The use of a silicon sheet for gradual wound closure after fasciotomy.

We present a silicon sheet for temporary wound covering and gradual wound closure after open fasciotomy. Fasciotomy was performed in a total of 70 limbs with compartment syndrome (CS). The main etiology of CS was predominantly vascular. All patients were treated with a silicon sheet to cover the soft tissue defect and gradually reapproximate the skin margins. In 53% of the patients, a delayed final wound closure was achieved after a mean of 11.9 days. This method allows final closure of fasciotomy wounds without scar contractures, marginal necrosis, infection, or significant pain.

Cellulose pads (Hydrotin-C): a new solid coupling agent.

OBJECTIVES: Hydrotin-C is a bacterial cellulose consisting of 90% of physiological solution. The cellulose pad is smooth and elastic and cannot be torn, and is therefore suitable for use on any local skin condition. The aim of this study was to evaluate the image quality (IQ) and transducer pressure of Hydrotin-C-Pads as a solid coupling agent compared with standard coupling gel. METHODS: To date, transthoracic echocardiography has been performed in 51 patients (ongoing study) using standard coupling gel and Hydrotin-C-Pads. The IQ was categorized as follows: 1 = excellent, 2 = good, 3 = poor, 4 = inadequate. All patients were questioned about the transducer pressure, which was categorized as: 0 = less, 1 = equal, 2 = more. The body mass index (BMI) was documented for all patients. RESULTS: The IQ was very good with Hydrotin-C-Pads. The IQ was better in 84% of all patients. In patients with a BMI of over 25 and in patients with a BMI of over 30, Hydrotin-C-Pads was also better compared with standard gel. The transducer pressure was lower in 33 patients. CONCLUSIONS: Hydrotin-C-Pads can be used as a solid ultrasonic coupling agent. Because of the consistent thickness of the coupling zone, the IQ seems to be better for Hydrotin-C-Pads compared with standard coupling gel. The transducer presser is lower, and these pads are easy to apply and are reusable and reduce the burden of clean-up after treatment.

Preserved Windkessel function in patients following reduction aortoplasty of the ascending aorta.

OBJECTIVE: Reduction ascending aortoplasty (RAA) is a controversial procedure. Agreement has not yet been made regarding the indication for surgery and surgical technique. The goal of this study was to examine the long-term outcome of RAA without external support, and to compare the accuracy of transthoracic echocardiographic with computed tomographic (CT) measurements. Of particular interest was whether the important elastic properties of the aorta, the Windkessel function, is preserved following reduction aortoplasty of the ascending aorta without external wrapping. METHODS: Ninety-eight patients with dilation of the ascending aorta underwent reduction aortoplasty with concomitant cardiac procedures. Fifty-four patients were available for follow-up. Measurement of the ascending aortic diameter was performed prior to and directly following surgery, and 37 months postoperatively (range: 10-96 months). Both echocardiography and CT imaging were performed. The elastic properties of the ascending aorta were determined by measuring the distension of the ascending aorta during diastole and systole by means of transthoracic echocardiography. Fifteen patients with graft replacement of the ascending aorta were examined, and the control group contained 11 healthy volunteers. RESULTS: The diameter of the ascending aorta was significantly reduced in all patients who had undergone RAA. The change in diameter between diastole and systole was 3 mm in patients with reduction aortoplasty. Patients with graft replacement had a change of only 0.07 cm. There was no relevant increase (2 mm) in diameter at follow-up. Echocardiographic and CT measurements of the aortic diameter did not differ. CONCLUSIONS: RAA without external wrapping shows good long-term results in patients with a dilated ascending aorta who underwent concomitant cardiac procedures. Echocardiography is very accurate in measuring the ascending aortic diameter, which makes it a cost-effective diagnostic tool. Moreover, ascending aortoplasty without external wrapping preserves the important elastic properties, namely the Windkessel function. Follow-up of the cardiac function and aortic diameter can be performed easily and precisely in the outpatient setting.

Unsupported reduction ascending aortoplasty: fate of diameter and of Windkessel function.

BACKGROUND: Moderate aneurysms of the ascending aorta that are associated with other cardiac diseases are frequently encountered by cardiac surgeons. Reduction ascending aortoplasty (RAA) provides an elegant technique to handle these aneurysms; however, its applicability is still under debate. Many surgeons reject RAA because of an assumed redilatation. We investigated the postoperative stability of RAA without external support and whether the elastic property of the aorta (Windkessel function) remains preserved. METHODS: From 1996 to 2003, 97 patients (mean age, 67 years) underwent RAA without external stabilization in our institution as a concomitant procedure during cardiac surgery. The diameter of the ascending aorta was measured before and directly after surgery, as well as postoperatively from 10 to 96 months (median, 32 months). RESULTS: The mean preoperative diameter was 4.55 +/- 0.43 cm, while the early postoperative diameter measured 3.53 +/- 0.44 cm. Fifty-four of the 97 patients were available for follow-up. The mean diameter measured at follow-up was 3.68 +/- 0.41 cm. The mean increase was 0.17 +/- 0.27 cm. There was no relevant difference in redilatation between patients with follow-up of more than 60 months or less. Furthermore, the aortic wall demonstrated a near normal diastolic-systolic augmentation assessed by echocardiography. CONCLUSIONS: Reduction ascending aortoplasty without external stabilization is a reliable treatment for patients suffering from a moderately enlarged ascending aorta who require cardiac surgery for other indications. In these cases, with the technique described, a redilatation can be prevented and the Windkessel function of the ascending aorta remains preserved.