Transdiaphragmatic Omental Harvest

Vyas, Raj M.; Pršić, Adnan; Orgill, Dennis P.

doi:10.1097/prs.0b013e31827c6e2e

Cited by 27 publications

(23 citation statements)

References 19 publications

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“…de Kraker, et al demonstrated that grip and pinch strength are significantly lower in severe RLD compared with mild RLD [3]. Our data support these findings, as the hands that had poor S-D outcome were the ones with an absent radius or preoperative abnormalities of the pollicized digit.…”

Section: Discussionsupporting

confidence: 87%

“…They found positive outcomes in two JHFT subtests (page turning and checker stacking) as well as patient/parent assessments of thumb appearance and function, despite poor strength and performance on the pegboard test. De Kraker, et al studied pollicized thumb range of motion, strength, sensation, and satisfaction in a series of 40 patients ages 5–25 years [3]. They also found high patient and parent satisfaction with surgical outcome despite diminished strength and range of motion, especially for interphalangeal and metacarpophalangeal extension and interphalangeal flexion.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstructive options are limited and most commonly include radial-most digit pollicization, toe to thumb transfer, or distraction lengthening [2]. Assessment of outcomes after finger pollicization in children with thumb hypoplasia has demonstrated decreased strength and performance on timed tests of function, yet patients and parents tend to rate their satisfaction and quality of life unexpectedly high [3–6]. …”

Section: Introductionmentioning

confidence: 99%

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Quantitative assessment of dynamic control of fingertip forces after pollicization

et al. 2015

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Dexterity after finger pollicization (reconstruction to thumb) is critical to functional outcomes. While most tests of hand function evaluate a combination of strength, coordination, and motor control, the Strength-Dexterity (S-D) paradigm focuses on the dynamic control of fingertip forces. We evaluated 10 pollicized and 5 non-pollicized hands from 8 participants ages 4–17 years (2 female, 6 male; 10.6 ± 4.5 years). Participants partially compressed and held an instrumented spring prone to buckling between the thumb and first finger to quantify dynamic control over the direction and magnitude of fingertip forces. They also completed traditional functional tests including grip, lateral pinch, and tripod pinch strength, Box and Blocks, and 9-hole peg test. Six of 10 pollicized hands and all non-pollicized hands had S-D scores comparable to typically developing children. However, dynamical analysis showed that pollicized hands exhibit greater variability in compression force, indicating poorer corrective action. Almost all pollicized hands scored below the normal range for the traditional functional tests. The S-D test Z-scores correlated moderately with Z-scores from the other functional tests (r=0.54–0.61; p= 0.02–0.04) but more weakly than amongst the other functional measures (r=0.58–0.83; p=0.0002–0.02), suggesting that the S-D test captures a different domain of function. A higher incidence of radial absence in the hands with poor S-D scores (3/4 vs. 0/6 in hands with normal S-D scores, p=0.03) was the only clinical characteristic associated with S-D outcome. Overall, these results suggest that while most pollicized hands can control fingertip forces, the nature of that control is altered.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative assessment of dynamic control of fingertip forces after pollicization

et al. 2015

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“…Existing studies of outcomes after early childhood finger pollicization for thumb hypoplasia have demonstrated decreased strength and performance on functional tests compared to age-matched norms and non-operated contralateral hands 21-25 . Despite their functional limitations, patients and parents tend to rate their satisfaction and quality of life unexpectedly high 26-29 .…”

Section: Introductionmentioning

confidence: 99%

Long term functional outcomes after early childhood pollicization

Lightdale-Miric

Mueske

Lawrence

et al. 2015

Journal of Hand Therapy

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Study Design Retrospective Cohort Introduction Pollicization creates a thumb from another finger to treat hypoplasia/aplasia. Important outcomes include strength, function, dexterity, and quality of life. Purpose of the Study To evaluate mid- to long-term outcomes and examine predictors of outcome after early childhood pollicization. Methods 8 children who underwent 10 pollicizations (age at surgery ≤ 5 years) were evaluated 3 to 15 years after surgery. Anthropometrics, range of motion, and basic medical history were obtained. Participants completed an upper extremity questionnaire (PODCI) and functional tests including grip and pinch strength, Box and Blocks, 9-hole pegboard, and strength-dexterity (S-D) tests. Results Almost all pollicized hands had poor strength and performed poorly on the traditional functional tests. Six of 10 pollicized hands had normal dexterity scores but were less stable in maintaining a steady-state force. Predictors of poorer outcomes included older age at surgery, reduced metacarpophalangeal and interphalangeal range of motion, and radial absence. Discussion Early childhood pollicization resulted in poor strength and overall function, but normal dexterity was often achieved using altered control strategies. Conclusions Most children will likely obtain adequate dexterity despite weakness after pollicization, but older children and those with the most severe involvement may have poorer outcomes.

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“…Ideally, short courses of antimicrobial prophylaxis are preferred over longer courses to reduce costs, drug additional surgical trauma and late flap-related morbidity such as muscular weakness, pain, and hernias [86] . An alternative plastic procedure to pectoralis muscle flaps is the use of omentum that promotes significant angiogenesis, immunologic function, and antimicrobial activity supporting tissue-generation promotion with great capacity to occupy dead space [6,87,88] . Usually, the use of omentum is considered in the case of complex wounds or when the defect is extremely wide with significant sternal loss.…”

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid-and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors -when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4(4): 265-273 Available from: URL: http:// www.wjgnet.com/2220-3141/full/v4/i4/265.htm DOI: http:// dx.doi.org/10.5492/wjccm.v4.i4.265 INTRODUCTIONDeep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery with a significant impact on both patient prognosis and hospital budgets [1][2][3][4][5] . Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI. By the end of the first year, Filsoufi et al [6] found a 15% absolute survival difference between patients ...

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Transdiaphragmatic Omental Harvest

Abstract: Transdiaphragmatic omental harvest provides safe and efficient coverage of deep sternal wounds without a laparotomy incision.

Cited by 27 publications

References 19 publications

Quantitative assessment of dynamic control of fingertip forces after pollicization

Quantitative assessment of dynamic control of fingertip forces after pollicization

Long term functional outcomes after early childhood pollicization

Deep sternal wound infection after cardiac surgery: Evidences and controversies

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