The pectoralis major myocutaneous flap (PMMF) remains a useful flap for head and neck reconstruction. Although free-tissue transfer is often preferred, the benefits of the PMMF should not be overlooked. A retrospective chart review was performed on all PMMFs used at Emory for head and neck reconstruction from 1992 through 2008. A total of 139 PMMF were performed in 136 patients with an average age of 65 years. Eighty-six patients were males. All patients except one had a history of Head and Neck Cancer. A smoking history was present in 92% of the patients. Defect location included oral cavity (n = 59), pharyngeal/fistulae (n = 48), temporal bone and cheek (n = 24), oropharyngeal (n = 4), and esophageal (n = 2). The PMMF was used in 4 occasions as a salvage procedure. The survival of the flap was 99.2% (138/139). The PMMF provided definitive closure of the defect in 100% of the cases. The overall average follow-up was 10.5 months. Eighteen patients (13%) developed complications after the procedure. Patients who had radiation therapy had significantly higher complication rates. The PMMF flap remains a very versatile technique with proven reliability for soft tissue coverage of many head and neck defects.
Where and how to care for children with infections, or those requiring protection, is a daily debate in many paediatric settings. The practice of placing patients into single rooms for infection control purposes is well documented but there is little guidance on when to remove patients from isolation rooms. Unless the appropriateness of isolation for each patient is evaluated daily, the availability of cubicles falls, resulting in potentially unnecessary transfers to other hospitals where such facilities are available. A new isolation policy was introduced to improve the availability of isolation rooms on paediatric wards in a large inner city teaching hospital with over 100 paediatric inpatient beds. A change management framework was used that included empowering organisational action and consolidating improvements. A number of strategies were introduced to prompt daily review of children in isolation, including clear criteria for isolation and nursing staff in the emergency department challenging the decision to admit a child into an isolation room. Introduction of the policy and subsequent audits have resulted in improved staff awareness, more effective use of isolation rooms and reduced transfers to other hospitals.
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