A selective vacuum assisted mesh mediated fascial traction approach following temporary abdominal containment for trauma laparotomy is effective in achieving closure

Background: Definitive primary abdominal closure is often not possible nor desirable following trauma laparotomy. In such situations, temporary abdominal containment (TAC) is necessary. This audit reviews our experience with TAC and interrogates our use of the Vacuum Assisted Mesh Mediated Fascial Traction approach (VAMMFT) to achieve delayed closure of the Open Abdomen (OA). Methods: We conducted a retrospective study over a 4-year period of trauma patients who underwent a trauma laparotomy and who required a TAC. Results: Over the four-year period, 596 patients underwent a laparotomy for trauma. Of these trauma laparotomies, 463 (78%) underwent primary closure and 133 (22%) required a TAC. Of these 133 patients who required a TAC, 37 died, 41 underwent delayed primary fascial closure at repeat laparotomy and 55 were left with an OA. Of this cohort of 55 patients, 15 underwent a VAMMFT procedure. The VAMMFT procedure yielded a 60% closure rate, with failure to close being due to late mesh insertion and sepsis. Conclusion: Our initial results with VAMMFT are encouraging. The technique appears to be effective and safe. Ongoing audit will allow us to accrue more patients and to better refine our algorithms and strategies

An Assessment of Wound Dressing by Nursing Personnel at Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H.) Shagamu; Ogun State; Nigeria

Introduction: A variety of effects may result in the occurrence of a wound which may result in immediate loss of all or part of organ functioning; sympathetic stress response; hemorrhage and blood clotting; bacterial contamination and death of cells. Careful asepsis is the most important factor in keeping these effects to a minimum and promoting the successful care of wounds which is dependent on the nurse's knowledge and understanding of normal wound healing physiology; method of closure and the optimal treatment of the wound and with this knowledge; nurses can provide a systematic and holistic patient assessment; and consider any potential wound related complications (Vuolo JC 2006). Aim: This investigation aimed to assess wound dressing performances among nursing personnel in the three surgical wards of Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H.) Shagamu Ogun State Nigeria.Methodology:The investigators utilized the descriptive method of research. A total of sixty nursing personnel in the male; female; and paediatric surgical wards were randomly selected for the investigation. Performance of wound dressing was assessed through an investigators formulated questionnaire and evaluation checklist based on the concept of sterile wound dressing technique.Results: Nurses have a very good performance of wound dressing as they applied the concepts/principles of sterile technique in the performance of the procedure. There was no significant difference between nurses in the performance of wound dressing and their demographic variables such as age; gender; religion; and educational qualification. However; significant difference was found between length of clinical experience and practice of wound dressing.Conclusion: Findings suggests a relationship between length of clinical experience and practice of good wound dressing. Hence regular seminars on wound dressing should be organized to refresh nurses and keep them up to date in nursing practice

A Comparison of Post-Incisional Subcutaneous; Intramuscular; and Subcutaneous plus Intramuscular Infiltrations of Lidocaine in Post-Caesarean Pain Control

Background. How best to relieve pain after caesarean section (CS) is still debated by many obstetricians. Pre- and post-incisional infiltrations with local anaesthetics have been widely tested and compared. However; the effect of the site of post-incisional infiltration with a local anaesthetic on the quality of pain reduction is not well documented.Objectives. To compare the effects of post-incisional infiltration of lidocaine into the subcutaneous tissue; rectus abdominis; or both subcutaneous tissue and rectus abdominis on pain after CS.Methods. Two hundred candidates for elective CS were randomly allocated to four matched groups of equal size. They received postincisional infiltration of either 1 lidocaine (in the rectus abdominis; the subcutaneous tissue; or both) or saline. The pain intensity and analgesic demand after CS; as well as the time to ambulation and breastfeeding; were documented and compared between the groups.Results. Post-CS pain intensity and analgesic demand were significantly lower; and the time to ambulation was significantly less; in the lidocaine groups than in the placebo group. The time to breastfeeding; however; was comparable between the two groups. Among the patients who received lidocaine; the site of infiltration was associated with no significant differences in terms of post-CS pain intensity and need for analgesics; or time to ambulation and breastfeeding.Conclusion. The site of post-incisional local wound infiltration with lidocaine is not a clinically important factor in pain relief after CS