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Biomedical subjects

Pascal Steenvoorde

Publications and source records attributed to Pascal Steenvoorde.

15 recordsLinked to original sources
PubMed2006

Negative pressure wound therapy to treat peri-prosthetic methicillin-resistant Staphylococcus aureus infection after incisional herniorrhaphy. A case study and literature review.

The preferred treatment for incisional hernias occurring post laparotomy involves use of prosthetic mesh. If this mesh becomes infected, it may have to be removed to achieve wound healing. A patient with a methicillin-resistant Staphylococcus aureus-infected prosthetic mesh received negative pressure wound therapy to help facilitate healing without removing the prosthetic mesh applied to manage his hernia. After almost 4 weeks of treatment, the wound was closed secondarily. The literature contains many case studies about the use of NPWT for a variety of wounds but information about its safety and effectiveness for managing methicillin-resistant Staphylococcus aureus-infected prosthetic mesh is limited. The results of this case study add to the evidence that controlled clinical studies are warranted.

Aged↗
PubMed2006

Treatment of postparotidectomy fistulae with fibrin glue.

Although fistulae resulting from superficial parotidectomy represent a serious problem, there is still little consensus on the optimal treatment. Some suggest management by applying dressings, while others advise surgery. In recent years several other strategies have been proposed. In this manuscript, we present two cases of postparotidectomy fistulae treated by injection with fibrin tissue glue (Tissucol Duo 500, Baxter AG, Vienna, Austria). Furthermore, a review of the literature is presented. In both patients the fistulae completely healed within months without complications. A literature search revealed that this is the first time postparotidectomy fistulae were treated this way. We conclude that postparotidectomy fistulae can be effectively treated with fibrin glue. Moreover, this treatment is simple, safe and has no side effects.

Aged↗
PubMed2006

Development of a clinical decision tool for suspected scaphoid fractures.

Scaphoid fractures are the most common carpal fractures; their overall incidence is however low. Missing a scaphoid fracture may lead to a non-union with a possible disastrous outcome for the patient; for this reason, treatment of a suspected scaphoid fracture, even without a proven fracture on the first radiograph, has been conservative with plaster treatment. There are many clinical tests developed to diagnose a scaphoid fracture. However not all tests are equally practical, and their sensitivity and specificity are not always known, or are very low. In this study 18 clinical tests were evaluated and a subset of 7 tests remained, which were found to be practical and/or had a high enough sensitivity. A clinical decision protocol was developed using a combination of these seven tests, in order to improve diagnostic accuracy and at the same time reduce unnecessary plaster cast treatment of patients with a suspected scaphoid, who turn out to only have a sprained wrist.

Decision Making↗
PubMed2006

Pilot study evaluating a clinical decision tool on suspected scaphoid fractures.

In an earlier study we have proposed a scaphoid decision-protocol in order to improve diagnostic accuracy in case of suspected scaphoid fractures. This pilot study evaluated this protocol. In this pilot study (n = 31) most cases with clinical suspicion of scaphoid fractures reached a positive test result on the combined 7 clinical tests (93.5%). Using this test combination, no scaphoid fractures were missed (no false-negatives; sensitivity 100%), but it also included many patients with no scaphoid fracture. Many of these, however, were found to have another fracture. In total, 48% had a scaphoid fracture, 19% another fracture and 32% no fracture. In the pilot study the proposed protocol seems to be a safe protocol, without missing scaphoid fractures. It leads to a reduction of unnecessary plaster casting of sprained wrists and produces a marked reduction in plain radiographic examinations.

Adolescent↗
PubMed2005

Maggot debridement therapy: free-range or contained? An in-vivo study.

OBJECTIVE: To determine which method of maggot debridement therapy--free-range or contained--is more effective for wound healing. METHODS: In vivo study of 64 patients with 69 chronic wounds that showed signs of gangrenous or necrotic tissue. Patients were treated with either free-range or contained maggot debridement therapy according to maggot availability, dressing difficulty, and physician preference. RESULTS: Significantly better outcomes were achieved with the free-range technique versus the contained technique (P = .028). With the free-range technique, the mean number of maggot applications and the total number of maggots per treatment were significantly lower than with the contained application technique (P = .028 and P < .001, respectively). CONCLUSION: This clinical in vivo study supports in vitro studies in which containment of maggots was found to reduce the effectiveness of maggot debridement therapy.

Aged↗
PubMed2005

Conservative treatment of a closed fracture of the clavicle complicated by pneumothorax: a case report.

Isolated clavicle fractures are frequently encountered in the accident and emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax as a complication of a clavicle fracture has only been reported five times in English literature. In all five cases the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, both pneumothorax and clavicle fracture were treated conservatively with good result. Although isolated clavicle fractures rarely present with complications and normally heal with routine immobilisation, we must be aware of the serious complications that may occur, which require urgent treatment. Thorough history, physical examination, with particular attention to the neurovascular and chest examinations and radiographs of the clavicle are necessary to prevent overlooking these potentially serious complications.

Clavicle↗
PubMed2004

Deep infection after ilioinguinal node dissection: vacuum-assisted closure therapy?

Wound infection rates after ilioinguinal node dissection are high; 9% to 16% have been reported. The authors report a patient who underwent an ilioinguinal node dissection for a regional metastasized melanoma. Unfortunately, a deep wound infection occurred with extensive skin necrosis and production of abundant wound fluid (750 cc daily). Despite 6-daily dressings, the wound deteriorated, necessitating further operative debridement. In theatre, the authors failed to identify the lymphatic fistula and therefore were unable to close it. In accordance with literature on treatment of groin infections after vascular prosthesis, vacuum-assisted closure (VAC) therapy was started. After 11 days of VAC therapy, the lymphatic leakage completely stopped. Concurrent successful management of the wound with split skin graft therapy led to a complete closure of the wound. The treatment was not painful, changes of the sponge could be done in the ward, and there were no complications.

Journal Article↗
PubMed2004

Exclusion of a crural pseudoaneurysm with a PTFE-covered stent-graft.

PURPOSE: To describe the successful endovascular treatment of an iatrogenic anterior tibial artery pseudoaneurysm with a polytetrafluoroethylene-covered stent-graft. CASE REPORT: A 58-year-old man was admitted to our hospital with pseudoarthrosis and malunion of the right distal tibia. Fibulotomy and intramedullary fixation were performed, which was complicated by a pseudoaneurysm of the anterior tibial artery. Under local anesthesia, a 4x31-mm Symbiot covered stent was successfully placed over the origin of the pseudoaneurysm. At 12 months, the pseudoaneurysm remained excluded, and the anterior tibial artery was patent. CONCLUSIONS: Endovascular treatment of a crural artery pseudoaneurysm seems to be a feasible treatment option. Further experience with this technique is needed to validate its safety and long-term patency.

Aneurysm, False↗
PubMed2002

Gastric perforation due to the ingestion of a hollow toothpick: report of a case.

A perforation due to the ingestion of a toothpick is a condition seldom seen in the stomach. We herein describe an 80-year-old woman with a perforation of the stomach due to an ingested hollow toothpick. The toothpick was easily removed during a mini-laparotomy. The site of perforation was closed with absorbable sutures and omentum was used to function as an overlying patch. The postoperative course was uncomplicated. The hollow toothpick functioned as a fistula between the contents of the stomach and the peritoneal cavity. This resulted in a very different clinical picture from that observed in "classical wooden" toothpick injury, where the toothpick is not able to function as a fistula. To the best of our knowledge, this is the first description of a hollow toothpick perforating the stomach. A hollow toothpick perforation must be considered in any patient with symptoms of intestinal perforation, even when there is no history of swallowing toothpicks. Removal of a toothpick and subsequent suturing of the puncture site is a simple and relatively minor surgical procedure, which may have a lower morbidity and mortality as compared to other causes of gastric perforation. A precaution to observe, is the potential danger that one of the members of the operating team might perforate a finger.

Abdomen, Acute↗