Pancreatic injury continues to present challenges to the trauma surgeon. The relatively rare occurrence of these injuries (0.2–12% of abdominal trauma), the difficulty in making a timely diagnosis, and high morbidity and mortality rates following complications justify the anxiety these unforgiving injuries invoke 1-3. Mortality rates for pancreatic trauma range from 9 to 34%, with a mean rate of 19%. Complications following pancreatic injuries are alarmingly frequent, occurring in 30 to 60% of patients 4. Nonetheless, if recognized early, the treatment of most pancreatic injuries is straightforward, with low morbidity and mortality. This review contains 10 figures, 2 tables, and 65 references. Key Words : Pancreatic trauma, injury, pediatric trauma, ERCP, MRCP, spleen-preserving pancreatectomy
{"title":"Pancreatic Trauma","authors":"James C. Becker, Brian C. Beldowicz, G. Jurkovich","doi":"10.2310/surg.2397","DOIUrl":"https://doi.org/10.2310/surg.2397","url":null,"abstract":"Pancreatic injury continues to present challenges to the trauma surgeon. The relatively rare occurrence of these injuries (0.2–12% of abdominal trauma), the difficulty in making a timely diagnosis, and high morbidity and mortality rates following complications justify the anxiety these unforgiving injuries invoke 1-3. Mortality rates for pancreatic trauma range from 9 to 34%, with a mean rate of 19%. Complications following pancreatic injuries are alarmingly frequent, occurring in 30 to 60% of patients 4. Nonetheless, if recognized early, the treatment of most pancreatic injuries is straightforward, with low morbidity and mortality.\u0000This review contains 10 figures, 2 tables, and 65 references.\u0000Key Words : Pancreatic trauma, injury, pediatric trauma, ERCP, MRCP, spleen-preserving pancreatectomy","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76040978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review contains 2 references. Key words: Hypernatremia, Edematous States ,Volume Depletion, Osmolality, Diuretics
{"title":"Hypernatremia","authors":"G. Mostafa","doi":"10.2310/anes.2411","DOIUrl":"https://doi.org/10.2310/anes.2411","url":null,"abstract":"Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications.\u0000\u0000This review contains 2 references.\u0000Key words: Hypernatremia, Edematous States ,Volume Depletion, Osmolality, Diuretics","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91131323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Bekeny, E. Zolper, Vikas S Kotha, Kenneth L. Fan, Carol Deane Benedict Mitnick, K. Evans
Chronic wounds of autoimmune and vasculitic etiologies, collectively referred to as “atypical ulcers”, are complex and heterogeneous. Evidence for a standardized approach remains deficient. Diagnosis requires a thorough history, physical exam, and investigative studies including serologic tests and wound biopsies. Management must be multidisciplinary and tailored to the individual patient and the unique characteristics of their wound. Medical therapy to stabilize the underlying disease is the most important aspect of therapy. Surgical intervention is often not appropriate and even contraindicated in some scenarios such as pyoderma gangrenosum. When medical therapy and local wound care fail and surgical intervention is deemed appropriate, inflammation must first be controlled with medical intervention before surgical intervention can be considered. This review contains 5 figures, 2 tables, and 26 references. Keywords: ulcer, wound healing, autoimmune diseases, vasculitis, pyoderma gangrenosum, scleroderma, rheumatoid nodule, immunosuppressive agents, rheumatology, patient care team
{"title":"Medical and Surgical Treatment of Vasculitic and Autoimmune Ulcers","authors":"J. Bekeny, E. Zolper, Vikas S Kotha, Kenneth L. Fan, Carol Deane Benedict Mitnick, K. Evans","doi":"10.2310/ps.10101","DOIUrl":"https://doi.org/10.2310/ps.10101","url":null,"abstract":"Chronic wounds of autoimmune and vasculitic etiologies, collectively referred to as “atypical ulcers”, are complex and heterogeneous. Evidence for a standardized approach remains deficient. Diagnosis requires a thorough history, physical exam, and investigative studies including serologic tests and wound biopsies. Management must be multidisciplinary and tailored to the individual patient and the unique characteristics of their wound. Medical therapy to stabilize the underlying disease is the most important aspect of therapy. Surgical intervention is often not appropriate and even contraindicated in some scenarios such as pyoderma gangrenosum. When medical therapy and local wound care fail and surgical intervention is deemed appropriate, inflammation must first be controlled with medical intervention before surgical intervention can be considered.\u0000This review contains 5 figures, 2 tables, and 26 references.\u0000Keywords: ulcer, wound healing, autoimmune diseases, vasculitis, pyoderma gangrenosum, scleroderma, rheumatoid nodule, immunosuppressive agents, rheumatology, patient care team","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87728800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rectal prolapse is the full thickness intussusception of the rectal wall with protrusion out of the anus. It is a benign condition associated with multiple anatomic abnormalities such as a redundant sigmoid colon, attenuation of sacral attachments, diastasis of the levators, a patulous anus, and a deep cul-de-sac. It often presents with concomitant symptoms of fecal incontinence and constipation, or both. In this review, we will discuss widely accepted abdominal procedures for the repair of rectal prolapse as well as advances in the arena. Pre-operative evaluation, management and planning as well as perineal procedures are discussed in a separate review. This review contains 9 figures, 1 table, and 44 references. Key Words: Rectal prolapse, abdominal procedures, resection, rectopexy, mesh, laparoscopic, robotic
{"title":"Rectal Prolapse: Abdominal Procedures","authors":"S. Wexner, Susan M. Cera, Victoria Valinluck Lao","doi":"10.2310/surg.2407","DOIUrl":"https://doi.org/10.2310/surg.2407","url":null,"abstract":"Rectal prolapse is the full thickness intussusception of the rectal wall with protrusion out of the anus. It is a benign condition associated with multiple anatomic abnormalities such as a redundant sigmoid colon, attenuation of sacral attachments, diastasis of the levators, a patulous anus, and a deep cul-de-sac. It often presents with concomitant symptoms of fecal incontinence and constipation, or both. In this review, we will discuss widely accepted abdominal procedures for the repair of rectal prolapse as well as advances in the arena. Pre-operative evaluation, management and planning as well as perineal procedures are discussed in a separate review.\u0000This review contains 9 figures, 1 table, and 44 references. \u0000Key Words: Rectal prolapse, abdominal procedures, resection, rectopexy, mesh, laparoscopic, robotic","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83201603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rectal prolapse is a condition wherein a full thickness intussusception of the rectal wall protrudes out of the anus. The diagnosis is rare, ~ 0.5% of the population, and occurs most often in elderly females. The diagnosis is associated with constipation, fecal incontinence, or both. The repair of rectal prolapse can be divided into perineal and abdominal procedures. In this review, we will discuss preoperative evaluation, management and planning as well as describe key widely accepted perineal procedures, the Delorme and Altemeier, and report recent advances. Abdominal procedure and advances in that arena will be discussed in a separate review. This review contains 9 figures, 7 tables, and 32 references. Key words: Rectal prolapse, perineal procedure, resection, Altemeier, Delorme, Thiersch wire, perineal stapled resection, levatoroplasty
{"title":"Rectal Prolapse: Perineal Procedures","authors":"S. Wexner, Susan M. Cera, V. Lao","doi":"10.2310/surg.2406","DOIUrl":"https://doi.org/10.2310/surg.2406","url":null,"abstract":"Rectal prolapse is a condition wherein a full thickness intussusception of the rectal wall protrudes out of the anus. The diagnosis is rare, ~ 0.5% of the population, and occurs most often in elderly females. The diagnosis is associated with constipation, fecal incontinence, or both. The repair of rectal prolapse can be divided into perineal and abdominal procedures. In this review, we will discuss preoperative evaluation, management and planning as well as describe key widely accepted perineal procedures, the Delorme and Altemeier, and report recent advances. Abdominal procedure and advances in that arena will be discussed in a separate review.\u0000This review contains 9 figures, 7 tables, and 32 references. \u0000Key words: Rectal prolapse, perineal procedure, resection, Altemeier, Delorme, Thiersch wire, perineal stapled resection, levatoroplasty","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82662288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nontechnical skills are the cognitive and social skills that underpin knowledge and expertise in high-demand workplaces. In the operating room (OR), surgeons with good nontechnical skills can effectively share information about their perceptions of ongoing situations with other team members, elicit critical information from others regarding the task and patient safety, and allow the formation of better shared mental representations about the operation in real time. In rare OR crises, surgeons use their nontechnical skills to delegate tasks and effectively manage challenging operations under time pressure. This review covers approaches in high-risk industry; the development, testing, and usage of the non-technical skills for surgeons (NOTSS) system; and the underpinning theory of nontechnical skills. Tables outline the NOTSS skills taxonomy, behavioral rating tools in surgery, and the skills taxonomy used in the aviation industry. This review contains 3 tables, and 95 references. Key Words: Non-technical skills, leadership, Situation Awareness, Decision Making, Communication, Teamwork, Coaching, Error, Simulation
{"title":"Nontechnical Skills in Surgery","authors":"S. Yule, D. Smink","doi":"10.2310/surg.2017","DOIUrl":"https://doi.org/10.2310/surg.2017","url":null,"abstract":"Nontechnical skills are the cognitive and social skills that underpin knowledge and expertise in high-demand workplaces. In the operating room (OR), surgeons with good nontechnical skills can effectively share information about their perceptions of ongoing situations with other team members, elicit critical information from others regarding the task and patient safety, and allow the formation of better shared mental representations about the operation in real time. In rare OR crises, surgeons use their nontechnical skills to delegate tasks and effectively manage challenging operations under time pressure. This review covers approaches in high-risk industry; the development, testing, and usage of the non-technical skills for surgeons (NOTSS) system; and the underpinning theory of nontechnical skills. Tables outline the NOTSS skills taxonomy, behavioral rating tools in surgery, and the skills taxonomy used in the aviation industry. This review contains 3 tables, and 95 references. Key Words: Non-technical skills, leadership, Situation Awareness, Decision Making, Communication, Teamwork, Coaching, Error, Simulation","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84128376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges. This review contains 17 figures, 4 tables, 1 video, and 36 references. Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging
{"title":"Flaps","authors":"Justin R. Fernandes, Lifei Guo","doi":"10.2310/ps.10006","DOIUrl":"https://doi.org/10.2310/ps.10006","url":null,"abstract":"Flaps are the basis for reconstructive surgery and allow the movement of tissue both locally and distantly, to cover wounds, restore form, and reestablish function. Some flap surgeries have been performed for thousands of years; a clear testament to their efficacy. For today’s plastic surgeon, the understanding of flap anatomy and physiology is an absolutely key. This chapter familiarizes the reader with the history and evolution of flap surgery as well as science behind them. We review the multiple classifications for various flap types. We begin with simple, random skin flaps and work up the reconstructive ladder to composite free flaps. Specific flaps will be discussed, including anatomy, operative techniques, and clinical applications. Finally, we examine various ways flaps may be modified to better meet complex reconstructive challenges.\u0000This review contains 17 figures, 4 tables, 1 video, and 36 references. \u0000Key words: Flap, random, pedicled, axial, free, microsurgery, skin, muscle, musculocutaneous, fasciocutaneous, perforator, fabrication, prefabrication, prelamination, supercharging, turbocharging","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87753895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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