Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.747
Filtrar
1.
Medicine (Baltimore) ; 99(34): e21947, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846864

RESUMO

An intermittent closure with silk suture is routinely used for closing different surgical wounds. However, subcuticular closure with absorbable sutures has gained considerable attention due to convenience and better cosmetic appearance.To compare the clinical outcomes and risk of surgical-site infection of subcuticular and intermittent closure after total-knee arthroplasty (TKA), 106 patients that underwent TKA between January 2017 to June 2019 at the Department of Orthopedics in Xiangya Hospital of Centre South University were retrospectively assessed. Forty-three had received running subcuticular closure (group A) and 58 underwent intermittent closure (group B). The Knee Society score was measured before and 6 months after operation. Inflammation markers including the serum levels of procalcitonin, interleukin-6, and C-reactive protein, and the erythrocyte sedimentation rate were evaluated before operation, 1 day after and 1 month after operation. Patient satisfaction with the closure was evaluated using the Likert scale at the last follow-up.No significant difference was seen in the 6-month postoperative Knee Society score, or in the 1-day and 6-month postoperative inflammation marker levels between both groups (P > .05). Likert scores were higher in group A compared to group B (4.0 ±â€Š1.0 vs 3.6 ±â€Š1.2, P < .05).Running subcuticular closure after TKA results in a better appearance compared to intermittent closure, although neither method has an advantage in terms of efficacy and risk of infection.


Assuntos
Artroplastia do Joelho/métodos , Pele/patologia , Suturas/tendências , Técnicas de Fechamento de Ferimentos/tendências , Idoso , Sedimentação Sanguínea , Proteína C-Reativa/análise , China/epidemiologia , Feminino , Humanos , Inflamação/metabolismo , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Pró-Calcitonina/sangue , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
2.
Surg Clin North Am ; 100(4): 733-740, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681873

RESUMO

This article reviews techniques for wound coverage that are not amenable to simple linear closure. The relevant anatomy and classification of flaps is discussed, as well as specific techniques for successful flap design.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Ferimentos e Lesões/cirurgia , Humanos , Manejo de Espécimes , Técnicas de Fechamento de Ferimentos
4.
Cochrane Database Syst Rev ; 7: CD004345, 2020 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-32712962

RESUMO

BACKGROUND: Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity. OBJECTIVES: To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication. SELECTION CRITERIA: Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth. DATA COLLECTION AND ANALYSIS: Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies. MAIN RESULTS: We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported. AUTHORS' CONCLUSIONS: In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.


Assuntos
Dente Serotino/cirurgia , Extração Dentária/métodos , Dente Impactado/cirurgia , Adulto , Viés , Drenagem/métodos , Alvéolo Seco/etiologia , Humanos , Lábio , Mandíbula , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos das Sensações/etiologia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/etiologia , Irrigação Terapêutica/métodos , Língua , Extração Dentária/efeitos adversos , Técnicas de Fechamento de Ferimentos , Adulto Jovem
7.
J Card Surg ; 35(7): 1621-1623, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32627233

RESUMO

Rupture of a congenital left ventricular diverticulum (CLVD), a rare anatomical anomaly, is a catastrophic event, with potential fatal consequences. Repair techniques documented in the literature include primary closure and single patch closure. We describe a case of a 57-year-old woman with symptomatic anterolateral CLVD. Our approach involves a linear incision through the epicardial surface of the diverticulum with exclusion of the cavity, and restoration of normal ventricular geometry via a two-patch technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Divertículo/cirurgia , Cardiopatias/cirurgia , Ventrículos do Coração/cirurgia , Técnicas de Fechamento de Ferimentos , Divertículo/congênito , Feminino , Cardiopatias/congênito , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Proc Natl Acad Sci U S A ; 117(27): 15497-15503, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576692

RESUMO

Bioadhesives such as tissue adhesives, hemostatic agents, and tissue sealants have potential advantages over sutures and staples for wound closure, hemostasis, and integration of implantable devices onto wet tissues. However, existing bioadhesives display several limitations including slow adhesion formation, weak bonding, low biocompatibility, poor mechanical match with tissues, and/or lack of triggerable benign detachment. Here, we report a bioadhesive that can form instant tough adhesion on various wet dynamic tissues and can be benignly detached from the adhered tissues on demand with a biocompatible triggering solution. The adhesion of the bioadhesive relies on the removal of interfacial water from the tissue surface, followed by physical and covalent cross-linking with the tissue surface. The triggerable detachment of the bioadhesive results from the cleavage of bioadhesive's cross-links with the tissue surface by the triggering solution. After it is adhered to wet tissues, the bioadhesive becomes a tough hydrogel with mechanical compliance and stretchability comparable with those of soft tissues. We validate in vivo biocompatibility of the bioadhesive and the triggering solution in a rat model and demonstrate potential applications of the bioadhesive with triggerable benign detachment in ex vivo porcine models.


Assuntos
Materiais Biocompatíveis/química , Hidrogéis/química , Ferida Cirúrgica/terapia , Adesivos Teciduais/química , Adesividade , Animais , Reagentes para Ligações Cruzadas/química , Modelos Animais de Doenças , Feminino , Teste de Materiais , Ratos , Bicarbonato de Sódio/química , Soluções , Succinimidas/química , Suínos , Técnicas de Fechamento de Ferimentos/instrumentação
9.
J Pediatr Orthop ; 40(6): 288-293, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501910

RESUMO

INTRODUCTION: Timing of wound closure in pediatric Gustilo-Anderson grade II and IIIA open long bone fracture remain controversial. Our aims are (1) to determine the proportion of patients with these fractures whose wounds can be treated with early primary wound closure (EPWC); (2) to compare the complication rates between EPWC and delayed wound closure (DWC); and (3) to determine factors associated with higher likelihood of undergoing DWC. PATIENTS AND METHODS: At a level-1 pediatric trauma center, 96 patients (younger than 18 y) who sustained Gustilo-Anderson grade II and IIIA open long bone fractures (humerus, radius, ulnar, femur, or tibia) within a 10-year period (2006-2016) were included for this study. Decision for EPWC versus DWC was at the discretion of the attending surgeon at time of initial surgery. Data collection was via retrospective review of charts and radiographs. Particular attention was paid to the incidence of return to operating room rate, nonunion, compartment syndrome, and infection. Median follow-up duration was 7.5 months (interquartile range: 3.6 to 25.3 mo). All patients were followed-up at least until bony union. RESULTS: Overall, 81% of patients (78/96) underwent EPWC. Of the grade II fractures, 86% underwent EPWC. Four patients (5%) in the EPWC group and 1 patient (6%) in the DWC group had at least 1 complication. When controlling for mechanism of injury, Gustilo-Anderson fracture type and age, there was no difference in rate of complications between the EPWC and the DWC groups. Grade IIIA fractures and being involved in a motor vehicle accident were factors associated with a higher likelihood of undergoing DWC. CONCLUSION: The majority of grade II and IIIA pediatric long bone fractures may be safely treatable with EPWC without additional washouts. Future prospective research is required to further define the subgroups that can benefit from DWC. LEVEL OF EVIDENCE: Level IV-therapeutic, case cohort study.


Assuntos
Extremidades/lesões , Fraturas Ósseas/cirurgia , Técnicas de Fechamento de Ferimentos , Adolescente , Criança , Feminino , Fraturas Expostas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/normas , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
10.
BMC Surg ; 20(1): 115, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456641

RESUMO

BACKGROUND: Treatments for perimembranous ventricular septal defects (pmVSD) mainly include conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricular device closure (PDC). We aimed to perform a network meta-analysis to compare the three approaches in patients with pmVSD. METHODS: We searched for comparative studies on device closure and conventional repair for pmVSD to April 2020. A network meta-analysis was performed under the frequentist frame with risk ratio and 95% confidence interval. The main outcome was the procedural success rate. Additional outcomes were postoperative complications, including residual shunt, intra-cardiac conduction block, valvular insufficiency, incision infection, and pericardial effusion. RESULTS: Twenty-four studies of 8113 patients were included in the comparisons. The pooled estimates of success rate favored the CSR compared with the PDC. No significant differences of success rate were found in the TDC versus CSR and the PDC versus TDC. The pooled estimates of incidences of the residual shunt, new tricuspid regurgitation, incision infection, and pericardial effusion favored the PDC compared with the CSR. There were no significant differences between the PDC and TDC approaches in all outcomes except new aortic regurgitation. CONCLUSION: The PDC technique not only reduces the risk of significant complications compared with the CSR, but also produces not inferior results compared with the TDC in selected pmVSD patients. PROSPERO REGISTRATION NUMBER: CRD42019125257.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Humanos , Metanálise em Rede , Derrame Pericárdico/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos
12.
J Surg Res ; 254: 58-63, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32417497

RESUMO

BACKGROUND: Intraoperative findings during gastroschisis surgery are the main predictor associated with increased mortality. The aim of our study was to determine the type of surgical findings associated with inpatient mortality in a cohort of patients with gastroschisis from a university hospital in Western Mexico. MATERIALS AND METHODS: Infants with surgically repaired gastroschisis during the period 2011-2017 at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, Mexico) were studied. Data regarding demographics, perinatal history, and intraoperative findings were collected and compared according to whether they were nonsurvivors (cases) or survivors (controls) at hospital discharge. Data were analyzed using logistic regression, determining its adjusted odds ratio (aOR) and its respective 95% confidence intervals (95% CIs). The proper adjustment of the model was verified using the Hosmer and Lemeshow test. RESULTS: Ninety-four patients with gastroschisis were studied, of which 13 were nonsurvivors (13.8%), and 81 (86.2%) were survivors at hospital discharge. In the group of survivors, primary surgical closure was performed more frequently (P = 0.018), whereas staged reduction with a silo predominated in the group of nonsurvivors (P = 0.018), and an increased frequency of complex gastroschisis (0.0001). After logistic regression analysis, intraoperative findings associated with nonsurvival were severe bowel matting (aOR: 7.3; 95% CI: 1.2-44), and prolapse of the small intestine and large intestine, plus any other organ (aOR: 15.9; 95% CI: 1.1-219.6). CONCLUSIONS: Mortality in our cohort was high (13.8%) and was significantly associated with severe bowel matting, and the prolapse of the small and large intestines, plus any other organ.


Assuntos
Gastrosquise/mortalidade , Gastrosquise/cirurgia , Pacientes Internados/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Gastrosquise/patologia , Hospitais Universitários , Humanos , Recém-Nascido , Enteropatias/patologia , Intestinos/patologia , Período Intraoperatório , México , Razão de Chances , Gravidez , Prolapso , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos
13.
Ulus Travma Acil Cerrahi Derg ; 26(3): 384-388, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436964

RESUMO

BACKGROUND: In this study, we aimed to evaluate the superiority of intracorporeal sutures and Hem-o-lok clips about efficiency, reliability and cost. METHODS: We performed laparoscopic surgery for acute appendicitis in this study. Appendiceal stump was closed by Hem-o-lok clips (Group I) and intracorporeal knotting (Group II) in a randomized manner. Groups were compared for demographic data (age, sex, body mass index, American Society of Anesthesiologists score) operation time, total cost, 2.6.12.24.hours and 7th day pain score. RESULTS: Demographic data, such as age, gender and BMI, were similar between groups (p>0.05). There was no significant difference between the groups concerning peroperative and postoperative complications (p>0.05). No postoperative nausea, vomiting, ileus and intraabdominal abscess were observed in patients. There was no significant difference between the groups about duration of operation, length of hospital stay and cost analysis (p>0.05). There was no significant difference in pain scores of groups. The effect of the operation type on pain scores was not statistically significant (p>0.05). CONCLUSION: This study showed that both intracorporeal knotting and Hem-o-loc clips were effective, reliable and similar cost-effective in laparoscopic appendectomy. The decision should be based on the surgeon's experience.


Assuntos
Apendicectomia , Apêndice/cirurgia , Laparoscopia , Técnicas de Fechamento de Ferimentos , Apendicectomia/efeitos adversos , Apendicectomia/instrumentação , Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Instrumentos Cirúrgicos , Suturas , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/instrumentação , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
14.
J Trauma Acute Care Surg ; 89(2): 377-381, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32332254

RESUMO

BACKGROUND: Various management strategies exist for the abdomen that will not close. At our institution, these patients are managed with polyglactin 910 mesh followed 14 days later (LATE) by split-thickness skin graft (STSG) or, in some cases, earlier (EARLY, <14 days), if the wound is judged to be adequately granulated. The purpose of this study was to evaluate the impact of STSG timing for wounds felt ready for grafting on STSG failure. METHODS: Consecutive patients over a 3-year period managed with polyglactin 910 mesh followed by STSG were identified. Patient characteristics, severity of injury and shock, time to STSG, and outcomes, including STSG failure, were recorded and compared. Multivariable logistic regression analysis was performed to identify predictors of graft failure. RESULTS: Sixty-one patients were identified: 31 EARLY and 30 LATE. There was no difference in severity of injury or shock between the groups. Split-thickness skin graft failure occurred in 11 patients (9 EARLY vs. 2 LATE, p < 0.0001). Time to STSG was significantly less in patients with graft failure (11 days vs. 15 days, p = 0.012). In fact, after adjusting for age, injury severity, severity of shock, and time to STSG, multivariable logistic regression identified EARLY STSG (odds ratio, 1.4; 95% confidence interval, 1.1-1.8, p = 0.020) as the only independent predictor of graft failure. CONCLUSION: Appearance of the open abdomen can be misleading during the first 2 weeks following polyglactin 910 mesh placement. EARLY STSG was the only modifiable risk factor associated with graft failure. Thus, for optimal results, STSG should be delayed at least 14 days after polyglactin 910 mesh placement. LEVEL OF EVIDENCE: Prognostic study, level IV.


Assuntos
Traumatismos Abdominais/cirurgia , Transplante de Pele , Telas Cirúrgicas , Técnicas de Fechamento de Ferimentos , Adolescente , Adulto , Idoso , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Poliglactina 910 , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Tempo , Índices de Gravidade do Trauma , Técnicas de Fechamento de Ferimentos/efeitos adversos , Cicatrização , Adulto Jovem
15.
Am J Surg ; 219(5): 764-768, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32199604

RESUMO

BACKGROUND: In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored. METHODS: A retrospective review was performed of newborns admitted with gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated gastroschisis, and performance of additional operations. RESULTS: 80 patients with gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p < 0.001). In addition, delayed closure was associated with increased total and NICU LOS (p < 0.05), parenteral nutrition duration (p = 0.02), ventilator days (p < 0.001), time to goal enteral feeds (p = 0.01), and all cost sub-categories except ward room costs (p < 0.01). CONCLUSION: Delayed fascial closure was associated with significantly greater hospital costs during the index admission.


Assuntos
Fasciotomia/economia , Gastrosquise/economia , Gastrosquise/cirurgia , Custos Hospitalares/estatística & dados numéricos , Técnicas de Fechamento de Ferimentos/economia , Feminino , Humanos , Recém-Nascido , Tempo de Internação/economia , Masculino , Nutrição Parenteral/economia , Fatores de Tempo
16.
J Surg Res ; 251: 248-253, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32179277

RESUMO

BACKGROUND: Our group has shown that personalized video feedback (PVF) is better than a task demonstration video at increasing wound closure skills among incoming surgical interns. However, offering PVF can be time-consuming. We sought to compare the educational effects and time required for group video feedback (GVF) and PVF. METHODS: We have mailed our matched incoming "surgical" interns a "welcome package" in mid-March for the past 3 y. The package includes similar resources each year. Incoming interns were asked to video record themselves performing six tasks three separate times between April 1 and June 15. After each submission in 2016 and 2017, incoming interns received 2 min of personalized feedback on their three separate wound closure videos (PVF). In 2018, incoming interns received 5 min of group-based feedback three separate times covering all six tasks (GVF). We compared performance (July Surgical Olympics) of these six skills against the interns from the previous 2 y who received PVF on only one skill (suturing). RESULTS: Twenty-three incoming interns received the pre-residency package and participated in the 2018 Surgical Olympics. This 2018 GVF class had a higher overall mean score for six stations (31.5 [standard deviation = ±7.7]) than the 2016 and 2017 PVF classes (25.6 [standard deviation = ±8]; P < 0.0001). Knot tying ability and suturing skill were similar between the classes. The GVF group performed better on the remaining four skills . The total time of surgical staff and educators spent per class in 2018 (GVF class) was 30 min and includes six tasks compared with 276 min of effort in each of the 2016 and 2017 classes (PVF included one task). CONCLUSIONS: GVF and PVF as a component of preemptive training had the same effect on improving suturing skills among the interns. GVF required less educator editing and voice over time. GVF is effective and efficient in enhancing incoming interns' performance in multiple skills.


Assuntos
Competência Clínica , Feedback Formativo , Internato e Residência/métodos , Gravação em Vídeo , Técnicas de Fechamento de Ferimentos/educação , Currículo , Humanos , Técnicas de Sutura/educação
17.
BMC Oral Health ; 20(1): 77, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32183831

RESUMO

BACKGROUND: The purpose of this study was to compare the effectiveness of absorbable collagen sponge insertion in tooth extraction sites for socket healing of the impacted mandibular third molar. METHODS: Thirty-six patients with bilateral mandibular impacted third molars based on Pell-Gregory and Winter classification were included in this study. This study was a randomized clinical trial utilizing a split-mouth design with one side assigned as collagen sponge insertion and the other side assigned as the control. Post-operative clinical complications, periodontal integrities, and radiographic outcomes were assessed at 1, 2, and 14-weeks post operatively. RESULTS: Five patients were excluded during the follow-up period due to loss of follow-up. The study was conducted on 31 patients in total. The mean VAS score of collagen sponge insertion side at 1 week post operation was 1.42 ± 1.26, which was significantly lower than the control side (P < 0.05). The mean probing depth of collagen sponge insertion side at 2-week post operation was 5.55 ± 2.28 mm, which was significantly lower than the control side (7.13 ± 1.86; P < 0.05). Other various measurements including radiographic outcomes showed no significant group differences. CONCLUSIONS: Placement of collagen sponge after extraction of mandibular impacted third molar reduced early stage post-operative complications and enhanced initial healing of soft tissues and periodontal defects. TRIAL REGISTRATION: This study was retrospectively registered at the WHO ICTRP platform and Clinical Research Information Service, KCT0003363. Registered 21 Sep 2018.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Colágeno/administração & dosagem , Dente Serotino/cirurgia , Tampões de Gaze Cirúrgicos , Extração Dentária , Dente Impactado/cirurgia , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos , Cicatrização
18.
Unfallchirurg ; 123(6): 496-500, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32140813

RESUMO

This article reports the case of a 42-year-old male patient, who sustained a gluteal compartment syndrome after drug-induced immobilization with subsequent rhabdomyolysis and sciatic nerve palsy. Unlike compartment syndrome of the forearm or lower leg, this is a rare condition. After immediate surgical decompression and installation of negative pressure wound treatment, hemofiltration in acute renal failure could be averted using forced diuresis. The sensorimotor function of the lower extremity improved already after the first treatment and secondary wound closure was possible after 1 week. The patient was discharged 11 days after admission with complete recovery of sensorimotor and renal functions.


Assuntos
Lesão Renal Aguda/prevenção & controle , Nádegas/lesões , Nádegas/cirurgia , Síndromes Compartimentais/cirurgia , Transtornos Relacionados ao Uso de Opioides/terapia , Lesão Renal Aguda/etiologia , Adulto , Síndromes Compartimentais/etiologia , Descompressão Cirúrgica , Diurese , Diuréticos/uso terapêutico , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa , Transtornos Relacionados ao Uso de Opioides/complicações , Recuperação de Função Fisiológica , Rabdomiólise/etiologia , Rabdomiólise/cirurgia , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia , Técnicas de Fechamento de Ferimentos
20.
Bull Cancer ; 107(3): 328-332, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32059813

RESUMO

INTRODUCTION: Dermatofibrosarcoma (DFS) is a common dermic sarcoma. It is a local malignant tumor occurring in young adults. The recurrence potential justifies an R0-type surgery with a three centimeters margin. We report our experience of the management of locally advanced DFS by resection and reconstructive surgery. METHODS: It is an ongoing descriptive study spanned from June 2005 to December 2018. We included all DFS cases treated by curative resection and reconstruction. A total of eight cases of DFS among 108 soft tissue sarcomas were studied. All patients were males. The mean age was 41.8 years [32-60]. Carcinologic results, cosmetic results, and outcomes were analyzed. RESULTS: R0-type resection was performed in six cases. In two cases, the resection was R1-type and resulted in amputation. In four cases, it was an iterative surgery. Average desease duration was 4 years [1-8]. Reconstructive surgery was needed for wound closure in six cases. Wounds healed in 28 days [18-90]. Outcomes showed hyperchromic keloid scars (N=2) at the trunk localization. CONCLUSION: DFS is a common cancer with a good outcome if managed earliest. Delayed diagnoses and inadequate first-time surgery led to tumor extension and recurrences. Locally advanced tumors management needs extensive resections and reconstructive surgery. In addition to surgery, Imatinib and radiotherapy improve outcomes, but are not available in our context.


Assuntos
Dermatofibrossarcoma/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Países em Desenvolvimento , Neoplasias Cutâneas/cirurgia , Adulto , Burkina Faso/epidemiologia , Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/patologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Queloide/etiologia , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Fotografação , Complicações Pós-Operatórias/etiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos , Cicatrização
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA