Deep infection of infrapopliteal autogenous vein grafts—Immediate use of muscle flaps in leg salvage

AbstractPurpose: The purpose of this study was to determine the efficacy of an aggressive management of infrapopliteal autogenous vein graft infection. Methods: Among 341 consecutive infrapopliteal autogenous vein bypass grafts performed at the Helsinki University Central Hospital, 14 patients (4%) had infragenicular wound infection that involved the vein graft. Six of these patients had graft rupture and bleeding. An extensive débridement was performed in all patients. Seven of the grafts had to be partially removed and replaced. The wound and the graft immediately were covered with local muscle flaps in 4 patients and with free muscle flaps in 10 patients. Results: One patient died, and another patient underwent above-knee amputation as a result of a persistent infection and necrosis of the local muscle flap during the 30-day postoperative period. No graft rupture occurred after the treatment of the infected conduit. Graft occlusion occurred in 4 patients who underwent regrafting because of graft rupture and in 1 patient with an infected intact conduit. One patient underwent amputation 15 months later because of an uncontrollable infection despite a patent graft and a functioning flap. At the 1-month, 6-month, 1-year, and 2-year follow-up periods, the leg salvage rates were 92%, 75%, 55%, and 44%, respectively. At the same intervals, 92%, 92%, 70%, and 70% of the patients survived and 85%, 68%, 34%, and 34% of the patients were alive without the loss of their legs. Conclusion: Radical surgical débridement and immediate muscle flap coverage seem to offer an effective alternative method to preserve an infected infrapopliteal autogenous vein graft and to achieve leg salvage. Poor results are expected when a regrafting procedure is necessary for the rupture of an infected vein graft. (J Vasc Surg 1998;28:611-6.

Amputation following internal fixation of an ankle fracture via the posterolateral approach - a case report

Peer reviewe

Industrial Innovation in Transition

In this study, the innovation management processes of Finnish companies in significantly changing business environment were examined. Data collection for this study draws on qualitative methods and interviews. Based on the analysis, it can be summarized that innovation activities are often characterized as processual and hierachically structured with emphasis on the traditional stage-gate–model. As a contrast, in some interviews also highly informal and unsystematic origins and processes of innovation are described. Strategy processes are often characterized according to the established terminology emphasizing rationality and formal processes. However, business strategies are also perceived as a limiting and hindering factor for innovations.  Based on the analysis, there seems to be heavy emphasis on incremental innovation, which builds on advancing current competencies, businesses, and capabilities. Large foreign companies and "players" are described as trendsetters, which are followed. The majority of characterizations do not convey an exploration spirit or passion for radical, disruptive innovations and creation or transformation to entirely new businesses. Descriptions of developing new social innovations (eg. Facebook, Twitter), novel business models, intrapreneurship or start-up mentality as well as passionate visions of transformational ideas and business opportunities appear seldom. Activities for developing processes for open innovation are seen as a future possibility. Currently there is a lack of open innovation tools and processes. Many companies accumulate "big data" from their operations. However, developing its widespread analysis and utilization is seen to take place in the future. Descriptions of active development of ideas to transform businesses and business models based on "big data" analytics are rare.  Industrial innovations originate from networks involving customers, suppliers and public R&D organizations. The study raises also some suggestions how to reform the Finnish innovation system. Development is needed in company innovation management processes, TEKES activities, new funding instruments and university incentive system. On the Finnish societal level, an innovation gap emerges between small companies and large enterprises

Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method

Body contouring surgery following massive weight loss positively affects a patient's quality of life. However, the procedure is prone to complications. Herein, we stratified complications timewise. Furthermore, we examined whether the weight loss method - bariatric surgery or lifestyle changes - affected the frequency or severity of complications. In this single-centre retrospective analysis, we included 158 patients with massive weight loss undergoing body contouring surgery between 2009 and 2015. We recorded 96 complications in 80 patients, with an overall rate of 51%. Most complications (80.2%) were minor (Clavien-Dindo grades 1 and 2) and superficial wound infections. Immediate complications (0-24 hours postoperation) affected 8.3% of patients, with early complications (1-7 post-operative days) affecting 16.7% of them and late complications (8-30 post-operative days) affecting 58.3% of them. We found no statistical difference in complication rates when comparing bariatric and non-bariatric patients. Older age (p = 0.042) at operation is associated with an increased risk for immediate haematoma or bleeding requiring surgery. Among early complications, a high maximum weight (p = 0.035) and a high preoperative weight (p = 0.0053) significantly correlated with a haematoma or bleeding requiring surgery. For late complications, seroma correlated with older age (p =0.0061). Complications are primarily minor and non-life threatening after body contouring surgery because of frequent massive weight loss. Here, no particular subgroup of massive weight loss patients appeared more prone to complications. Thus, for each patient, the risks associated with body contouring surgery following massive weight loss should be considered individually. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Response to the comment on “Abdominoplasty in massive weight loss patient: Modifying the technique to improve the safety”

Non peer reviewe

Ampumavammat

English summar

The risk for end-stage renal disease is increased after burn

Objective: Acute kidney injury (AKI) commonly complicates burn. Recently, AKI has been suggested to be causally related to chronic end-stage renal disease (ESRD), but controversial data also exist. Our aim was to study the risk of ESRD after burn in a nationwide analysis. Methods: All burn patients undergoing hospitalization between 1998 and 2011 were identified from the National Hospital Discharge Register, and the data were linked with the Finnish Registry for Kidney Diseases, which includes all individuals receiving chronic renal replacement therapy (RRT) in Finland. Results: Altogether 41,179 adults were treated at hospitals for burns in Finland between 1998 and 2011. Of these, 86 had a diagnosis of AKI related to the burn. Forty-three burn survivors had ESRD and RRT initiated related to or after the burn. The overall risk for ESRD after burn was increased (standardized incidence ratio, SIR, 2.40, 95% CI 1.73-3.23) compared with the Finnish population. Standardized incidence ratio was 3.11 (95% CI 1.66-5.32) in women and 1.89 (95% CI 1.27-2.69) in men. Of these 43 patients, 38 had a specific non-burn-related diagnosis of ESRD identified in the registry, and ESRD was deemed unlikely to be directly related to the burn. In five patients, the diagnosis of ESRD was unknown cause of renal failure, and causality of the burn with ESRD was evaluated as plausible. Conclusion: In conclusion, a significantly increased risk of ESRD was recorded after a severe burn. Our results do not support increased incidence of ESRD solely as a consequence of AKI due to burn, but burn may increase the risk of ESRD in patients with pre-existing chronic kidney disease. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.Peer reviewe

Actualized lower body contouring surgery after bariatric surgery - a nationwide register-based study

Massive weight loss might lead to excess skin folds causing functional, physical, and psychosocial discomfort. Following bariatric procedures, an increasing number of patients are seeking lower body contouring surgery (LBCS). The proportion of bariatric patients who undergo LBCS is largely unknown. The aim of this current study was to analyse the incidence and realization of LBCS in bariatric patients in Finland. National retrospective register linkage study including all adult patients who received bariatric surgery in Finland during 1998-2016. The data were obtained from the Finnish national health registers maintained by the Finnish Institute for Health and Welfare. Altogether 1089 (14.1%) of 7703 bariatric patients underwent LBCS during the study period. The majority of the LBCS procedures were abdominoplasty (89%). Median latency between bariatric surgery and LBCS was 31 months. The patients with LBCS were younger (p <0.001) and received sleeve gastrectomy (p <0.001). We revealed an annual correlation between LBCS and bariatric procedures (r = 0.683). With a two-year latency between the bariatric and post-bariatric operations, the correlation co-efficiency was strong (r = 0.927). LBCS operations ranged from 5 to 215 per hospital district. Most LBCSs (97.3%) were performed in public hospitals, and some (41%) were performed in university hospitals. This study shows that only 14.1% of bariatric patients undergo LBCS. There is a correlation between bariatric procedures and succeeding plastic surgical reconstructive procedures.Peer reviewe

Sähkösavukkeet ja haavan paraneminen

Vertaisarvioitu. English abstract.Nikotiini on verisuonia voimakkaasti supistava aine. Sen tiedetään haittaavan haavan paranemista ¬verisuonikouristuksen ja vähentyneen hapensaannin kautta. Tutkimusnäyttö viittaa siihen, että nikotiinia sisältävän sähkösavukkeen käyttö heikentää haavan ¬paranemista ja kudoskielekkeiden verenkiertoa. Sähkösavukkeiden käyttäjät eivät miellä itseään tupakoijiksi, joten on tärkeää kysyä sähkösavukkeista ¬erikseen. Jo nykyisen tutkimustiedon perusteella ennen elektiivistä kirurgiaa sähkösavukkeiden käyttäjiä tulisi ¬opastaa lopettamaan samalla lailla kuin tupakoijiakin.Peer reviewe

Reconstruction of the superficial femoral vessels with muscle flap coverage for soft tissue sarcomas of the proximal thigh.

Peer reviewe