Surgical Technology International
33rd edition
Contains 45 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
376 pages
October 2018 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Pain Reduction with Negative Pressure on Surgical Site Incisions
Philip Wrotslavsky, DPM, FACFAS Board Certified Foot and Ankle Reconstruction, American Board of Foot and Ankle Surgery, Scripps Mercy Hospital, San Diego, CA
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Postoperative pain management for surgery in the lower extremities has historically been managed mechanically through the use of elevation, ice, compression and drains. Pharmacological management includes the use of nerve blocks and analgesics. Due to the current opioid crisis, new methods are being sought to reduce post-operative pain so that patients are at lower risk for opioid addiction. Postoperative edema control is vital to reduce tension on the incision, since increased incisional tension may cause an increase in pain at the surgical site. Ice, elevation, compression and drains all contribute to edema reduction, and thereby reduce pain and incisional tension. This report introduces a new method for post-operative pain control in lower-extremity surgery. In the author’s present clinical experience with 15 patients, the application of negative pressure at the incision site using the PREVENA™ Incision Management System (KCI USA, Inc., San Antonio, TX) was associated with a decrease in post-operative pain as well as a decrease in the use of narcotics for post-operative pain management.
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Comparing the Cumulative Incidence of Pressure Injuries Using Multilayer Foam Dressings in Seriously Ill and Frail Patients: A Quality Improvement Project
Jerra Sullivan, MSN, RN, CWOCN, Skin Care/Diabetes Program Manager, Nursing Practice, Quality & Education, Beverly Hospital, Beverly, Massachusetts, Dr. Kevin Woo, PhD, RN, NSWOC, FAPWCA, Associate Professor, School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario
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Maintaining skin integrity is benchmarked for patient safety and quality of care. The purpose of this quality improvement project was to evaluate the incidence of pressure ulcers in high-risk, seriously ill patients from critical care areas comparing the number of hospital-acquired pressure injuries (HAPIs) after implementation of a new silicone multi-layer foam dressing with the number of HAPIs developed during a period in the previous year within which other silicone multi-layer foam dressings were used for prevention. This study took place in three intensive care units (ICUs) including 326 patients from three community-based hospitals in Massachusetts. The cumulative incidence during the study period was 0% as opposed to 0.32% from the previous year. Multi-layer foam dressings are beneficial for pressure ulcer prevention, taking into consideration the cost-effectiveness of care and optimal patient outcomes.
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Tolerance of Biofilms to Antimicrobials and Significance to Antibiotic Resistance in Wounds
Anne-Marie Salisbury, PhD, Senior Microbiologist/Lab Manager, Steven L. Percival, PhD, CEO, 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science (CEBS), Liverpool Bio-Innovation Hub, Liverpool, UK, Kevin Woo, PhD, RN, NSWOC, FAPWCA, Associate Professor, School of Nursing, School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Sandip Sarkar FRCS, MA, PhD, Consultant Vascular and Endovascular Surgeon, Barts Health NHS Trust, London, United Kingdom, Greg Schultz, PhD, Director, Institute for Wound Research, University of Florida, Gainesville, Florida, Matthew Malone, FFPM, RCPS (Glasg), Director of Research, High Risk Foot Service, Liverpool Hospital, Liverpool, Australia, Dieter Mayer, MD, Assistant Professor, Head of Wound Care, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland
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A biofilm is a community of microorganisms that adhere to each other and to surfaces and secrete extracellular polymeric substances (EPS) encasing themselves in a matrix. Biofilms are a major healthcare concern, as they can form on medical devices leading to infection. Additionally, there is growing evidence to show their ability to form in chronic wounds, which leads to delayed wound healing and inflammation. Due to a number of reasons, such as formation of the EPS resulting in sub-inhibitory concentrations of antimicrobials reaching the bacterial cells, slow growth rate of bacterial cells rendering some antibiotics ineffective, and the presence of persister cells, biofilms show increased tolerance to many antimicrobials and antibiotics. Additionally, studies have started to emerge showing a link between resistance to antimicrobials and antibiotics. Cross-resistance can be attributed to a number of factors, for example, increased expression of multidrug efflux pumps that efflux a wide range of substrates and horizontal gene transfer of genetic material encoding multiple resistance genes between different species within the polymicrobial biofilm. Antimicrobial resistance is an increasing threat caused by multiple factors including cross-resistance, and it is a global health concern. This review focuses on current research on antimicrobial and antibiotic resistance and cross-resistance found between antimicrobials and antibiotics commonly used in woundcare to evaluate the significance of this acquired antibiotic resistance. Furthermore, the review discusses the significance of antimicrobial tolerance and the role biofilms play in enhancing antibiotic resistance.
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Scoping Review of Clinical Outcomes Related to Advanced Training in Wound Care
Veronika Anissimova RN, BMedSc, MCIScWH, CETN(C), Registered Nurse, (Enterostomal Therapist), The Hospital for Sick Children, Toronto, Ontario, Megan Brittain, MClSc, Professor, Deborah Anne Loundes, BSc, DCh, MClSc, Professor, The Michener Institute of Education at UHN, Toronto, Ontario, Kevin Woo, PhD, RN, NSWOC, FAPWCA, Associate Professor, Queen’s University, School of Nursing/School of, Rehabilitation Therapy, Kingston, Ontario
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Introduction: There are different levels of wound education which exist amongst healthcare providers treating wounds. It is unknown if advanced wound training can lead to improved clinical outcomes.
Purpose: To review and summarize existing literature focused on the impact of different healthcare professionals with advanced wound care training and the associated effect of clinical outcomes.
Materials and Methods: The methods used to conduct this scoping review are based on the methodological framework developed by Arksey and O’Malley. An electronic search was performed by independent reviewers using Scopus, CINAHL, PubMed, Google, and EWMA. Consensus decision-making amongst the reviewers resulted in relevant final articles being selected for review.
Results: In the literature, there is no universally accepted definition for advanced training in wound care. Seven of the eight selected articles focused on nurses with a specialization in wound healing and their impact on wound healing outcomes. The five main themes identified were wound improvement, cost savings, influence on other nurses, wound recurrence rate, and advanced education.
Conclusion: A minimum level of advanced training or education would be beneficial to ensure consistency in the provision of advanced wound care by professionals practicing wound care.
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