The American surgeon
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The American surgeon · Nov 2018
Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections.
Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. ⋯ Time to wound coverage did not vary with initial wound coverage technique (P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.
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The American surgeon · Nov 2018
Comparative StudySimplicity and Safety: Minimized Pancreatic Fistula Rate after Distal Pancreatectomy through Pancreas Stump Sutured Fish-Mouth Closure.
Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. ⋯ The PF rate was 2.0 per cent in 50 patients after sutured fish-mouth closures, but 20 per cent in cases using other techniques including stapling (P = 0.007); no other variable was linked to PF occurrence. Length of stay was linked to complications, resection extent, malignancy, and transfusions (all at P < 0.02), but not to PF. PF rate after DP in this experience is unaffected by splenic vessel resection but seems to be minimized through a sutured fish-mouth closure technique.
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The American surgeon · Nov 2018
Variations in Teaching Assistant Case Experience during General Surgical Residency.
In 2014 to 2015, the American Council for Graduate Medical Education required that graduating surgical residents must complete 25 cases as a teaching assistant (TA). The definition of TA varies among programs. The purpose of this study is to gain insight into how many cases residents log as a TA, the operative setting, and the types of cases performed. ⋯ The definition of TA differs among programs. Also, the types of cases that residents log as TA varies among programs as there are no clear guidelines set by the American Council for Graduate Medical Education as to what constitutes a TA case. Nonetheless, in most programs, senior residents perform more than 25 TA cases.