M Sasmor | PubMed Health

PubMed1992

Free flaps in the elderly.

Microsurgical transfer of tissue has become a primary tool of the reconstructive surgeon. The elderly, as a growing segment of our society, are requiring free-tissue transfers in proportion to their numbers. To investigate the potential morbidity of free-tissue transfers in the elderly, we studied consecutive populations of 31 patients above the age of 65 years and 90 patients below the age of 65 years. Complication rates were 65 and 49 percent, respectively. Premorbid medical conditions were present in 87 percent of patients 65 years and older and in 72 percent of those under 65 years. Medically related complications in free-tissue transfers, previously unreported in the literature, were 35 percent in the elderly group and 10 percent in the younger group. Wound-healing complications were seen in equal proportions between groups. The rates of wound and medically related complications observed in the elderly group were nearly double those observed in the younger group; however, after correction for the presence of preexisting medical conditions, no significant differences were seen between the two groups. These observations suggest that age alone is not a variable in risk for free-tissue transfers. Elective microsurgery can be performed in the elderly patient with a high expectation of success.

Adolescent↗

PubMed1986

The initial surgical intensive care unit nursing experience with the permanent total artificial heart.

The Utah experience with implantation of the Jarvik-7 demonstrated that this TAH can be implanted successfully within the confines of the adult human mediastinum. The device has proven its capacity to sustain the patient's life without causing the patient pain. There is no immunologic rejection of the heart, and in fact most other organ systems appear to accommodate well to the artificial pump. As is the nature of any experiment, problems were encountered and questions raised. Laboratory investigation is underway to test the durability of various prosthetic valves in the Jarvik-7. Subsequent recipients of the Jarvik-7 implant have experienced embolic episodes. The quick connects are being scrutinized closely for a predilection for thrombi accumulation. The significance of reperfusing persons who have adapted to chronic states of low cardiac output is still not completely understood. The ramifications of rapidly reperfusing cellular and organ systems is currently being studied. Ethical considerations as described by Woolley are being discussed at length. Protocols are being established with flexible guidelines for management of the TAH patient. Some of these protocols include infection control, anticoagulation, and hematological guidelines; nutritional support, physical therapy, and rehabilitation programs. More extensive preoperative evaluation and testing protocols are being developed. Further clarifications of the nurses' responsibility in maintaining the TAH equipment are being made. Certification methods are being developed to ensure the nurse's competency. Data collection methods are being refined by adapting information flow charts and computer hard copies specifically to the TAH patient. The Utah experience with TAH implantation in humans is still in its infancy. Twenty years of animal research provided a strong base from which to approach the first human subject. However, "there are limitations in extrapolating information from the best animal models and relating it to the critically ill human being." Animals used in the research were young and healthy; human candidates who meet the criteria for implant are generally extremely debilitated. This, coupled with the absence of human historical perspective or precedent, left many unknowns for the first TAH recipient. Our patient expired on March 23, 1982 of pseudomembranous colitis. Despite his death after 112 days of life sustained on the mechanical heart, he participated in a successful pioneering scientific experiment.

Acute Kidney Injury↗