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ABSTRACT: Few studies have examined the cost-effectiveness of microsurgery, and little is known about the cost-effectiveness of flap monitoring. We studied the costs related to microsurgery during 2004 to 2006 in Kuopio University Hospital. A total of 99 patients were reconstructed with 109 flaps. Primary success was achieved in 64% of cases. Reoperation for anastomosis was conducted in 25% and for other surgical complications in 27%. The intended result was achieved in 94% of cases. The mean total cost of hospital care was 20,000 euro in head and neck cancer surgery, 15,500 euro in defects of the lower extremities, and 9200 euro in breast reconstruction. The costs were greatly influenced by surgical complications (i.e., if the primary reconstruction failed, then the secondary microvascular flap almost doubled the expense involved; mean expenses per case 27,900 euro). Microdialysis was used in flap monitoring with an additional cost of 535 euro per patient. We found that microdialysis provided an early diagnosis of perfusion failure and helped to save the flap. It was estimated that if one or two flaps per year are saved due to more effective monitoring, then the extra costs of using microdialysis are covered.
Journal of Reconstructive Microsurgery 09/2009; 25(9):521-6. · 1.43 Impact Factor
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ABSTRACT: Major scrotal and penile skin loss is uncommon and management of such an injury is a challenging problem for genitourinary reconstruction surgeons. Less than 50% scrotal skin loss can often be closed without difficulties immediately after trauma with surrounding tissue. In cases of more significant skin loss, the testes may be preserved by placing them in thigh pouches or dressed with wet dressings until reconstruction, or split thickness skin grafting can be performed. The surgeon's decision depends on the cause of skin loss - trauma, Fournier's gangrene or others. We describe a case of massive scrotal and penile skin loss due to an incident with an agricultural machine. The scrotal reconstruction, performed in three steps, was chosen because of its simplicity, early closure of the wound, excellent cosmetic appearance and maintenance of sexual functions. In the first step the penis was covered with remnant scrotal and preputium skin, and the testes were placed in thigh pouches. Incision of thigh flaps was planned to perform the second step and finally scrotal reconstruction with thigh pedicle flaps was done. Results were satisfactory from an esthetical and functional point of view.
Urologia Internationalis 01/2008; 81(1):122-4. · 0.99 Impact Factor
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ABSTRACT: Enteral nutrition as an important component of modern treatment is mandatory for patients suffering from major burns. Regardless of the initial estimation of caloric requirements, actual daily volume of energy consumption may vary depending on the general condition of the patient and the side effects of enteral nutrition. The aim of our study was to investigate the relation between caloric value of enteral nutrition and treatment course.
The prospective study involved 103 adult patients treated in the Hospital of Kaunas University of Medicine for 2 degrees -3 degrees burns of 10-80% body surface area from 1 January 2001 till 31 December 2003. All patients received enteral nutrition during the acute phase. After the completion of the treatment, caloric value of enteral nutrition was estimated, and patients were divided into two groups: group A received more than 30 kcal/(kg 24 h); and group B, received less than 30 kcal/(kg 24 h). We compared patients' mortality, complication rate, and hospital stay time.
The mortality of patients, who enterally received less than 30 kcal/(kg 24 h), was 32.6%, comparing to 5.3% mortality in patients who received 30 or more kcal/(kg 24 h) (p < 0.01). The caloric value of less than 30 kcal/(kg 24 h) increased the frequency of pneumonia by 2.0 times, and the frequency of sepsis by 1.8 times (p < 0.05). The duration of the treatment of survivors in this group was by 12.6 days longer (p = 0.01).
The caloric value of enteral nutrition seems to be associated with patient mortality, complication rate, and treatment duration. The results of the treatment of patients who received more or 30 kcal/(kg 24 h) were much better. Because determined relationship may not be directly causal, further study is needed to determine whether active intervention to improve nutrition could improve outcomes.
Burns 02/2006; 32(1):83-6. · 1.96 Impact Factor
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ABSTRACT: The aim of the study was to investigate the causative agents of bacteremia in burned patients during 1999-2003.
All case records of 82 burned patients with bacteremia treated at the Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital were analyzed during 1999-2003.
Mean body surface area burned in bacteremic patients was 29%. Bacteremia was diagnosed, on an average, on the 15th day after hospitalization and the 16th day after the burn. The causative agent of bacteremia in 71% of cases was methicillin-resistant Staphylococcus aureus; 11% of bacteremias were caused by Pseudomonas aeruginosa, and in 78% of cases Pseudomonas was sensitive to gentamicin. In all years, methicillin-resistant Staphylococcus aureus was the most common agent of bacteremia. Altogether, 55 patients out of 82 recovered. The mean duration of inpatient treatment was 48 days.
Bacteremia was diagnosed at the beginning of the third week of hospital stay. More than half of bacteremic patients (67%) survived. The most common causative agents of bacteriemia were methicillin-resistant Staphylococcus aureus and gentamicin-sensitive strains of Pseudomonas aeruginosa.
Medicina (Kaunas, Lithuania) 02/2006; 42(7):576-9. · 0.42 Impact Factor
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ABSTRACT: The objective of the study was to assess if enteral nutrition reduces the rate of severe complications and complication-related mortality in case of major burns.
Two groups were included in the study. Group A was assessed prospectively and included 67 patients treated in Kaunas University of Medicine Hospital in 2000-2003. These patients received 30-40 kcal/kg/day in enteral way over the period of wound surgery. Group A was compared with Group B, which was assessed retrospectively and included 71 patients without enteral nutrition treated in 1997-1998. Groups were homogeneous by patients' age; extent of general and deep burn area; Baux and Burn indexes.
10 patients (15%) in Group A had pneumonia, 3 (30%) of them died; 11 (16%) had lung edema, 3 (27%) of them died; 24 (36%) had sepsis, 3 (12.5%) of them died; renal insufficiency was diagnosed to 4 patients (6%) in Group A, 2 (50%) of them died. In Group B (without enteral nutrition) pneumonia was diagnosed to 27 patients (38%) of 71, 18 (63%) of them died; lung edema--to 20 (28%), 18 (90%) of them died, 19 patients (27%) had sepsis, 12 (63%) of them died; renal insufficiency was diagnosed to 10 patients (14%), all of them (100%) died.
Enteral nutrition statistically significantly diminished frequency of pneumonia and lung edema for burned patients. Pneumonia, lung edema, sepsis and renal insufficiency were less hazardous for life of patients with enteral nutrition (p<0.05).
Medicina (Kaunas, Lithuania) 02/2004; 40(10):957-61. · 0.42 Impact Factor
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ABSTRACT: Objective of this study was to investigate mortality of burned patients, treated in Kaunas University of Medicine Hospital during 1993-2002, changes of mortality, causes of death, to assess patients' age, gender, burn agent, and adjacent diseases.
Retrospective analysis of case-records of 283 burned patients deceased during 1993-2002 was done.
During 1993-2002, 1876 burned adult patients were hospitalized in Kaunas University of Medicine Hospital. The mortality rate of burned patients was between 9 and 22% (average--13.3%, standard deviation--3.8). Age of deceased patients was on average 56 years (standard deviation--8); actually 21.6% were older that 80 years. There were 62% men among deceased burned patients. Common body surface area burned was 32% (standard deviation--28.6%), deep burn area was at average 22% (standard deviation--19.8%). Seventy two percent of burns were caused by fire, and 10% of patients were scalded. In 35% case-records adjacent diseases were not mentioned, in 57% atherosclerosis and ischemic heart disease were diagnosed, 5% of patients had respiratory diseases, 7% had central nervous system troubles, mental disorders were diagnosed in 2%. Eight percent were cachectic at admission, 6%--with chronic alcohol dependence. In 70% of patients pneumonia was diagnosed, in 13%--pulmonary edema, and in 39%--sepsis. Deceased patients were treated until death on average 14 days (standard deviation--6); during first two weeks 50% died.
At higher mortality risk are elder burned patient with major burns, especially with serious adjacent diseases. Common death causes in burned patients are pneumonia, pulmonary edema and sepsis.
Medicina (Kaunas, Lithuania) 02/2004; 40(4):374-8. · 0.42 Impact Factor
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ABSTRACT: Burns form 5-12% of all traumas. About 2,200 of patients are annually hospitalized in Lithuania. In most cases people of the employable age get burned. The treatment is often long-lasting, and afterwards recovered patients often have invalidity from burn sequels. The mortality of hospitalized burned patients is about 10%. The most common causes of death are pulmonary edema, pneumonia, sepsis and multiorgan failure. All these complications are related with insufficient nutrition. These complications are extremely frequent and dangerous for patients with more than 20% of body burned. The nutritional support of burned patient gives a possibility to increase the survival probability, to decrease complication rate and hospitalization time. Currently in Lithuania there are no standards for burned patient nutrition. More attention is given to strategy of surgical strategy and techniques, as well as antibiotic therapy. This article is the review of the different aspects of artificial nutrition of burned patient: indications, modes of nutrition, mixtures and terms of nutritional support.
Medicina (Kaunas, Lithuania) 02/2004; 40(1):1-8. · 0.42 Impact Factor
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ABSTRACT: The aim of study was to investigate if new treatment methods reduced mortality and diminished hospital stay time for survivors.
We assessed patients, treated in Kaunas University of Medicine Hospital with 10-80% 2B-3 degrees body surface area burned. Group A, which was assessed prospectively, included 89 patients, treated during 2001-2003. All patients in Group A received sufficient enteral nutrition, in 21 patient early escharectomy and skin-grafting were done. This group was compared with Group B, assessed retrospectively and included 89 patients, treated in 1997-1998. They did not receive enteral nutrition and were treated without early escharectomy and skin grafting.
Groups were homogeneous by age, extent of general and deep burn, and burn indexes. For 24% patients in Group A early escharectomy and skin-grafting was done, they were operated on the average at 3.6 day after admission (standard deviation - 1.32). In Group A mortality was 5.6%. Average hospital stay time for survivors was 35.7 days (standard deviation--20.4) or 0.9 day/% body surface area burned, standard deviation--0.6. In Group B no early escharectomies and skin grafting were done. Mortality in Group B was 23.6%, hospital stay time for survivors--40.6 days (standard deviation--23.6), or 1.9 day/% body surface area burned. These indicators were statistically significantly different compared to Group A (p<0.05). The significant influence of new treatment methods in major burns was established.
New methods, early escharectomy and skin grafting and enteral nutrition, introduced in Kaunas University of Medicine Hospital in the last 5-7 years significantly reduced mortality and hospital stay time for survivors (p<0.05).
Medicina (Kaunas, Lithuania) 01/2004; 40(4):370-3. · 0.42 Impact Factor
