Handbuch methodischer Grundfragen zur Masterplan-Erstellung - Kommunale Masterpläne für 100 % Klimaschutz

Masterplan-Kommunen sind die Vorreiter unter den Klimaschutzkommunen und müssen über das bisher in der Breite bereits Begonnene hinausgehen. Sie stehen vor großen strukturellen und finanziellen Herausforderungen, aber auch vor großen Chancen. Die Chancen ergeben sich insbesondere für ein verbessertes und lebenswerteres Umfeld in der Kommune und damit auch für eine gesteigerte Lebensqualität. Die Einbindung aller Akteure in der Kommune, innerhalb und außerhalb der Verwaltung, ist ein wichtiger Baustein auf dem Weg zum Ziel „Null Emissionen“. Vor allem die Einbindung der Wirtschaft vor Ort und der Bürgerinnen und Bürger ist essenziell, wenn eine Transformation angestoßen und umgesetzt werden soll. Das Handbuch unterstützt die Masterplan-Kommunen mit der vorliegenden methodischen Herangehensweise auf ihrem Weg

Risk factors associated with the development of sepsis after reconstructive flap surgery*

Sepsis is a serious and potentially life-threatening condition. Risk factors that are associated with the development of sepsis may differ as it relates to reconstructive flap surgery. The purpose of this study is to identify the incidence and predictors for sepsis in patients undergoing reconstructive flap surgery. The ACS-NSQIP database was queried from 2005 to 2016 for factors related to sepsis in patients undergoing reconstructive flap surgery. CPT codes were used to identify patient cohorts. A sepsis group was compared to a control group that underwent the same procedures without the postoperative manifestations of sepsis. Statistical analyses were performed to ascertain risk factors associated with the development of sepsis. 24,257 patients who underwent flap reconstruction were included in this study. Of these, 511 developed sepsis postoperatively (2.1%). Multivariate analysis showed that male gender (p <.001), African-American race (p <.001), hypertension requiring medication (p <.001), smoking (p <.001), a higher Charlson comorbidity Index score (p <.001), evidence of preoperative wound infection (p <.001), chronic steroid use (p <.001), and prolonged operative time (p <.001) all significantly were associated with the development of sepsis. Sepsis resulted in a higher chance of 30-day mortality (p <.001) and increased the risk of developing septic shock (OR: 2.578, CI: 1.241–5.354) This study shows that postoperative sepsis is a serious complication of reconstructive flap surgery. Risk reduction and prevention of potentially life-threatening complications is always a priority. Awareness of the risk factors contributing to the development of sepsis is crucial for early intervention and treatment

Gluteal Fasciocutaneous Flap Reconstruction after Salvage Surgery for Pelvic Sepsis

BACKGROUND: Chronic pelvic sepsis mostly originates from complicated pelvic surgery and failed interventions. This is a challenging condition that often requires extensive salvage surgery consisting of complete debridement with source control and filling of the dead space with well-vascularized tissue. OBJECTIVE: This study aimed to describe the outcomes of gluteal fasciocutaneous flaps for the treatment of secondary pelvic sepsis. DESIGN: Retrospective single-center cohort study. SETTINGS: Tertiary referral center. PATIENTS: Patients who underwent salvage surgery for secondary pelvic sepsis between 2012 and 2020 using a gluteal flap were included in this study. MAIN OUTCOME MEASURES: Percentage of complete wound healing. RESULTS: In total, 27 patients were included, of whom 22 underwent index rectal resection for cancer and 21 had undergone (chemo)radiotherapy. A median of 3 (interquartile range, 1-5) surgical and 1 (interquartile range, 1-4) radiological interventions preceded salvage surgery during a median period of 62 (interquartile range, 20-124) months. Salvage surgery included partial sacrectomy in 20 patients. The gluteal flap consisted of a V-Y flap in 16 patients, superior gluteal artery perforator flap in 8 patients, and a gluteal turnover flap in 3 patients. Median hospital stay was 9 (interquartile range, 6-18) days. During a median follow-up of 18 (interquartile range, 6-34) months, wound complications occurred in 41%, with a reintervention rate of 30%. The median time to wound healing was 69 (interquartile range, 33-154) days, with a complete healing rate of 89% at the end of follow-up. LIMITATIONS: Retrospective design and heterogeneous patient population. CONCLUSIONS: In patients undergoing major salvage surgery for chronic pelvic sepsis, the use of gluteal fasciocutaneous flaps is a promising solution because of the high success rate, limited risks, and relatively simple technique.</p

Gluteal Fasciocutaneous Flap Reconstruction after Salvage Surgery for Pelvic Sepsis

BACKGROUND: Chronic pelvic sepsis mostly originates from complicated pelvic surgery and failed interventions. This is a challenging condition that often requires extensive salvage surgery consisting of complete debridement with source control and filling of the dead space with well-vascularized tissue. OBJECTIVE: This study aimed to describe the outcomes of gluteal fasciocutaneous flaps for the treatment of secondary pelvic sepsis. DESIGN: Retrospective single-center cohort study. SETTINGS: Tertiary referral center. PATIENTS: Patients who underwent salvage surgery for secondary pelvic sepsis between 2012 and 2020 using a gluteal flap were included in this study. MAIN OUTCOME MEASURES: Percentage of complete wound healing. RESULTS: In total, 27 patients were included, of whom 22 underwent index rectal resection for cancer and 21 had undergone (chemo)radiotherapy. A median of 3 (interquartile range, 1-5) surgical and 1 (interquartile range, 1-4) radiological interventions preceded salvage surgery during a median period of 62 (interquartile range, 20-124) months. Salvage surgery included partial sacrectomy in 20 patients. The gluteal flap consisted of a V-Y flap in 16 patients, superior gluteal artery perforator flap in 8 patients, and a gluteal turnover flap in 3 patients. Median hospital stay was 9 (interquartile range, 6-18) days. During a median follow-up of 18 (interquartile range, 6-34) months, wound complications occurred in 41%, with a reintervention rate of 30%. The median time to wound healing was 69 (interquartile range, 33-154) days, with a complete healing rate of 89% at the end of follow-up. LIMITATIONS: Retrospective design and heterogeneous patient population. CONCLUSIONS: In patients undergoing major salvage surgery for chronic pelvic sepsis, the use of gluteal fasciocutaneous flaps is a promising solution because of the high success rate, limited risks, and relatively simple technique.</p

Handbuch methodischer Grundfragen zur Masterplan-Erstellung : kommunale Masterpläne für 100 % Klimaschutz

Masterplan-Kommunen sind die Vorreiter unter den Klimaschutzkommunen und müssen über das bisher in der Breite bereits Begonnene hinausgehen. Sie stehen vor großen strukturellen und finanziellen Herausforderungen, aber auch vor großen Chancen. Die Chancen ergeben sich insbesondere für ein verbessertes und lebenswerteres Umfeld in der Kommune und damit auch für eine gesteigerte Lebensqualität. Die Einbindung aller Akteure in der Kommune, innerhalb und außerhalb der Verwaltung, ist ein wichtiger Baustein auf dem Weg zum Ziel „Null Emissionen“. Vor allem die Einbindung der Wirtschaft vor Ort und der Bürgerinnen und Bürger ist essenziell, wenn eine Transformation angestoßen und umgesetzt werden soll. Das Handbuch unterstützt die Masterplan-Kommunen mit der vorliegenden methodischen Herangehensweise auf ihrem Weg