Ann R Coll Surg Engl 2005; 87: 427-431 427The annual incidence of stoma formation in England is 20,800, 1 although recent literature would suggest that this figure is unnecessarily high. The management of obstructing left-sided colorectal cancer has changed in recent times, with increased use of on -table lavage with primary resection and anastomosis 2,3 and colorectal stenting 4 to avoid stoma formation. Sphincter preserving surgery for rectal cancer should also reduce permanent stoma rates. 5Persistently high morbidity and mortality rates associated with stoma creation and reversal are behind attempts to reduce their formation. Long-term complication rates of 58% in colostomies 6 and up to 76% in ileostomies 7 have been reported. It is also recognised that around 15% of temporary stomas created at the time of anterior resection become permanent. 8There has been much recent work examining risk factors for mortality in colorectal cancer surgery, 9 such as ASA grade and age, but whether the presence of a stoma affects mortality has not been previously examined. Studies have addressed the mortality following stoma reversal (0-4%), 10 but the literature is scant when stoma creation is concerned.We have examined whether the incidence of stoma formation is declining in the practice of a typical district general hospital, and investigated the prevalent morbidity and mortality associated with stoma creation, together with their risk factors. Patients and MethodsAll patients undergoing colostomy or ileostomy formation (elective and emergency) from January 1992 to December 2000 were identified. Data were collected from patient records maintained prospectively by the stomatherapy department, supported by information from operation notes and patient case records. Complications recorded were necrosis, prolapse, peristomal infection or abscess, retraction, stenosis, parastomal hernia, fistula and malignant change at the stoma site.Complications not included were skin excoriation and laparotomy wound problems.Operations were performed by one of seven consultant general surgeons or their registrars, three of whom had a declared interest in coloproctology. Patients undergoing bowel resection without stoma formation were not studied. Statistical analysisResults are expressed as the mean (SD) Stoma Care, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, Mid-Glamorgan, UK ABSTRACT INTRODUCTION As stoma formation is thought to be declining, we performed a study to evaluate the rate of stoma formation and the impact on stoma complication rates, together with risk factors for complications.
In clinical practice many wounds are slow to heal and difficult to manage. The recently introduced technique of topical negative pressure therapy (TNP) has been developed to try to overcome some of these difficulties. TNP applies a controlled negative pressure to the surface of a wound that has potential advantages for wound treatment and management. Although the concept itself, of using suction in wound management is not new, the technique of applying a negative pressure at the surface of the wound is. This paper explores the origins and proposed mechanisms of action of TNP therapy and discusses the types of wounds that are thought to benefit most from use of this system.
T elemedicine is a relatively new development within the UK, but is increasingly useful in many areas of medicine including plastic surgery.1,2 It is widely felt that telemedicine has the potential to improve patient care within health care systems through cost saving and time efficiency in patient care.3 It is already being used with great success in many hospitals in the US and Australia as well as the military service within the UK. DefinitionTelemedicine is the assessment and review of patient information (history, examination or investigations) by health professionals who are separated temporally and/or spatially from their patients (i.e. the practise of medicine from a distance). This interaction is most usually between clinicians but can involve direct clinician-patient contact (e.g. telepsychiatry). 5There are several types classified according to the type of interaction and the information transmitted. Usually, it is divided into two main areas -real-time and store-andforward. Real-time telemedicine is used in videoconferencing and involves synchronous interaction between doctor and patient. Store-and-forward telemedicine involves prior 'storage' of either video or still images, which are then sent to the clinician. This may be at a later time or date. Examples of store-and-forward applications are teledermatology and teleradiology. Telemedicine in acute plastic surgical trauma and burns SM Jones, C Milroy, MA Pickford Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, UKBackground: Telemedicine is a relatively new development within the UK, but is increasingly useful in many areas of medicine including plastic surgery. Plastic surgery centres often work on a hub-and-spoke basis with many district hospitals referring to one tertiary centre. The Queen Victoria Hospital is one such centre receiving calls from more than 28 hospitals in the Southeast of England resulting in approximately 20 referrals a day. Objective: A telemedicine system was developed to improve trauma management. This study was designed to establish whether digital images were sufficiently accurate enough to aid decisionmaking. A store-and-forward telemedicine system was devised and the images of 150 trauma referrals evaluated in terms of injury severity and operative priority by each member of the plastic surgical team. Results: Correlation scores for assessed images were high. Accuracy of 'transmitted image' in comparison to injury on examination scored > 97%. Operative priority scores tended to be higher than injury severity. Conclusions: Telemedicine is an accurate method by which to transfer information on plastic surgical trauma including burns.
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