South African Journal of Surgery - Volume 46, Issue 1, 2008
Volume 46, Issue 1, 2008
Author Klaas (N.) M. A. BaxSource: South African Journal of Surgery 46, pp 4 –8 (2008)More Less
Source: South African Journal of Surgery 46, pp 14 –16 (2008)More Less
Background. A new device made by ThebeMedicare allows efficient local anaesthetic washout of wound areas, by utilising an attachment to an existing drain. The aim of this trial was to explore 'proof of concept' in patients undergoing abdominoplasty procedures.
Patients and methods. Thirty-one patients who had undergone abdominoplasty procedures were selected for instillation of a local anaesthetic preparation, ropivacaine (Naropin, AstraZeneca) into the wound site on day 1 and 2 after surgery, followed by early mobilisation. Efficacy of the system, patient comfort and mobilisation were documented.
Results. The abdominoplasty patients experienced no discomfort from the procedure and claimed effective relief of pain for an average of 12 hours following instillation of local anaesthetic. All mobilised effectively. The device worked well, with no technical problems.
Conclusion. The lavage drain extension has proved to be a cost-effective and efficient way of providing postoperative pain control and promoting early mobilisation in this patient group.
Source: South African Journal of Surgery 46, pp 14 –16 (2008)More Less
Background. Injuries to the stomach are common following abdominal trauma, and there are few management controversies. This study was undertaken to document experience with the management of gastric injuries in a single surgical ward in a tertiary institution.
Patients and methods. This prospective study was of a cohort of all patients found at laparotomy to have gastric injuries, over a 7-year period (1998 - 2004). Demographic data, clinical presentation, findings at laparotomy, and outcomes were documented. Prophylactic antibiotics were given at induction of anaesthesia. All patients found to have gastric injuries were given antifungal therapy.
Results. Of the 488 patients undergoing laparotomy for abdominal trauma over this period, 99 (20%) were found to have gastric injuries, of whom 6 were female (M:F ratio 14:1). The mean age (± standard deviation (SD)) was 28.9±11.1 years. Mean delay before surgery was 7.6±5.2 hours. Seventeen patients presented in shock. Injury mechanisms were firearms(52), stabbing (43) and blunt trauma (4). The mean injury severity score (ISS) was 13.6±7.4. Forty-two patients required management in the intensive care unit (ICU), with a mean ICU stay of 4.7±4.6 hours. Twenty-nine patients developed complications, and 14 died. There was only 1 gastric injury related complication. Causes of death were multiple organ dysfunction syndrome (MODS) (8) and hypovolaemic shock(4), septic shock (1) and renal failure (1). Patients presenting in shock had a significantly higher mortality than those without shock (p<0.0001). Delay before laparotomy did not influence outcome. There were 20 patients with isolated gastric injuries, none of whom died. Mean hospital stay was 8.8±7.7 days.
Conclusion. We reaffirm that stomach injuries are common following abdominal trauma. Isolated gastric injuries are uncommon. Complications specific to gastric injuries are uncommon but devastating. Mortality is related to associated injuries.
Torque removal force for osseointegrated implants - two experimental studies : maxillofacial surgerySource: South African Journal of Surgery 46, pp 18 –21 (2008)More Less
Objective. To introduce a rabbit-based model for testing the torque removal force (TRF) of implants and to compare the TRF of a series of titanium implants.
Methods. Two experiments were performed at the University of the Witwatersrand. In the first, a Swedish- (SSM-N) or a South African-manufactured (SSM-S) implant was implanted into the tibiae of 12 rabbits and the TRF measured at 1, 3 and 6 months. In the second experiment, the TRF of 4 South African manufactured titanium implants in the tibia or femur of 32 rabbits were compared at 3 and 6 weeks. The implants were: 1 threaded machined (SSM-S), and 3 surface-enhanced - 1 threaded (SLA), 1 threaded tapered (MTT) and 1 pitted (RI).
Results. In experiment 1, TRF increased significantly with time (p<0.05) but there was no significant difference between TRF for the South African and Swedish machined-surface implant types. In experiment 2, the TRF of the MTT implant was significantly greater (p<0.0001) than the other 3 types, which did not differ significantly from each other. Time had no significant effect.
Conclusion. In an internationally used rabbit-based model, South African and Swedish machined-surface titanium implants were equivalent; surface-enhanced implants produced higher TRF, and a tapered implant showed the highest TRF.
Source: South African Journal of Surgery 46, pp 22 –25 (2008)More Less
Total glossectomy (with or without total laryngectomy) followed by postoperative radiotherapy remains the principal treatment method for advanced base of tongue carcinoma. The procedure remains controversial owing to poor cure rates and the inevitable functional deficits associated with it. However, even though total glossectomy is a major surgical procedure that impacts on speech, deglutition and quality of life, it may offer patients the best chance of cure in many centres, especially in the developing world.
Methods. We did a retrospective chart review of all patients at Groote Schuur Hospital, Cape Town, who had undergone total glossectomy, with or without total laryngectomy, for stage IV squamous cell carcinoma (SCC) of the tongue between 1998 and 2004.
Results. Eight patients had a total glossectomy performed during the study period. At 2, 3 and 5 years 63%, 38% and 25% of patients respectively were alive without disease. No patient required permanent nasogastric or gastrostomy feeding, and all returned to a full oral diet. Three of 5 patients who had laryngeal preservation and could be assessed for speech had intelligible speech. All but 1 patient (88%) reported pain relief following surgical excision. Perineural invasion was present in 75%, and 38% had positive resection margins. Five patients had recurrence, 2 cervical, 1 local, and 2 local and cervical.
Conclusion. Advanced SCC of the tongue is a devastating disease causing severe pain and disorders of speech and swallowing. Total glossectomy (with or without total laryngectomy) and postoperative radiotherapy is a reasonable treatment option, particularly in the developing world setting. It has cure rates superior to primary radiotherapy, and provides motivated patients with excellent pain relief and a reasonable quality of life.
Results of open wound technique in the treatment of post-sequestrectomy dead space : Orthopaedic SurgerySource: South African Journal of Surgery 46, pp 26 –27 (2008)More Less
Background and method. Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic, Ekpoma, Edo State, Nigeria, between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation, sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-square test was used for statistical analysis.
Results. The median age was 13 years, with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p<0.05), even though it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years, with a median of 2 years.
Conclusion. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good, and we advocate its use in resource-poor settings.
Source: South African Journal of Surgery 46, pp 28 –29 (2008)More Less
The HIV pandemic has introduced a new dimension to the diagnosis and management of pancreatic head masses, adding opportunistic infections and malignancy to the differential diagnosis. Tuberculosis and Kaposi's sarcoma have been well described as primarily involving the pancreas and are diseases which can in theory be managed medically without surgical resection. We report another obscure malignancy that adds to this quandary in the HIV-positive patient.