Gauze packing of open surgical wounds: empirical or evidence-based practice?

INTRODUCTION: Most surgical wounds are closed primarily, but some are allowed to heal by secondary intention. This usually involves repeated packing and dressing of the raw wound surfaces. Although the long-term care of such wounds has devolved to the care of nurses in the community or out-patient setting, the initial wound dressing or cavity packing is done by the surgeon in the operating theatre. Many surgeons are unaware of the growth of the discipline of wound care, and still use traditional soaked gauze for dressing and packing open surgical wounds and cavities. RESULTS: This review summarises the some of the modern alternatives available and the evidence--or the lack of it--for their use in both the acute and chronic setting.     

Pelvic incidence: a fixed value or can you change it?

Background Context

There has been renewed interest in the pelvic vertebrae by spinal surgeons recently. Those involved in working with patients with adult spinal deformity focus on the position of the fused spine as it relates to the pelvis, and determine success or failure by specific numbers for given pelvic parameters. The pelvic parameters that are commonly measured for these patients are pelvic tilt, sacral slope, and pelvic incidence (PI). Out of the three, PI has always been considered to be the fixed measurement, whereas pelvic tilt and sacral slope have the capacity to change in relation to external forces. The assumption that the PI does not change has not been proven in a healthy, asymptomatic population.

Patients With Chronic Pelvic Pain: Endometriosis or Interstitial Cystitis/Painful Bladder Syndrome?

BACKGROUND: Endometriosis and interstitial cystitis/painful bladder syndrome share similar symptoms. Interstitial cystitis was once considered rare, but it is now recognized as more common than previously thought. This review examines evidence that patients presenting with symptoms typically attributed to endometriosis or with unresolved pelvic pain after treatment for endometriosis may, in fact, have interstitial cystitis, and suggests approaches for appropriate diagnosis. METHODS: A MedLine search using "chronic pelvic pain," "endometriosis," "interstitial cystitis," and "bladder origin pain" as key words was performed for the most recent English-language articles. Additional references were obtained through cross-referencing the bibliography cited in each publication. DISCUSSION: The symptoms of endometriosis and interstitial cystitis frequently overlap, and these 2 conditions may even coexist in the same patient. In cases of unresolved endometriosis and persistent pelvic pain, patients may have interstitial cystitis. A variety of tools are available to aid in identifying interstitial cystitis. CONCLUSION: Gynecologists should be alert to the possible presence of interstitial cystitis in patients who present with chronic pelvic pain typical of endometriosis.     

Pelvic discontinuity: Where are we today?

Pelvic discontinuities in revision total hip arthroplasty remain a challenging problem with an evolving set of treatment options. Discontinuities occur when bone loss of the acetabulum and subsequent unstable movement of the acetabular component result in a fracture between the anterior and posterior columns. These resemble chronic nonunions by the time of revision arthroplasty and are managed differently from the acute fracture type occurring during primary or revision acetabular reconstruction in a previously stable pelvis. We review the treatment options and describe our preferred method of treatment using surgical distraction.     

Procedures used for correction of isolated penile torsion: are they competitive or complementary?

International Urology and Nephrology - To report our experience in starting the correction of penile torsion, whatever its degree (moderate or severe) with one or more simple procedures either...     

Lateral Pelvic Node Metastasis in Locally Advanced Rectal Cancer: Are We Exaggerating or Ignoring?

Annals of Surgical Oncology -     

Noninvasive cerebrovascular evaluation: A prerequisite for angiography?

Results of cerebrovascular evaluation were reassessed in 768 patients to determine whether angiography performed in unselected patients was safe and economically efficient, and whether previous noninvasive screening was sensitive enough and effective in increasing the yield of subsequent angiography.In 543 patients undergoing angiography without previous noninvasive screening, positive results were Table II Available Noninvasive Methods for Cerebrovascular Evaluation

     

14.

Building a Multidisciplinary Pelvic Floor Clinic: Why Bother?     

《Seminars in Colon and Rectal Surgery》2023,34(1):100933

Patients attending the pelvic floor clinic may have symptoms of defaecatory, urinary and sexual dysfunction, including incontinence and prolapse. Pelvic floor dysfunction is multifactorial and multi-compartmental. A holistic approach which addresses all aspects and compartments is essential to achieve optimal assessment and outcomes. The team must be multidisciplinary and cohesive, with open channels of communication and discussion. A multidisciplinary clinic provides a platform to ensure an efficient pathway for the patient and healthcare system, all aspects of care are simultaneously addressed, and patient care is optimised. This section outlines the drivers for, and potential outcomes from, running a multidisciplinary clinic.     

15.

Pelvic floor reconstructive surgery: which aspects remain controversial?     

Natale F  Weir JM  Cervigni M 《Current opinion in urology》2006,16(6):407-412

PURPOSE OF REVIEW: The article focuses on recently published original and review papers on current controversial aspects of pelvic reconstructive surgery. RECENT FINDINGS: A detailed Medline search was performed on records published in the previous 12 months. Controversial areas concerning which important work has been recently published include (a) prophylactic treatment of stress urinary incontinence, (b) the use of prosthetic materials (particularly for anterior segment reconstruction), (c) laparoscopic surgery. The considerations of the recent International Consultation on Incontinence are also reported. Other controversial areas in the field of pelvic reconstructive surgery such as the question of uterine preservation during the surgery for uterovaginal prolapse provided no significant new data in the period of this review. SUMMARY: In this evolving field, there is still poor standardization of what constitutes anatomical and functional cure. The transvaginal approach is the most promising of all techniques, and new techniques are evolved mainly in this area. There continues to be a need for multicenter prospective randomized trials providing level I evidence. Recurrence rates, particularly in the anterior wall, are still unacceptably high. Evidence is urgently needed to decide whether the use of prosthetic materials may provide the answer, if so, which material and which method?     

16.

Pelvic Reconstruction After Abdominoperineal Resection: Is It Worthwhile?     

Butler CE  Rodriguez-Bigas MA 《Annals of surgical oncology》2005,12(2):91-94

     

17.

Intraoperative indocyanine green angiography: ready for prime time?     

Kulik A  Rubens FD  Ruel M 《The Journal of thoracic and cardiovascular surgery》2007,133(2):592-593

     

18.

Pelvic muscle rehabilitation: Where do we go from here?     

《Journal of wound, ostomy, and continence nursing》1997,24(2):98-105

Pelvic muscle rehabilitation has been used in the treatment of stress and urge urinary incontinence for many years. This article reviews the anatomy of the female pelvic floor and its role in the maintenance of continence. The purpose and goals of pelvic muscle rehabilitation are reviewed, and implications for future applications and research are discussed.     

19.

Repair of Pelvic Organ Prolapse: What is the Goal?     

Margarita M. Aponte  Nirit Rosenblum 《Current urology reports》2014,15(2):1-5

The release of the U.S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh (TVM) for pelvic organ prolapse (POP) has resulted in changes in the pelvic reconstruction community. This monograph reviews the implications of the FDA statements over the last 18–24 months. Recent findings show that there have been significant developments in the areas of regulatory mandates, media and medico-legal activity, and statements from surgical societies. In summary, well-publicized communications from the FDA and major medical organizations are defining a change in the use of TVM for POP.     

20.

Ectopic Pregnancy and Pelvic H?matocele     

《Annals of surgery》1889,10(5):395-397

     

Periorbital Doppler sonography

Supraorbital Doppler

Frontal artery Doppler

Complete periorbital Doppler

Flow pattern recordings

Provocative maneuvers

Ophthalmodynamometry

Ophthal mop lethysmography

Kartchner method

Gee method

Buffington method

Vertebral artery blood flow (Doppler)

Oropharyngeal approach (Keller et al)

Submastoid approach (Kaneda)

Chassaignac tubercle approach (Corson et al)

Modified Chassaignac tubercle approach (Pollak)

Phonoangiography

Simple

With ECG recording

Carotid blood velocity recordings

Spectral analysis

Thermography

Ultrasonic imaging

Building a Multidisciplinary Pelvic Floor Clinic: Why Bother?

Patients attending the pelvic floor clinic may have symptoms of defaecatory, urinary and sexual dysfunction, including incontinence and prolapse. Pelvic floor dysfunction is multifactorial and multi-compartmental. A holistic approach which addresses all aspects and compartments is essential to achieve optimal assessment and outcomes. The team must be multidisciplinary and cohesive, with open channels of communication and discussion. A multidisciplinary clinic provides a platform to ensure an efficient pathway for the patient and healthcare system, all aspects of care are simultaneously addressed, and patient care is optimised. This section outlines the drivers for, and potential outcomes from, running a multidisciplinary clinic.     

Pelvic floor reconstructive surgery: which aspects remain controversial?

PURPOSE OF REVIEW: The article focuses on recently published original and review papers on current controversial aspects of pelvic reconstructive surgery. RECENT FINDINGS: A detailed Medline search was performed on records published in the previous 12 months. Controversial areas concerning which important work has been recently published include (a) prophylactic treatment of stress urinary incontinence, (b) the use of prosthetic materials (particularly for anterior segment reconstruction), (c) laparoscopic surgery. The considerations of the recent International Consultation on Incontinence are also reported. Other controversial areas in the field of pelvic reconstructive surgery such as the question of uterine preservation during the surgery for uterovaginal prolapse provided no significant new data in the period of this review. SUMMARY: In this evolving field, there is still poor standardization of what constitutes anatomical and functional cure. The transvaginal approach is the most promising of all techniques, and new techniques are evolved mainly in this area. There continues to be a need for multicenter prospective randomized trials providing level I evidence. Recurrence rates, particularly in the anterior wall, are still unacceptably high. Evidence is urgently needed to decide whether the use of prosthetic materials may provide the answer, if so, which material and which method?     

Pelvic muscle rehabilitation: Where do we go from here?

Pelvic muscle rehabilitation has been used in the treatment of stress and urge urinary incontinence for many years. This article reviews the anatomy of the female pelvic floor and its role in the maintenance of continence. The purpose and goals of pelvic muscle rehabilitation are reviewed, and implications for future applications and research are discussed.     

Repair of Pelvic Organ Prolapse: What is the Goal?

The release of the U.S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh (TVM) for pelvic organ prolapse (POP) has resulted in changes in the pelvic reconstruction community. This monograph reviews the implications of the FDA statements over the last 18–24 months. Recent findings show that there have been significant developments in the areas of regulatory mandates, media and medico-legal activity, and statements from surgical societies. In summary, well-publicized communications from the FDA and major medical organizations are defining a change in the use of TVM for POP.