STI Volume 31

 

$195.00

Surgical Technology International 31

 

Surgical Technology International Vol. 31 contains 59 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

December-2017- ISSN:1090-3941

 

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both electronic and print versions

 

Advanced Wound Healing

The Use of Acellular Dermal Matrices (ADM) in Breast Reconstruction: A Review
Christian Eichler, MD, Obstetrician/Gynecologist, Carolin Schulz, Medical Researcher, Nadine Vogt, MD, Obstetrician/Gynecologist, Mathias Warm, MD, Obstetrician/Gynecologist/Department Head

 

Abstract


The use of acellular dermal matrices (ADM), sometimes referred to as extracellular matrix (ECM), has become an interesting aspect of breast reconstruction. A great deal of literature is available, totaling over 7000 ADM-based reconstructions. Most often, ADMs are used in a skin sparing mastectomy (SSM) scenario, although heterologous breast augmentation with a sub-pectoral fixation may also require an ADM application. Their use has become an attractive, but expensive option. Available data shows head to head comparisons between individual ADMs to be mostly retrospective in nature with only a few prospective trials available. Points of interest include postoperative hematoma, postoperative skin irritation, infection, red breast syndrome, and revision surgery. This work will, therefore, highlight the individual properties of ADMs used in breast reconstruction and compare the available data on complication rates and costs for these devices.

870

9-07-2017

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A Pilot Retrospective Study to Evaluate Two Multi-Layer Foam Dressings for the Management of Moderately Exudative Pressure Injuries
Kevin Woo, PhD, RN, FAPWCA, Associate Professor, Jennifer Kasaboski, RN, ET

 

Abstract


Prevention and treatment of pressure injuries (PI) is a standard benchmark for quality of care, performance, risk reduction, and patient safety. Foam dressings are designed to wick away a large volume of exudate with minimal lateral movement to prevent periwound skin maceration; this renders foam dressings a popular choice for the treatment of chronic wounds with high to moderate amounts of exudate. In addition, multi-layer foam dressings may have added benefits to alleviate pressure and minimize shear as the dressing materials slide against each other. The purpose of this retrospective pilot study was to evaluate the effectiveness and safety of two different multi-layer foam dressings (Optifoam® Gentle, Medline Industries, Inc. Northfield, Illinois; Mepilex® Border, Mölnlycke Health Care, Gothenburg, Sweden) for the management of pressure injuries that produce a moderate amount of exudate. A total of 15 patients and 25 wound treatments were reviewed over a period of 12 months in the study. The difference in the mean surface areas at baseline between the two dressings was not statistically significant (p=.38). All wounds improved over time. There was no difference in healing rate (cm2/day) for wounds that were treated with the Mepilex® Border dressing (M=.12 cm2/day, SD=.19) compared to the Optifoam® Gentle dressing (M=.18 cm2/day; SD=.25); t (23)= .85, p=.40. Findings of this study suggest similar clinical performance between the two foam dressings. Foam dressings were used for the management of several shallow stage 3 and 4 PIs in place of packing. Results of this study challenge the commonly accepted notion that wounds with depth should always be packed with dressing material.

888

3-07-2017

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Noninvasive Vascular Assessment of Lower Extremity Wounds in Diabetics: Are We Able to Predict Perfusion Deficits?
Iram Naz, MD, Research Fellow, Elliot Walters, MD, Research Fellow, Cameron M. Akbari, MD, FACS, Associate Professor of Surgery, Christopher E. Attinger, MD, Professor of Surgery, Paul J. Kim, DPM, MS, Associate Professor

 

Abstract


Vascular assessment of the lower extremity is a critical step in any patient presenting with lower extremity chronic wounds to predict the likelihood of healing and risk of amputation. This concept is vital in patients with diabetes due to their complex vascular anatomy and disease distribution. Three arteries supply the six angiosomes of the lower extremity (i.e., three-dimensional blocks of tissue fed by a “source” artery in the foot and ankle). In diabetic patients, assessment of adequate blood flow to the lower extremities is complicated by the presence of arterial calcification, associated neuropathy, and inflammation. This review focuses on noninvasive vascular assessment methods to better understand perfusion and direct therapy to improve diabetic wound healing. Clinical examination of pulses and Ankle Brachial Index (ABI) can be supplemented by handheld Doppler assessment of direction of blood flow and pulse volume recordings to understand the site and extent of peripheral arterial disease. Duplex ultrasound has been used, but is operator dependent. CT angiogram has limitations in the presence of calcifications and renal insufficiency, prevalent in the diabetic population. Novel modalities, like hyperspectral imaging, ICG fluorescence angiography, and nuclear imaging are being studied for their potential to overcome some of these challenges, but the data is limited. At present, these newer modalities are not widely available, but once validated by robust data, they may supplant older, less reliable techniques and improve our ability to predict wound healing. This will help reduce healthcare costs and improve outcomes as wound care specialists will be able to more accurately direct patients to the best treatment plan to preserve mobility and reduce mortality.

904

25-09-2017

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Biofilms, Their role and Treatment Options in the Chronic Non-healing Wound
Michel F. Moore, MD, Doctor of Medicine

 

Abstract


The discovery of the existence of biofilms in the 1970s has resulted in a greater understanding of how bacteria form a synergistic relationship to facilitate their survival by incorporating and sharing the individual attributes that individual bacteria have with the polymicrobial flora that composes the biofilm. Advances in molecular biology have aided in delineating complexity of biofilms, but the abundance and plethora of the microbial world provides an ongoing and daunting task. The enormity of this task is reflected in the chronic non-healing wound, as it is estimated that 60% of all chronic non-healing wounds have a biofilm component. The etiology of the wound, its anatomical location, the chronicity of the wound, and the varying polymicrobial population that exists in the varying clinical settings where treatment occurs, adds to the difficulty of this problem. A review of the present existing knowledge of biofilms in the chronic non-healing wound and their clinical relevance is discussed. The relevance of clinical findings, readily available laboratory tests, and an analysis of the primary mode of action of certain treatment options are also discussed as to their effectiveness in the treatment of chronic non-healing wounds.

 

916

21-11-2017

 

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