Activity

The collective five-year experience with the acute management of pelvic trauma at a busy South African trauma service is reviewed to compare the usefulness and applicability of current grading systems of pelvic trauma and to review the compliance with current guidelines regarding pelvic binder application during the acute phase of resuscitation.

A retrospective review was conducted over a 5-year period from December 2012 to December 2017 on all polytrauma patients who presented with a pelvic fracture. Mechanism of injury and presenting physiology and clinical course including pelvic binder application were documented. Pelvic fractures were graded according to the Young- Burgess and Tile systems.

There was a cohort of 129 patients for analysis. Eighty-one were male and 48 female with a mean age was 33.6 ± 13.1 years. Motor vehicle-related collisions (MVCs) were the main mechanism of injury (50.33%) and pedestrian vehicle collisions (PVCs) were the second most common (37.98%). The most common associated i

It would appear that our application of pelvic binders in patients with acute pelvic trauma is ad hoc. Appropriate selection of patients, who may benefit from a binder and it’s timely application, has the potential to improve outcome in these patients.

It would appear that our application of pelvic binders in patients with acute pelvic trauma is ad hoc. KP-457 Appropriate selection of patients, who may benefit from a binder and it’s timely application, has the potential to improve outcome in these patients.

To document the microbiology of ulcerative skin cancers, histological types, anatomical distribution and post-surgical complications among patients in KwaZulu-Natal and to determine whether a link exists between the presence of these bacteria and postoperative complications after resectional surgery and reconstruction.

One hundred swabs from ulcerative cancer wounds were collected from October 2015 to August 2017. The swabs were taken on admission according to swabbing protocol in the ward. Variables analysed were histology, anatomical site, microbiology, management and outcomes and patient specific risk factors – age, smoking, comorbidities and retroviral disease (RVD) status.

Of the 100 skin cancer wounds, 87 cultured pathogenic bacteria the majority were squamous cell carcinomas (SCC) (48%); the remaining tumours were sarcomas (17%), basal cell carcinomas (BCC) (14%), melanomas (14%) and other carcinomas (3%). Among the bacteria cultured,

was the most common pathogen found in 47% of the wounds, followed by

(25%) and beta-haemolytic

(15%). The most virulent of pathogens beta-haemolytic

most frequently found in melanomas. Of the 74 wounds that underwent reconstruction, 24 had complications (wound sepsis, dehiscence, graft loss, flap sepsis). Although wound complications are multifactorial, it was observed that all 24 of the wounds that complicated cultured pathogenic bacteria (

,

and

). It was also found that there were 13 wounds that did not culture any pathogenic bacteria; these showed no complications on follow-up.

Although complications post-reconstruction of these lesions are multifactorial, the data from this study shows that pathogenic bacteria may play a role in increasing the post-surgical complication risk.

Although complications post-reconstruction of these lesions are multifactorial, the data from this study shows that pathogenic bacteria may play a role in increasing the post-surgical complication risk.

Acute laparotomy for trauma or sepsis often prevents definitive closure due to need for relook laparotomy or to prevent abdominal compartment syndrome. Skin-only closure is widely used in our setting. In this study, we review the safety and effectiveness of this technique.

Patients presenting with intra-abdominal pathology undergoing acute laparotomy and then subsequent skinonly closure using 2-0 prolene were included in the study and followed postoperatively for a three-month period for adverse events stratified by Clavien-Dindo grading, and rate of definitive closure.

During the study period, twenty-five patients underwent emergent laparotomy and skin-only closure. The median age of patients undergoing skin-only closure was 27 years (standard deviation 9.1). Six patients presented with major trauma and 19 presented with sepsis. Twenty-one patients underwent subsequent fascial closure. One patient was unable to undergo fascial closure and was managed as a planned ventral hernia. Fourteen patients developed a postoperative complication. There were no deaths and no readmissions to intensive care. Three further patients developed a ventral hernia.

Skin-only closure, in carefully selected patients, is a feasible alternative to other temporary abdominal closure techniques in a resource-constrained setting.

Skin-only closure, in carefully selected patients, is a feasible alternative to other temporary abdominal closure techniques in a resource-constrained setting.

Emergency laparotomy (EL) encompasses a diverse range of procedures that general surgeons commonly perform for both trauma and non-trauma related conditions in South Africa (SA). Despite differences in the underlying pathology and influence of the surgical procedure, these patients share one care pathway for preoperative, operative and postoperative care. This study reviewed patients undergoing trauma EL and non-trauma EL in a general surgery setting at a rural KwaZulu-Natal tertiary hospital to compare results between the groups using a modified National Emergency Laparotomy Audit (NELA) tool format.

Consecutive adult patients undergoing midline EL at Ngwelezana Hospital between 1 March and 31 May 2018 were included. Patient factors analysed were demographic data (age, gender) and risk factors National Confidential Enquiry into Perioperative Deaths (NCEPOD) grade, American Society of Anesthesiologists (ASA) grade, and comorbidity. Process of care factors included grade of the physician, time to surgery, time of surgery and duration of surgery. The primary outcome measure was mortality. Secondary outcome measures were intensive care unit (ICU) admissions, complications, and length of stay (LOS) > 14 days.

The study included 110 participants who met the inclusion criteria representing a total of 174 laparotomies. The trauma EL group had lower ASA grades (

= 0.003), less comorbidities (

= 0.002), more often went to theatre within six hours (42/56; 75.0%) (

< 0.001), more admissions to ICU (23/56; 41.1%) (

< 0.001), more complications (29/56; 51.8%) (

= 0.039), and higher length of stay > 14 days (16/56; 28.6%) (

= 0.037).

The trauma EL group represents a high-risk group for morbidity and mortality at Ngwelezana Hospital.

The trauma EL group represents a high-risk group for morbidity and mortality at Ngwelezana Hospital.