The following best classifies a patient with an acute osteomyelitis of the sternum which presents 2 weeks after median sternotomy and coronary grafting, and which is culture positive:
Pairolero Type B. Pairolero classified sternal osteomyelitis into three categories. The first is characterised by a culture-negative serous discharge within days of surgery without cellulitis, chondritis or osteomyelitis. The second is acute, suppurative and culture positive osteomyelitis, and the third presents months after surgery and is often an acute-on-chronic osteomyelitis.
Which one of the following statements regarding Poland's syndrome is false?
Its incidence is 1:2500 live births. E is false. Poland’s syndrome is a rare congenital anomaly characterised by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. Literary data suggest its sporadic nature. The prevailing theory of its cause is hypoplasia of the subclavian artery or its branches, which may lead to a range of developmental changes. The incidence of Poland’s syndrome varies between groups (e.g. male versus female patients, congenital versus familial cases) and ranges from 1 in 7,000 to 1 in 100,000 live births.
1. Fokin AA, Robicsek F. Poland's syndrome revisited. Ann Thorac Surg 2002; 74(6): 2218-25.
The following is false in breast reconstruction:
TRAM flaps reduce abdominal wall strength compared with DIEP flaps with resultant detriment to activities of daily living and quality of life. A is false. There is no evidence that the preservation of abdominal wall strength from DIEP flaps versus TRAM flaps translates to better maintenance of activities of daily living. Pedicled TRAM flaps are purported to have a higher incidence of flap necrosis and partial flap loss compared with free flaps. DIEP flaps are associated with less postoperative pain than TRAM flaps. There is no evidence than TRAM flaps result in abdominal hernias compared with DIEP flaps.
The following statements are true except:
The use of the DIEP flap to reconstruct lower limb defects has not been described. This statement is incorrect; the use of DIEP flaps to reconstruct lower limb defects in 25 patients with promising results was described in 2005 1. A study of 375 DIEA perforator (DIEP) flaps (325 with preoperative CTA and 50 cadaveric dissections) showed that peritonealcutaneous perforators were rare anatomical variations (4/375: 1.1%) and that they may affect outcomes in DIEP flap surgery if not assessed preoperatively. Computed axial tomography (CTA) was significantly able to detect this anomaly and aid operative planning 2. In a study of 138 DIEP breast reconstructions, 70 underwent pre-operative CTA analysis, and 68 had pre-operative Doppler investigation. Surgery time in the CTA group was significantly lower (p<0.001) than in the control group (264min [SD+/-62] versus 354min [SD+/-83]), respectively. The study suggested that the use of CTA helped reduce surgery time, and reduce the risk of postoperative complications 3. In addition, the time saved during DIEP flap surgery was shown to compare favourably to the cost of the computed tomographic angiography pre-operatively 4. A paper reviewing the radiation dose of routine investigations compared it to abdominal wall CTA and the background equivalent radiation dose (Table below) 5.
Radiation exposure with CTA in DIEP flap planning:
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