11/705. The role of the plastic surgeon in the management of surgical infection.At our Medical Center, our reconstructive service has actively sought referrals of acute and chronic infections by declaring an interest in undertaking the integrated management and reconstruction of these cases. The practices of the two senior surgeons were reviewed for three academic years (1992 to 1995). Cases of surgical infection were analyzed as to site, ablative procedures, and reconstructive procedures. In total, 139 patients with 147 infections were identified. Sites of infection included head and neck (9.5 percent), trunk and pelvis (39.5 percent), upper extremity (22 percent), and lower extremity (29 percent). One-hundred thirty-one ablative procedures were done on this group, as were 126 reconstructive procedures, including 17 fasciocutaneous flaps, 26 pedicled muscle flaps, and 28 microsurgical flaps. With a mean follow-up of 14 months, 92 percent of these patients had resolution of infection. The 8 percent failure group included recurrences, amputation, and death. This series demonstrates that a plastic surgery service can attract a diverse population of surgical infections and manage them successfully with ablation and a wide variety of reconstructive procedures. The coordination of ablation and reconstruction may be optimally performed by the plastic surgeon.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/705. A comparison of dicloxacillin and ampicillin in the antibiotic prophylaxis of total hip replacement.The effect of two semi-synthetic penicillins, dicloxacillin and ampicillin was compared in systemic antibiotic prophylaxis in total hip replacement patients. The drugs were given in routine oral dosage for eight days to two patient groups each consisting of 50 patients. There was no fatality. In the ampicillin group there were three staphylococcal infections but no infections in the dicloxacillin group. Two of the infections occurred in reapplication cases leading to the loosening of the prosthesis. One infection appeared after a primary operation with a superficial recurrence 10 months later. In the ampicillin group, side effects were diagnosed in 12 cases and in the dicloxacillin group in one case.- - - - - - - - - - ranking = 0.4keywords = infection (Clic here for more details about this article) |
13/705. Clinical results with exposed polyglactin 910 resorbable membranes for guided tissue regeneration.Three cases are presented where early exposure of a resorbable membrane occurred during guided tissue regeneration therapy. An antimicrobial regimen was selected to determine whether infection of exposed membranes could be controlled to the point of achieving acceptable clinical results without membrane removal. The results suggest that with the use of the antimicrobial regimen: (1) exposure is compatible with successful clinical results, and (2) removal is not necessary.- - - - - - - - - - ranking = 0.1keywords = infection (Clic here for more details about this article) |
14/705. Reconstruction of a cranial bone defect with hydroxyapatite and free flap transfer.The authors report a successful reconstruction of an extensive frontotemporal bone defect after craniotomy, which was complicated with infection and necessitated removal of frontal and temporal bones. The large frontotemporal bone defect was reconstructed using prefabricated hydroxyapatite blocks in combination with the free vastus lateralis muscle flap. The patient's functional and cosmetic restoration has been maintained for 10 months' follow-up.- - - - - - - - - - ranking = 0.1keywords = infection (Clic here for more details about this article) |
15/705. Hyperbaric oxygen therapy in deep sternal wound infection after heart transplantation.The results of orthotopic heart transplantation (OHTx) are still burdened with considerable early mortality due to graft rejection or infection. sternum osteomyelitis is an infrequent postoperative complication. We report a case of deep sternal wound infection (2 months after OHTx) that was treated with hyperbaric oxygen therapy in addition to local surgical treatment.- - - - - - - - - - ranking = 0.6keywords = infection (Clic here for more details about this article) |
16/705. Staphylococcal infection under a LASIK flap.PURPOSE: To report a staphylococcal infection under a laser in situ keratomileusis (LASIK) flap and to discuss the management of this rare and potentially devastating complication. methods: A patient was referred to our practice having had bilateral LASIK. She was found to have abscesses under the left corneal flap. staphylococcus aureus was identified as the infecting organism by corneal scrape and treated with appropriate antibiotics. The cornea improved, and then the abscess recurred. The abscess was again scraped and intensive treatment reinstituted. RESULTS: After successful treatment, the patient recovered excellent visual acuity with only a minimal astigmatic error. CONCLUSION: The possible reasons for the apparent improvement and then recurrence of the abscess are discussed. The management of this case including the need for corneal scrape and antibiotic prophylaxis is discussed in relation to previously reported cases.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
17/705. Minimizing wound complications in cochlear implant surgery.OBJECTIVE: An extended postauricular incision has replaced the standard C-shaped scalp flap for cochlear implant surgery at our institution. The postoperative wound complication rates of the two incisions were evaluated. STUDY DESIGN: This study was a retrospective case review. SETTING: This study was performed in a tertiary referral center. patients: A total of 256 adult and pediatric patients who underwent cochlear implantation during a 10-year period (1986 to 1996) were reviewed. MAIN OUTCOME MEASURE: Postoperative wound complications were identified. Major complications included flap necrosis, wound dehiscence with or without implant exposure, and wound infection requiring hospitalization. hematoma, seroma, or superficial wound infections were considered minor complications. RESULTS: There were 6 major and 6 minor complications among 116 patients with the standard scalp flap (complication rate, 10.3%). There was only 1 minor complication among 140 implants using the postauricular incision (0.7%). CONCLUSION: The extended postauricular incision appears to significantly reduce the incidence of wound complications in cochlear implant surgery.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
18/705. Use of hyperbaric oxygen and negative pressure therapy in the multidisciplinary care of a patient with nonhealing wounds.The case of a 55-year-old woman with nonhealing wounds located on the sternum, abdomen, and lower left extremities is described. The wounds were related to surgical incisions from coronary artery bypass grafting and were complicated by respiratory insufficiency, diabetes mellitus, and infection. This article presents a brief overview of the collaborative care provided in this case and a pictorial review of this patient's wounds during a 4-month period.- - - - - - - - - - ranking = 0.1keywords = infection (Clic here for more details about this article) |
19/705. Cervical cord compression caused by a pillow in a postlaminectomy patient undergoing magnetic resonance imaging. Case report.A 66-year-old man, who had undergone osteoplastic laminectomy for posttraumatic cervical myelopathy, underwent a second operation in which the replaced laminae were removed because of postoperative deep wound infection. Follow-up dynamic magnetic resonance imaging with flexion and extension views of the neck 1 year postsurgery demonstrated that the cervical cord was markedly compressed from behind in the extended position, although a wide subarachnoid space was observed in this region when the neck was in the flexed position. The cause of cord compression was the pillow that was placed underneath the patient's neck for maintaining the extended position, not the neck extension itself. This finding indicates that care must be taken during neuroradiological examination not to place a pillow under the neck of a patient who has undergone laminectomy. Nuchal compression could lead to cervical cord injury after laminectomy. Laminoplasty benefits the patient by protecting the cervical cord from secondary injury.- - - - - - - - - - ranking = 0.1keywords = infection (Clic here for more details about this article) |
20/705. Acute appendicitis complicated with necrotizing soft tissue infections in the elderly: report of a case.A case of acute appendicitis complicated with necrotizing soft tissue infections (NSTIs) in an extremely elderly woman (98 years-old) is reported. She was admitted to our hospital with a history of increasing pain localized in the right lower abdomen. Abdominal ultrasonography revealed appendicolithiasis and periappendiceal fluid. An appendectomy and closure of the perforated cecum was performed. On the 5th post-operative day, the patient developed skin erythemas and crepitation in the right lower quadrant. An exploration and drainage of the recent operative incision was performed under the diagnosis of NSTIs. Despite the declining overall incidence of appendicitis, it has been increasing among the elderly. The elderly patients are associated with underlying defects in immune function. NSTIs, which are characterized by rapidly progressing inflammation and necrosis of soft tissue, comprise a spectrum of disease ranging from necrosis of the skin to life-threatening infections. The most common etiology of NSTIs was post-operative infections of the abdominal wall, which primarily occurred after operations with extensive fecal contamination. NSTIs are no longer a rare post-operative complication in the elderly and initial treatment should be selected according to the condition of the patient.- - - - - - - - - - ranking = 0.7keywords = infection (Clic here for more details about this article) |
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