Femoral hernias occur in both genders

Femoral her nias are un com mon in chil dren, due to the un fa mil iar ity it is an of ten mis di ag nosed con di tion. In this ar ti cle, we pre sent a 6 - year old male pa tient and a 14 - year old fe male pa tient. Ini tially the pa tients were di ag nosed with a in guinal her nia and a hy dro cele of the canal of Nuck, re spec tively. In the first case the pa - tient re turned af ter the first surgery with a re cur ring bulging, dur ing the sur gi cal ex plo ration of the sec ond surgery a femoral her nia was found. In the sec ond case a femoral her nia was ob served dur ing surgery in stead of a hy dro cele of the canal of Nuck. With the aim of pre vent ing mis di ag no sis, clin i cians must be aware of femoral her ni a tion in chil dren, es pe cially when clin i cal pre sen ta tion is not typ i cal

Implementation of a Bundle of Care to Reduce Surgical Site Infections in Patients Undergoing Vascular Surgery

BACKGROUND: Surgical site infections (SSI’s) are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI’s rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: A prospective surveillance for SSI’s after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI’s (28,5±29.3 vs 10.8±11.3, p<0.001) and deep-SSI’s (48.3±39.4 vs 11.4±11.8, p<0.001) had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32–6.63). Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009. CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI’s in patients undergoing vascular surgery

Treatment of surgical site infections (SSI) IN patients with peripheral arterial disease : an observational study

INTRODUCTION: The management of surgical site infections (SSI's) in vascular surgery has been challenging over the years. To assess the outcomes associated with the various strategies, we performed a review of all SSI's after elective vascular procedures in patients with moderate to severe peripheral arterial disease in a single centre hospital. METHODS: All patients with a SSI after peripheral vascular surgery were retrieved from a database on Surgical site infections (SSI)-surveillance after vascular surgery between March 2009 and January 2012. At admission, all patients were approached by microbiological wound sampling and empirical start of antibiotics. Further wound management was based on personal experience and preference of the attending vascular surgeon. Endpoints were treatment success (complete wound healing while staying alive and without major amputation), survival and major amputation during one year follow up. RESULTS: A total of 40 patients with a SSI were identified (60% superficial SSI and 40% deep SSI). In 92% of the patients with a superficial SSI's were successfully treated with adjusted antibiotics and incisional drainages. In the contrast, 25% of the patients with deep-SSI's were successfully treated. No particular treatment was more successful than the others. CONCLUSION: Adjusted antibiotic use and adequate wound drainage are sufficient strategies for superficial SSI management. The management of deep-SSI's is a challenging undertaking and future research on indications and timing of these wide arrays of treatment options is suggested

Treatment of surgical site infections (SSI) IN patients with peripheral arterial disease : an observational study

INTRODUCTION: The management of surgical site infections (SSI's) in vascular surgery has been challenging over the years. To assess the outcomes associated with the various strategies, we performed a review of all SSI's after elective vascular procedures in patients with moderate to severe peripheral arterial disease in a single centre hospital. METHODS: All patients with a SSI after peripheral vascular surgery were retrieved from a database on Surgical site infections (SSI)-surveillance after vascular surgery between March 2009 and January 2012. At admission, all patients were approached by microbiological wound sampling and empirical start of antibiotics. Further wound management was based on personal experience and preference of the attending vascular surgeon. Endpoints were treatment success (complete wound healing while staying alive and without major amputation), survival and major amputation during one year follow up. RESULTS: A total of 40 patients with a SSI were identified (60% superficial SSI and 40% deep SSI). In 92% of the patients with a superficial SSI's were successfully treated with adjusted antibiotics and incisional drainages. In the contrast, 25% of the patients with deep-SSI's were successfully treated. No particular treatment was more successful than the others. CONCLUSION: Adjusted antibiotic use and adequate wound drainage are sufficient strategies for superficial SSI management. The management of deep-SSI's is a challenging undertaking and future research on indications and timing of these wide arrays of treatment options is suggested

Multivariate analysis of variables in relation to the occurrence of surgical site infections (SSI) after vascular surgery with adjusted Odds ratio’s (AOR) and the 95% confidence interval (CI).

<p>Multivariate analysis of variables in relation to the occurrence of surgical site infections (SSI) after vascular surgery with adjusted Odds ratio’s (AOR) and the 95% confidence interval (CI).</p

Categorical variables in relation to the occurrence of surgical site infections (SSI) after vascular surgery.

<p>ASA class: American Society of Anesthesiologists classification.</p><p>Wound class: Classification based on the intrinsic contamination of the incision site.</p>*<p>ASA 1∶3 pts, ASA 2∶176 pts.</p