HARVESTING SURAL FLAP WITH COVERED PEDICLE

ABSTRACT Objectives: The aim was to evaluate the viability and the outcomes of the sural flap performed with the pedicle covered by a strip of skin. Methods: A prospective cohort of 20 consecutive cases were evaluated in terms of flap viability, complication rate, and the amount of skin graft required. The location of the defects was the middle third of the tibia in 3 cases, the ankle and hindfoot in 15 cases, the middle foot in 1 case, and the forefoot in 1 case. The flap design was the same as described by Masquelet. The only modification included a strip of skin over the entire length of the pedicle. The intermediary skin between the donor site and the defect was incised and the skin was undermined to accommodate the pedicle without compression. Results: All cases had a satisfactory evolution, with adequate healing and without flap loss. Both the donor site and the pedicle were primarily closed in all cases. In one patient, the flap developed a limited area of superficial epidermolysis that healed spontaneously. Conclusion: the modified sural flap with a covered pedicle is feasible and reliable with a lower rate of complications when compared with the conventional sural flap. Level of Evidence IV, Cohort Studies

Surgery information reduces anxiety in the pre-operative period

PURPOSE: Patients preparing to undergo surgery should not suffer needless anxiety. This study aimed to evaluate anxiety levels on the day before surgery as related to the information known by the patient regarding the diagnosis, surgical procedure, or anesthesia. METHOD: Patients reported their knowledge of diagnosis, surgery, and anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure patient anxiety levels. RESULTS: One hundred and forty-nine patients were selected, and 82 females and 38 males were interviewed. Twenty-nine patients were excluded due to illiteracy. The state-anxiety levels were alike for males and females (36.10 ± 11.94 vs. 37.61 ± 8.76) (mean ± SD). Trait-anxiety levels were higher for women (42.55 ± 10.39 vs. 38.08 ± 12.25, P = 0.041). Patient education level did not influence the state-anxiety level but was inversely related to the trait-anxiety level. Knowledge of the diagnosis was clear for 91.7% of patients, of the surgery for 75.0%, and of anesthesia for 37.5%. Unfamiliarity with the surgical procedure raised state-anxiety levels (P = 0.021). A lower state-anxiety level was found among patients who did not know the diagnosis but knew about the surgery (P = 0.038). CONCLUSIONS: Increased knowledge of patients regarding the surgery they are about to undergo may reduce their state-anxiety levels.PROPÓSITO: Pacientes que vão ser operados não devem sofrer ansiedade. Este estudo tem por objetivo comparar o grau de ansiedade no dia anterior à cirurgia entre pacientes que têm informação sobre seu diagnóstico, cirurgia e anestesia. MÉTODOS: Pacientes referiram seu conhecimento sobre o diagnóstico, a cirurgia e a anestesia. O inventário de Spielberger, State-Trait Anxiety Inventory (STAI), mediu a ansiedade. RESULTADOS: Cento e quarenta e nove pacientes foram selecionados, 82 mulheres e 38 homens foram entrevistados. Vinte e nove pacientes foram excluídos do estudo por analfabetismo. A ansiedade-estado foi semelhante para homens e mulheres, (36,10 ± 11,94 vs. 37,61 ± 8,76) (mean ± SD). A ansiedade-traço foi maior entre mulheres (42,55 ± 10,39 vs. 38,08 ± 12,25, P = 0,041). O nível de educação não influenciou a ansiedade-estado mas mostrou-se inversamente relacionado à ansiedade-traço. O diagnóstico fora claro para 91,7% dos pacientes entrevistados, cirurgia para 75% e anestesia para 37,5%. O desconhecimento da cirurgia elevou a ansiedade-estado (P = 0,021) cujo menor índice foi encontrado entre pacientes que não conheciam seu diagnóstico, mas sabiam sobre a cirurgia (P = 0,038). CONCLUSÕES: O conhecimento sobre a cirurgia a ser realizada pode reduzir o estado de ansiedade

ORIGINAL RESEARCH SURGERY INFORMATION REDUCES ANXIETY IN THE PRE-OPERATIVE PERIOD

PURPOSE: Patients preparing to undergo surgery should not suffer needless anxiety. This study aimed to evaluate anxiety levels on the day before surgery as related to the information known by the patient regarding the diagnosis, surgical procedure, or anesthesia. METHOD: Patients reported their knowledge of diagnosis, surgery, and anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure patient anxiety levels. RESULTS: One hundred and forty-nine patients were selected, and 82 females and 38 males were interviewed. Twentynine patients were excluded due to illiteracy. The state-anxiety levels were alike for males and females (36.10 ± 11.94 vs. 37.61 ± 8.76) (mean ± SD). Trait-anxiety levels were higher for women (42.55 ± 10.39 vs. 38.08 ± 12.25, P = 0.041). Patient education level did not influence the state-anxiety level but was inversely related to the trait-anxiety level. Knowledge of the diagnosis was clear for 91.7% of patients, of the surgery for 75.0%, and of anesthesia for 37.5%. Unfamiliarity with the surgical procedure raised state-anxiety levels (P = 0.021). A lower state-anxiety level was found among patients who did not know the diagnosis but knew about the surgery (P = 0.038). CONCLUSIONS: Increased knowledge of patients regarding the surgery they are about to undergo may reduce their state-anxiety levels

The patient-physician interactions as seen by undergraduate medical students

CONTEXT: The interaction between a physician and his or her patient is complex and occurs by means of technical performance and through a personal relationship. OBJECTIVE: To assess the interaction between the medical professional and his or her patient with the participation of medical students assuming a role as observers and participants in a medical appointment in an outpatient office. DESIGN: Questionnaire interview study. SETTING: General Medicine outpatient offices, Hospital das Clínicas, Faculty of Medicine, University of São Paulo. PARTICIPANTS: Medical students performed an ethnographical technique of observation, following 199 outpatient medical appointments with Clinical Medicine Residents. MAIN MEASUREMENTS: A questionnaire filled out by observer students measured the physician's attitudes towards patients, as well as patients' expectations regarding the appointment and his or her understanding after its completion. RESULTS: Patients showed higher enthusiasm after the appointment (4.47 ± 0.06 versus 2.62 ± 0.10) (mean ± SEM), as well as some negative remarks such as in relation to the waiting time. The time spent in the consultation was 24.66 ± 4.45 minutes (mean ± SEM) and the waiting time was 123.09 ± 4.91 minutes. The physician's written orientation was fairly well recalled by the patient when the doctor's letter could be previously understood. CONCLUSION: Patients benefit from physicians who keep the focus on them. In addition, this program stimulated the students for their accomplishment of the medical course

Estudo do alcance do retalho do músculo grande dorsal para o revestimento cutâneo da coluna An anatomic study of latissimus dorsi and its suitability for spinal soft tissue coverage

INTRODUÇÃO: A crescente indicação cirúrgica na terapêutica das patologias da coluna vertebral, ocasionada pela melhoria tecnológica aplicada ao tratamento cirúrgico, que proporciona cada vez mais uma cirurgia mais segura, mais rápida, menos invasiva e com melhores resultados funcionais, tem nos levado a um aumento nas complicações pós-operatórias da coluna vertebral. As complicações podem ser mecânicas, biológicas, estruturais ou relacionadas ao material de síntese. As infecções em cirurgia de coluna vertebral, embora raras, ocorrem em 3-6%, constituem um dilema para o cirurgião de coluna, além de graves desdobramentos clínicos para o paciente. A importância do uso do retalho do grande dorsal esta implicada na tentativa de cobertura de partes moles e melhora no padrão vascular regional. OBJETIVO: Avaliar a confiabilidade do retalho do músculo grande dorsal para cobertura de defeitos cutâneos na coluna. MATERIAL E MÉTODO: Foram dissecados 17 músculos grande dorsal de cadáver e medido o quanto eles passavam da linha média na altura de C7, T7 e transição toracolombar. RESULTADOS E CONCLUSÃO: O estudo anatômico realizado comprovou a eficácia desse método.<br>INTRODUCTION: There has been a dramatic increase in spine surgery. New surgical instrumentation and less invasive techniques make surgical procedure faster, safer, achieving better functional results. With this increasing number of operations, the number of back surgery failures has also increased. Complications may be mechanical, biological, or related to problems on instrumentation frames. The rate of spinal infections lies between 3-6 % and it´s still a challenge. After debridement and removal of all infected nonviable soft tissue, it is sometimes difficult to obtain wound closure. Pedicled latissimus dorsi muscle flap coverage provides wound healing by promoting vascularized tissue to reduce dead spaces, enhancing local oxygen delivery, and facilitating antibiotic concentration. OBJECTIVE: Evaluate the suitability of the latissimus dorsi flap for covering spinal skin defects. MATERIAL AND METHODS: 17 cadaveric latissimus dorsi flaps were made, measuring how much they surpassed the middle line at C7, T7 and thocaolumbar transition. RESULTS AND CONCLUSION: This study warrants the suitability of this flap to cover spinal skin defects