[Split thickness skin graft for coverage of soft tissue defects]. / Spalthauttransplantation zur weichteildefektdeckung.

OBJECTIVE: Coverage of skin or soft tissue defects of various sizes by transplantation of spit thickness skin grafts. INDICATIONS: Skin or soft tissue defects of any size or location as long as there is a good blood supply to the wound bed. CONTRAINDICATIONS: Wound bed providing poor blood supply (e.g., tendon or bone), vessels or nerve without soft tissue coverage, any kind of implant material which is not covered by vital soft tissue. Relative contraindications include defect position at the flexion side of joints or other mechanically stressed locations (e.g., heel, neck) and local infection. SURGICAL TECHNIQUE: By meticulous debridement of the recipient site and coagulation of venous bleedings, the recipient site is prepared for skin grafting. Thereafter, the split thickness skin graft is harvested and, if necessary, modified by the meshing procedure. Then, the skin graft is placed in the defect and fixated at the wound margins. To promote healing, a special compression dressing is used to cover the split thickness skin graft. In case of uneventful wound healing, this dressing should be left in place for 5 days. POSTOPERATIVE MANAGEMENT: After removal of the compression dressing, daily changes are done using double layers of fatty gauze, alternated with periods without dressing. In the case of uneventful healing, the skin transplant can be covered starting in week 2 with a thin film of cream ointment. RESULTS: Split thickness skin grafting is a routine maneuver in reconstructive surgery and allows predictable, good results. Partial skin graft losses are mostly due to a combination of inadequate debridement and local infection. If the operation in done technically correct, total graft losses are rare.

Testing of a new pneumatic device to cause pain in humans.

BACKGROUND: Surgical pain typically combines superficial and deep pain. We wished to generate pain that resembled surgical pain, reliably and reproducibly, in volunteers. METHODS: We constructed a computer-controlled pneumatic device to apply pressure to the anterior tibia. The reproducibility of the pain was tested by rating the pressure that caused pain rated 4-5 on a visual analogue scale (VAS) on days 0, 7, and 24 in 10 volunteers. The effect of remifentanil (0.025, 0.05, 0.075, and 0.1 microg kg-1 min-1) on pain tolerance in another set of volunteers (n=11) was used as an indirect measure of the reliability of pain production. RESULTS: The pressure needed (0.7 (0.3) to 0.9 (0.4) atm (mean (SD)) to induce pain rated 4-5 (VAS) did not vary, showing long-term reproducibility of the method. When pressure was applied to cause increasing pain in volunteers (n=11) 0.05 microg kg-1 min-1 remifentanil increased pain tolerance by 50%. An approximate doubling of the dose (0.1 microg kg-1 min-1) increased pain tolerance significantly more. The linear logarithmic dose-effect relationship shows that the device causes pain reliably, and this can be reduced with opioid treatment. CONCLUSION: This pneumatic device can apply pain reliably and reproducibly.

[Evaluation of an established course of hospital management through structured telephone survey of former participants]. / Evaluierung eines etablierten Universitätslehrganges für Krankenhausmanagement durch telefonische Befragung ehemaliger Teilnehmer.

AIM OF THE STUDY: Participation in courses for health and hospital management is increasingly becoming a conditio sine qua non for candidates for executive positions in the health professions. The aim of this study was thus to evaluate the two-semester university course for health and hospital management offered by the University of Innsbruck since 1994. METHODS: A structured telephone survey was conducted to poll the participants (n = 184) of previous courses concerning time invested, cost-benefit ratio, quality of the course as well as implementation of course content. RESULTS: The university courses (n = 7) for health and hospital management of the University of Innsbruck evaluated in this study were rated in the upper half of the of the five-part scale (scores 2 to 3) for overall quality, cost-benefit ratio and implementation of course content. Only approx. 25 % of the course participants reported that the course had a positive influence on their career. The relatively high course fee was borne in part by the local hospital operator, a fact that had a certain influence on the selection of course participants. Participation in the course was largely made possible by exemptions from job duties (approx. 75 %) and to a lesser extent by vacation time (approx. 20 %) or time off for overtime (approx. 5 %). Of total absences from the course (3.18 +/- 3.41 d) 75 % was for job-related reasons, 6 % for illness and 19 % for other reasons. Overall, participants were absent more often, the larger the number of personnel in their department or clinic. CONCLUSION: All in all, the courses were considered important and recommendable, particularly with regard to communication, organization, time management and cost awareness. Streamlining (i. e. more content in less time), stronger practical orientation and a switch from mainly local to more international speakers would be important steps toward improving course quality. Thanks to its demonstrated quality, it can be said that the university course for health and hospital management held by the University of Innsbruck and evaluated in this study is certainly a worthwhile course offered in a still emerging market, namely one that will come under increasing pressure from the candidates for executive positions in the health professions to provide what is best for their careers and the health services industry in general.