Groin incision

  • 文章类型: Journal Article
    背景:闭合切口负压治疗可降低外周动脉手术后患者手术部位感染的风险。
    目的:探讨外周动脉手术后腹股沟切口应用负压治疗的患者经验,并研究他们对血管科收到的自我护理信息表的看法和态度。
    方法:一项以伽达默尔哲学解释学为基础的定性研究是在治疗结束后第7天通过电话进行半结构化访谈,共有10名参与者。所有人都在出院时收到了自我护理信息表,并在家中接受了封闭切口负压治疗3-6天。参与者以股骨血栓内膜切除术的形式在腹股沟进行了开放的外周动脉手术。Kvale和Brinkmann的研究指导了数据收集,分析,和解释。
    结果:患者在外周动脉手术后发现自己在应对陌生情况,因此需要隐藏作为切口治疗一部分的泵和管道,以保护自身形象。他们的治疗成为了永恒的伴侣,一些患者将设备视为他们身体的延伸,而另一些患者则感觉到其对日常生活活动的影响。患者认为治疗提供了安慰,尽管有限制,导致可管理性的感觉和越来越多的控制感。他们认为书面信息内容丰富,但仍有改进的空间。
    结论:患者在外周动脉手术后出院后对腹股沟切口进行闭合切口负压治疗的经验表明,他们认为这是安全且可控的。病人需要支持,然而,在学习如何隐藏治疗和扩大自己的参与和提高自我保健。研究发现,患者的参与和个性化的信息对于促进从医院到家庭自我护理的健康过渡至关重要,并且必须进一步改善书面信息。
    Closed-incision negative pressure therapy may lower the risk of surgical site infections in patients after peripheral arterial surgery.
    To explore patient experience of negative pressure therapy applied to groin incisions after discharge following peripheral arterial surgery, and to study their perception and attitudes toward the self-care information sheet they received at the vascular department.
    A qualitative study underpinned by Gadamer\'s philosophical hermeneutics was conducted semi-structured interviews by telephone around day seven after therapy ended with ten participants. All had received self-care information sheet at the discharge and been home with closed-incision negative pressure therapy for 3-6 days. The participants had open peripheral arterial surgery in the groin in form of femoral thromboendarterectomy. Kvale and Brinkmann\'s research guided the data collection, analysis, and interpretation.
    Patients found themselves coping with an unfamiliar situation after peripheral arterial surgery and the need arose to conceal the pump and tubing that were part of their incision treatment to protect their self-image. Their treatment became a constant companion, with some patients viewing the equipment as an extension of their bodies and others feeling its impact on activities of daily living. Patients perceived the treatment as providing reassurance, albeit with constraints, leading to feelings of manageability and an increasing sense of control. They viewed the written information as informative but with room for improvement.
    Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery showed that they perceived it as safe and manageable. Patients need support, however, in learning how to hide the treatment and to expand their own involvement and improve self-care. The study found that patient involvement and individually tailored information is essential to facilitating a healthy transition from hospital to self-care at home and that written information must be improved further.
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  • 文章类型: Journal Article
    目的:手术部位感染(SSI)是血管外科常见的并发症,并与患者发病率增加有关,重新接纳和重新干预。这项研究的目的是评估闭合切口负压伤口治疗(CiNPWT)对SSI率和住院时间的影响。
    方法:本研究报告符合STROBE指南。我们从12个月的回顾性队列中评估了SSI的基线发生率,在CINPWT的实践干预发生变化后,与6个月的前瞻性队列相比。主要终点是SSI的发生率(根据CDC-NHSN指南),而次要终点包括住院时间,重新接纳,再干预和存活天数和出院天数(DAOH)至90天。
    结果:共进行了127例腹股沟切口:回顾性分析中76例(65例),前瞻性分析中51例(42例)(其中69%接受CiNPWT)。SSI的主要终点在21.1%的回顾性队列和9.8%的前瞻性队列中可见(p=0.099)。发现再入院与回顾性队列显着相关(p=0.016),而回顾性队列中的总入院(包括再入院)明显更长(p=0.013)。与回顾性队列(77天(64-83)相比,采用CiNPWT方案后DAOH-90为83天(77-85),p=.04)。
    结论:CiNPWT的介绍与住院时间缩短和DAOH-90改善相关。关于CINPWT的进一步试验应包括以患者为中心的结果和医疗成本分析。
    OBJECTIVE: Surgical site infection (SSI) is a common complication in vascular surgery, and is associated with increased patient morbidity, readmission and reintervention. The aim of this study was to assess the impact of closed-incision negative pressure wound therapy (CiNPWT) upon rate of SSI and length of hospital stay.
    METHODS: This study was reported in line with the STROBE guidelines. We assessed the baseline incidence of SSI from a 12-month retrospective cohort and, following a change in practice intervention with CiNPWT, compared to a 6-month prospective cohort. The primary endpoint was incidence of SSI (according to CDC-NHSN guidelines) while secondary endpoints included length of hospital stay, readmission, reintervention and Days Alive and Out of Hospital (DAOH) to 90-days.
    RESULTS: A total of 127 groin incisions were performed: 76 (65 patients) within the retrospective analysis and 51 (42 patients) within the prospective analysis (of whom 69% received CiNPWT). The primary endpoint of SSI was seen in 21.1% of the retrospective cohort and 9.8% of the prospective cohort (p = .099). Readmission was found to be significantly associated with the retrospective cohort (p = .016) while total admission (inclusive of re-admission) was significantly longer in those in the retrospective cohort (p = .013). DAOH-90 was 83 days (77-85) following introduction of the CiNPWT protocol as compared to the retrospective cohort (77 days (64-83), p = .04).
    CONCLUSIONS: Introduction of CiNPWT was associated with a reduced length of hospital stay and improved DAOH-90. Further trials on CINPWT should include patient-centred outcomes and healthcare cost analysis.
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  • 文章类型: Case Reports
    中心静脉导管尤其是股静脉导管的放置是危重患者的常见做法。对导丝的潜在并发症(例如导丝迀移)的认识是最重要的。尽管血管外科医生或介入放射科医生可能会发现,在初级或缺乏经验的人通过时,由高级人士密切监督,在放置导管之前和之后使用超声波,使用检查表可能有助于识别和防止其发生。我们提出了在我们机构中导丝迁移的中央静脉插管的非常罕见的并发症。一名12岁女孩因癫痫持续状态和吸入性肺炎被送往儿科急诊室(PEU),随后转移到儿科重症监护病房(PICU)进行通气支持。在右股中央静脉导管插入术后,她的导丝意外迁移到左颈内静脉。她通过右腹股沟切口成功取出导丝。
    Central venous catheter placement especially the femoral venous catheter is a common practice in critically ill patients. Awareness of potential complications of the guidewire such as guidewire migration is of utmost importance. Though potentially retrievable by a vascular surgeon or interventional radiologist if it occurs, close supervision by a senior person during passage by a junior or inexperienced person, the use of ultrasound before and after placement of catheter, and use of a checklist may help to identify and prevent its occurrence. We present a very rare complication of central venous cannulation of a guidewire migration in our institution. A 12-year-old girl presented to the Paediatric Emergency Unit (PEU) with status epilepticus and aspiration pneumonia and subsequently transferred to the Paediatric Intensive Care Unit (PICU) for ventilatory support. She had accidental guidewire migration to the left internal jugular vein following a right transfemoral central venous catheterization. She underwent successful guidewire retrieval via a right groin incision.
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  • 文章类型: Comparative Study
    Surgical site infections (SSIs) of the groin remain a crucial problem in vascular surgery, prompting great interest in preventative techniques, such as closed incision negative pressure therapy (ciNPT). This prospective randomised study aimed to assess the potential benefits of ciNPT application after groin incisions for vascular surgery.
    The study included 204 patients who underwent vascular surgery for peripheral artery disease (PAD) at two sites between July 2015 and May 2017. These patients received post-operative treatment with ciNPT (intervention group) or standard wound dressings (control group). After exclusion, 188 patients were assessed for SSIs using the Szilagyi classification.
    The mean patient age was 66.6 ± 9.4 years (range 43-85 years), and 70% were male (n = 132). Regarding PAD stage, 52% were stage IIB, 28% stage III, and 19% stage IV. Among the patients, 45% (n = 85) had had a previous groin incision. Bacterial swabs were performed in each case of suspected SSI (22.8% [43/188]), while 76.7% (33/188) were negative, there were 5% [5/98] positive swabs in the intervention group and 5.5% [5/90] in the control group). Antibiotics were given to 13.2% of the intervention group, and 31.1% of the control group (p = .004). The control group experienced more frequent SSIs (33.3%; 30/90) than the intervention group (13.2%; 13/98; p = .0015; absolute risk difference -20.1 per 100; 95% CI -31.9 to 8.2). This difference was based on an increased rate of Szilagyi I SSI in the control group (24.6% vs. 8.1%, p = .0012).
    The results confirmed a reduced superficial SSI rate after vascular surgical groin incision using ciNPT compared with standard wound dressings.
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  • 文章类型: Journal Article
    缺乏儿科人群围手术期预防性抗生素益处的数据。在这项研究中,我们旨在评估2009年至2015年期间使用和不使用术前预防性抗生素的脑性瘫痪患者在接受孤立软组织手术后的感染率.
    我们回顾了2009年至2015年间在我们医院接受孤立软组织手术(上肢和下肢)的所有脑瘫儿童的记录。包括术后至少30天随访的儿童。有腹股沟切口的儿童被排除在外。
    确定了两组:抗生素组(77名儿童有203个切口和343个手术)有一个手术部位感染;无抗生素组(48名儿童有102个切口和177个手术)没有手术部位感染。
    这些结果表明,术前使用抗生素不会改变术后手术部位感染率。
    III级治疗研究。
    UNASSIGNED: Data on the benefits of perioperative prophylactic antibiotics in the paediatric population are lacking. In this study, we aimed to assess the rate of infection after isolated soft-tissue procedures in patients with cerebral palsy with and without preoperative prophylactic antibiotics between 2009 and 2015.
    UNASSIGNED: We reviewed the records of all children with cerebral palsy who underwent isolated soft-tissue procedures (on the upper and lower limb) at our hospital between 2009 and 2015. Children with at least 30-day postoperative follow-up were included. Children who had groin incisions were excluded.
    UNASSIGNED: Two groups were identified: the antibiotic group (77 children with 203 incisions and 343 procedures) had one surgical site infection; the no-antibiotic group (48 children with 102 incisions and 177 procedures) had no surgical site infections.
    UNASSIGNED: These results suggest that the use of preoperative antibiotics does not change the rate of postoperative surgical site infections.
    UNASSIGNED: Level III therapeutic study.
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