Surgery Journal最新文献

Introduction  Despite many significant changes as a result of the coronavirus disease 2019 (COVID-19) pandemic, and reductions in overall trauma workload, patients with fragility hip fractures continued to present to hospital. As we plan for ongoing service provision during future waves of the pandemic, valuable lessons can be learned from patients that have been treated surgically during the "first wave." Methods  All patients admitted to our center (a busy District General Hospital in London, United Kingdom) with a hip fracture during a 13-week period representing the initial rise ("United Kingdom first wave") in COVID-19 cases, from February 17 ^th to May 17 ^th , 2020 (study group) were compared with hip fracture patients from the equivalent 13-week period in February to May 2019 (control group). The primary outcome was 30-day mortality, and additional information was collected in terms of length of stay (LOS), SARS-CoV-2 antigen testing, and cause of death. Results  During the COVID-19 study period, 69 patients were admitted with a hip fracture, compared with 70 patients in the control group ( p  = 0.949). There was no significant difference in 30-day mortality between the two groups (5.8 vs. 7.1%, p  = 0.747). Mean LOS was shorter in the COVID-19 period compared with the control group (11.6 vs. 19.6 days, p <0.001, effect size 0.572). Forty-six patients (66.7%) had a SARS-CoV-2 antigen swab test, as testing was not available in the early period, and 10 patients (14.5%) tested positive. None of the patients, who presented before the antigen testing was available, had clinical suspicion of COVID-19 retrospectively. Two "COVID-19 positive" patients (20%) died within 30 days of admission. Conclusion  We report reassuring short-term results demonstrating no statistically significant difference in the 30-day mortality rate of hip fracture patients admitted during the United Kingdom's first wave of the COVID-19 pandemic compared to the equivalent period in the previous year. Hip fracture incidence remained stable, and LOS was reduced, likely due to recent departmental changes as well as a drive to discharge patients quickly during the pandemic. We agree with existing reports that elderly hip fracture patients with COVID-19 have a higher risk of perioperative mortality, however, our results suggest that overall mortality for the whole hip fracture population was similar to the previous year, in which deaths were more commonly attributed to respiratory infections associated with other pathogens. Further work may be needed to evaluate the outcomes during subsequent waves of the pandemic as mutations in the virus and conditions may affect outcomes.

Background  The aim of this study was to assess patient-reported symptoms and health-related quality of life, 12 to 24 months after injury in patients with midfacial fractures. Methods  Patients diagnosed with midfacial fractures were assessed regarding symptoms related to the fracture as well as assessment of the patients overall health-related quality of life using the Gothenburg Trismus Questionnaire (GTQ), the Folkestad facial trauma questionnaire, and EuroQol five-dimensional (EQ-5D). Questionnaires were distributed to the study patients 12 to 24 months after the trauma. Medical records were retrospectively surveyed for age, gender, trauma etiology, date of injury, fracture classification, treatment regimen, and time of surgery. Results  Sixty-seven percent of the study group reports sensibility disturbance in the face 12 to 24 months after trauma and 52% reported cosmetic consequences related to the trauma. Numbness in the face was the symptom reported to be most disturbing for the patients. Few of the patients reported severe jaw-related problems, problems with muscular tension, or eating limitation according to the validated questionnaire GTQ. Conclusion  Sensibility disturbance remains a significant and common symptom 12 to 24 months after midfacial trauma. There is a need for a validated patient-reported outcome instrument for facial trauma that covers multiple aspects of facial trauma such as vision disturbance and diplopia, jaw-related problems, and facial pain as well as sensibility disturbance and cosmetic consequences.

Minimally invasive reconstruction combines principles of tissue engineering and regenerative medicine for healing complex wounds. This approach was successfully demonstrated on a 64-year-old diabetic and hypertensive male patient, who was brought unconscious to our emergency after surviving an automobile collision with severe brain and right-dominant upper extremity injuries. Uncontrolled hyperglycemia, severe anemia, diffuse axonal brain injury, wrist drop, and loss of thumb extension and abduction were noted. Extensive degloving, skin necrosis, extensor and flexor forearm muscle crush injuries, and ruptured extensor tendons were observed. Serial wound debridement combined with platelet-poor plasma injection into the muscles, platelet-rich plasma injections into the tendons and subcutis, and low-negative pressure wound therapy were performed sequentially to salvage the injured soft-tissues. Improvements were noticed during the second exploration after 5 days. Surviving muscles showed adequate vascularization and revival of innervation during the third exploration after another 5 days. Thereafter, absorbable synthetic tissue scaffold was applied over a sizeable 270 cm ² wound as a flap-alternative. Tissues regenerated well within the scaffold during the next 2 months, halving the wound area to 132 cm ² . A thick split-skin graft was applied over the remaining granulating neodermis, which "took" completely. Six months postoperatively, the patient regained most hand functions and performed all activities satisfactorily, while the grafted area appeared almost identical to surroundings. Minimally invasive reconstruction thus produced satisfying results with fewer shorter simpler surgeries, minimal anesthesia, short-duration hospitalization, lower health care costs, lesser risks, and excellent patient-reported outcomes.

Background  Necrotizing fasciitis (NF) is a life-threatening condition requiring urgent attention. It is clinically difficult to diagnose, linked to severe systemic toxicity, and has poor prognosis. In 2001, Andreasen and coworkers described the "Finger test" for the diagnosis of NF. Subsequent studies have suggested early recognition and management of NF. In this study, we compare the LRINEC-Laboratory Risk Indicator for Necrotizing Fasciitis-scoring system with the "Finger test" and histopathological examination for diagnosis of NF. Results  In our study, LRINEC scoring system and Finger test are statistically significant in the diagnosis of NF. Males are more frequently affected, and the most common organism causing NF is Staphylococcus . Histopathology remained the gold standard for diagnosis of NF, while LRINEC score and Finger test were good diagnostic tools for early diagnosis, with sensitivities of 83.33 and 86.11%, respectively. Conclusion  LRINEC laboratory-based scoring system is easy and reliable diagnostic tool though histopathology remains the gold standard. There is statistically significant correlation between histopathology and laboratory criteria. LRINEC test is independently better than bedside Finger test alone or combined LRINEC and bedside Finger test.