Seminars in pediatric surgery
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Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. ⋯ Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed.
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Appendectomy has been the standard of care for appendicitis since the late 1800s, and remains one of the most common operations performed in children. The advent of data-driven medicine has led to questions about every aspect of the operation-whether appendectomy is even necessary, when it should be performed (timing), how the procedure is done (laparoscopic variants versus open and irrigation versus no irrigation), length of hospital stay, and antibiotic duration. The goal of this analysis is to review the current status of, and available data regarding, the surgical management of appendicitis in children.
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The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. ⋯ Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time.
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Semin. Pediatr. Surg. · Jun 2015
ReviewSurgical innovation and quality assurance: Can we have both?
Innovation is the major force for progress in pediatric surgery. Most of the progress in surgery has evolved secondary to novel approaches developed by surgeons confronted with difficult pathologic conditions. Up to the present time, most surgical innovation has been practiced with few rules for guidance. ⋯ There is a significant potential for autonomous surgical innovators to clash with well-meaning proponents of quality improvement. A suggested remedy to encourage surgical innovators while protecting patients from unintended harm is for institutions to develop Surgical Innovation Committees to evaluate and give oversight to the early application of new techniques and devices. Scientific evaluation under the auspices of an IRB should follow when feasible.
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Burn injuries affect approximately a million children in the United States on an annual basis. Moderate to severe burns require hospitalization, usually under the direction of a Pediatric Surgical service. ⋯ This article provides an overview of the initial evaluation and resuscitative measures for pediatric burn patients, most current wound care, indications for grafting, and the role of nutrition, including use of pharmacologic adjuncts. Use of colloid solutions, indications for use of skin substitutes, and transfer criteria will also be addressed.