Getting Into One's Skin: The History of Skin Autografting.

Surgeons who treat and manage complex wounds rely on many techniques and modalities to properly close their wounds. In modern times, the concept of the reconstructive ladder helps practitioners make decisions on which method to employ to create the best result. Skin autografting is a part of that algorithm, but few know of the arduous history of this field. Dating back thousands of years ago, the history of skin autografting is complex and spans several continents and eras. This article discusses the history and nuance of a surgical technique that has had years of refinement. The discussion begins with ancient times and delves into how skin autografting made a resurgence during the renaissance and the late 1800s and the influence that World War I posed on the advancement of this surgical principle.

From Palm Leaves to Thermoplastic Polyurethanes-The History of Vascular Catheter Development and Use.

Vascular catheterization procedures are performed on millions of patients in the United States annually. Diagnostic and therapeutic, these procedures allow for the detection and treatment of diseased vessels. The use of catheters, however, is no new phenomenon. Ancient Egyptians, Greeks, and Romans constructed tubes from hollow reeds and palm leaves to be tunneled through the vasculature of cadavers to study cardiovascular system function, while eighteenth century English physiologist Stephen Hales used a brass pipe cannula to perform the first central vein catheterization on a horse. In 1963, American surgeon Thomas Fogarty developed a balloon embolectomy catheter, while in 1974, German cardiologist Andreas Grüntzig developed a more refined angioplasty catheter using polyvinyl chloride with improved rigidity. Vascular catheter material has since continued to evolve and is tailored to the specific needs of the procedure but would not have been possible without its rich and diverse history of development.

Diagnostics in a Surgeon's Pocket-The History of Telepaque and Oral Cholecystograms.

Biliary diseases such as cholelithiasis, choledocholithiasis, and cholecystitis all rely on imaging modalities to help make diagnoses. In modern times, ultrasound, computer tomography, and nuclear medicine scans help precisely visualize biliary and hepatic anatomy and pathology. The predecessor of these imaging modalities was the cholecystogram. This involved administration of contrast media that reliably had hepatic uptake and biliary excretion without causing significant side effects followed by radiograms of the abdomen. In the 1950s, iopanoic acid, known as telepaque, was a novel oral contrast, developed and clinical trialed for the use in diagnosing biliary pathology. A small, off-white colored powder available in a pill form, telepaque was readily available, conveniently administered by physicians at the bedside and produced beautiful cholangiograms within hours of administration. This paper briefly discusses the advent, physiology, and use of this novel compound that helped surgeons for many decades.

Negative Pressure Wound Therapy Can Prevent Surgical Site Infections Following Sternal and Rib Fixation in Trauma Patients: Experience From a Single-Institution Cohort Study.

The management of patients with traumatic injuries can be a challenge. Many require surgical intervention, are at an increased risk of surgical site infections (SSIs), and have an associated increase in hospital length of stay and cost. Closed-incision negative pressure therapy (ciNPT) has shown benefits in the management of certain surgical sites by preventing infection and improving wound healing. In the setting of chest wall reconstruction after traumatic sternal and/or rib fractures, no study so far has examined the efficacy of this treatment. We report a single-center retrospective cohort study, examining outcomes using ciNPT following rib and sternal fixation in trauma patients. Data on 71 patients who suffered from rib and/or sternal fractures, requiring surgical intervention, were collected over a time period of three years, from December 2016 to December 2019. The patient population was 66% male (47/71), had a mean age of 63.3 years (range 23-90 years old), and suffered from injuries related to motor vehicle or motorcycle accidents (45/71, 63%). Among the patients treated with ciNPT, none developed signs of SSIs during their initial hospitalization or within two months post-discharge follow-up. Negative pressure therapy is an effective wound care management system for preventing infections in closed-incision sites following chest wall reconstruction.

Rare Case of a Transverse Colon Schwannoma.

Schwannomas are tumors comprised of schwann cells of the peripheral nervous system and infrequently present in the gastrointestinal tract. Transverse colon schwannomas are an even more rare subtype of gastrointestinal schwannomas. This study presents the case of a transverse colon schwannoma, in addition to presenting a literature review.

The Effectiveness of Laparoscopic-assisted Percutaneous Endoscopic Gastrostomy in Patients with Unfavorable Anatomy: A Single-center Retrospective Cohort Study.

Percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patients unable to maintain adequate nutrition via the oral route. In patients with morbid obesity, altered intra-abdominal anatomy due to prior abdominal surgery, the interposition of the colon or other factors precluding endoscopy, feeding tube placement by laparoscopic means (LAPEG) can provide a potentially safe alternative. The objective of this study was to examine the efficacy and outcomes of laparoscopic-assisted placement of PEG in adult patients. This is a retrospective cohort analysis of adult patients, who underwent PEG and/or laparoscopic-assisted percutaneous endoscopic gastrostomy placement (LAPEG) by two surgeons at a single institution. A total of 36 patients underwent PEG and/or LAPEG. No significant differences were found in the total and postoperative length of stay and mortality. There were no procedure-related complications in the LAPEG group versus two in the PEG group (8.7%), but this did not reach statistical significance. LAPEG was 100% successful in gaining enteral feeding access in patients that had failed PEG. The most common reason for PEG placement failure was colonic interposition (39%), followed by intra-abdominal adhesions and gastric displacement by hiatal hernia (each 23%). 38.5% of LAPG procedures could be done via 5-mm single port access, 38.5% required two-port and 23% required three-port access. In conclusion, LAPEG is a feasible minimally invasive alternative to gain enteral feeding access in patients that have failed PEG that does not increase the length of stay, morbidity or mortality.

Combined Extra- and Intrapleural Hematoma After Blunt Chest Injury in an Anticoagulated Patient.

The objective of this study was to describe the atypical presentation of combined intrapleural and extrapleural hematomas in patients on anticoagulant therapy and explain the best workup and treatment for this pathology. This case report details the presentation, initial treatment, initial workup, and subsequent final treatment and workup of an elderly female patient that arrived at our trauma facility after suffering a blunt force trauma. The patient received anticoagulation therapy for her comorbidities prior to this incident. The outcome of interest was to better understand the best diagnostic and treatment modalities for treating combined intrapleural and extrapleural hematomas.

Revisiting the utility of technical performance scores following tetralogy of Fallot repair.

OBJECTIVE: Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot. METHODS: This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome. RESULTS: Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29%) with 1 death. Technical performance scores assigned were optimum in 28 patients (25%), adequate in 59 patients (52%), and inadequate in 26 patients (23%). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P = .79), and equivalent mean total cost ($100,000 vs $187,000; P = .25). Longer cardiopulmonary bypass time per 1-minute increase (P < .01) was associated with longer postoperative length of stay and reintervention (P = .02). The need to return to bypass also increased total cost (P < .01). CONCLUSIONS: Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.

Prospective, Randomized, Double-Blind, Parallel-Group, Comparative Effectiveness Clinical Trial Comparing a Powder Vehicle Compound of Vitamin D With an Oil Vehicle Compound in Adults With Cystic Fibrosis.

BACKGROUND: There is little consensus on the most efficacious vehicle substance for vitamin D supplements. Fat malabsorption may impede the ability of patients with cystic fibrosis (CF) to absorb vitamin D in an oil vehicle. We hypothesized that vitamin D contained in a powder vehicle would be absorbed more efficiently than vitamin D contained in an oil vehicle in patients with CF. METHODS: In this double-blind, randomized controlled trial, hospitalized adults with CF were given a one-time bolus dose of 100,000 IU of cholecalciferol (D3) in a powder-based or oil-based vehicle. Serum D3, 25-hydroxyvitamin D, and parathyroid hormone concentrations were analyzed at 0, 12, 24, and 48 hours posttreatment. The area under the curve for serum D3 and the 12-hour time point were also assessed as indicators of D3 absorption. RESULTS: This trial was completed by 15 patients with CF. The median (interquartile range) age, body mass index, and forced expiratory volume in 1 second were 23.7 (19.9-33.2) years, 19.9 (18.6-22.6) kg/m2, and 63% (37%-80%), respectively. The increase in serum D3 and the area under the curve was greater in the powder group ( P = .002 and P = .036, respectively). Serum D3 was higher at 12 hours in the powder group compared with the oil group ( P = .002), although levels were similar between groups by 48 hours. CONCLUSIONS: In adults with CF, cholecalciferol is more efficiently absorbed in a powder compared with an oil vehicle. Physicians should consider prescribing vitamin D in a powder vehicle in patients with CF to improve the absorption of vitamin D from supplements.

A comprehensive review of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a late-onset fatal neurodegenerative disease affecting motor neurons with an incidence of about 1/100,000. Most ALS cases are sporadic, but 5-10% of the cases are familial ALS. Both sporadic and familial ALS (FALS) are associated with degeneration of cortical and spinal motor neurons. The etiology of ALS remains unknown. However, mutations of superoxide dismutase 1 have been known as the most common cause of FALS. In this study, we provide a comprehensive review of ALS. We cover all aspects of the disease including epidemiology, comorbidities, environmental risk factor, molecular mechanism, genetic factors, symptoms, diagnostic, treatment, and even the available supplement and management of ALS. This will provide the reader with an advantage of receiving a broad range of information about the disease.