Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.
In a relatively short period of time, the need for incorporating primary surgical palliative care into surgical education and residency curriculum has become apparent. This provides an opportunity for growth for surgeons and surgical residents and a method to explore spirituality and wholeness of the patient. It also has the potential for increasing the sense of fulfillment that residents and surgeons alike can drive from caring for complex surgical patients. Given the significant constraints of today’s graduate medical education world, there remain challenges that must be overcome when designing curricula and incorporating surgical palliative care into practice and resident education. The Surgical Palliative Care Society brings hope for the future of this specialty and encourages multidisciplinary discussions about the practice of, education in, and research on surgical palliative care.
Surgical palliative care, palliative care interventions, and palliative surgery all reference a blend of these 2 sub-specialty fields. Despite prior published definitions, use of these phrases both clinically and in the literature is varied and can lead to confusion and misunderstanding. Herein, we proposed the adoption of standardized nomenclature to guide the consistent use of these phrases.
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