Use of Negative-Pressure Wound Therapy With Instillation and Dwell in Breast Reconstruction

SUMMARY

The use of negative-pressure wound therapy (NPWT) has expanded over the last 3 decades, paralleled and documented by an increase in research. This article discusses the evolution and current applications of NPWT in modern breast reconstruction. Negative-pressure wound therapy with instillation and dwell (NPWTi-d) technology can be used to remove infectious material, facilitate salvaging compromised tissue, and stabilize the soft-tissue environment. Published consensus NPWTi-d guidelines can aid in treatment selection and implementation of this new technology. The therapeutic approach of simultaneously removing infectious material and actively improving mastectomy flap perfusion and thickness is a burgeoning concept, and illustrative cases are presented. NPWTi-d preliminary use has led to reconstruction salvage with reproducible early experience and outcomes, and it is hoped that it will raise interest and awareness of this promising application of the technology to improve breast reconstruction outcomes.

Arthroscopic washout of the knee: a procedure in decline

BACKGROUND

Osteoarthritis (OA) of the knee is a chronic, progressive condition which often requires surgical intervention. The evidence for the benefits of arthroscopic debridement or washout for knee OA is weak and arthroscopy is currently only indicated in the UK if there is a history of mechanical locking of the knee.

OBJECTIVES

To investigate whether there has been any change in the number of arthroscopies performed in the UK since the 2007 NICE guidance on knee arthroscopy and the 2008 Cochrane review of arthroscopic debridement for OA of the knee.

METHODS

We interrogated data from the Hospital Episodes Statistics (HES) database with Office of Population Censuses and Surveys-4 (OPSC-4) codes pertaining to therapeutic endoscopic operations in the 60-74 year old and 75 and over age groups.

RESULTS

The number of arthroscopic knee interventions in the UK decreased overall from 2000 to 2012, with arthroscopic irrigations decreasing the most by 39.6 per 100,000 population (80%). However, the number of arthroscopic meniscal resections increased by 105.3 per 100,000 (230%) population. These trends were mirrored in both the 60-74 and 75 and over age groups.

CONCLUSIONS

Knee arthroscopy in the 60-74 and 75 and over age groups appears to be decreasing but there is still a large and increasing number of arthroscopic meniscal resections being performed.

[Joint infections. Known facts and new trends]

Acute septic arthritis is a surgical emergency because rapid septic destruction of articular cartilage can lead to impairment or even loss of joint function. Diagnosis consists of patient history, clinical examination, laboratory results, (sonography- guided) joint aspiration and radiography. Emergency therapy is based on arthroscopic or open joint debridement and lavage combined with systemic antibiotic therapy. No data are available for the recommendation of local antibiotics but antiseptic solutions are not recommended because of cartilage damage. New trends in diagnostics are positron emission tomography/computed tomography (PET/CT), urine sticks for analysis of joint fluid and molecular pathology. Chronic joint empyema is more diagnostically demanding and is difficult to treat. In cases of necrotic and infected articular cartilage, joint resection has to be performed for quiescence of infection. Options following successful treatment of empyema are arthroplasty, arthrodesis or permanent resection.

Trends of ear syringing at Ibadan, Nigeria

Ear syringing is a procedure by which the external auditory canal is irrigated with a normal saline at body temperature. It is a procedure which every doctor or nurse should be able to perform proficiently. A study of 622 patients that needed ear syringing was done between December 1999 and June 2001 to determine its trend. There were 341(55%) males and 281(45%) females with age ranged from 3.5months to 89 years: 44.4% were in the first decade of life. Cerumen auris 99% remained the commonest indication for syringing in this study with bilateral cerumen auris constituting 53.1% while right and left cerumen auris constituted 24.4% and 21.5% respectively. Cerumen auris constituted 66% of total 933 Otologic cases seen during the study period. Other indications were otitis externa 0.7% (otomycosis 0.5%; bacterial 0.2%) and foreign body 0.3%. The majority of patients (86%) required between 500mls and 1000mls of fluid for irrigation and 94.9% required not more than one attempt at syringing. The complications recorded were mainly vertigo 0.2% and tympanic membrane perforation 0.2% respectively. Thus ear syringing, though simple and sometimes taken for granted may be fraught with dangers; it is a very safe procedure in trained hands and that after at least three attempts of ear syringing for cerumen auris and if it persists despite effective applications of cerumenolytic agents prior to irrigation, the procedure should be discontinued and other methods of imparted cerumen auris removal should be employed.

Ductal lavage in the screening of high-risk women

Due to the high incidence of breast cancer and the excessively high false-positive rate of current screening technologies, adjunctive risk assessment measures are needed. Nipple aspiration cytologic analysis and random fine-needle aspirations have been proposed; however, ductal lavage and cytologic analysis of the effluent is a more sensitive and specific test. The dilemma lies in what should be done subsequent to a ductal lavage yielding malignant or atypical cells. The procedures and potential management strategies are discussed.

Ductal lavage: clinical utility and future promise

This article discusses the use of ductal lavage to enhance the tolerability, efficiency, and reproducibility of collecting breast duct epithelial cells for analysis for breast cancer risk assessment. Aspects discussed include the rationale for use of ductal lavage, identification of appropriate candidates for the procedure, clinical implications, ongoing evaluation of the procedure, and its future utility.

Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia

BACKGROUND

Suboptimal bowel preparation for colonoscopy can lead to missed colonic lesions. The aim of this study was to describe the impact of preparation quality on detection of suspected colonic neoplasia.

METHODS

Data from the Clinical Outcomes Research Initiative national endoscopic database for the period January 1, 2000 to December 31, 2001, were analyzed. Patient demographics, quality of preparation, and colonoscopy findings were abstracted from the database.

RESULTS

Overall, 93,004 colonoscopies with adequate documentation were reviewed. Preparation was adequate for 71,501 (76.9%) of these procedures. On multivariate analysis, preparation adequacy was associated with colonic lesion detection, odds ratio (OR) 1.21: 95% CI [1.16, 1.25]. Adequate preparation demonstrated a closer association with identification of "nonsignificant" lesions (polyps <or=9 mm), OR 1.23: 95% CI [1.19, 1.28], compared with "significant" lesion detection (mass lesion, polyps >9 mm), OR 1.05: 95% CI [0.98, 1.11].

CONCLUSIONS

Bowel preparation is inadequate for almost a quarter of patients undergoing colonoscopy. These results suggest that inadequate preparation quality only hinders detection of smaller lesions, while having negligible impact on detection of larger lesions. These results should be confirmed in prospective studies.

Recent advances in colostomy care

Recent advances in colostomy care are described. A colostomy is a surgically created opening of the large bowel through the abdominal wall. Three kinds of stoma care are presented, paying particular attention to several advances and setbacks. The special conditions of colostomy care in China are described.

Ophthalmic irrigants: a current review and update

The search for an ideal intraocular irrigating solution is of paramount importance to te ophthalmic surgeon. An intraocular irrigating solution, as well as surgical technique, can have deleterious effects on ocular tissues. Since an intraocular irrigating solution comes in contact with the cornea, lens, trabecular meshwork, uvea, vitreous, and retina, and ideal irrigant would be ome that ensures biological function for all of these tissues. In a practical sense, the best irrigant is one that causes the least possible damage to the structural integrity and function of the intraocular environment. This paper summarizes the development, uses, and efficacy of intraocular irrigating solutions as currently used during intraocular surgery.