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Re: Операция на переднем полукольце таза при налич
Dan Schlatterer 04 Июнь 2007, 17:25
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hello to all,
pelvic ex-fix is a good option in these situations. in dwelling catheters for any lengthy time period are significant risk for infections (including foley catheters placed for weeks for urethral injuries). resorbable beads develop a fluid which is hard to interpret in terms of the "drainage" they can produce. the fluid always looks like infection although it may just be the beads resorbing. the infection is from the catheter and placing antibiotics around the plate may
help locally but will not prevent infection since the origin/pathway is remote from the surgical site. I have a case myself currently where a pt initially had a suprapubic catheter for 5 days and then urology exchanged for a foley catheter (pt had a urethral tear and APC II pelvis). I placed a supra-acetabular pelvic ex-fix at admission to close the pelvis. a week after the suprapubic catheter was removed I went back and plated the pubic symphysis. 4 wks later the pt returned to the office with very cloudy fluid in the foley and drainage from the pubic incision. urology says the foley got clogged and caused urine to come out of the urethral tear and into my surgical area.
so now I am comfronted with an infection of the pubic region. so to me in dwelling catheters for lengthy time periods are risky. it sounds as if the matta group has a different experience which we would be interested in hearing more about. thanks
dan schlatterer
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Re: Операция на переднем полукольце таза при налич
Bruce Ziran 04 Июнь 2007, 17:27
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The absorbable beads are osmotic and may develop a seroma. We are publishing such in J Trauma, in galleys now, but having said that, the seroma can be prevented/controlled. THe one thing for sure in this situation is that one must accept that by definition, the space of Retzius and any metal in this area will be colonized with bacteria. On the other hand, colonization does not equal infection. For that reason, even if a SP catheter is changed, all that does is lower the CFU load available to colonize or infect the tissue bed. It is like fighting terrorists in the mountains and caves. They hide all over and no matter how much one bombs, napalms or whatever, there is always some left behind to re-colonize. I would suspect that even so, the reason Matta has such good results is that the true infection rate is still low. Unfortunately, with infection, the incidence is so low, that the numbers required to get a sufficiently powered analysis is too large. Imagine in their series if they have 25 without infection, but the 26th is the one that gets it. That is a 4% rate, as compared with an expected 1% incidence. While 400% greater infection rate, it is still low enough to consider doing.
I would agree with dan but beleive the matta approach is quite reasonable.
Also, consider that a pelvic ex fix is quite difficult to maintain. I am a big fan of exfix and frames, but I hate pelvic fixators and have not had good success with the pins for longer periods. I like the idea of trying to get rid of the SP altogether and changing to a foley if possible. But if forced to place anteriorly, I would use ATB beads.
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine
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Re: Операция на переднем полукольце таза при налич
Отправитель: Lois Ann Nichols 04 Июнь 2007, 19:13
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How can the seroma be prevented/controlled?
Lois Nichols
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Re: Операция на переднем полукольце таза при налич
Отправитель: Bruce Ziran 04 Июнь 2007, 19:14
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Limit the amount of beads, nice closure (multi-layer if possible), and use of drains. It is not fool proof, and despite the issues we have with CaSu, we still use them for atb delivery in cases where the risk of infection in a colonized tissue bed is greater than the problems of CaSu.
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine
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