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Reconstructive surgery – Harvesting, skin mucosa, bone, cartilage
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
The donor site can be extremely painful and this must be anticipated and prevented. A commonly used technique is to apply an alginate-soaked dressing (such as Kaltostat) impregnated with long-acting local anaesthetic, such as 0.5% buvicaine. Regular systemic analgesia is also useful. The alginate dressing is then, and importantly, stabilized with an adhesive dressing such as Opsite or Tegaderm™. The wound should be left untouched for 14 days. It is essential to keep the wound under observation to check for haematoma formation or infection as the wound may need to be exposed and cleaned up.
Pressure Ulcers in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
The wound bed should be clean and moist to prevent infections and promote granulation. Monitor closely for local or systemic infection and continue the measures described in Stage I plus debridement, if indicated. Autolytic or enzymatic debridement is recommended for light to moderate exudates. Surgical debridement is necessary if there is necrotic tissue and infection.19 If the ulcer is covered with necrotic tissue, wound gel can be used. For wound beds without necrotic tissues, foam dressings and cavity fillers are recommended. An alginate dressing is appropriate to use if excessive exudate is present. Stage III ulcers usually heal spontaneously with appropriate cleaning; when treated conservatively, they have a recurrence rate of 32%–77%. Surgical management can reduce the rate of recurrence in some patients.20
Perianal sepsis
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Jean-Claude R Givel, Michael H Cotton
Following examination and drainage, if no fistula is found, the abscess cavity should be packed as necessary for hemostasis with antiseptic solution, such as povidone iodine or chlorhexidine in the dressing. This will be removed the following day and then renewed with an alternative comfortable dressing. In the presence of residual infection, an alginate dressing with silver can be used. The patient should be discharged home either with instructions on wound management or followed up in an ambulatory care unit.
Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator
Published in Acta Oto-Laryngologica, 2022
Hirohiko Tachino, Hiromasa Takakura, Hideo Shojaku, Michiro Fujisaka, Shinsuke Ito, Yutaro Oi, Anh Tram Do, Chiharu Fuchizawa, Tatsuya Yunoki, Atsushi Hayashi
After the bone was removed and the entire sac was exposed, the lacrimal endoscope was reinserted into the lacrimal sac to push on the medial wall of the sac. Endonasally, the tented lacrimal sac was incised vertically at the center of the exposed sac by a microsurgical knife. Then, the anterior flap between the lacrimal sac mucosa and nasal mucosa was first united by placing a suture at the upper and lower one fourth of the flaps (Figure 1(E)). The posterior flap was united in a similar manner by placing a suture at the upper and lower one fourth of the flaps. A bayonet-type micro needle holder Yasargil FD097R (B. Brown, Tuttlingen, Germany) was easiest to use when suturing with 6-0 PROLENE BV-1 (Ethicon, NJ, USA) in the confined working space. Both the nasal mucosal flap with the periosteum and the lacrimal sac flap were pierced with the suture needle, respectively. To tie the free ends of the suture, the surgical knot was made outside the nose and it was brought in with a Hope knot pusher KP001 (Hope Denshi Co., Chiba, Japan) (Figures 1(F,G) and 2). The suture was cut leaving 2–3 mm of suture material. Finally, a Lacrifast lacrimal intubation tube (Kaneka Medical Products, Osaka, Japan) was placed through the upper and lower puncta and retrieved endonasally (Figure 1(H)). Sorbusan alginate dressing (Alcare, Tokyo, Japan) was placed around the marsupialized lacrimal sac of the lateral nasal wall as packing material and was removed a few days after surgery. Eye drops with tosufloxacin and fluorometholone were administered for one week after surgery. We did not remove the suture after surgery. The lacrimal intubation tube was removed 4 weeks after the operation.
Surgical management of hand deformities in patients with recessive dystrophic epidermolysis bullosa
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Xianyu Zhou, Yan Zhang, Mengmeng Zhao, Yuluo Jian, Jinny Huang, Xusong Luo, Jun Yang, Di Sun
The soft silicone-coated dressing Mepitale (Mӧlnlycke Health Care Company, Gothenburg, Sweden) was used instead of the skin grafts to cover the secondary hand wounds in all patients. The digits, palm and wrist were covered with a silicone-coated dressing that was tailored to form a glove based on the size of the reconstructed hand [21]. The wrist was then covered with an Alginate dressing (Smith & Nephew Company, London, UK) and non-adhesive polyurethane foam dressing (Allevyn, Smith & Nephew Company, London, UK) (Figure 1(C)). To separate the web spaces between digits, a silver nanoparticle antibacterial tulle (Anson Company, Shenzhen, China) was placed in each web space and stitched to the wrist dressing (Figure 1(D)). Alginate and polyurethane foam dressings were also used to wrap the palm and digits and were placed in the first web space to maintain the thumb in an abducted position (Figure 1(E)). Finally, the hands were wrapped in polyurethane foam dressing and multiple layers of gauze (Figure 1(F)). Antibiotics were administered prophylactically for three days postoperation. The Mepitale dressing was changed one-week postoperation. The hands were carefully washed with benzalkonium chloride and betadine solutions under general anesthesia. Then silicone-coated dressing, alginate dressing, non-adhesive polyurethane foam dressing and silver nanoparticle antibacterial tulle were used to wrap the hands, according to the procedure described above. Dressings were changed weekly. Three to four weeks later, the completely dysfunctional ‘cocoon’ hand (Figure 2(A)) wounds gradually healed and the Kirschner wires were removed (Figure 2(B)). A soft elastic glove and cotton strip were used to maintain the interdigital spaces after the removal of the Kirschner wires (Figure 2(C)). Furthermore, a thermoplastic splint was used to immobilize the palm side and facilitate thumb abduction and digit extension, thus beneficiating the surgical outcomes. The splint required appropriate adjustments after each dressing replacement.