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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Clinical Trial
Relationship between Operating Room Teamwork, Contextual Factors, and Safety Checklist Performance.
Studies show that using surgical safety checklists (SSCs) reduces complications. Many believe SSCs accomplish this by enhancing teamwork, but evidence is limited. Our study sought to relate teamwork to checklist performance, understand how they relate, and determine conditions that affect this relationship. ⋯ Surgeon buy-in and surgical teamwork characterized by shared clinical leadership, open communication, active coordination, and mutual respect were critical in prompting case-related conversations, but not in completing procedural checks. Findings highlight the importance of surgeon engagement and high-quality, consistent teamwork for promoting checklist use and ensuring a safe surgical environment.
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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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Patients with phlegmonous appendicitis can be managed nonoperatively, yet debate continues about the need for interval appendectomy (IA), given the low risk of recurrence or neoplasm. We sought to determine for which patient age interval appendectomy is cost-effective. ⋯ Interval appendectomy should be considered in patients younger than 34 years of age.