Jennifer Ha

Effect of early and late mobilisation on split skin graft outcome

Background:u2002 There is an increasing trend towards early mobilisation post‐split skin grafting of the lower limbs. This study was performed to determine if early mobilisation impacts negatively on graft healing and patient morbidity.

Split thickness skin graft removal from free flaps: indications and technique.

A variety of methods are commonly used in plastic surgery for skin defect reconstruction. Split skin graft (SSG) is the most commonly used method in the soft tissue defects reconstructive ladder to achieve coverage. One of the most distressing postoperative problem associated with SSG is donor site pain because of the healing process and the stimulation of nociceptive fibers, which is proportional to the size of the harvested area. In the “bowtie scar” method, we describe a technique harvesting the SSG in addition to a gracilis-free flap. The bowtie scar method is an efficient and economical use of donor tissue from the gracilis-free flap. It allows for rapid healing, minimal scarring, and improved cosmesis.

Fibrin glue and porcine-derived mesh repair of ruptured umbilical hernia in a patient with ascites

ZusammenfassungGRUNDLAGEN: Bei Leberkranken mit Aszites ist die Ruptur einer Umbilikalhernie mit hohem Mortalitätsrisiko verbunden. METHODIK: Wir berichten über einen Patienten mit Leberzirrhose, Aszites und akuter, spontaner Ruptur einer Umbilikalhernie. Der Umbilikalhernien-Verschluss erfolgte mit einem Schweinenetz und Tisseel™ Fibrinkleber. ERGEBNISSE: Die Wunde heilte bland ab und war nach 6 Monaten rezidivfrei. SCHLUSSFOLGERUNGEN: Fibrinkleber und Schweinenetz können zum erfolgreichen Verschluss einer rupturierten Umbilikalhernie bei Leberzirrhose und Aszites eingesetzt werden.SummaryBACKGROUND: Rupture of an umbilical hernia carries a risk of high mortality for patients with liver failure complicated by ascites. There is no consensus on the management of this condition, as it has been managed both conservatively and operatively. METHODS: We report a case which demonstrates a unique surgical approach to the management of a spontaneous rupture of an umbilical hernia in a patient with liver cirrhosis and ascites with the porcine-derived mesh and Tisseel™ fibrin glue. RESULTS: The wound has remained intact and there is no recurrence at his twelve-month follow-up. CONCLUSIONS: We report the feasible use of Tisseel™ fibrin glue with porcine mesh to successfully repair a ruptured umbilical hernia in a cirrhotic patient with gross ascites.

Carotid sheath ‘intubation’ during an emergency surgical cricothyroidotomy

A previously well 62-year-old man was admitted to a regional hospital, with scalp swelling, headache, fever and rigors following a scalp injury 3u2005weeks prior. He developed meningism with progressive left-sided hemiparesis, and had a focal seizure on his fourth day of admission. Following a generalised seizure on day 5 of admission, he was referred to a metropolitan tertiary hospital, for neurosurgical intervention of an extradural and subdural empyema.nnPrior to transfer by the Royal Flying Doctor Service, he required a definitive airway and was taken to the emergency department, for sedation and intubation. Two unsuccessful attempts at orotracheal intubation were performed by the emergency physician, followed by successful placement of a laryngeal mask airway (LMA). The decision to attempt surgical cricothyroidotomy was made as the LMA did not suffice as a definitive airway. A vertical incision in the skin of the anterior neck exposed what was believed to be the cricothyroid membrane (CTM). Three attempts at insertion of an endotracheal tube …