Perioperative risk of death after general surgery is quoted as overall less than 1%. However, each individual's risk varies widely according to many identified factors with some having a significantly increased risk of a worse outcome. The observation that manipulating and targeting certain physiological parameters in selected patients can influence this risk has been reported in numerous studies. Yet it is still not widely practised to assist the process, despite the availability of various invasive and non-invasive monitors. This may be in part because of a lack of experience with the practicalities of perioperative optimization, and lack of knowledge in applying currently available tools. This article aims to try and address this deficit and increase awareness of how and when to utilize monitoring equipment to achieve optimal results for the patients we treat.

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Background: Surgical literature is full of innumerable solutions to the problems of wound healing and it speaks of itself that the problem is not so simple and straight forward to tackle with. The aim of the present study was to compare three modalities moist saline dressing, collagen sheet dressing and epidermal growth factor in early epithelization and healing of chronic wounds. to study the effect of various dressing modalities on epithelization of chronic wound in terms of time required for healing and the quality of scar it forms, the functional results both early and late, post-healing morbidity and complications and the practicality and the cost involved in using these modalities.Methods: Prospective randomized controlled study. Study including chronic wound cases admit to AVBRH Sawangi over period of 3 years.Results: Reduction in size of wound by 70-100% was found highest in Epigrof group. In Epigrof treated group 88% of wounds healed within 3 weeks while 80% in collagen group and 56% in moist dressing group it. Collagen dressing is the most cost effective of the three whereas Epigrof was most costly due to the initial cost of purchase. The scar quality was satisfactory in 19 of Epigrof group and 17 of the collagen sheet group and 15 of the moist dressing group.Conclusions: Epidermal growth factor is superior in epithelization, collagen is the next best local applicant, but collagen sheet is more cost effective than Epigrof and non-adherent dressings.

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Background: Non-healing wound is a commonly encountered entity with a broader effect on both the sufferer and the treating doctor. Time taken in healing these wound is directly related to financial loss as well as loss of working hours, thus ultimately increasing the financial burden. Chronic wound has devitalized tissue at the base which is barrier to cell migration and acts as supportive environment for bacterial growth. Considering the effect of devitalized tissue on wound healing there lies importance of debridement in wound management. Debridement is an effective technique to achieve desirable wound bed preparation by removing the dead and devitalized tissue. Hence a study was conducted at a rural hospital with main aim to assess role of surgical sharp debridement in non-healing wound in complete healing or preparing wound for further definitive treatment.Methods: The study was conducted at AVBRH Sawangi (Meghe), Wardha. Random 50 patients of non-healing ulcer were selected for the study. One group was of early debridement while other group of dressing with moist dressing only. Wound were assessed for healing, wound contraction, scar quality at regular intervals. They were assessed for duration of wound to heal completely/ get ready for further intervention like SSG/ Flaps, Cost of treatment and Time taken by the patient to return back to work.Results: 36% of patients in moist dressing group heal completely by 4 weeks while 56% of patients in debridement group heal completely by 4 weeks. Early recovery leads to early normalcy so less loss of wages and thus making the group cost effective.Conclusions: Early debridement was found to be an effective tool in wound healing in non-healing ulcers.