Canadian journal of surgery. Journal canadien de chirurgie
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This review examines the principles and practice of antibiotic prophylaxis in surgery. Such prophylaxis is required to decrease the frequency of postoperative infection in most patients with clean-contaminated and contaminated wounds, to prevent infrequent but devastating infection of prostheses in cardiovascular and orthopedic surgery and to prevent endocarditis in noncardiac surgery in patients who have valvular heart disease. Prophylaxis should begin before operation; it is usually unnecessary afterwards. ⋯ The latter is more certain, but oral prophylaxis in bowel surgery may offer additional protection by reducing colonic flora, and topical wound and peritoneal antibiotics may be augment protective antibiotic levels at those sites. Antibiotics, such as the cephalosporin cefazolin (but not cephalothin), which penetrate blood and tissues rapidly and for prolonged periods, afford excellent prophylaxis at most sites. But for prophylaxis in colonic surgery, antibiotics directed against Bacteroides fragilis may be superior, and to prevent endocarditis in noncardiac surgery, vancomycin or a combination of penicillin and an aminoglycoside is best.
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Review
Results of minor foot amputations for ischemia of the lower extremity in diabetics and nondiabetics.
Results of 208 minor amputations were analyzed in 179 patients who had no food pulses. Wound healing was assessed at 3 months in relation to diabetes and previous vascular surgery. ⋯ Transmetatarsal amputation should be considered more often as a conservative amputation for gangrene of the toes. The absence of a palpable posterior tibial pulse is a contraindication to the Syme's amputation.