Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience.

OBJECTIVES: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS. MATERIALS AND METHODS: Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ(2)) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. RESULTS: In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. CONCLUSIONS: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.

A simple device to teach tube thoracostomy.

BACKGROUND: Chest tube insertion is an important component of medical and surgical education. This article reports a cost-effective and easily reproducible method for hands-on education of tube thoracostomy placement. METHODS: A wood base is constructed, and a large rack of ribs are secured to simulate the thorax. Partially inflated examination gloves and bagels are used to simulate the lung and diaphragm, respectively. RESULTS: A life-like, cost-efficient thoracostomy model is created allowing for proficiency training in chest tube insertion. According to Advanced Trauma Life Support criteria, 123 military personnel were satisfactory, 4 remedial, and 7 instructor potential using the described model. CONCLUSIONS: We have developed a simple, inexpensive training device for insertion of chest tubes and tested it on 134 military personnel.

Effect of amnion-derived cellular cytokine solution on healing of experimental partial-thickness burns.

BACKGROUND: Amnion-derived multipotent progenitor (AMP) cells, unlike most stem cells, have been demonstrated to be nontumorigenic and nonimmunogenic. Amnion-derived cellular cytokine solution (ACCS), a secreted product of AMP cells, is a cocktail of cytokines existing at physiological levels and has been used to accelerate epithelialization of experimental partial-thickness burns. METHODS: Using modifications of Zawacki's guinea pig partial-thickness scald burn model, a total of 65 animals were treated with ACCS, ACCS + AMP cells, unconditioned medium (UCM) + AMP cells, or either UCM alone or saline as controls. Dosage times ranged from every other day to once a week. Percent epithelialization was serially determined from acetate wound tracings. Histology was performed on wound biopsies. RESULTS: ACCS, UCM + AMP cells, and ACCS + AMP cells improved epithelialization compared with the two control groups (P < 0.05). When ACCS was delivered more frequently, statistically significant more rapid epithelialization occurred (P < 0.05). By day 7, all groups treated with ACCS had reached at least 90% epithelialization, whereas control groups were only 20-40% epithelialized (P < 0.05). Histology showed excellent regeneration of the epidermis with rete ridge formation. Hair growth occurred in ACCS-treated animals but not in the control group. CONCLUSIONS: Amnion-derived cellular cytokine solution accelerates the healing of experimental partial-thickness burns. Based on these findings, a multicenter clinical trial is underway.