1/24. Special problems associated with abdominal aneurysmectomy in spinal cord injury patients.There were 8 patients with spinal cord injury in the last 100 consecutive patients with abdominal aortic aneurysm resected at the Long Beach veterans Administration Hospital. Emphasis is placed upon the problems in management not found in individuals without spinal cord injury. A successful outcome is dependent upon: (a) aggressive control of foci of infection, (b) early diagnosis and planned surgical intervention, (c) continuous intraoperative arterial and central venous pressure monitoring and (d) alertness to the prevention of postoperative complications, with emphasis upon careful tracheal toilet and anticipation of delayed wound healing.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/24. 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 = 4keywords = pressure (Clic here for more details about this article) |
3/24. Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.Sternal osteomyelitis and mediastinitis caused by pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/24. Subatmospheric pressure dressing for saphenous vein donor-site complications.Newer endoscopic techniques have been successful at reducing saphenous vein donor-site wound complications, but not entirely eliminating them. Tissue necrosis with superimposed infection is typically treated with antibiotics and surgical debridement. Typically, primary reclosure is not possible and the open leg wound is allowed to slowly granulate with dressing changes until a skin graft can be performed. This report describes an alternative treatment using subatmospheric pressure dressing to promote granulation tissue and wound closure in saphenous vein donor-site wounds.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
5/24. Fatal posterior fossa pneumocephalus due to hydrogen peroxide irrigation of lumbar wound.Fatal brain stem failure developed suddenly in a 40-year-old male undergoing irrigation of an infected wound consequent to lumbar disc space infection. CT of head revealed posterior fossa pneumacephalus compressing the brain stem, which most likely developed from ingress of nascent oxygen under pressure through a defect in the thecal sac.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/24. The role of plasma transglutaminase (F XIII) in wound healing of complicated pressure sores after spinal cord injury.STUDY DESIGN: A case report. OBJECTIVES: To demonstrate stimulating action of F XIII in wound healing of complicated pressure sores. SETTING: A spinal cord Injury Center in germany. methods: Clinical exam, clinical and photographic wound control, biochemical serum monitoring. RESULTS: Recurrent pressure sores in plegic patients are common complications requiring long-standing conservative or operative therapy. Additional risk factors such as diabetes increase the complication rate for surgery. Surgery itself may be difficult in recurrent pressure sores due to limited remaining soft tissues. We report the case and treatment of a 47-year-old patient with long-standing and recurrent ulcers and complications after flap surgery. As a final option we added plasma transglutaminase (factor xiii) to our treatment scheme which changed the course of the disease dramatically and we achieved complete and rapid healing. CONCLUSION: Our experience suggests that F XIII has a positive role in treating pressure sores as shown already in several other surgical fields. Its use is giving the surgeon an additional tool in complicated cases.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
7/24. Rapid healing of MRSA infection at the suprafascial radial donor site.methicillin-resistant staphylococcus aureus (MRSA) infection at the radial suprafascial donor site resulted in significant loss of the skin graft, but no tendon exposure, in two patients. The complication was successfully managed with wound debridement, appropriate antibiotics, a negative-pressure wound dressing and early partial-thickness skin grafting. The suprafascial dissection creates a donor site that resists both skin graft loss and tendon exposure. It also allows early re-grafting with no loss of function in the event of skin graft loss from infection. These advantages have not been described previously.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/24. Chronic postoperative endophthalmitis due to pseudomonas oryzihabitans.PURPOSE: To report a case of chronic postoperative endophthalmitis caused by the gram-negative bacterium pseudomonas oryzihabitans.DESIGN: Interventional case report.methods: A 77-year-old man was referred to our service for nonpainful uveitis in the right eye accompanied by increased intraocular pressure of 2 years' duration with onset 4 months after uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens implantation. The uveitis partially responded to topical corticosteroid therapy but was recurrent with tapering of steroids. An anterior chamber tap and vitreous biopsies sent for cultures were negative. Owing to the persistence of inflammation despite intraocular vancomycin injection, the lens implant and capsule were removed and culture of the latter revealed the bacterium P. oryzihabitans.RESULTS: There was no recurrence of inflammation after removal of the lens implant and capsule.CONCLUSIONS: Unlike other gram-negative organisms, which are associated with poor outcomes, P. oryzihabitans may masquerade as chronic uveitis because of its low virulence.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/24. Adverse alteration of wound flora with topical negative-pressure therapy: a case report.Topical negative pressure (TNP) has achieved widespread use in the treatment of problematic wounds. We report the case of a patient treated with TNP for groin-wound dehiscence following inguinal block dissection. During treatment, clinical signs of sepsis developed, in association with a progressively worsening anaerobic wound infection. This infection settled with antibiotic therapy and cessation of TNP treatment. We postulate that the air-free environment created by TNP potentiated the growth of the anaerobic bacteria, resulting in significant sepsis, and therefore recommend close surveillance of bacterial flora while using this therapy, particularly in susceptible patients.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
10/24. Reconstruction of recurrent pressure sores using free flaps.The authors describe two successful reconstructions of recurrent pressure sores with free fasciocutaneous flaps. In Case 1, a free lateral thigh flap pedicled on the first and third direct cutaneous branches of the deep femoral vessels was used to cover a large recurrent sacral pressure sore. The vascular pedicle was dissected to the deep femoral trunk proximally and anastomosed to the inferior gluteal vessels. In Case 2, a free medial plantar flap was transferred to a recurrent ischial pressure sore. The vascular pedicle was dissected to the posterior tibial vessels proximally. The long vascular pedicle of the flap was passed through the femoral subcutaneous tunnel, and end-to-side microvascular anastomoses were performed to the superficial femoral trunk without any vein grafts. The authors advocate the use of free tissue transfer for recurrent pressure sore reconstruction.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
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