Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage

Objective: Multiple large decubitus ulcers present a reconstructive challenge to the plastic surgeon. When stage IV pressure sores become recurrent or extensive, traditional flaps either have already been exhausted or would not be sufficient to cover the defect. Methods: A retrospective review was performed on all paraplegic patients who had chronic, extensive, and stage IV decubitus ulcers, and underwent reconstruction using a pedicled continuous musculocutaneous flap of the entire leg between 1998 and 2007. The extent and size of the debrided pressure sores, number of previous flap reconstructions, intraoperative blood loss, postoperative complications, and years of follow-up were all recorded. A description of the operative technique is also given. Results: Four patients underwent a total leg fillet flap in the study period, with follow-up ranging from 2 to 7 years. Indications included extensive and bilateral trochanteric, sacral, and ischial pressure sores. Complications included intraoperative blood loss and postoperative heterotopic calcification. Conclusions: The total leg fillet flap is a very large and robust flap that offers paraplegic patients coverage of extensive stage IV pressure sores of the trochanteric, sacral, and ischial areas

Wundheilungsstörungen nach medianer Sternotomie : neue, stadiengerechte Klassifikation und Ergebnisse der Defektdeckung mit gefäßgestieltem, myocutanem Latissmus-dorsi-Lappen

Die mediane Sternotomie ist in der Kardio-Chirurgie der wichtigste Zugang zum Herzen. Postoperative Wundheilungsstörungen in diesem Bereich sind seltene, jedoch gefürchtete Komplikationen, die zu schwerwiegenden Konsequenzen führen können. Die zunächst einfache oberflächliche Wundheilungsstörung kann sich verkomplizieren und über eine Osteomyelitis des Sternums zu einer Mediastinitis mit eventuell letalen Konsequenzen führen. Aktuell geben unterschiedliche Autoren eine Inzidenz von 1 % – 8 % an. Die Mortalität der Sternumosteitis wird dabei zwischen 10 % und 30 % angegeben. Wird der Pathomechanismus der Erkrankung zu einem Algorithmus zusammengefasst, so kann sich über einen descendierenden Verlauf eine oberflächliche Wundheilungsstörung zu einer Sternumosteitis und schließlich zu einer Mediastinitis entwickeln. Natürlich kann sich die Infektion auch ascendierend ausbreiten. Über eine Infektion des Mediastinums oder des Sternums kann sich eine Infektion über die Weichteile bis an die Körperoberfläche ausdehnen. Der typische Patient, der eine Wundheilungsstörung erleidet ist in aller Regel polymorbide. Besonders bei diesem Patientenkollektiv sind eine kurze Behandlungsdauer und eine schnelle, postoperative Rehabilitation für das Ergebnis vorrangig. Ist der gewählte Therapieplan nicht aggressiv genug, so kommt es häufig zu chronischen Erkrankungen mit Fistelungen und einem konsekutiven Fortschreiten der Infektion in Weichteilen und Knochen. Neben medizinischen Gesichtspunkten kommen auch der wirtschaftliche Aspekte zu tragen. Wiederholte Operationen, lange Liegezeiten auf der Intensivstation und wiederholte sowie langwierige Rehabilitationsphasen sind nur wenige Beispiele der kostenintensiven Therapiebestandteile. Aufgrund der schwer beherrschbaren Infektsituation ist eine konsequent aggressive, definitive und zuverlässige Versorgung der infizierten Wunden von höchster Priorität. Dabei spielt es keine Rolle, ob es sich dabei um Wundheilungsstörungen im Bereich der Haut- und Unterhautweichteile, des Sternums oder des Mediastinums handelt. Zur Behandlung der Wundheilungsstörung nach medianer Sternotomie existieren verschiedene Behandlungsansätze und Therapieoptionen. Diese reichen von einfachen Debridements mit Sekundärvernähungen über Spül-Saug-Drainagen mit Antibiotika versetzen Lösungen bis hin zu Sternumteilresektionen, Vakuumverbänden und komplexen Lappenplastiken. ...Since 1957 median sternotomy provides surgeons with easy access to mediastinum, heart, and great vessels. Sternal wound complications after median sternotomy are rare but serious complications. An aggravation and extension of these diseases can lead to sepsis or lethal complications. Before, the postoperative infection rate was higher than 25%, present literature however shows an incidence of 1% - 8%. Similarly the mortality rate decreased from 80% to 5% - 30% today. If complications after median sternotomy are divided in an algorithm, a descending wound infection can be separated form an ascending one. A descending infection is a primary superficial wound infection that becomes more complicated by progressing into the deep structures. After an osteitis of the sternum, a sternal instability and furthermore a mediastinitis can result. On the contrary, the ascending process starts with an infection of the mediastinum or sternum that develops to a superficial outbreak as a fistula or a chronic wound. Due to these serious complications and the difficult treatment, first priority should be a consequent, aggressive and reliable therapy. Regardless, whether there is only a superficial wound complication or a fulminate mediastinitis. Patients that suffer from a wound healing complication are usually polymorbid. Especially for these patients a quick and fast therapy is necessary. If the treatment is not aggressive enough, fistulas and chronic infections may result. Apart from the health threat, economical aspects must be considered, too. Repeated operations, extended stays at the intensive care unit and long time periods for rehabilitation are only some examples for cost-intensive constituents. They come along with a prolonged hospital stay, increased hospital costs, and a high morbidity and mortality rate. In general, different treatment options for complications after median sternotomy have been proposed by various authors. They vary from an open treatment, a debridement with closed irrigation by an antibiotic solution, a vacuum therapy, and finally muscle flaps like the pectoralis flap or the latissimus dorsi flap. Because of the absence of a consistent and sufficient classification a comparison of the treatment options becomes impossible. ..

Leveraging Initial Cognitive Load to Predict User Response to Complex Visual Tasks

In this study, we were able to show how cognitive load measurement during the initiation of a complex visual task can predict user response. We measured cognitive load using pupil size and microsaccade rate. The initial phase of task was defined as the first 25 percent of the trial Reaction Time (RT), which was variable up to 50 seconds. The complex visual task entailed a set of twelve words that could be grouped based into 1, 2, or 3 categories or sets, e.g., the words bed, pillow, headboard, etc. can be grouped into a single set that is bedroom. We found a significant correlation between initial cognitive load and final user response to the task. This study provides new insights into the initial cognitive processes that would have practical applications in adaptive user interface design, early warning controls, and detection in human performance

Complications and Solutions in Propeller Flap Surgery

open7siPropeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluation and management of complications.embargoed_20210801Cajozzo, M; Jiga, LP; Jandali, Z; Muradov, M; Pignatti, M; Cordova, A; D'Arpa, SCajozzo, M; Jiga, LP; Jandali, Z; Muradov, M; Pignatti, M; Cordova, A; D'Arpa,

Role of the Cadaver Lab in Lymphatic Microsurgery Education:Validation of a New Training Model

Microsurgical transplantation of vascularized lymph nodes (VLNT) or lymphatic vessels (VLVT) alongside derivative lymphaticovenous procedures are promising approaches for treatment of lymphedema. However, clinically relevant training models for mastering these techniques are still lacking. Here we describe a new training model in human cadaver and validate its use as training tool for microsurgical lymphatic reconstruction

The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital

AbstractPrimary Epstein-Barr virus infection (PEI) is acquired increasingly later in life in developed countries, involving a growing number of adults. No studies have examined the effect of age on PEI. We conducted a prospective, single-centre, noninterventional survey to assess the clinical and economic effects of PEI care according to age. We included all serology-confirmed cases observed in all departments of a large regional hospital. Clinical and biologic data, therapeutics and costs of care were examined. Over a 6-year period, we included 292 subjects (148 children and 144 adults) with a median age of 15.4 years (range 9 months to 79 years). Adults were hospitalized more often (83% vs. 60%) and for longer periods of time (median 4 days vs. 2 days) than children (p ≤ 0.0001 for both). Two adults required a secondary transfer into the intensive care unit, although no children did. Typically, adults showed higher levels of activated lymphocytes and liver abnormalities. They also required the use of systemic corticosteroids more often (45% vs. 23%, p < 0.0001) and for longer periods of time (median 7 days vs. 3 days, p 0.02) than children. Overall, the costs were significantly higher for adults than for children (median, €1940 vs. €1130, p < 0.0001), mainly because of the frequency and duration of hospitalizations. Age increases the immune response and clinical severity of PEI, resulting in substantial additional costs for the community. Better recognition of the disease in adults could shorten the average length of hospital stay

The Journey Home: Violence, Anchoring, and Refugee Decisions to Return

While the UNHCR promotes voluntary repatriation as the preferred solution to refugee situations, there is little understanding of variation in refugees’ preferences regarding return. We develop a theoretical framework suggesting two mechanisms influencing refugees’ preferences. First, refugees’ lived experiences in their country of origin prior to displacement and in their new host country create a trade-off in feelings of being anchored to their origin or host country. Second, firsthand exposure to traumas of war provides some refugees with a sense of competency and self-efficacy, leading them to prefer to return home. We test these relationships with data from a survey among Syrian refugees hosted in Lebanon. We find refugees exposed to violence during the war have a sense of attachment to Syria and are most likely to prefer return. Refugees who have developed a detachment from Syria or an attachment to Lebanon are less likely to prefer return