Skin grafts are commonly used for reconstruction of defects following excision of facial skin cancers. Tie-over bolster dressings are routinely placed to secure these grafts, but are they necessary ...for healing or graft success?A total of 96 patients was treated from 2013-2019 who underwent full thickness skin graft (FTSG) reconstruction following facial skin cancer excision were retrospectively analysed. All patients were treated by one consultant with non-fenestrated FTSG’s placed on defects varying from 10 to 55mm in maximum diameter. Grafts were sutured circumferentially with a continuous resorbable suture. Tie-over bolster dressings were not used, and the recipient site was dressed with MepitelTMand SteristripsTM. Primary defect sites where we used this technique included the pinna, the nose and face and less commonly, the scalp. Graft harvest sites included the neck, pre-auricular and submental regions.Complete graft take was noted in 94/96 patients. Partial graft failure was observed in two patients, one who healed and had successful late scar revision surgery and one who was managed conservatively and healed well. Two further patients with complete graft healing later underwent minimal revisional contour surgery with satisfactory results.This retrospective study has shown FTSG success in cutaneous defects of the head and neck to be excellent without the use of tie-over bolsters. This has significant benefits of saving operative time, reducing cost, and sparing the patient both unnecessary intraoperative steps, and the inconvenience of a bolster with its often-painful removal.
We recommend that the use of tie-over bolsters in the management of most FTSG reconstructed head and neck cutaneous defects be considered an unnecessary step. We believe there are no adverse effects of our described simple technique, and that there are significant benefits to the patient.
Training image‐based approaches for stochastic simulations have recently gained attention in surface and subsurface hydrology. This family of methods allows the creation of multiple realizations of a ...study domain, with a spatial continuity based on a training image (TI) that contains the variability, connectivity, and structural properties deemed realistic. A major drawback of these methods is their computational and/or memory cost, making certain applications challenging. It was found that similar methods, also based on training images or exemplars, have been proposed in computer graphics. One such method, image quilting (IQ), is introduced in this paper and adapted for hydrogeological applications. The main difficulty is that Image Quilting was originally not designed to produce conditional simulations and was restricted to 2‐D images. In this paper, the original method developed in computer graphics has been modified to accommodate conditioning data and 3‐D problems. This new conditional image quilting method (CIQ) is patch based, does not require constructing a pattern databases, and can be used with both categorical and continuous training images. The main concept is to optimally cut the patches such that they overlap with minimum discontinuity. The optimal cut is determined using a dynamic programming algorithm. Conditioning is accomplished by prior selection of patches that are compatible with the conditioning data. The performance of CIQ is tested for a variety of hydrogeological test cases. The results, when compared with previous multiple‐point statistics (MPS) methods, indicate an improvement in CPU time by a factor of at least 50.
Key Points
The first use of image quilting approach in geosciences
Adaptations for exact conditioning and 3‐D simulation
A drastic acceleration compared to existing algorithms
This work investigates the thermal insulation performances of clothing based on down and a quilting method. The effect of several parameters was studied, including the amount of down, quilting ...number, and their geometry. An experimental study was combined with a geometrical model to confirm that a regular hexagonal geometry is the best to maximize the heat insulation properties. For the overall tiling, the best thermal resistance was obtained by using 8.67 g of down, and the thermal conductivity is the lowest when the filling was 5.14 g down. The heat resistance was also found to increase by decreasing the quilting number, but the effect is less significant as the number increases. Also, a lower amount of down in each quilting place resulted in higher heat loss. So, improving the filling down quality helped to increase heat retention. The correct space division and filling quality lead to improved warmth retention of cold protection down products.
Background
To reduce the incidence of seromas, we have adapted the quilting procedure used in open abdominoplasty to the endoscopic-assisted repair of concomitant ventral hernia (VH) and diastasis ...recti (DR). The aim of this study was to describe the technique and assess its efficacy by comparing two groups of patients operated on with the same repair technique before and after introducing the quilting.
Methods
This retrospective study included data prospectively registered in the French Club Hernie database from 176 consecutive patients who underwent surgery for concomitant VH and DR via the double-layer suturing technique. Patients were categorized into two groups: Group 1 comprised 102 patients operated before introducing the quilting procedure and Group 2 comprised 74 operated after introducing the quilting. To carry out comparisons between groups, seromas were classified into two types: type A included spontaneously resorbable seromas and seromas drained by a single puncture and type B included seromas requiring two or more punctures and complicated cases requiring reoperation.
Results
The global percentage of seromas was 24.4%. The percentage of seromas of any type was greater in Group 1 (27.5%) than in Group 2 (20.3%). The percentage of Type B seromas was greater in Group 1 (19.6%) than in Group 2 (5.4%), when the percentage of Type A seromas was greater in Group 2 (14.9) than in Group 1 (7.9%). Differences were significant (
p
= 0.014). The operation duration was longer in Group 2 (83.9 min) than in Group 1 (69.9 min). Four complications requiring reoperation were observed in Group 1: three persistent seromas requiring surgical drainage under general anesthesia and one encapsulated seroma.
Conclusion
Adapting the quilting technique to the endoscopic-assisted bilayer suturing technique for combined VH and DR repair can significantly reduce the incidence and severity of postoperative seromas.
Objective
This study looks at the outcome of percutaneous quilting technique for the treatment of closed degloving injuries or Morel-Lavallée lesions (MLL).
Design
Prospective single-centre ...nonrandomized case series.
Participants
Patients with MLL visiting our hospital between January 2012 and May 2018.
Method
The method involves percutaneous single-stage suturing of skin and deep fascia with heavy, non-absorbable, non-braided sutures starting from periphery to centre.
Outcome Measures
Resolution of the lesion.
Results
Twenty-two patients with MLL treated, which included 18 males and 4 females with an average age of 22 (range 16–52). Lesions varied in length from 12 to 60 cm. The average time gap from the injury to drainage of the lesion was 7 days (range 2–60 days). We followed these cases weekly for 4 weeks and then once a month until 6 months and then at the end of the year. All 22 cases healed uneventfully.
Conclusion
Percutaneous drainage along with suturing of the skin and subcutaneous tissue to deep fascia prevents the discordant movement and obliterates the dead space-aiding apposition of the layers. This is a simple and effective procedure with low recurrence rates that addresses the primary pathology of MLL.
Level of Evidence
Therapeutic level IV.
Arts-Based Evaluation Hurlbut, Karyn; Brousselle, Astrid
Canadian journal of program evaluation,
12/2023, Volume:
38, Issue:
2
Journal Article
Peer reviewed
Open access
Arts-based evaluation is an effective way to engage people and uncover meaningful, valid results. In the project that was used to inform this article, an arts-based approach was used to gain an ...understanding of the effects the Communities ChooseWell Program has had according to the Champions’ experiences. Communities ChooseWell is an Alberta Recreation and Parks Association Program that promotes healthy eating and active living in communities across Alberta. The evaluation was completed using an arts-based approach which allowed us to explore varied long-term effects in different contexts. The arts used within this project include painting, writing narratives, and quilting. This article will present some reflections and recommendations that could inform evaluators that are interested in using arts-based approaches. This article starts with information from relevant literature about arts-based approaches to evaluation followed by what was learned throughout the ChooseWell arts-based evaluation and recommendations for evaluators when planning an arts-based evaluation.
OBJECTIVEThe purpose of this study was to consider the use of drainage when performing an abdominoplasty with regards to postoperative complications for two groups of patients. PATIENTS AND ...METHODFrom January 1st 2017 to December 31th 2019, 215 patients underwent an abdominoplasty in our institution. In this retrospective, comparative, single institution study, patients were divided into two groups: "drainage" D (n=162) when suction completed abdominoplasty, "no drainage" ND (n=53) when suction didn't completed abdominoplasty. Early and distant complications were retrieved for each group and compared. RESULTSThere was no significant difference between the two groups concerning the occurrence of seroma postoperatively (8% of patients in group D and 11.3% of patients in group AD). The drainage group D experienced more seroma's punctures (2,3± 1,0) and the mean of punctured fluid was higher (386,5ml±350,4ml) compared to the no drainage group ND (1,3+- 0,5 number of punctures with a mean punctured fluid of 165,8mL± 224,2mL). The mean hospital stay was shorter for group ND (2,9± 1,8 days) than for group D (4,4+- 1,7 days), P<0,0001. CONCLUSIONPerforming an abdominoplasty with quilting suture but drainless doesn't seem to increase postoperative complications statistically. The authors recommend, under the guise of a quilting suture, not to systematically drain the abdominoplasties and to reserve this technique for patients at risk of complications (high BMI, significant weight loss and co-morbidities).
Background
There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association ...with surgical site occurrences as compared to conventional closure (CC) for mastectomy.
Methods
MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings.
Results
Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR 95%CI = .32 .18, .57; P < .0001) than CC. Hematoma rates (OR 95%CI = 1.07 .52, 2.20; P = .85), SSI rates (OR 95%CI = .93 .61, 1.41; P = .73), and flap necrosis rates (OR 95%CI = .61 .30, 1.23; P = .17) did not significantly vary between QS and CC.
Conclusion
This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
L’objectif de cette étude était d’évaluer l’intérêt du drainage en comparant la survenue de complications dans deux séries de patients ayant bénéficié d’une abdominoplastie associée ou non à un ...drainage aspiratif.
Du 1er janvier 2017 au 31 décembre 2019, 215 patients ont bénéficié d’une abdominoplastie dans notre centre. Nous avons réalisé une étude rétrospective, unicentrique, comparant deux groupes de patients en fonction de la mise en place ou non d’un drainage aspiratif lors de l’intervention (groupe « drainage » (D), 162 patients et groupe « absence de drainage » (AD), 53 patients). Les complications précoces et à distance ont été répertoriées et analysées.
Il n’y avait pas de différence significative entre les deux groupes concernant la survenue de sérome (groupe D, 8 % versus groupe AD, 11,3 %). La quantité moyenne de liquide ponctionné était plus importante pour le groupe D (386,5ml±350,4ml versus 165,8ml±224,2ml) ainsi que le nombre moyen de ponctions (2,3±1,0 versus 1,3±0,5). La durée d’hospitalisation moyenne était plus courte dans le groupe AD (2,9±1,8 versus 4,4±1,7 avec p<0,0001).
La réalisation d’une abdominoplastie avec capitonnage et sans drainage ne semble pas augmenter significativement le taux de complications. Les auteurs recommandent, sous couvert d’un capitonnage, de ne pas drainer systématiquement les abdominoplasties et de réserver cette technique aux patients à risque (IMC élevé, perte pondérale importante et comorbidités).
The purpose of this study was to consider the use of drainage when performing an abdominoplasty with regards to postoperative complications for two groups of patients.
From January 1st 2017 to December 31th 2019, 215 patients underwent an abdominoplasty in our institution. In this retrospective, comparative, single institution study, patients were divided into two groups: “drainage” D (n=162) when suction completed abdominoplasty, “no drainage” ND (n=53) when suction didn’t completed abdominoplasty. Early and distant complications were retrieved for each group and compared.
There was no significant difference between the two groups concerning the occurrence of seroma postoperatively (8% of patients in group D and 11.3% of patients in group AD). The drainage group D experienced more seroma's punctures (2,3± 1,0) and the mean of punctured fluid was higher (386,5ml±350,4ml) compared to the no drainage group ND (1,3+- 0,5 number of punctures with a mean punctured fluid of 165,8mL± 224,2mL). The mean hospital stay was shorter for group ND (2,9± 1,8 days) than for group D (4,4+- 1,7 days), P<0,0001.
Performing an abdominoplasty with quilting suture but drainless doesn’t seem to increase postoperative complications statistically. The authors recommend, under the guise of a quilting suture, not to systematically drain the abdominoplasties and to reserve this technique for patients at risk of complications (high BMI, significant weight loss and co-morbidities).
PDF
