Biomedical subjects
Publications and source records attributed to S Dinman.
Soft tissue reconstruction of the lower extremity has evolved considerably over the last 25 years. We no longer have to rely only on awkward pedicle flaps, or ultimately, amputation in order to heal a leg wound. The following is a brief history of the flaps prior to the development and use of the operating microscope and an increased knowledge of the circulation distal to the knee.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The incidence of dogbite injuries in children has risen steadily in the United States in the past several years. Plastic surgical nurses should familiarize themselves, with the initial care, surgical repair, complications of dog bites, emotional care, and discharge instructions so that children can be provided optimal care.
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Managed care, case management, and outcomes criteria have moved the practice of health care from the tertiary level to the outpatient settings. Advanced practice nurses (APNs) have adapted to these changes by modifying their practices to reflect general practice. With the increasing number of APNs, a credentialing process should be adopted at the state level to regulate the minimum academic requirements, continuing education, and inclusion into the nonphysician data bank on the national level.
Free flaps are used to reconstruct defects that cannot be repaired by traditional methods using local adjacent tissue. Advantages include a single operation, decreased immobility, increased vascular supply to tissues for healing, minimal risk of flap loss, and primary closure of the donor site. Disadvantages are a long operation, two surgical sites, need for surgery if vascular compromise occurs, donor site morbidity, and expense. Preoperative care focuses on readiness for surgery and avoidance of medications (nicotine, caffeine) and situations (cold exposure) that cause vasospasm. Intraoperative nursing care includes positioning, range of motion, and pneumatic compression devices for the long case. The operating microscope requires special care and instruments. After surgery, blood flow to the flap is closely monitored. Laser flow Doppler can be used with data recorded on a flow sheet. Common postoperative problems include temperature instability, pain, blood pressure fluctuations, and oliguria. Dismissal teaching includes avoidance of vasoconstrictive medications and dressing changes.
Mammalian bites account for 1% of all emergency department visits and dogs are common perpetrators. School-aged children are the most vulnerable and experience the majority of this type of trauma. Most of the cases involve a known dog and many of the attacks involve the family pet. When a child presents with a severe dog bite, the injury should be managed using appropriate assessment and intervention techniques. In some cases, conscious sedation can be used to provide amnesia, analgesia and sedation during the surgical repair. Proper preparation of the wound prior to repair will decrease infection rates. The need for tetanus and rabies prophylaxis must be evaluated in all dog bites. Facial injuries may require complex repair and reconstruction with appropriate surgical referral. Thorough discharge instructions are an important aspect of the nursing role.