- National organizations such as the Trauma Quality Improvement Program of the American College of Surgeons have described the importance of palliative care integrated throughout the clinical course.
- Increasing numbers of surgeons are fellowship trained and certified by the American Board of Surgery in Hospice and Palliative Medicine in addition to surgical specialties.
- The importance of accurate prognostication for surgical patients and thoughtful communication of anticipated outcomes of different treatment plans has been recognized through frameworks such as the “Best Case/Worst Case” scenario.1
- Structured descriptions of gaps and opportunities in the field promote future advancement and development of surgical palliative care.
- Studies in surgical and nonsurgical patients demonstrate that palliative care, hospice enrollment, and lower-intensity end-of-life care do not decrease survival.
Latest Updates
- National organizations such as the Trauma Quality Improvement Program of the American College of Surgeons have described the importance of palliative care integrated throughout the clinical course.
- Increasing numbers of surgeons are fellowship trained and certified by the American Board of Surgery in Hospice and Palliative Medicine in addition to surgical specialties.
- The importance of accurate prognostication for surgical patients and thoughtful communication of anticipated outcomes of different treatment plans has been recognized through frameworks such as the “Best Case/Worst Case” scenario.1
- Structured descriptions of gaps and opportunities in the field promote future advancement and development of surgical palliative care.
- Studies in surgical and nonsurgical patients demonstrate that palliative care, hospice enrollment, and lower-intensity end-of-life care do not decrease survival.
Plastic Surgery Considerations for the General Surgeon
- Refinements of component separation have solved many problems. Rather than simply performing a suture approximation of the rectus muscles in the midline, both prosthetic and bioprosthetic meshes have been used to reinforce the midline closure as a direct supported repair.
- Skin grafts are harvested using a mechanical dermatome for split-thickness grafts or from well-hidden area of lax skin (groin crease, postauricular area) for a full-thickness graft. Skin grafts survive the transfer process from the donor to the recipient site through plasma imbibition and inosculation.
- Although many surgeons will attest to the improved exposure and access following the panniculectomy portion of the procedure, there are no randomized prospective data demonstrating improved outcomes with panniculectomy for abdominal wall access.
Plastic Surgery Considerations for the General Surgeon
- Refinements of component separation have solved many problems. Rather than simply performing a suture approximation of the rectus muscles in the midline, both prosthetic and bioprosthetic meshes have been used to reinforce the midline closure as a direct supported repair.
- Skin grafts are harvested using a mechanical dermatome for split-thickness grafts or from well-hidden area of lax skin (groin crease, postauricular area) for a full-thickness graft. Skin grafts survive the transfer process from the donor to the recipient site through plasma imbibition and inosculation.
- Although many surgeons will attest to the improved exposure and access following the panniculectomy portion of the procedure, there are no randomized prospective data demonstrating improved outcomes with panniculectomy for abdominal wall access.
- Cerebral edema and intracranial hypertension are the major cause of early mortality in acute liver failure (ALF)
- Liver transplantation is the only proven liver replacement therapy to reduce mortality
- N-Acetylcysteine (NAC) should be administered to all patients with ALF due to acetaminophen
- New methods for predicting prognosis, such as the Acute Liver Failure Study Group Index, may offer improved sensitivity in predicting the need for liver transplant or death in ALF.
- Correction of coagulopathy with fresh frozen plasma in the absence of bleeding or procedures does not improve survival and may precipitate complications.
- The directed neurologic examinations for neuromuscular disease focus heavily on the motor and sensory examinations and the cranial nerves involved in motor function, although valuable information may still be learned from other subsections of the neurologic examination. Most neuromuscular diseases do not primarily impact cognitive function, so the mental status testing included in the screening examination is usually sufficient. However, there are exceptions, such as the frontotemporal executive dysfunction that can occur in patients with amyotrophic lateral sclerosis, the generalized cognitive dysfunction that can occur in some of the muscular dystrophies, and the alteration in consciousness that can occur in association with respiratory failure due to neuromuscular weakness.
- The directed neurologic examinations for neuromuscular disease focus heavily on the motor and sensory examinations and the cranial nerves involved in motor function, although valuable information may still be learned from other subsections of the neurologic examination. Most neuromuscular diseases do not primarily impact cognitive function, so the mental status testing included in the screening examination is usually sufficient. However, there are exceptions, such as the frontotemporal executive dysfunction that can occur in patients with amyotrophic lateral sclerosis, the generalized cognitive dysfunction that can occur in some of the muscular dystrophies, and the alteration in consciousness that can occur in association with respiratory failure due to neuromuscular weakness.
- The directed neurologic examinations for neuromuscular disease focus heavily on the motor and sensory examinations and the cranial nerves involved in motor function, although valuable information may still be learned from other subsections of the neurologic examination. Most neuromuscular diseases do not primarily impact cognitive function, so the mental status testing included in the screening examination is usually sufficient. However, there are exceptions, such as the frontotemporal executive dysfunction that can occur in patients with amyotrophic lateral sclerosis, the generalized cognitive dysfunction that can occur in some of the muscular dystrophies, and the alteration in consciousness that can occur in association with respiratory failure due to neuromuscular weakness.
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