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Risk Factors that Influence Hospital Length of Stay in Diabetic Foot Ulcer with Negative Pressure Wound Therapy at RS. dr. Cipto Mangunkusumo Simbolon, Prabowo W; Ibrahim, Hilman
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. It is estimated that around 15% of diabetic patients will experience diabetic foot ulcer (DFU) in their lifetime. Negative Pressure Wound Therapy (NPWT) is proven to be more effective than conventional treatments. NPWT creates a moist wound environment, increases local blood flow and stimulates tissue granulation thereby accelerating wound healing. This study was conducted to determine the risk factors that affect the length of stay of DFU with NPWT. Knowing this risk factors may be helpful for optimizing management strategy. Method. This research was a retrospective study with a cross-sectional analytic design in 105 subjects treated in January 2016 to December 2018 at RS. dr. Cipto Mangunkusumo. Patient characteristics, demographics and risk factors were taken from medical records. The length of stay of the patient from the first application of NPWT to its outcomes was the main result, then the correlation to the risk factors that influence it was analyzed. Results. The length of stay of DFU with NPWT was 19.9 ± 19.3 days. Risk factors affecting the length of stay were history of ulcers (r = 0.01; p = 0.034), wound depth (r = 0.292; p = 0.003), Hb (r = 0.05; p = 0.039), HbA1c (r = 0.06; p = 0.033), Albumin (r = 0.06; p = 0.017), PCT (r = 0.10; p = 0.035), and duration of DM (r = 0.193; p = 0.009). Conclusion. This study showed that the length of stay of DFU with NPWT was influenced by systemic factors (duration of DM, Hb, HbA1c, albumin, and PCT) and local factors (history of previous ulcers and wound depth). The depth of the wound was the most positively related factor to the length of stay in DFU post NPWT (r = 0.292; p = 0.003). Interventions on factors that can be corrected before the application of NPWT may amplify the result of NPWT and reduce the length of treatment.
Cardiac Tamponade and Laceration of Right Ventricle in Blunt Thoracic Injury: A Case Report Simbolon, Prabowo W; Putra, Muhammad A
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Introduction. Cardiac tamponade caused by blunt thoracic injuries is a rare case with a high mortality rate. Generally, patients with blunt cardiac injury were not survived before they reach the hospital. We present the case of a 50-year-old man was admitted to our emergency department after a motorcycle hit the cart he was pushing on the street, and then the handle hit the chest. He presented with hemodynamically unstable and a bruised on precordial area, then he went into cardiac arrest. Standard CPR was done for 2 minutes, continued with intubation and ROSC. FAST showed fluid in the pericardial sac. After doing pericardiocentesis, an amount of blood about +/- 40 mL was aspirated. A median sternotomy was performed, and lacerations were found in the right ventricle and right ventricle pulmonary junction. Method. Literature searching was done in Proquest, PubMed and ScienceDirect database. The research papers were selected based on exclusion and inclusion criteria and were critically appraised using the tools from PRISMA. Result. Two articles were found to be relevant to the topic. Experimental research was not found; there were only two case-report articles. A median sternotomy was a preferable surgical approach in blunt chest trauma with the presentation of cardiac tamponade with hemodynamically unstable. Conclusion. Prompt diagnosis and definitive operation can be lifesaving in traumatic acute cardiac tamponade caused by blunt chest trauma based on the level of evidence 4. The FAST examination was beneficial in diagnosing cardiac tamponade and pericardiocentesis can be a temporary measure. A median sternotomy was a safe surgical approach in controlling the cardiac injury. The patient was discharged on the fifth post-operation day.