Journal of the American College of Surgeons
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Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here we evaluate the role for thigh-based flaps founded on acceptable outcomes and low morbidity. ⋯ The overall complication rate with this technique is comparable with the more commonly used vertical rectus abdominis myocutaneous flap, but the potential for, and severity of, donor site complications is reduced with this technique. As such, gracilis flaps can be considered an acceptable alternative to abdominal flaps for selected perineal wounds.
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Earlier work suggested that telephone follow-up could be used in lieu of in-person follow-up after surgery, saving patients time and travel and maximizing use of scarce surgeon and facility resources. We report our experience implementing and evaluating telephone postoperative follow-up within an integrated health system. ⋯ Telephone postoperative care can be used in select populations as a triage tool to identify patients who require in-person care and decrease overall in-person clinic use.
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Multicenter Study
Early Clinical Outcomes of a Novel Antibiotic-Coated, Non-Crosslinked Porcine Acellular Dermal Graft after Complex Abdominal Wall Reconstruction.
Non-crosslinked porcine acellular dermal grafts (NCPADG) are currently the mainstay biomaterial for abdominal wall reconstruction (AWR) in complex hernia patients. We report early clinical outcomes using a novel rifampin/minocycline-coated NCPADG for AWR. ⋯ Data suggest that use of a novel rifampin/minocycline-coated NCPADG was associated with a low rate of postoperative surgical site occurrences/postoperative complications during the first 30 days of follow-up in complex AWR patients. In addition, data suggest a low rate of hernia recurrence at 6-month follow-up. Additional study is warranted to determine whether early antimicrobial protection of the device translates into longer-term protection of the repair.