Papers by Jan J. van Wingerden MBChB, MMed, PhD, FACS, FCS(SA)
Journal of Cardiothoracic Surgery, Jan 23, 2014
Early recognition and, where possible, avoidance of risk factors that contribute to the developme... more Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better i...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
Tijdschrift voor Geneeskunde
Fig. 3: Anatomie van de onderarm. Fig. 2: Het retinaculum van het 2e extensorencompar-timent (ext... more Fig. 3: Anatomie van de onderarm. Fig. 2: Het retinaculum van het 2e extensorencompar-timent (extensor carpi radialis longus en brevis) wordt met haakjes opengehouden. De brede witte pijl laat het punt zien waar het 1e en het 2e extensorencom-partiment elkaar kruisen: de intersectie. Verdikking van het synovium is zichtbaar net distaal hiervan (smalle lange pijl). De n. radialis superficialis wordt opzijgehouden (smalle korte pijl). Fig. 1: Zwelling van de linkeronderarm (pijl). Een 67-jarige vrouw heeft sinds 2 jaar pijn aan de radi-ale zijde van haar rechteronderarm, net proximaal van de pols. Gedacht werd aan de ziekte van Quervain. Daarom werd 1 jaar terug een decompressie van het eer-ste extensorencompartiment uitgevoerd. Dit gaf geen verlichting van de klachten. Bij onderzoek wordt een drukpijnlijke, crepiterende zwelling gevonden proximaal van het oude litteken (fig. 1). Flexie en extensie in de pols zijn pijnlijk. De diagnose "intersectiesyndroom" wordt gesteld. Na...
Journal of Hand Surgery (European Volume), 2012
Asian Cardiovascular & Thoracic Annals, Jan 11, 2016
Considerable advances have already been made in the treatment of deep thoracic wound infections f... more Considerable advances have already been made in the treatment of deep thoracic wound infections following a median sternotomy for cardiac surgery. Further improvement in diagnosis, treatment, and outcome will require a targeted approach by multidisciplinary teams. Clear communication and synergy between the various clinical and supportive disciplines would assist in removing the last barriers to standardized evidence-based studies and the development of improved evidence-based guidelines. An extensive literature search without language restrictions was carried out on PubMed (Medline), EMBASE, and Web of Science, covering the period 1988 to week 16, 2014, and a manual search of the reference lists was performed regarding all possible definitions and classifications of post-sternotomy mediastinitis. Two hundred and eighteen papers describing post-sternotomy infections in a multitude of terms were identified, and the strengths and weaknesses of the most popular definitions and terms re...
Annals of Plastic Surgery, Apr 1, 2004
Annals of plastic surgery, 2008
Late hematoma formation is a rare complication of augmentation mammaplasty. Late hematoma formati... more Late hematoma formation is a rare complication of augmentation mammaplasty. Late hematoma formation related to excessive or vigorous squeezing of the breast during sexual activity has not been described. We present 2 such cases and review the English-language literature on all causes of late hematoma formation after breast augmentation reported thus far. It is suggested that this newly reported cause is probably underreported, either because of unnoticed small hematomas or because of embarrassment of the patient. Bleeding is probably caused by the rupture of vulnerable vessels in the tissue capsule, triggered by a minor or more obvious trauma. Late hematomas might be a cause of late capsular contraction in the augmented breast. Ultrasound or magnetic resonance imaging is a reliable method to confirm the diagnosis of late hematoma formation. Treatment should preferably be surgical, but in minor cases observation may be justified.
European Journal of Plastic Surgery, 2006
Interactive cardiovascular and thoracic surgery, 2015
The Annals of thoracic surgery, 2015
This is a small tribute to the monumental contributions of the early pioneers who introduced 2 in... more This is a small tribute to the monumental contributions of the early pioneers who introduced 2 invaluable thoracic procedures; an exposure through which the mediastinum and the heart could be safely approached, the median sternotomy, and an approach and method to revascularize an intrathoracic organ by transferring the omentum into the chest. The origin, rediscovery, and application of these procedures are strangely linked. With the renewed interest in variations of the median sternotomy and the effectiveness of using the intrathoracic omentum, the legacy of the original innovators lives on.
Interactive cardiovascular and thoracic surgery, 2012
Interactive cardiovascular and thoracic surgery, 2011
The primary question addressed was whether muscle flaps (MFs) offer a significant advantage over ... more The primary question addressed was whether muscle flaps (MFs) offer a significant advantage over an omental flap (OF) in the management of deep sternal wound infection (DSWI) following cardiovascular surgery in terms of outcome (morbidity and mortality). Altogether, 333 citations (from PubMed and EMBASE and using a manual search, without language restriction) were identified using the reported strategy. Focusing on publications from single institutions with experience with both types of flap in the treatment of DSWI, 16 studies represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. These 16 observational studies covered 1046 patients, and all reported mortality rates. Unadjusted data from five of six studies investigating a possible association between mortality and flap type suggested a higher mortality rate following reconstruction with MFs....
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2007
Malignant melanoma of the vermilion of the lip is a rare entity, and because of the common occurr... more Malignant melanoma of the vermilion of the lip is a rare entity, and because of the common occurrence of other benign pigmented lesions, it is easily overlooked. Early diagnosis is of the utmost importance, in the first instance to minimise the risk of haematogenous, lymphatic, perineural and trans- (salivary) ductal spread. The second reason for early diagnosis is that surgery is the only effective form of treatment. A number of important clinical lessons were learned from this cohort study of malignant melanoma of the vermilion of the lip. Two observations are of note--first, the absence of palpable regional lymph nodes does not exclude the presence of a malignant melanoma, yet all patients presenting with palpable nodes were suffering from a preterminal disease. Secondly, apart from 1 case (our case 2), melanoma of the lip seems to occur on the lower lip only. There are no clear guidelines regarding the necessary extent of extirpation for malignant melanoma of the vermilion of th...
Interactive CardioVascular and Thoracic Surgery, 2013
Plastic and Reconstructive Surgery, 2013
Plastic and Reconstructive Surgery, 2007
Plastic and Reconstructive Surgery, 1988
Plastic and Reconstructive Surgery, 1990
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Papers by Jan J. van Wingerden MBChB, MMed, PhD, FACS, FCS(SA)