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  • br Telemedicine Communication among medical personnel is imp

    2018-11-06


    Telemedicine Communication among medical personnel is important in daily patient care. Good communication consists of providing and receiving information efficiently and correctly. With the development of smartphones and high-speed mobile data networks, photos and videos can be captured and shared in a real-time fashion, and it is especially suitable for postoperative free microvascular flap monitoring. Engel and colleagues reported 113 consecutive free flaps monitored with in-person examinations and assessed remotely via photographs transmitted over smartphones. The accuracy rate was 98.7% and 94.2% for in-person and smartphone photographic assessments, respectively. The response time to reexploration in the smartphone group was statistically shorter than that in the in-person group. Chen and colleagues reported 112 intestinal flaps monitored by images that were accessed via the Internet. Only two out of nine reexplored flaps were lost completely, and the rate of salvage for the intestinal flap was apparently higher than those reported in the literature. Hee Hwang and Mun used smartphone and mobile messenger applications including multimedia during the initial postoperative SAR 405 of 123 consecutive free flaps. The flap survival rate increased from 96.2% to 100%, and the threatened flap salvage rate rose from 50% to 100%. The time interval between the first notification of flap compromise and the start of reexploration was significantly shortened (4.0 hours vs. 1.4 hours).
    Introduction Difficult abdominal wall closure is a great challenge, especially in patients with abdominal compartment syndrome or repetitive abdominal surgery. Delayed abdominal wall closure may cause wound infection, bowel ischemia, ventral herniation, and cosmetic dysfunction. Several methods, including split-thickness skin graft, local or free flap transfer, and silicon mesh, have been reported with different benefits. The component separation technique was suggested to be a natural method of fascia-fascia closure without complications of artificial implants because of the creation of the linea alba, successfully providing a midline anchor. However, separation of components is indicated only when the defect does not exceed 6 cm in the subxiphoid area, 10 cm at the waist, and 5 cm in the suprapubic region, respectively, on either side.
    Materials and methods
    Discussion The partition technique was presented by Lindsey in 2003 which initially dissected the skin and subcutaneous tissue from the muscle layer, bilaterally to the anterior axillary lines, followed by parallel, parasagittal, staggered releases of the transversalis fascia, transversalis muscle, external oblique fascia, external oblique muscle, and rectus fascia from the costal margin to the pelvic inlet. Compared with temporary silicon mesh or free flap use, the partition technique can close the abdominal fascia defect without donor site morbidity, and in fact this technique decreased the infection rate and yielded better cosmetic function. Compared with the component separation technique, the partition technique may be used to close larger abdominal fascia defects because of more space released from both the external oblique muscle and transversalis muscle than the external oblique muscle alone anatomically. In addition, the patients with a stomy may have an adhesive muscle layer, which will limit the mobilization of the external oblique muscle in the component separation technique. The advantage of the partition technique here is that it supplies elastic space by the partition method even in the adhesive tissue around the stomy. In this study, four of the 11 cases suffered from complications (two major complications requiring further débridement and two minor complications). The analysis of related parameters including age, width of fascia defect, fascia defect width/abdominal circumference ratio, body weight, albumin level, and BMI suggested that the fascia defect width/abdominal circumference ratio is the most reliable parameter followed by the width of fascia defect to predict the immediate postoperative complications of abdominal fascia closure by the partition technique. In the literature hypoalbuminemia of different extents (Khan et al: <35 g/L; Markel et al: <3 g/dL) was of high frequency in abdominal wound dehiscence, and nutrition status is an important factor for wound healing, but no significant difference in albumin level was noted between patients with and without complications in this report. The small number of cases may be the major cause.