Perigraft Seroma after Extra-anatomic Bypass : Case Series and Review of the Literature

Background: Extra-anatomic bypass (EAB) remains a viable alternative for lower limb revascularization if aorto-bifemoral bypass and endovascular therapy are contraindicated. Among EAB, perigraft seroma (PS) occurs in about 4% of cases. Diagnostic and therapeutic management, as well as standardized treatment paradigm, are still not well defined. The aim of this study is to report 5 PS cases in EAB and to review the literature about similar cases. Methods: We retrospectively reviewed EAB performed during the period 2002-2015. Among these, PS cases were analyzed. A similar description for all cases found in the literature through research on the major international databases (PubMed, Scopus, EMBASE) was conducted. Results: During the study period, 797 bypasses-528 (66.3%) anatomical and 269 (33.7%) extra-anatomical-were performed. Among the latter, 169 femoro-femoral (FF), 20 axillo-femoral (AXF), 22 axillo-bifemoral (AxBF), and 58 aortouni-iliac endoprosthesis (AUI) + FF bypasses were performed. Five cases (1.86%) of PS in EAB population were detected: 3 after AxBF and 2 after AUI + FF. Although we initially preferred percutaneous drainage, a surgical choice with graft explant and replacement were imposed by the high recurrence rate. Literature analysis identified 20 additional cases (11 after AxBF, 7 after AXF and one after AUI + FF). Conclusions: Our case series and the literature confirm that the most widely used therapy is the surgical drainage with primary or secondary replacement of the graft of a different material. Percutaneous drainage has proved to be ineffective because not conclusive and potential to increase risk of graft infection. Careful follow-up, even years after surgery, remains necessary for PS diagnosis and management, to prevent complications and potential infection

Successful Fat Grafting in a Patient with Thromboangiitis Obliterans

Thromboangiitis obliterans, or Buerger disease, is a rare nonatherosclerotic segmental inflammatory vasculitis that generally affects young tobacco smokers. Although no surgical treatment is available, the most effective way to halt the disease's progress is smoking cessation. In this case report, a 29-year-old smoker showed up to emergency department with gangrene of his fifth left toe and extensive plantar ulceration. After investigative angiography, he was diagnosed with Buerger disease. On November 2017, he underwent fifth left toe amputation and hyperbaric therapy. Five months after amputation, the patient was rehospitalized because of surgical wound dehiscence, wide ulceration, and pain. He was treated with lipofilling using the Coleman technique. Two weeks after the fat grafting procedure, the patient suspended pain control medication, and after 2 months, the surgical wound was almost healed. Fat grafting (lipofilling) is mostly used in plastic surgery; it offers regenerative effects, with minimal discomfort for the patient. This case report demonstrates a successful alternative use of lipofilling for this unique condition and opens up new options for use of this technique in other fields

Venous pseudoaneurysm of the great saphenous vein stump as late complication of flush saphenofemoral ligation and stripping

Guidelines now recommend endovenous thermal ablation over open treatment of saphenous incompetence, but flush saphenofemoral ligation and stripping remain relevant when appropriately applied and expertly executed. Complications are rare but could be severe, needing further surgical correction. We report a unique case of a late venous pseudoaneurysm of the great saphenous vein stump after flush saphenofemoral ligation and stripping, successfully treated with surgical sac excision. We highlight the importance of continuous follow-up for patients previously submitted to open venous surgery

Guidelines for venous thromboembolism and clinical practice in Italy : a nationwide survey

INTRODUCTION: Venous thromboembolism (VTE) is a major health problem that has fostered the definition of specific guidelines by Scientific Societies. The type of procedure as well as trauma are crucial for VTE in surgical patients (General Surgery, Gynaecology and Orthopaedics). MATHERIALS AND METHODS: The project stemmed from a National grant from the Italian Ministry of research. A data-survey framework was prepared and made available as a form to be filled and was sent to 714 centres to investigate the application of the guidelines for VTE across the national territory. RESULTS: A number of 146 centres replied (20,4% of total): 48 Departments of General Surgery, 46 Departments of Ginaecology, 52 Departments of Orthopaedics. About 70% of the Centres had appropriate information about surgery as a risk factor for VTE. The answers have demonstrated an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm diagnostic suspect of TE (80%). The data concerning diagnostic data waiting and morbidity/mortality have been further analyzed. Data waiting have been compared with morbidity and mortality rates related to DVT-PE that showed an increase of mortality connected to the diagnostic data timing of supply with an exponential trend linked to the data acquisition delay. CONCLUSIONS: Risk stratification and adequate application of prophylaxis and treatment devices represent a real possibility to control morbidity and mortality for VTE. Moreover diagnostic data waiting conditions adequate prophylaxis. In Italy, only the 40% of the centres is able to supply diagnostic data within 12 hours. KEY WORDS: Deep Vein Thrombosis, Pulmonary Embolism, Venous Thromboembolism, Guideline

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background: Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods: The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results: Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions: Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence: Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance