This month in Scientific American™ Surgery:

  • Pulmonary Insufficiency and Respiratory Failure
  • Preoperative Evaluation of the Vascular Patient
  • Surgical Management of Ulcerative Colitis
  • Chest Wall Procedures


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Depicted are gas volume and flow as demonstrated by spirometry.

Critical Care

Pulmonary Insufficiency and Respiratory Failure

BRUCE CHUNG, MD
Wake Forest University, Winston-Salem, NC
JAMES JASON HOTH, MD, FACS
Wake Forest School of Medicine, Winston-Salem, NC

 

Pulmonary insufficiency is the most common complication after surgical procedures. Pulmonary prehabilitation programs help to optimize pulmonary function in elective surgery. Recognition of pulmonary contusion and chest trauma as significant risk factors for pulmonary insufficiency indicates aggressive management early in the hospital course. The Berlin definition of acute respiratory distress syndrome (ARDS), along with advances in the understanding of ARDS and its treatment strategies (including ventilation), are also discussed.

 


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Vascular System

Preoperative Evaluation of the Vascular Patient

ISSAM KOLEILAT, MD
Greenville Health Systems, Greenville, SC
CHRISTOPHER G. CARSTEN, MD
Division of Vascular Surgery, Greenville Health Systems, Greenville, SC

 

Critical to the care of the vascular patient is the adequate, appropriate, and timely assessment of cardiac function. A variety of novel adjunctive techniques to assess cardiac function are under investigation. One involves the use of reactive hyperemia, using temperature rebound after arm cuff inflation before and after exercise. Another method attempts to evaluate risk based on elevated pulse pressure; however, it has not proven to be predictive of risk. Others have evaluated common carotid artery intima-media thickness as a predictor of adverse cardiac events.  The clinical use of these methods is currently limited and investigational.

 


Gastrointestinal Tract and Abdomen

Surgical Management of Ulcerative Colitis

Robert R. Cima, MD, MA
Professor, Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Foundation, College of Medicine, Rochester, MN
Amy Lightner, MD
Assistant Professor, Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Foundation, College of Medicine, Rochester, MN
John H. Pemberton, MD
Professor, Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Foundation, College of Medicine, Rochester, MN

 

Immunosuppressive drugs are increasingly used for the treatment of ulcerative colitis; therefore, a three-stage approach to an ileal pouch-anal anastomosis (IPAA) is more common. A three-stage approach is used for patients who require emergency surgery, are in poor medical condition due to their underlying disease, or are significantly immunosuppressed. Stage I is total abdominal colectomy, which removes most of the diseased colon. This improves the patient’s clinical condition while allowing the patient to be tapered off any immunosuppressive medications. Stage II entails either completion procedure with end ileostomy or IPAA. If IPAA is selected, then stage III reverses the ileostomy.

 


Thorax

Chest Wall Procedures

JASON L. MUESSE, MD
Division of Cardiothoracic Surgery, Emory University, Atlanta, GA
SETH D. FORCE, MD
Division of Cardiothoracic Surgery, Emory University, Atlanta, GA

 

When resecting a sternoclavicular joint for infection, some have found a delayed technique to cover the acquired defect to be more successful than immediate reconstruction. Incision and drainage of the sternoclavicular joint, followed by about 3 weeks of open wound care with the aid of a negative pressure wound vacuum device, before proceeding with joint resection and advancement flap coverage had a 100% success rate, compared with simultaneous débridement and flap coverage, which had only a 50% success rate due to reinfection and seroma formation.