowledge which call for further high-quality research. Standardised definitions for the collection of infection data and the use of burns specific infection control guidelines are also critical to understanding and improving patient outcomes.

Breast Augmentation in Athletic Women: A Retrospective Survey Assessing Pectoral Muscle Function and Implant Aesthetics Post-Augmentation.

BACKGROUND: Breast augmentation is the most common cosmetic, surgical procedure (1). Implant insertion planes include subglandular or submuscular. Submuscular augmentation is often preferred in women with less soft tissue coverage; requiring pectoralis major dissection (2). However, loss of functional muscle fibres is undesirable in athletic women who actively train the pectoral region. OBJECTIVES: 1. Assessment of pectoralis function and strength after breast augmentation in athletic women. 2. Augmentation aesthetical satisfaction at rest and whilst training. METHODS: A retrospective survey was sent to female, fitness competitors with breast implants via social media over a six-month period. The survey assessed baseline demographics, pectoral strength (bench press, push-ups, pectoral fly), aesthetical satisfaction and issues during training including pain, rippling, firmness and implant movement. RESULTS: Eighty-one participants were surveyed. The mean age of augmentation was 29.7 (±8.41), and mean age of survey completion was 37.6 (±7.22) years. Submuscular augmentation was performed in 72.8% of participants. Recovery post-operative and time spent training was synonymous. The majority of participants' pectoral strength was unaffected or positively affected by breast augmentation. Assessment of post-operative performance and training issues of pain, rippling and firmness yielded no statistically significant difference between groups. Implant movement during pectoral exercises was 2.5 times more likely with submuscular augmentations, p= 0.038. Overall, the majority of the population were very satisfied or satisfied with their breast aesthetic at rest (92.6%) and during training (79.0%). CONCLUSIONS: Breast augmentation in athletic women has a high satisfaction rate with the majority maintaining or improving the strength of the pectoral region regardless of augmentation plane. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .

Small bowel obstruction with situs inversus abdominalis: A case report.

INTRODUCTION: Situs inversus abdominalis (SIA) is an uncommon condition that causes intestinal malrotation in the paediatric population as its primary complication (Brown, 2017). Presentations of acute surgical emergencies in adults secondary to SIA are extremely rare (Brown, 2017). PRESENTATION OF CASE: A 38-year-old female with situs inversus abdominalis (SIA) presented with small bowel obstruction (SBO). The patient had a history of a paediatric omphalocele repair. The patient failed conservative management and required surgical intervention including a laparotomy and adhesiolysis without intestinal resection for resolution of her symptoms. DISCUSSION: Only 2 cases of SBO secondary to SIA have been documented in the literature; both resulting in bowel resection with a 50 % mortality rate (Mallick, 2006). This is the third reported case and the only case to avoid bowel ischemia. We attribute this to early presentation by the patient, prompt imaging, careful surgical planning with consultant led surgical intervention and a multidisciplinary team approach to recovery. CONCLUSION: Acute surgical emergencies in patients with congenital anomalies should have a low threshold for imaging and intervention with detailed pre-operative planning and a senior surgeon led approach.

Management of a nine litre abdominal wall seroma post ventral hernia repairs: A case report.

INTRODUCTION: seromas are a common and challenging complication post mesh hernia repairs (Morales-Conde, 2012; Salamone, 2015; Vasilakis, 2014). PRESENTATION OF CASE: A 52-year-old male was referred to General Surgery with a large abdominal mass in the setting of morbid obesity and multiple abdominal operations culminating in a ventral hernia repair seven years prior. He had no other abdominal symptoms or malignancy red flags. Imaging demonstrated a large, complex anterior abdominal wall seroma of 40 × 25 × 20 cm. No seromas of this size and location have been reported in the literature. DISCUSSION: Surgical management required drainage, partial capsulectomy and scarification of the remnants with multidisciplinary team involvement for recovery including general surgeons, anaesthesia, intensivists and allied health professionals. CONCLUSION: The patient recovered well from his operation.