Background: The objective of the study was to evaluate the effectiveness of surgical Apgar score (SAS) in predicting morbidity and 30 day mortality in general surgical procedures and also to compare the predictability of the score in elective and emergency surgeries for outcome thereafter.Methods: 120 patients undergoing general surgical procedures in JSS Hospital, Mysuru from November 2016 to April 2018 were included in the study. Necessary data was collected. Surgical Apgar score was calculated for each patient and analysis done.Results: 75% of the patients included in the study were in the age group of over 40 years. Around 23% of the patients belong to age group>60 years. 18.25% of patients in the age group >60 years had a low Apgar score of <4. Whereas surgical Apgar score 9-10 was highest in the age group <40 years. Diabetes, hypertension, smoking were significantly associated with post-operative complications. 74.25% of the surgeries involved in the study were elective in nature. Amongst the 35 patients with an Apgar score of <4, major complications occurred in 33% and a 30-day mortality rate of 23% was observed. Morbidity was higher in emergency surgeries as compared to elective surgical procedures.Conclusions: Surgical Apgar score is a simple and useful method of predicting the morbidity and the 30 day mortality of patients undergoing general surgical procedures. It is more sensitive in predicting the outcome in emergency cases as compared to the elective cases.
Superficial acral fibromyxoma (SAF) is a rare, distinctive benign soft tissue lesion that often involves the fingers and toes, with the great toe being the most frequently affected site. We report a case of SAF diagnosed by fine needle aspiration cytology and confirmed by histopathology. The pre-operative cytological diagnosis will help the surgeon to plan for a wider excision that prevents recurrence.
Background: Skin grafts are used to cover the healing wound, in which adherence of the graft to the wound bed is the important element. Honey has been shown to increase the adherence of skin grafts to wound beds and have antibacterial and anti-inflammatory effects and increase healing rate of wounds.Methods: In a single centre based prospective comparative study from November 2016 to April 2018, 60 patients (in 30 patients graft was fixed with sterilised honey, in 30 patients it was fixed with conventional methods like skin staples/sutures). All patients in two groups were evaluated for area of graft uptake, graft contracture, incidence of hematoma/seroma, mean hospital stay post surgery, post-operative pain, Infection rate and Cost effectiveness. Statistical analysis used are chi-square test, independent t test/ Mann-Whitney test, paired t test/ Wilcoxon test. P<0.05 is considered statistically significant.Results: Although graft uptake was same in both the groups, graft contracture, discharge from graft site and infection rate were less in the honey group. There was no seroma formation in the honey group. Honey significantly reduced postoperative pain (p<0.0001%) and is also cost-effective as the hospital stay was shorter in the honey group (p<0.0001%).Conclusions: Honey has strong adhesive properties, anti-inflammatory action and helps in minimization of scarring, and stimulation of angiogenesis as well as tissue granulation and epithelium growth. It also reduces surgical time for skin graft fixation. Sterilized honey has proven advantage as a skin graft fixator.
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