Journal of the American College of Surgeons
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The optimal strategy for oncologic sternectomy reconstruction has not been well characterized. We hypothesized that the major factors driving the reconstructive strategy for oncologic sternectomy include the need for skin replacement, extent of the bony sternectomy defect, and status of the internal mammary vessels. ⋯ Despite more extensive sternal resections, total/subtotal sternectomies resulted in equivalent postoperative complications when combined with the appropriate soft-tissue reconstruction. Good surgical and oncologic outcomes can be achieved with defect-characteristic-matched reconstructive strategies for these complex oncologic sternectomy resections.
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The aim of this study was to identify the ischemic tolerance of the ileum. In microvascular transfer of autologous bowel segments, the most critical factor for survival is ischemic time. In earlier animal studies, the tolerance of ischemic time was shorter for the ileum than for the jejunum, and an ischemic time of <1 hour was suggested for microvascular transfer of the ileum. It was believed that there are more bacteria in the ileum than in the jejunum and therefore autolysis and necrosis will be triggered sooner after the initiation of ischemia. However, in a clinical scenario, the tolerance for ischemic time of the ileum has not yet been clarified. ⋯ Clinically, the ileum segments can tolerate ischemia well within 2 hours. Segmental ileum transfer can be more widely applied in other fields. Care in each step of transfer is mandatory for functional success.
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Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center. ⋯ Significant disparities in socioeconomic status exist in severely injured pediatric patients treated in the PICU. Disparities were associated with adverse outcomes. These results should inform community and public health efforts to identify the areas and populations at highest risk for violence-related injuries.
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Historical Article
Personal reflections on the first 50 years of cardiovascular surgery.