PET is superior to CT for mediastinal staging of non-small cell lung cancer, independent of performance index or clinical context of PET imaging.
Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. Once the compartment pressure has been relieved and stabilized, the wound should be closed as quickly and early as possible to avoid later complications. Skin grafting can lead to morbidity and scarring at both the donor and fasciotomy site. Primary closure results in a more functional and esthetic outcome with less morbidity for the patient, but can often be difficult to achieve secondary to edema, skin retraction, and skin edge necrosis. Our objective was to examine fasciotomy wound outcomes, including time to definitive closure, comparing traditional wet-to-dry dressings, and the vacuum-assisted closure (VAC) device. This retrospective chart review included a consecutive series of patients over a 10-year period. This series included 458 patients who underwent 804 fasciotomies. Of these fasciotomy wounds, 438 received exclusively VAC. dressings, 270 received only normal saline wet-to-dry dressings, and 96 were treated with a combination of both. Of the sample, 408 patients were treated with exclusively VAC therapy or wet-to-dry dressings and 50 patients were treated with a combination of both. In comparing all wounds, there was a statistically significant higher rate of primary closure using the VAC versus traditional wet-to-dry dressings (P < 0.05 for lower extremities and P < 0.03 for upper extremities). The time to primary closure of wounds was shorter in the VAC. group in comparison with the non-VAC group. This study has shown that the use of the VAC for fasciotomy wound closure results in a higher rate of primary closure versus traditional wet-to-dry dressings. In addition, the time to primary closure of wounds or time to skin grafting is shorter when the VAC was employed. The VAC used in the described settings decreases hospitalization time, allows for earlier rehabilitation, and ultimately leads to increased patient satisfaction.
Cosmetic patients have many options when seeking out their surgeons. In midsize and larger cities, these options span not only different specialties but also different levels of experience. Because surgical experience can best be gained first hand, there exists a special and symbiotic relationship between a surgeon-in-training and his or her patient. Benefits stem from the opportunity for a surgeon to gain independent experience while offering cost effective benefits to patients who may or may not otherwise have access to cosmetic surgery. To meet the needs of both patients and the surgeons-in-training, the Wake Forest University Plastic and Reconstructive Surgery Training Program has set up and maintained a chief resident run cosmetic surgery clinic for 17 years. Each chief resident serves as primary surgeon 1 day a week during the chief year. We present a 7-year retrospective outcome analysis of this experience. The authors performed an Institutional Review Board approved retrospective chart review of all patients who received major cosmetic procedures performed in the WFU chief resident clinic over a 7-year span from 2000 to 2007. A total of 210 charts were reviewed. Fourteen charts were excluded because of inadequate records or non esthetic procedures performed concomitantly. All procedures were viewed as independent events. A total of 196 patients underwent 272 procedures. All procedures were evaluated for major and minor complications and revisions. A total number of 272 initial cosmetic procedures were performed in a 7-year span. Adverse events were divided into major and minor complications. There were no major complications for any of the procedures. Overall minor complication rate was 8.0%. Overall revision rate was 14.4%. Procedures with greatest probability of revision were abdominoplasty and reduction mammaplasty. Chief resident clinics provide a unique experience wherein surgeons-in-training are allowed to hone previously developed surgical acumen while providing a safe and expectedly desirable result for their patients. Because many cosmetic patients desire secondary touch up procedures, a rate of 14.4% in this cohort is neither unexpected nor unacceptable. In addition, the postoperative evaluation and the decision to pursue secondary procedures provides a unique perspective to the chief residents. A chief resident run clinic can be an effective and safe learning tool, providing benefit to patient and the surgeon in training.
Despite suspicions that increased severity of deformity in infants with metopic craniosynostosis correlates with decreased cognitive and motor development, no such associations could be demonstrated. The results of this study did suggest, however, that children with isolated metopic craniosynostosis might show specific developmental delays in language acquisition. Finally, there were no significant correlations between cognitive development and prenatal risk factors.
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