PubMed · 7014182
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J L Werth. 1981. Basic skin closure.. https://pubmed.ncbi.nlm.nih.gov/7014182/
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Treatment of sternal wound complications is controversial, particularly in immunosuppressed heart transplant recipients. Regardless of the severity of infection, we combine immediate, aggressive débridement with bilateral pectoralis major myocutaneous advancement flaps in a single procedure. Compared with management with pectoralis major turnover flaps or distant pedicled muscle flaps, treatment of these sternal wounds with pectoralis major myocutaneous advancement flaps is simpler and quicker and provides better aesthetic results. Furthermore, because pectoralis major myocutaneous flaps are based on the thoracoacromial arteries, whether or not the internal mammary arteries have previously been harvested for coronary grafts is irrelevant. Twenty consecutive heart transplant recipients with sternal wound complications were treated with this technique. No intraoperative or perioperative deaths occurred. The morbidity rate was 30%, with seroma treated by needle aspiration in four patients (20%) being the most common complication. Only one patient had a postoperative wound infection. All patients had excellent functional and aesthetic results.
Functional endoscopic sinus surgery (FESS) is the treatment of choice in the majority of chronic inflammatory diseases of the paranasal sinuses. Currently used surgical instruments for FESS are based on a "grab and tear"-approach, thus predisposing to increased bleeding--especially in nasal polyps--which can significantly reduce the visual field and might lead to consecutive complications, including the injury of the anterior skull base and optic nerve. In the present paper the author introduces a new surgical system, invented by Setliff and Parsons (8), which enables the rhinosurgeon to operate in a near-bloodless field, thus providing an unimpaired vision for a safer approach to the paranasal sinuses. In addition, the system ensures meticulous cutting of tissue instead of tearing, which also reduces the risk of complications. Our experiences with the "micro debrider system" have confirmed the usefulness of this instrumentarium, especially in the operative management of nasal polyps, in terms of less traumatic surgery and better visual field, thus implying fewer complications during FESS.
OBJECTIVE: The authors determined the risk factors of mortality in patients with necrotizing soft-tissue infections (NSTIs) and examined the incidence and mortality from NSTI secondary to Streptococcus pyogenes. METHODS: All patients with NSTIs who were treated between January 1989 and June 1994 were analyzed for presentation, etiology, factors important in pathogenesis and treatment, and mortality. RESULTS: Sixty-five patients were identified with NSTIs secondary to postoperative wound complications (18), trauma (15), cutaneous disease (15), idiopathic causes (10), perirectal abscesses (3), strangulated hernias (2), and subcutaneous injections (2). Necrotizing soft-tissue infections were polymicrobial in 45 patients (69%). S. pyogenes was isolated in only 17% of the NSTIs, but accounted for 53% of monomicrobial infections. Eight of ten idiopathic infections were caused by a single bacterium (p = 0.0005), whereas 82% of postoperative infections were polymicrobial. An average of 3.3 operative debridements per patient and amputation in 12 patients were necessary to control infection. The overall mortality was 29%; mortality from S. pyogenes infection was only 18%. The average time from admission to operation was 90 hours in nonsurvivors versus 25 hours in survivors (p = 0.0002). Other risk factors previously associated with the development of NSTIs did not affect mortality. CONCLUSIONS: Early debridement of NSTI was associated with a significant decrease in mortality. S. pyogenes infection was the most common cause of monomicrobial NSTI, but was not associated with an increased mortality.