1448 Photo-Biomodulation(PBM) Therapy In Resistant Chronic Ulcers Caused By Kaposi's Sarcoma - An Effective Adjunct For Wound Healing

Introduction

Photo-biomodulation (PBM), also known as low level Laser therapy (LLLT), is a novel non-pharmacological adjunct for enhancing the healing process of resistant wounds and ulcers. PBM promotes cellular proliferation and activates angiogenesis. We present a novel approach in the treatment of radiotherapy-related ulcer resistant to standard ulcer care.

Case description

A 60-year-old gentleman was referred with a complex left heel ulcer and pain following radiotherapy and chemotherapy post non-HIV related Kaposi's sarcoma resection. Conservative management failed and a below knee amputation was considered. The patient opted for an advanced therapy program. Repeated sessions of PBM were given (660 nm and 810 nm wavelength, 20Hz, 44.6 milliwatt/cm2, 26.76 Joules/cm2). The wound was covered with a novel fish skin xenograft Kerecis™ and supported with PICO™ dressing. A combination of further debridement, PBM, re-application of Kerecis™, PICO™ dressing and long-term antibiotics allowed a new vascularized layer with good pulsatile flow along wound edges to establish within 6 weeks at a rate of 4mm2/week. Achilles tendon was partially excised, and maggots were used. Full coverage of the ulcer bed with a new healthy granulation tissue was achieved in 12 weeks’ time. The pain improved dramatically, opioids were stopped, and the patient managed to mobilize independently again with occasional aids. The wound was allowed to heal with secondary intention.

Conclusions

PBM, Kerecis and best standards of wound care allowed avoiding a major amputation and healing of a malignancy-related and radiotherapy-related ulcer. PBM can be considered as an adjunct in slow / non-healing wounds for skin malignancies and radiotherapy patients.

Control chart methods for monitoring surgical performance: a case study from gastro-oesophageal surgery

Graphical methods are becoming increasingly used to monitor adverse outcomes from surgical interventions. However, uptake of such methods has largely been in the area of cardiothoracic surgery or in transplants with relatively little impact made in surgical oncology. A number of the more commonly used graphical methods including the Cumulative Mortality plot, Variable Life-Adjusted Display, Cumulative Sum (CUSUM) and funnel plots will be described. Accounting for heterogeneity in case-mix will be discussed and how ignoring case-mix can have considerable consequences. All methods will be illustrated using data from the Scottish Audit of Gastro-Oesophageal Cancer services (SAGOCS) data set.

Is there a Minimum Caseload that Achieves Acceptable Operative Mortality in Abdominal Aortic Aneurysm Operations?

BACKGROUND

Studies have shown correlation between operative workload and mortality for major operations. Is there a threshold for case volume that predicts an acceptable mortality for abdominal aortic aneurysm surgery?

METHODS

Hospital Episode Statistics (HES) Data for England between 1997-2002 was analysed using ICD-10 codes I71.x and OPCS-4 codes L16.x-L26.x. Mortality was identified by the method of discharge.

RESULTS

31,078 operations on abdominal aortic aneurysms were studied in 223 NHS Trusts. 6,007 in-hospital deaths were identified in both elective and emergency cases (overall mortality rates 7.7% and 40%, respectively). Trusts with large elective workloads had reduced mortality for both elective and emergency operations. Using parabolic regression and logarithmic transformation, 14 elective operations per Trust per year was identified as a cut-off point above which the decrease in mortality rate with increasing case volume was relatively small. A similar effect was not seen with increasing emergency workload alone.

CONCLUSION

HES data analysis suggests increasing elective workload correlates with lower in-hospital mortality for elective and emergency operations on abdominal aortic aneurysm. Data suggests a range of hospital caseload that correlate with an acceptable elective and emergency mortality rate.