scholarly journals Multivariate Analysis of Early Surgical Management Factors Affecting Posttraumatic Penoscrotal Avulsion Injury: A Level I Trauma Center Study

2020 ◽  
Author(s):  
MIN JI KIM ◽  
Dong Hwan Lee ◽  
Dong HA Park ◽  
Il Jae Lee
Keyword(s):  
Surgical Treatment ◽  
Scale Score ◽  
Surgical Management ◽  
Trauma Center ◽  
High Speed ◽  
Treatment Algorithm ◽  
Institutional Review Board ◽  
Comprehensive Treatment ◽  
Institutional Review ◽  
Braden Scale

Abstract Background To conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment. Methods We conducted a retrospective chart review study. Patients with penoscrotal defects admitted to our level Ⅰ trauma center from 2017 to 2019 were evaluated. The Braden scale score was used for wound evaluation and the Korean patient classification system (KPCS) was used for assessment of severity. Univariate and multivariate analyses were performed for potential risk factors associated with early surgical management. Results In total, there were 58 male patients, and the average Braden scale score was 12.08 ± 2.54, with the scrotum (36.20%), and the penile shaft (32.76%) being popular sites for injuries. The wounds requiring surgical treatment were 20.68% (n=12), with local flaps (33.33%) being most commonly used. The significant predictors of advanced wounds which required surgical treatment were old age (p=0.026, Odds Ratio [OR] 8.238), orthopedic combined injuries (p=0.044, OR 1.088), intubation (p=0.018, OR 9.625), restrain (p=0.036, OR 0.157) and blood transfusion (p<0.001, OR 2.462).Conclusion In multiple trauma patients, penoscrotal defects caused by high-speed trauma are an important matter of concern. Specifically, patients with combined skeletal injuries or requiring respiratory care were prone to advanced wounds. We proposed a five-category algorithm to manage such patients, which included severity of the patient’s condition, respiration, hemodynamic status, comorbidity, and immobilization. Additionally, inter-departmental cooperation and active intervention by plastic surgeons is needed for the comprehensive treatment of such injuries. Trial registration This study was performed in line with the principles of the Declaration of Helsinki. The study and all its protocols were approved by the institutional review board of Ajou Medical Center (approval no. AJIRB-MED-MDB-17-254). The need for informed consent was waived by the institutional review board of our hospital due to the retrospective design of the study.

scholarly journals Multivariate Analysis of Early Surgical Management Factors Affecting Posttraumatic Penoscrotal Avulsion Injury: A Level I Trauma Center Study

2020 ◽  
Author(s):  
MIN JI KIM ◽  
Dong Hwan Lee ◽  
Dong HA Park ◽  
Il Jae Lee
Keyword(s):  
Surgical Treatment ◽  
Scale Score ◽  
Surgical Management ◽  
Trauma Center ◽  
High Speed ◽  
Treatment Algorithm ◽  
Institutional Review Board ◽  
Comprehensive Treatment ◽  
Institutional Review ◽  
Braden Scale

Abstract Background To conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment. Methods We conducted a retrospective chart review study. Patients with penoscrotal defects admitted to our level Ⅰ trauma center from 2017 to 2019 were evaluated. The Braden scale score was used for wound evaluation and the Korean patient classification system (KPCS) was used for assessment of severity. Univariate and multivariate analyses were performed for potential risk factors associated with early surgical management. Results In total, there were 58 male patients, and the average Braden scale score was 12.08 ± 2.54, with the scrotum (36.20%), and the penile shaft (32.76%) being popular sites for injuries. The wounds requiring surgical treatment were 20.68% (n=12), with local flaps (33.33%) being most commonly used. The significant predictors of advanced wounds which required surgical treatment were old age (p=0.026, Odds Ratio [OR] 8.238), orthopedic combined injuries (p=0.044, OR 1.088), intubation (p=0.018, OR 9.625), restrain (p=0.036, OR 0.157) and blood transfusion (p<0.001, OR 2.462).Conclusion In multiple trauma patients, penoscrotal defects caused by high-speed trauma are an important matter of concern. Specifically, patients with combined skeletal injuries or requiring respiratory care were prone to advanced wounds. We proposed a five-category algorithm to manage such patients, which included severity of the patient’s condition, respiration, hemodynamic status, comorbidity, and immobilization. Additionally, inter-departmental cooperation and active intervention by plastic surgeons is needed for the comprehensive treatment of such injuries. Trial registration This study was performed in line with the principles of the Declaration of Helsinki. The study and all its protocols were approved by the institutional review board of Ajou Medical Center (approval no. AJIRB-MED-MDB-17-254). The need for informed consent was waived by the institutional review board of our hospital due to the retrospective design of the study.

scholarly journals Multivariate analysis of early surgical management factors affecting posttraumatic penoscrotal avulsion injury: a level I trauma center study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Min Ji Kim ◽  
Dong Hwan Lee ◽  
Dong Ha Park ◽  
Il Jae Lee
Keyword(s):  
Surgical Treatment ◽  
Scale Score ◽  
Surgical Management ◽  
Trauma Center ◽  
Treatment Algorithm ◽  
Institutional Review Board ◽  
Comprehensive Treatment ◽  
Institutional Review ◽  
Braden Scale ◽  
Level I

Abstract Background To conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment. Methods We conducted a retrospective chart review study. Patients with penoscrotal defects admitted to our level I trauma center from 2017 to 2019 were evaluated. The Braden scale score was used for wound evaluation and the Korean patient classification system (KPCS) was used for assessment of severity. Univariate and multivariate analyses were performed for potential risk factors associated with early surgical management. Results In total, there were 58 male patients, and the average Braden scale score was 12.08 ± 2.54, with the scrotum (36.20%), and the penile shaft (32.76%) being popular sites for injuries. The wounds requiring surgical treatment were 20.68% (n = 12), with local flaps (33.33%) being most commonly used. The significant predictors of advanced wounds which required surgical treatment were old age (p = 0.026, odds ratio [OR] 8.238), orthopedic combined injuries (p = 0.044, OR 1.088), intubation (p = 0.018, OR 9.625), restraint (p = 0.036, OR 0.157) and blood transfusion (p < 0.001, OR 2.462). Conclusion In multiple trauma patients, penoscrotal defects caused by high-speed trauma are an important matter of concern. Specifically, patients with combined skeletal injuries or requiring respiratory care were prone to advanced wounds. We proposed a five-category algorithm to manage such patients, which included severity of the patient’s condition, respiration, hemodynamic status, comorbidity, and immobilization. Additionally, inter-departmental cooperation and active intervention by plastic surgeons is needed for the comprehensive treatment of such injuries. Trial registration This study was performed in line with the principles of the Declaration of Helsinki. The study and all its protocols were approved by the institutional review board of Ajou Medical Center (approval no. AJIRB-MED-MDB-17-254). The need for informed consent was waived by the institutional review board of our hospital due to the retrospective design of the study.

scholarly journals An Update on Surgical Treatment of Parkinson Disease

2019 ◽  
pp. 106-107
Author(s):  
Konstantin V. Slavin
Keyword(s):  
Surgical Treatment ◽  
Parkinson Disease ◽  
Preoperative Evaluation ◽  
Treatment Algorithm ◽  
Operative Management ◽  
Technological Innovations ◽  
Comprehensive Treatment ◽  
Disease Mechanisms ◽  
Medical Side ◽  
Deep Brain

Over the last several decades, surgery became an integral part of comprehensive treatment of advanced Parkinson disease (PD).  Better understanding of disease mechanisms and advancement of technological innovations resulted in universal acceptance of deep brain stimulation (DBS) as an important part of the PD treatment algorithm. Based on experience with thousands of operated patients, the criteria for patient selection, preoperative evaluation, procedural details, and nuances of post-operative management are now well established. As a matter of fact, surgery in general and DBS in particular are now included in every guideline of PD management making it an option to consider when disease progresses and medical side effects occur.

Cystic Biliary Atresia: A Wolf in Sheep's Clothing

2013 ◽  
Vol 79 (9) ◽  
pp. 870-872 ◽  
Author(s):  
Sarah J. Hill ◽  
Matthew S. Clifton ◽  
Sarkis C. Derderian ◽  
Mark L. Wulkan ◽  
Richard R. Ricketts
Keyword(s):  
Surgical Treatment ◽  
Obstructive Jaundice ◽  
Biliary Atresia ◽  
Neonatal Jaundice ◽  
Surgical Intervention ◽  
Institutional Review Board ◽  
Significant Delay ◽  
Institutional Review ◽  
Improved Outcomes ◽  
Cystic Biliary Atresia

Neonatal obstructive jaundice is frequently explained by biliary atresia (BA) or the presence of a choledochal cyst (CC). Cystic biliary atresia (CBA) has been a proposed as a subtype of BA with projected improved outcomes. We aimed to characterize these lesions further. We conducted an Institutional Review Board-approved review of all patients treated for obstructive jaundice at our tertiary children's hospital over 10 years. Over the decade we evaluated 91 children with obstructive jaundice: 13 CBA, 52 BA, and 26 CC. Patients with isolated CBA and BA were diagnosed significantly earlier than those with CC (15.9, 54, and 281 days, respectively; P = 0.0001). There was a significant delay between diagnosis and surgical intervention for patients with CBA compared with BA: 17 days versus 5.7 days ( P = 0.004). There was no difference in rate of transplant between CBA and BA (31 vs 50%; P = 0.35). The time from surgery until transplant was 13.9 and 18.6 months for CBA and BA, respectively ( P = 0.62). Although radiographically similar to CC, CBA behaves similarly to isolated BA. Delay in recognition and surgical treatment may affect outcomes and lead to an increased incidence of liver failure. The presence of a cystic biliary malformation in the setting of neonatal jaundice should be regarded as CBA until proven otherwise.

scholarly journals Comprehensive surgical treatment strategy for spinal metastases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Arthur Wagner ◽  
Elena Haag ◽  
Ann-Kathrin Joerger ◽  
Philipp Jost ◽  
Stephanie E. Combs ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Symptom Control ◽  
Treatment Algorithm ◽  
Spinal Metastases ◽  
Complication Rates ◽  
Oncological Treatment ◽  
Dorsoventral Stabilization ◽  
Level I

AbstractThe management of patients with spinal metastases (SM) requires a multidisciplinary team of specialists involved in oncological care. Surgical management has evolved significantly over the recent years, which warrants reevaluation of its role in the oncological treatment concept. Any patient with a SM was screened for study inclusion. We report baseline characteristics, surgical procedures, complication rates, functional status and outcome of a large consecutive cohort undergoing surgical treatment according to an algorithm. 667 patients underwent 989 surgeries with a mean age of 65 years (min/max 20–94) between 2007 and 2018. The primary cancers mostly originated from the prostate (21.7%), breast (15.9%) and lung (10.0%). Surgical treatment consisted of dorsoventral stabilization in 69.5%, decompression without instrumentation in 12.5% and kyphoplasty in 18.0%. Overall survival reached 18.4 months (95% CI 9.8–26.9) and the median KPS increased by 10 within hospital stay. Surgical management of SMs should generally represent the first step of a conclusive treatment algorithm. The need to preserve long-term symptom control and biomechanical stability requires a surgical strategy currently not supported by level I evidence.

The use of Integra dermal regeneration matrix in the surgical treatment of a recurrent, extensive malignant skin lesion in the temporal region

2013 ◽  
Vol 154 (6) ◽  
pp. 225-227 ◽  
Author(s):  
Csaba Halmy ◽  
Zoltán Nádai ◽  
Krisztián Csőre ◽  
Adrienne Vajda ◽  
Róbert Tamás
Keyword(s):  
Surgical Treatment ◽  
Skin Lesion ◽  
Surgical Management ◽  
Skin Grafting ◽  
Skin Tumor ◽  
Temporal Region ◽  
Aesthetic Result ◽  
Malignant Skin ◽  
Dermal Regeneration Template ◽  
Dermal Regeneration

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull. Orv. Hetil., 2013, 154, 225–227.

Comprehensive Surgical Management of Chronic Suppurative Osteomyelitis Extending to The Lower Border of Mandible – A Case Report

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
Deepak Kaul ◽  
Farahnaz Muddebihal ◽  
Mohammed Anwar Ul Haque Chand
Keyword(s):  
Developing Countries ◽  
Case Report ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Surgical Debridement ◽  
Reconstruction Plate ◽  
Left Posterior ◽  
High Nutrient ◽  
Inferior Border ◽  
Precipitating Factor

Osteomyelitis of maxillofacial skeleton is common in developing countries such as India. This case report describes successful surgical treatment of chronic suppurative osteomyelitis {CSO} of the mandible of a 35yr old female. The precipitating factor was thought to be eventful extraction in the {left } posterior body at the inferior border of mandible. Methods: Presurgical course of antibiotics ( Amoxycillin and metronidazole for 7 days and later followed by doxycycline for 1 month).Surgical debridement of the affected bone and reinforcing it with reconstruction plate using AO principles was done . Patient was kept on a high nutrient diet consisting of proteins. Conclusion: The case report demonstrates the typical features of CSO . The combination of the antibiotics therapy and surgical debridement was successful in the treatment of chronic suppurative osteomylitis.

THE VALUE OF SKELETAL MUSCLE MASS IN PREDICTING SHORT-TERM OUTCOMES OF SURGICAL TREATMENT FOR KLATSKIN TUMOR

2018 ◽  
Vol 64 (5) ◽  
pp. 564-569
Author(s):  
Yuriy Zharikov ◽  
Tatyana Zharikova ◽  
Vladimir Nikolenko
Keyword(s):  
Skeletal Muscle ◽  
Surgical Treatment ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Negative Impact ◽  
Treatment Algorithm ◽  
Preoperative Treatment ◽  
Klatskin Tumor ◽  
Short Term ◽  
Oncological Patients

The objective of this review study was to analyze the relationship between skeletal muscle mass and postoperative short-term outcomes morbidity in patients with Klatskin tumor who underwent surgical treatment. Low index skeletal muscle mass had a negative impact factor on postoperative morbidity following resection of Klatskin tumor and should therefore be considered as preoperative risk assessment. The further study of body composition in oncological patients allowed revealing the group of patients with high probability of postoperative complications and this factor needed to be added to future models predictive scale of short-term outcomes with the aim of making the most rational preoperative treatment algorithm.

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