Objective:To evaluate the impact of a multidisciplinary program on dehydration risk after ileostomy creation. Background:Dehydration after ileostomy creation is a significant complication and the most common reason for readmission. We implemented a multidisciplinary program to address this problem, including improved perioperative education and increasing wound ostomy and continence nurse (WOCN) support. Methods:We queried patients who underwent ileostomy creation from 2010-2019. We evaluated patient characteristics (including sex, age, comorbidities), operative characteristics (including approach, class, duration, estimated blood loss), and perioperative characteristics (including WOCN consultation, antimotility agents, ileostomy output, length of stay [LOS], follow up, and adverse events). Primary outcome was 60-day readmission for dehydration. Univariate and multivariate logistic models were created to identify factors associated with dehydration. Results:Nine hundred and ninety-eight patients underwent ileostomy creation, with a median LOS of 6 days. The readmission rate for dehydration was 5.4% (vs 11.5% previously), with a median time to readmission of 8.5 days. Patients readmitted for dehydration had slightly higher ileostomy output prior to discharge (750 vs 500 mL/24h) and later post-operative follow up (13 vs 11 days). On multivariate analysis, risk factors associated with dehydration were diabetes (p = 0.001), open surgery (p = 0.001), adverse events (p < 0.001), and higher ileostomy output (p = 0.004). Conclusions:Readmission for dehydration after ileostomy creation has significantly decreased with the implementation of a multidisciplinary program. A potential area of improvement is close follow up within 1 week for high-risk patients to identify and address early signs of dehydration.
Burns are a common condition presenting to the emergency room. Most of them are thermal burns. Burn wound healing is a complex process characterized by inflammation, proliferation, repair, and remodeling stages. A Special Burn Care Cream (SBCC) improves burn wound healing. We report a case of burns after a gunpowder explosion. A 36-year-old male patient was transferred to the burn center of a state hospital in Ankara, Turkey, following a gunpowder explosion on his face and neck. He had showed up with a second- to third-degree burn injury, about 14% total body surface area. He presented to our outpatient clinic 5 days later. Twice surgical debridement was performed to treat burn wounds on the face and neck. All the necrotic tissues were removed. Daily, the burn wound beds were cleaned by irrigation of the wound surface with gauze and saline. Then SBCC was applied to the wound area and left open. On the 10th day of treatment, complete recovery was achieved. No adverse effects were recorded. The SBCC increases the healing rate of burn wounds by promoting cell adhesion, proliferation, and differentiation. The cream promotes the proliferation and differentiation of fibroblasts and keratinocytes. In addition to other treatments, the SBCC application may be an alternative treatment approach for closure of burn wounds that have failed to heal with conventional treatments. Prospective and randomized controlled studies are needed to demonstrate the efficacy of SBCC.
The aim of this research was to prove the functionality of a smart tibial sensor for use during total knee replacements. The accuracy of such device provides surgeons with an objective tool for load balancing in the knee, where currently the joint is balanced based on the surgeon’s ‘feel’ of a balanced knee. Literature surrounding the kinematics and tibiofemoral joint forces through the flexion arc coupled with qualitative feedback from an orthopedic surgeon provided a basis for proving thefunctionality of the smart-sensor. Two full body cadavers underwent a cruciate-retaining total knee replacement using Zimmer’s Persona Knee System. Varying thicknesses adjusted the height of the tibial smart-sensor between 10 mm to 13 mm in increments of 1 mm. The contact points and loads were observed through the flexion arc (0°, 45°, and 90°). The results found similar results between the literature surrounding both the compartmental forces and contact points throughout the range of motion. Moreover, qualitative feedback determined that the smart-sensor was robust and durable throughout its use in both cadavers demonstrating its potential as a reusable device. Minor adjustments to the graphical user interface would improve the ease of use for the surgical team. This sensor demonstrated the functionality of the smart-sensor through cadaveric testing in predicating both the load and location throughout a range of motion. Continued development of this sensor would provide surgeons with an accurate and robust tool for intraoperative joint balancing which could extend to all joints in the body.
Since its first description almost four decades ago in the plastic surgery field, the angiosome theory has shown encouraging clinical success in Chronic Limb-Threatening Ischemia (CLTI) revascularization in recent years. Gradual scientific knowledge and evidence-based feedback are necessary to assess its usefulness and to overcome various challenges lingering in its practical application at the patient’s bedside. Despite the increasing number of publications in recent years indicating its acceptable suitability in clinical practice, only a few provide conspicuous information regarding the applicability of angiosome-guided Direct Revascularization (DR) compared with the analysis of hurdles in the vascular approach, regardless of its clinical results. The current review aimed to provide an updated interpretation of DR applicability rates in daily practice, delineated through tangible assessments of feasibility, clinical match, and technical success (as previously mentioned). This analysis considered the applicability of DR, Indirect Revascularization via collaterals, (IRc), and “Wound-Targeted Revascularization” (WTR) within the broader perspective of “Intentional Topographic Revascularization” (ITR) in patients with CLTI foot. ITR affords a novel conceptualization of regional foot reperfusion via deliberate anatomical and functional orientation of the foot arterial flow to the ischemic zones (owing specific pedal arteries and regional collaterals). The analysis of data revealed significant differences in the current clinical definitions, interpretation, and application methods of TR. Inconsistent views on DR were also observed in the context of “wound-dependent” localization and the identification of the most suitable target foot artery for treatment. Unfortunately, a standardized definition of angiosome-oriented DR, IR, IRc, and WTR has not been established. Owing to the lack of a universally accepted definition and unified anatomical and functional foot arterial occlusive disease stratification, evidence supporting the applicability of ITR (by all its variants) is still awaited.
