• Title/Summary/Keyword: Surgical management

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Multifactorial analysis of the surgical outcomes of giant congenital melanocytic nevi: Single versus serial tissue expansion

  • Kim, Min Ji;Lee, Dong Hwan;Park, Dong Ha
    • Archives of Plastic Surgery
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    • v.47 no.6
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    • pp.551-558
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    • 2020
  • Background Giant congenital melanocytic nevus (GCMN) is a rare disease, for which complete surgical resection is recommended. However, the size of the lesions presents problems for the management of the condition. The most popular approach is to use a tissue expander; however, single-stage expansion in reconstructive surgery for GCMN cannot always address the entire defect. Few reports have compared tissue expansion techniques. The present study compared single and serial expansion to analyze the risk factors for complications and the surgical outcomes of the two techniques. Methods We retrospectively reviewed the medical charts of patients who underwent tissue expander reconstruction between March 2011 and July 2019. Serial expansion was indicated in cases of anatomically obvious defects after the first expansion, limited skin expansion with two more expander insertions, or capsular contracture after removal of the first expander. Results Fifty-five patients (88 cases) were analyzed, of whom 31 underwent serial expansion. The number of expanders inserted was higher in the serial-expansion group (P<0.001). The back and lower extremities were the most common locations for single and serial expansion, respectively (P =0.043). Multivariate analysis showed that sex (odds ratio [OR], 0.257; P=0.015), expander size (OR, 1.016; P=0.015), and inflation volume (OR, 0.987; P=0.015) were risk factors for complications. Conclusions Serial expansion is a good option for GCMN management. We demonstrated that large-sized expanders and large inflation volumes can lead to complications, and therefore require risk-reducing strategies. Nonetheless, serial expansion with proper management is appropriate for certain patients and can provide aesthetically satisfactory outcomes.

Epidermoid Carcinoma of the Larynx - Twenty-year Experience with 263 Cases - (후두(候頭) 유표피암(類表皮癌) - 20년간(年間) 263 치험례(治驗例)를 중심(中心)으로 -)

  • Park Yoon-Kyu;Yoo Bong-Ok;Seel David J.;Lee Young-Sik;Chun Kyung-Doo
    • Korean Journal of Head & Neck Oncology
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    • v.3 no.1
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    • pp.15-24
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    • 1987
  • This study is limited to epidermoid carcinoma arising in the larynx. The 623 patients in this series comprised 1.6% of all malignant neoplasms seen during the 20-year period .from 1965 to 1984 ; it comprised 13.2% of all cancers of the head and neck registered during this period. The male: female ratio was 11:1, and the highest incidence was in the fifth decade of life. Analysis by anatomical site revealed that 51.7% were supraglottic, 36.1% glottic, and 6.8% subglottic in oriain. One-hundred eighty-nine(79%) were clinically Stage III or Stage IV lesions at the time of the first visit. Of the total of 263 cases, 113 refused treatment, 4 definite radiation for $T_1$. lesion,21 underwent palliative therapy only, and 125 underwent surgical management with intent to cure. This surgical category included 53 patients who had surgical treatment only and 72 who underwent combined therapy(preoperative radiation, postoperative radiation, or inductive chemotherapy followed by surgery and postoperative radiation). The surgical management varied from partial laryngectomy to widefield laryngectomy and ipsilateral neck dissection. In 14.4% pathologically positive node or nodes were found in the clinically negative contralateral neck nedes. Such contralateral spread was most common in supraglottic site of origin(222%). Combined modality of management was compared to single therapy. Although results at three years showed no difference in determinate disease-free survival between patients treated by surgery only and those treated by surgery followed by postoperative radiation therapy at 5 years a statistically significant difference emerged, only 36% of those receiving surgery alone surviving as compared to 65.4% in the surgery with radiation group.

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Medical Equipment Purchasing Plan and Analysis of Actual Utilization (의료장비 도입계획과 실제이용에 대한 실태분석)

  • Lee, Hag-Sun;Yu, Seung-Hum;Lee, Hae-Jong;Kim, Sung-Kyu
    • Korea Journal of Hospital Management
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    • v.5 no.2
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    • pp.22-39
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    • 2000
  • The purpose of this study was to determine the difference between estimated profit and utilization of medical equipment upon purchasing and actual results at one teaching hospital in Seoul, Korea Medical equipments over $100,000 from 1992 to 1997 were selected and results were as follows: 1. Twenty equipments out of thirty exceeded estimated profits and the difference was 3.98 billion won and ten equipments did not reach the estimated profits and 5.5 billion won was the difference. Diagnostic equipment exceeded the estimated profit which surgical equipment didn't. 2. Eleven equipments exceeded estimated utilization, which showed 100%. In the mean time, eighteen equipments didn't reach the estimated utilization, which was 71%. Diagnostic equipment showed the less estimated utilization than surgical equipment 3. Twenty-one equipments showed the 6.83 billion won profits and nine equipments showed the 1.6 billion won deficits. Diagnostic equipment was more profitable than surgical equipment. Finally. diagnostic equipment helped improving hospital management than surgical equipment. 4. Main factors which showed the big difference from the initial plan were lacking reasonable estimated method, no evaluation system for purchase, emphasis in medical treatment, excessive expenditure in maintenance, duplicated investment for medical equipment and leadership commitment. As a result. Substantial planning is required from the requesting department in consideration of estimated profit and utilization and systematic quality control is needed to confirm. Also, One-sided decision making should be avoided to purchase a high cost medical equipment and efforts should be made in examining carefully and developing a reasonable analytic method.

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Management of complex surgical wounds of the back: identifying an evidence-based approach

  • Zolper, Elizabeth G.;Saleem, Meher A.;Kim, Kevin G.;Mishu, Mark D.;Sher, Sarah R.;Attinger, Christopher E.;Fan, Kenneth L.;Evans, Karen K.
    • Archives of Plastic Surgery
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    • v.48 no.6
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    • pp.599-606
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    • 2021
  • Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4-23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

Incidence and management of condylar resorption after orthognathic surgery: An overview

  • Barone, Selene;Cosentini, Giorgio;Bennardo, Francesco;Antonelli, Alessandro;Giudice, Amerigo
    • The korean journal of orthodontics
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    • v.52 no.1
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    • pp.29-41
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    • 2022
  • Objective: Condylar resorption (CR) is one of the major post-surgical complications of orthognathic surgery. This systematic review (SR) aimed to evaluate epidemiological data, risk factors, and therapeutical management of CR. Methods: Six databases were screened by two investigators until September 2020 to obtain all SRs. After reading the titles and abstracts, eligible SRs were determined and data extraction was performed. Using the latest version of A Measurement Tool to Assess Systematic Reviews, the methodological quality of the included SRs was determined. Results: Ten SRs with low or critically-low methodological quality were included in this review. Mandibular hypoplasia on the sagittal plane and hyperdivergent growth pattern on the vertical plane were the most common skeletal alterations in which CR could occur after orthognathic surgery. Post-operative condylar changes were analyzed both on two-dimensional and three-dimensional (3D) radiographic examinations. The incidence of CR was not related to the fixation method. Based on the severity of the pathological conditions, management of CR can include conservative or surgical therapy. Conclusions: Despite the limited evidence in literature, CR is considered a consequence of orthognathic surgery. However, an accurate diagnosis of CR and a better orthognathic surgical planning must include 3D radiographic examinations to improve pre- and post-surgical comparison. Well-designed studies with long-term follow-up and 3D data are needed to clarify the findings of this analysis..

Pain management in periodontal therapy using local anesthetics and other drugs: an integrative review

  • Eduarda Cristina Santos;Daniela Huller;Sabrina Brigola;Marceli Dias Ferreira;Marcia Thais Pochapski;Fabio Andre dos Santos
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.5
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    • pp.245-256
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    • 2023
  • Background: Surgical and non-surgical periodontal procedures often lead to postoperative pain. Clinicians use pharmacological methods such as anesthetics, anti-inflammatory drugs, and analgesics for relief. However, the multitude of options makes it challenging to select the best approach for routine dental care. Objective: This review aimed to describe previous studies regarding the pharmacological management used for pain control during periodontal procedures as well as factors that may interfere with patients' perception of pain. Methods: We included studies (period of 2000-2023, whose approach corresponded to the pharmacological protocols used for preoperative, trans-operative, and postoperative pain control in adult patients undergoing surgical and non-surgical periodontal therapy. Results: A total of 32 studies were included in the analysis, of which 17 (53%) were related to anesthetic methods and 15 (47%) were related to therapeutic protocols (anti-inflammatory/analgesic agents). These studies predominantly involved nonsurgical periodontal procedures. Studies have reported that factors related to age, type of procedure, and anxiety can influence pain perception; however, only seven of these studies evaluated anxiety. Conclusions: Numerous methods for pain control can be applied in periodontal therapy, which are accomplished through anesthetic methods and/or therapeutic protocols. Factors such as anxiety, age, and type of procedure are related to pain perception in patients. Thus, it is the responsibility of dentists to evaluate each clinical situation and define the best protocol to follow based on the literature.

Flexible laryngeal mask airway management for dental treatment cases associated with difficult intubation

  • Tsukamoto, Masanori;Hitosugi, Takashi;Yokoyama, Takeshi
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.17 no.1
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    • pp.61-64
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    • 2017
  • Nasotracheal intubation is generally a useful maxillofacial surgery that provides good surgical access for intraoral procedures. When nasotracheal intubation is difficult, laryngeal mask airway (LMA) insertion can be performed, and the flexible $LMA^{TM}$ (FLMA) is also useful for anesthetic management. However, the FLMA provides limited access to the mouth, which restricts the insertion of instrumentation and confines the surgical field available. Here, we present our experience using the FLMA airway management for dental treatment cases involving difficulty with intubation.

Validation of the Risk Prediction Tool for Wound Infection in Abdominal Surgery Patients (복부 수술환자의 수술부위 감염 위험 예측 도구의 타당도 검증)

  • Jung, Hyun Kyoung;Lee, Eun Nam
    • Journal of Korean Critical Care Nursing
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    • v.15 no.3
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    • pp.75-87
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    • 2022
  • Purpose : This retrospective investigation study aimed to determine the predictive validity of superficial surgical site infection assessment tools by measuring the risk score at the surgical site. Methods : This study included patients hospitalized to the general surgery department of a Hospital from January 2021 to December 31, 2021. The inclusion criteria were age ≥19 years, general abdominal surgery under general anesthesia, and hospital stay longer than 2 days. Patients who had undergone transplantation were excluded. Results : Tool validity results showed that tools including surgical time and operative procedure were more accurate than previously developed tools, with a sensitivity of 71.1%, specificity of 71.4%, positive prediction of 12.3%, negative prediction of 97.8%, and area under the curve of 0.743 (95% confidence interval, 0.678~0.745). The tool's cut-off score was 15, and the risks of infection was increased by 6.14 times at or above this cut-off point. Preoperative hair removal period, surgical wound classification, surgery time, body temperature on the second day after surgery, drainage tube type, and suture type affected the risk of infection at the surgical site. Conclusion : The incidence of healthcare-associated infections has been declining in the past decade; however, surgical site infections still account for a considerable proportion. Therefore, early identification of high-risk groups for surgical site infection is crucial for reducing the incidence of surgical site infection using appropriate management.

Early mobilization and delayed arterial ligation (EMDAL) as a surgical technique for splenectomy and shunt surgery in portal hypertension

  • Harilal S L;Biju Pottakkat;Kalayarasan Raja;Senthil Gnanasekaran
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.1
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    • pp.48-52
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    • 2024
  • Backgrounds/Aims: Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension. Methods: During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group. Results: Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group. Conclusions: The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.

Korean Surgical Practice Guideline for Pancreatic Cancer 2022: A summary of evidence-based surgical approaches

  • Seung Eun Lee;Sung-Sik Han;Chang Moo Kang;Wooil Kwon;Kwang Yeol Paik;Ki Byung Song;Jae Do Yang;Jun Chul Chung;Chi-Young Jeong;Sun-Whe Kim;Committee of the Korean Surgical Practice Guideline for Pancreatic Cancer
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.26 no.1
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    • pp.1-16
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    • 2022
  • Pancreatic cancer is the eighth most common cancer and the fifth most common cause of cancer-related deaths in Korea. Despite the increasing incidence and high mortality rate of pancreatic cancer, there are no appropriate surgical practice guidelines for the current domestic medical situation. To enable standardization of management and facilitate improvements in surgical outcome, a total of 10 pancreatic surgical experts who are members of Korean Association of Hepato-Biliary-Pancreatic Surgery have developed new recommendations that integrate the most up-to-date, evidence-based research findings and expert opinions. This is an English version of the Korean Surgical Practice Guideline for Pancreatic Cancer 2022. This guideline includes 13 surgical questions and 15 statements. Due to the lack of high-level evidence, strong recommendation is almost impossible. However, we believe that this guideline will help surgeons understand the current status of evidence and suggest what to investigate further to establish more solid recommendations in the future.