Abstract:
PURPOSE:Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. METHODS:Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. RESULTS:Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. CONCLUSIONS:Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Mattison G,Leis AR,Gupta SCdoi
10.1097/SAP.0000000000000173subject
Has Abstractpub_date
2014-05-01 00:00:00pages
S18-21eissn
0148-7043issn
1536-3708pii
00000637-201405001-00006journal_volume
72 Suppl 1pub_type
杂志文章abstract::Definitive repair of recurrent ventral hernias using abdominal wall reconstruction techniques is an essential tool in the armentarium for general and plastic surgeons. Despite the great morbidity associated with incisional hernia, no consensus exists on the best means for treatment (Korenkov et al, Langenbecks Arch Su...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181dc8409
更新日期:2010-05-01 00:00:00
abstract::Idiopathic avascular necrosis of the scaphoid, or Preiser disease, is a rare condition. Both the etiology and the pathology are still not well understood. We here present 2 cases with this disease and discuss the recommended treatment according to the stage of disease progression and by reference to previous studies i...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e31827fafa1
更新日期:2014-11-01 00:00:00
abstract::The nasal reconstruction in 8 patients and cheek reconstruction in 1 using a free flap from the deltoid region has been successfully undertaken in our department since August 1987. The flap has a direct cutaneous artery--the acromial artery--as its vascular axis. The experiences and a brief anatomical review of the do...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198907000-00003
更新日期:1989-07-01 00:00:00
abstract::The history of the artificial eye, from antiquity to the present, is described. Around the beginning of the nineteenth century, glass eyes replaced the earlier metal ones--not always well tolerated. In 1835, cryolite glass was used instead of lead glass; to this day it remains the lightest and most desirable substance...
journal_title:Annals of plastic surgery
pub_type: 历史文章,杂志文章
doi:10.1097/00000637-197908000-00014
更新日期:1979-08-01 00:00:00
abstract::There are a variety of traditional treatments for the removal of unwanted hair. Recently, lasers have been developed to remove hair. The long-pulsed ruby laser uses light at a wavelength of 694 nm with a 3-msec pulse to destroy hair. Seventy-two patients were treated with this laser from one to four times in a variety...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199807000-00001
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:The reported rate of isolated medial orbital wall fractures varies widely but has been found to be as high as 55% of all orbital fractures. Identifying and repairing medial orbital wall defects by using appropriate materials improves patient outcome considerably; however, most related research has focused on...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001012
更新日期:2017-03-01 00:00:00
abstract::The last 30 years has seen a shift in surgical treatment of breast diseases to less invasive, more conservative treatment options. The mammotome equipment was originally introduced as a diagnostic tool, but advances in technology have extended its role to therapeutic procedures. The mammotome device (8-gauge) is inser...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000095441.40759.1f
更新日期:2004-02-01 00:00:00
abstract::Metastatic spread of head and neck cancer signifies a grave change in prognosis for the patient. The presence or absence of detectable metastasis is valuable knowledge both in planning treatment and in predicting prognosis. Knowledge of the metastatic behavior patterns of such tumors, and of the diagnostic means of de...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198005000-00008
更新日期:1980-05-01 00:00:00
abstract::Glomus tumors develop from a thermoregulatory unit called the glomus body which is found in high density within the digits of both the hands and feet. To note, even though less frequently, these tumors can present in extradigital locations. Usually it presents as a small, 1-cm bluish nodule. Glomangioma (multiple glom...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000222729.59856.e1
更新日期:2006-10-01 00:00:00
abstract::With the current tendency of increasing minimally invasive cosmetic surgeries, some rare but disastrous complications of facial filler injections come into sight, such as visual loss. The study aims to investigate the possible route that the injected droplet accesses the ophthalmic artery to explain and prevent such d...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0000000000000572
更新日期:2015-09-01 00:00:00
abstract::Current recipient vessels for microvascular breast reconstruction include the internal mammary and the thoracodorsal systems. This review will focus on the advantages of the internal mammary artery and vein and reasons for their preference. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e31821daac3
更新日期:2012-05-01 00:00:00
abstract::Although compartment syndromes of the forearm are infrequently encountered, they are well described in the literature. Forearm compartment syndrome uncommonly occurs after percutaneous arterial blood sampling and is usually associated with anticoagulant therapy. Our review of the English literature revealed no other c...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/00000637-199405000-00017
更新日期:1994-05-01 00:00:00
abstract::Improvements were made by us in several distally based pedicled flaps of the nutrient vessels of the saphenous nerve with lower rotation points. However, these flaps are still insufficient for trauma complicated by bone defects. Accordingly, we conducted a systematic study of the anatomic theory on distally based pedi...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e318188b958
更新日期:2009-07-01 00:00:00
abstract::Despite the advances in laser treatment of port wine stains (PWS), re-emergence of these lesions still occurs. We carried out a retrospective audit of all children that received laser treatment of PWS between 1997 and 2000 using the flashlamp-pumped dye laser with a 585-nm wavelength. Out of 110 patients treated, 15 r...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000221620.83178.fc
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Obstetric brachial plexus palsy is caused by traction during birth. Most patients regain useful function with spontaneous recovery. In some cases, cross reinnervation occurs between the biceps and triceps muscles. In these cases, smooth active motion of the elbow joint is impaired by simultaneous biceps and ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002075
更新日期:2019-10-01 00:00:00
abstract::This case report documents the successful removal of a sizable and symptomatic adenoma sebaceum from the face, nose, and palate with the carbon dioxide laser. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00
abstract::Norian CRS, Bone Cement (Synthes CMF), and Mimix (Lorenz) have been used to reconstruct large cranio-orbital defects in 85 patients. Resorbable mesh (Macropore), used in combination in selected patients, obviates dura pulsations that have been postulated to cause fragmentation of alloplastic material. Norian is compos...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000168157.10664.9c
更新日期:2005-07-01 00:00:00
abstract::Cleidocranial dysplasia (CCD) is a rare hereditary disorder characterized by skeletal malformations and dental abnormalities. Mutations of the transcription factor RUNX2 are responsible for the pathogenesis of CCD. We present a case of a 10-year-old boy with CCD, presenting with hypoplastic clavicles, delayed closure ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0000000000001827
更新日期:2019-07-01 00:00:00
abstract::The author addresses rippling of the breast in patients with breast implants as a result of breast reconstruction or in cases of primary or secondary breast augmentation. The technique consists of rotating a flap of scar tissue from thicker parts of the breast to the thin, affected areas. The technique is simple both ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200205000-00009
更新日期:2002-05-01 00:00:00
abstract::Seventeen whole-breast tissue specimens of mammary cystic disease were prepared using Marcum's whole-mounting technique. Histological studies were performed on from 10 to 19 slides of tissue containing the suspected pathological foci. Cysts in the cleared breast tissues were numerous, and cyst walls were covered by si...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-197911000-00005
更新日期:1979-11-01 00:00:00
abstract::Skin sparing mastectomy (SSM) removes the breast, nipple-areolar complex, previous biopsy incisions, and skin overlying superficial tumors. Preservation of the native skin envelope facilitates immediate breast reconstruction. The procedure has been adopted for the treatment of breast cancer. All cases of SSM and immed...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200103000-00003
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:The ingredients of substances implanted for breast augmentation sometimes remain unknown due to lack of information from patients. Significant clinical problems sometimes necessitate removal and reconstruction. Thus, preoperative diagnostic imaging to identify the ingredients of implants may improve the trea...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000214185.94467.a3
更新日期:2006-07-01 00:00:00
abstract::Giant omphalocele is a rare, large abdominal wall defect in which the intra-abdominal organs herniate through the umbilical cord and are covered by a sac. Surgical management of giant omphalocele is challenging, and optimal treatment remains controversial. Two generally accepted treatment options are staged closure an...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000589
更新日期:2016-06-01 00:00:00
abstract::The high number of reconstructive dilemmas brought about by more aggressive treatment of congenital malformations and burns has created the need for large quantities of donor skin for local coverage. Tissue expansion with external ports has become part of the authors' surgical armamentarium. From January 1996 to Novem...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200044010-00003
更新日期:2000-01-01 00:00:00
abstract::Finger pulp loss is often observed in daily practice. When the lateral and dorsal surfaces of the injured digit remain intact, a neurovascular island flap can be designed and raised from that part of the finger for pulp reconstruction. Two types of homodigital lateral-dorsal neurovascular island flaps were used in 17 ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200045060-00008
更新日期:2000-12-01 00:00:00
abstract::It has been reported that breastfeeding problems occur in women who have breast implants. The breastfeeding success of women who had augmentation with saline implants and subsequently had a live birth (n = 107) was compared with that of women of similar age who had hypoplastic breasts and had children before their con...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181c925e4
更新日期:2010-05-01 00:00:00
abstract::There is an ongoing demand for surgeons to demonstrate that they can operate well, maintain their performance, and deliver acceptable results. Currently, surgeons are assessed by a series of subjective and peer-reviewed interviews, but at no stage is the objective assessment of surgical competence measured. The author...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000037271.26659.f4
更新日期:2003-03-01 00:00:00
abstract::Many controllable factors can influence free flap success rates, including the choice of recipient vessels, which can be as crucial as selecting the optimum donor site. The extremities are unique in that their dual venous systems offer an even greater diversity of options and perhaps risks. Whether the superficial as ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200044060-00009
更新日期:2000-06-01 00:00:00
abstract::The perforator flaps are characterized by their thinness and the adjustable length of their vascular pedicle. The purpose of this investigation is to refine the anatomy of the perforators in the middorsoradial forearm and present our clinical experience using this free perforator flap in the reconstruction of finger d...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181d3772e
更新日期:2011-01-01 00:00:00
abstract::Glomus tumors are uncommon, benign soft tissue tumors that can occur in a familial or sporadic pattern. Only 15 pedigrees have been reported to date. We report a family with three generations developing multiple glomus tumors of the skin. Although controversy exists over pattern of inheritance, review of the published...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199401000-00013
更新日期:1994-01-01 00:00:00