RESUMO
Background: Gastrointestinal hollow viscous perforations constitute one of the important causes of acute pain abdomen in adults and if not treated properly may lead to significant morbidity and sometimes mortality. Successful treatment requires a thorough understanding of anatomy, microbiology, pathophysiology of the disease process and in-depth knowledge of the therapy, including resuscitation, antibiotics, source control, and physiologic support. Aim: To evaluate the etiopathology, clinical signs and symptoms, investigations in the management of gastrointestinal hollow viscous perforations. Materials and Methods: This was a prospective study conducted on patients presenting with gastrointestinal hollow viscous perforations to the Department of General Surgery, Rajarajeswari Medical College and Hospital over a period of 2-year from July 2013 to June 2015. A total of 110 patients were included in the study. A written, informed consent was taken from all patients before enrolling into the study. The Institutional Ethical Committee clearance was taken before starting the study. A pre-formed questionnaire was used to collect the clinical information from the patients. Results: The majority of the patients involved were males (81%) and in the age group of 30-50 years. 80% of the perforations were noted in the Gastroduodenal region, and the remaining was seen in the small bowel (13%) and appendix (7%). Pain abdomen was the presenting complaint in all patients (100%) while vomiting was seen in 50% and abdominal distension was seen in 80% of the patients. 91% of the patients had gas under the diaphragm. Wound infection (9%) lead the list of post-operative complications with a residual abscess (6%) following behind burst abdomen (4%) and fecal fistula (1%). 2% (2 patients) of patients died due to varied reasons. Conclusion: Even after the introduction of proton pump inhibitors, the incidence of perforations resulting from acid peptic disease is still high. Early recognition of perforation, prompt surgical intervention, good post-operative care, recognition of co-morbid conditions and early recognition, and management of complications would reduce morbidity and mortality.
RESUMO
Background: Wounds with bare bone, joint and tendons in the extremities have been a formidable challenge to plastic surgeons. Although several skin substitutes are used in West, as both dermal and epidermal analogue, they are expensive and most of them are unavailable in India. It is in this scenario that Healicoll – a type 1 pure collagen as a possible dermal substitute is being investigated. The material ‘Healicoll’ is a type-1 native collagen derived from the bovine source and is bioengineered, biocompatible and biodegradable skin substitute. The advantages of Healicoll have led us to an increase in its use for complex wounds. Medical literature on Healicoll, thus far has only reported its use for superficial burns and ulcers. Materials & Methods: The purpose of this study was to evaluate the advantages of using an inexpensive, easily available, bioengineered skin substitute ‘Healicoll’ for the closure of bare bone, joints and tendon. Results: Healicoll was used in three patients with two patients having undergone surgery involving use of Healicoll for bare bones, joints and tendons after release of contracture following burns and trauma, and one patient was treated with Healicoll as an outpatient procedure for bare bones following electrical burns. The mean hospital stay was 15 days. In all the three cases, a clear neodermis had covered the bones and joints in 5 days time and was ready to support the take of skin graft. Conclusions: Based on our initial experience, Healicoll skin substitute offers an excellent alternative for rapid reconstruction obviating the need for flap cover for wounds that have been difficult to reconstruct.