Hours Of Delay Research Articles

Factors Affecting Length of Stays in the Emergency Department of a Teaching Hospital: A Retrospective Study From Najran, Saudi Arabia.

Reducing the frequency of emergency department (ED) patient visits for treatment, particularly in urgent instances, is a global healthcare objective. Additionally, a more extended stay in the ED can harm a patient's prognosis during later hospitalization. This study aims to investigate the factors affecting the length of stay in the ED in a teaching hospital. A retrospective chart review study was done between January 1, 2021, and February 31, 2021, involving 122 adult patients who had delayed ED visits to King Khalid Hospital in Najran, Saudi Arabia. Data on the patient's characteristics, visit time, and the causes for the delay based on the Canadian Triage and Acuity Scale (CTAS) were gathered and analyzed. Factors associated with more than six hours of delay were investigated in a univariate analysis. The mean age was 52.3 ±13.5 years, and 42 (34.4%) were more than 65 years of age. More than half of the study population were female (n=66; 54.1%). Most delays occurred among CTAS 4 and 5 cases (47.5%), and 22 (18.0%) occurred during holidays. The mean delay time was 6.1 ±1.8 hours. The leading delay causes were multiple consultations with further investigations (37.7%) and conflict between the teams (36.1%). In univariate analysis, ED visiting at holiday time (OR: 0.14; 95% CI: 0.04-0.40, p <0.001) and CTAS 4 and 5 (OR: 2.22; 95% CI: 0.95-5.30, p = 0.003) significantly had more delay. Factors associated with delay in univariate analysis were multiple consultations with further investigations (OR: 2.82; 95% CI: 1.32-6.26, p = 0.013), various assessments in different ED areas with a late arrival of the specialist (OR: 0.43; 95% CI: 0.20-0.91, p = 0.042), and conflict between the teams (OR: 2.50; 95% CI: 1.17-5.54, p = 0.031). In this study, multiple assessments in different ED areas and conflict between the teams were the main factors that caused delays in ED. Implementing a timeframe monitoring system for consultations while emphasizing accelerated decision-making and disposition for patients and understanding teamwork collaboration may reduce patients' length of stay in the ED. Implementing these strategies and evaluating their impact on the length of stay in the ED requires further investigation.

Evaluating the impacts of major transportation disruptions – San Francisco Bay Area case study

The constraints of transportation networks are fundamental to disaster planning. Having the capability of evaluating the emergent dynamics of such networks in the context of large traffic incidents can inform the design of traffic management strategies. On February 7, 2019, the Richmond-San Rafael Bridge in the San Francisco Bay Area, connecting multiple cities and carrying over 100 000 vehicles daily, had to be suddenly closed for over 9 hours due to a structural failure of its upper deck. This incident caused major disruptions in the region as the typical traffic was interrupted and detoured as travelers found alternate routes. In this study, we demonstrate the capability of large-scale traffic impact assessments of major network disruptions using the Richmond-San Rafael Bridge closure as a case study. Using a high-performance, parallel-discrete event traffic simulation, we assess the traffic impacts resulting from the bridge closure at both the regional system and city levels. Our model estimates that the region incurred an additional 14 000 vehicle hours of delay and 600 000 vehicle miles in distance due to the bridge closure. The incident affected over 55 000 trips; certain trips experienced an increase of 46 min in delay and 26 miles in travel distance. The median traffic volume on neighborhood streets in San Francisco, Vallejo, and San Rafael increased by 30%, 22%, and 13%, respectively. The results suggest that the cities’ local roads provided the additional adaptive capacity to disperse the traffic. With large-scale modeling of a critical network disruption using dynamic rerouting capability, complete road network, and full demand, we provide valuable insights into the response dynamics of this specific event. In doing so, the value of such regional analyses to incident and disaster planning is demonstrated.

THE EFFECT OF DELAY IN TEMPERATURE VARIATIONS ON RESULTS OF GLUCOSE TEST IN DM PATIENTS WITH HYPERCHOLESTEROLEMIA

Background: The pre-analytic stage has the most significant contribution to error, which is 60% to 70%. This is an excellent contribution to the dependability of laboratory results. Delays in the examination often occur in the laboratory due to various factors influencing glucose examination outcomes. Purpose: To ascertain the effect of long delays in various temperatures on the results of plasma NaF and serum glucose tests in diabetes mellitus patients who have hypercholesterolemia. Method: Pre-test and post-test design used in a pre-experimental method. In the pretest, plasma NaF and serum glucose levels were checked immediately. In the posttest, the plasma NaF and serum samples were delayed for 4 and 8 hours at the temperature of the refrigerator (4°C) and room temperature (25°C). Result: The results of One-way ANOVA test analysis of the plasma NaF glucose level with an immediate examination, a delay of 4 and 8 hours at room temperature (25°C) showed no effect with a Sig. of 0.423 &gt; 0.05. Plasma NaF glucose level with an immediate examination, 4 and 8 hours delay in refrigerator temperature (4°C) showed no effect with Sig. of 0.772 &gt; 0.05. Serum glucose levels with an immediate examination, 4 and 8 hours delay at room temperature (25°C) showed no effect with a Sig. of 0.333 &gt; 0.05. Serum glucose levels with an immediate examination, 4 and 8 hours delay in refrigerator temperature (4°C) showed no effect with a Sig. of 0.604 &gt; 0.05. Conclusion: There was no effect of 4 hours and 8 hours of delay at the temperature of the refrigerator (4°C) and room temperature (25°C) on the results of NaF and serum glucose examinations in patients with diabetes mellitus who have hypercholesterolemia.

Angioplastie coronaire dans la prise en charge des syndromes coronariens Aigus au Sénégal : défis et résultats

IntroductionPercutaneous coronary intervention (PCI) remains a major therapeutic tool in the management of acute coronary syndromes (ACS). However, it is not widely practiced in sub-Saharan Africa, particularly for the management of ACS. The availability of a catheterization laboratory for 24-hour management of ACS in Dakar is an important step in improving the prognosis of patients. The objective of our study was to evaluate the clinical and prognostic profile of patients presenting an ACS and treated by PCI. Patients and methodsThis is a retrospective study that included all patients who underwent PCI for ACS at hospital principal Dakar during the period from January 2019 to December 2020. ResultsOur study included 112 patients with a mean age of 60 years (extremes 31–96 years) and a male predominance (sex ratio 4.09). Cardiovascular risk factors were dominated by hypertension (47.3%) and smoking (39.3%). Chest pain was present in 97% of patients. Left ventricular systolic function was impaired in 56 patients with a mean of 50% and extremes of 20 and 78%. Thrombolysis with streptokinase was used in 13 patients with STEMI. The majority of coronary angiogram (95%) were performed between 8 am and 5 pm. The radial route was the most commonly used (85.7%). Double vessel coronary artery disease was predominant (39,3%) and the left anterior descending artery was the most affected (60.7%). The PCI was performed in all patients and in more than half of the cases (55%) within 12 hours of delay. The PCI success rate was 96.4%. Sixty-seven patients (59.8%) underwent balloon predilation. PCI was performed with a drug-eluting stent in the majority of patients (92.8%). The outcome was favorable in 96.4% of the patients, but there were 3 deaths (2.7%). ConclusionTreatment of ACS by PCI is a reality in Senegal with a considerable success rate. However, intervention delays remain one of the major challenges of this management.

Design of embedded data analyzer based mitigation model for traffic congestion and its challenges

The various miseries posed by the traffic congestion problem have no chance of being unheard of by literally anyone in today's world. With the incessant increase in the number of vehicles getting registered every year, the frustrating minutes and sometimes even hours of delay due to jams, distressing amounts of wasted fuel during vehicle idling, the resulting outrageous pollution rates, et cetera should hardly come off as shocking to us. This paper aims to show today's scenario by presenting the data obtained from various surveys. The paper also extends the discussion with a typical model design of an embedded data analyzer towards resolving the challenges of traffic conjunction control. These surveys include the time lost due to traffic, the wastage of fuel during idling, the pollution that results, et cetera and then introduces a solution to ameliorate the prevailing utterly disagreeable situation.

Why is traffic congestion getting worse? A decomposition of the contributors to growing congestion in San Francisco-Determining the Role of TNCs

Traffic congestion has worsened noticeably in San Francisco and other major cities over the past few years. This change could reasonably be explained by strong economic growth or other standard factors such as road and transit network changes. However, the worsening congestion also corresponds to the emergence of Transportation Network Companies (TNCs), such as Uber and Lyft, raising the question of whether the two trends may be related. Our research decomposes the contributors to increased congestion in San Francisco between 2010 and 2016, considering contributions from five incremental effects: road and transit network changes, population growth, employment growth, TNC volumes, and the effect of TNC pick-ups and drop-offs. We do so through a series of controlled travel demand model runs, supplemented with observed TNC data collected from the Application Programming Interfaces (APIs) of Uber and Lyft. Our results show that road and transit network changes over this period have only a small effect on congestion, population and employment growth each contribute about a quarter of the congestion increase, and that TNCs are the biggest contributor to growing congestion over this period, contributing about half of the increase in vehicle hours of delay, and adding to worsening travel time reliability. This research contradicts several studies that suggest TNCs may reduce congestion, and adds evidence in support of other recent empirical analyses showing that their net effect is to increase congestion. It is more data rich and spatially detailed than past studies, providing a better understanding of where and when TNCs add to congestion. This research gives transportation planners a better understanding of the causes of growing congestion, allowing them to more effectively craft strategies to mitigate or adapt to it.

Therapeutic turnaround times for common laboratory tests in a tertiary hospital in Kenya.

We evaluated therapeutic TAT for a tertiary hospital in Western Kenya, using a time-motion study focusing specifically on common hematology and biochemistry orders. The aim was to determine significant bottlenecks in diagnostic testing processes at the institution. A total of 356 (155 hematology and 201 biochemistry) laboratory tests were fully tracked from the time of ordering to availability of results to care providers. The total therapeutic TAT for all tests was 21.5 ± 0.249 hours (95% CI). The therapeutic TAT for hematology was 20.3 ± 0.331 hours (95% CI) while that for biochemistry tests was 22.2 ± 0.346 hours (95% CI). Printing, sorting and dispatch of the printed results emerged as the most significant bottlenecks, accounting for up to 8 hours of delay (Hematology-8.3 ± 1.29 hours (95% CI), Biochemistry-8.5 ± 1.18 hours (95% CI)). Time of test orders affected TAT, with orders made early in the morning and those in the afternoon experiencing the most delays in TAT. Significant inefficiencies exist at multiple steps in the turnaround times for routine laboratory tests at a large referral hospital within an LMIC setting. Multiple opportunities exist to improve TAT and streamline processes around diagnostic testing in this and other similar settings.

Techniques for efficient detection of rapid weather changes and analysis of their impacts on a highway network

Adverse weather conditions have a significant impact on the safety, mobility, and efficiency of highway networks. Weather contributed to 23 percent of all non-reoccurring delay and approximately 544 million vehicle hours of delay each year (2014). Nearly 2.3 billion dollars each year are spent by transportation agencies for winter maintenance that contribute to close to 20 percent of most DOT’s yearly budgets (2014). These safety and mobility factors make it important to develop new and more effective methods to address road conditions during adverse weather conditions. Given weather and traffic sensors installed along side of the highway networks, how can we automatically detect weather and traffic change events and prevent from the traffic delay or harsh weather accidents? To this end, we propose a novel framework to address this problem. This paper develops techniques for efficiently detecting rapid weather change events and analyzing their impacts on the traffic flow characteristics of a highway network. It is composed of three components, including 1) detection of rapid weather change events in a highway network using the streaming weather information from a sensor network of weather stations; 2) detection of rapid traffic change events on the traffic flow characteristics (e.g., travel time) of the highway network; and 3) analysis of correlations between the detected weather and traffic change events in space and time. The proposed approach was applied to a weather dataset provided by New York State Mesonet and a traffic flow dataset the National Performance Management Research Data Set (NPMRDS) provided by NYSDOT. The empirical results provide potential evidence about the significant impacts of rapid weather change events on traffic flow characteristics of the Interstate 90 (I-90) Highway in the state of New York. We show the quantitative performance evaluation of our change event detection algorithm and three baseline methods on manually labeled the weather dataset and our method outperforms baselines in terms of precision, recall and F-score. We present the analysis of Top K detected change events as case studies and also provide the spatio-temporal correlation statistics of top k weather and traffic change events. The limitations of the proposed approach and the empirical study are also discussed.

Optimal Schedules of Light Exposure for Multiple Individuals for Quick Circadian Alignment

The invention of quick transportation modes that allow trans-meridian travel has caused circadian misalignment to be a common problem amongst people today. This leads to lower cognitive alertness in the short term and increases the risks of other maladies in the long term. Light, when applied at correct levels and times, can shift and re-entrain the circadian clock to the local time zone, and minimize the negative impact of any circadian misalignment. In this paper, we developed a new method (algorithm) to calculate common optimal light schedules of light exposure and avoidance, to quickly re-entrain the circadian systems of a group of individuals who have different internal circadian parameters. We used an experimentally validated mathematical model to define a target circadian phase, from which, our optimization algorithm iteratively adjusts the switching times of a bang-bang light input (restricted to two light levels) to minimize the difference between the current phase of all individuals and the target phase, within a set time period. The proposed algorithm generated light schedules that successfully minimizes the re-entrainment time of all the individuals with phase shifts up to 12 hours of delay or advancement.

A Frequency Domain Control Perspective on Xenon Resistance for Load Following of Thermal Nuclear Reactors

Xenon (Xe) is a noble gas with an isotope (Xe-135) that has an extremely high absorption cross section of neutrons moving at thermal energies. Xe-135 is produced through a chain of decay of isotopes resulting from nuclear fission, in addition to directly resulting from fission. The decay chain results in a phase lag between Xe-135 concentration and the neutron flux or power in a nuclear reactor. The phase lag results in oscillations and several hours of delay between the set power and the response power of a reactor. To enable rapid load following of reactors to a maximum of one change per hour, or a frequency of $2.7\times 10^{-4}$ Hz ( $1.74\times 10^{-3}$ rad/s), a Bode-step controller is designed to expand the functional bandwidth of the reactor and to stabilize the control loop. The resulting controller is capable of projecting the Xe-135 concentrations and providing a phase lead to overcome the inherited phase lag. The controller was found to eliminate the power oscillation and enable the targeted “one change per hour” power set point change.

Empirical Estimation of Effects of Flexible Working on Mobility and Congestion in the Netherlands 2000 to 2016

Flexible working, enhanced by information and communication technologies, seems relevant for transport policy, but information about the development of flexible working in the Netherlands and the impact on mobility and congestion is incomplete. The KiM Netherlands Institute for Transport Policy Analysis devised a method to identify the development of flexible working and its impacts on mobility and congestion using an online panel survey and other data. The research findings reveal that working at home and shifting hours to avoid using cars during peak hours are the most important types of flexible working in the Netherlands and that they increased between 2000 and 2016. If there had not been flexible working, the number of car kilometers on working days in the Netherlands from 2000 to 2016 on all roads would have increased by 2.6% more than the observed development. Total public transport kilometers would have been 2% higher. The hours of delay with all types of flexible working on national roads in the Netherlands from 2000 to 2016 increased by 42%, instead of by the 60% it would have been had there not been flexible working (an impact of 18%). Working at home had the largest impact on congestion avoidance over the entire day. During peak hours, peak hour travel avoidance by car had the largest impact. Delay was reduced by approximately 0.1 h on national roads by working 1 day at home or by shifting hours from morning peak to off-peak on one occasion. This reduction was approximately 0.2 h during the afternoon peak.

The Cost of Convenience: Ridehailing and Traffic Fatalities

We examine the effect of the introduction of ridesharing services in U.S. cities on fatal traffic accidents. The arrival of ridesharing is associated with an increase of approximately 3% in the number of motor vehicle fatalities and fatal accidents. This increase is not only for vehicle occupants but also pedestrians. We propose a simple conceptual model to explain the effects of ridesharing’s introduction on accident rates. Consistent with the notion that ridesharing increases congestion and road use, we find that its introduction is associated with an increase in arterial vehicle miles traveled, excess gas consumption, and annual hours of delay in traffic. On the extensive margin, ridesharing’s arrival is also associated with an increase in new car registrations. We find weaker increases in accidents related to drunk driving. These effects are higher in cities with prior higher use of public transportation and carpools, consistent with a substitution effect, and in larger cities and cities with high vehicle ownership. The increase in accidents appears to persist—and even increase—over time. Back-of-the-envelope estimates of the annual cost in human lives range from $5.33 billion to $13.24 billion per year.

Effect of time to primary repair on final visual outcome after open globe injury

Background/AimHistoric data suggest that open globe injuries should be repaired within 12–24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It...

The torsed intraabdominal testis presenting with a mechanical large intestinal obstruction – A maiden case report

Torsion of an intraabdominal testis is a well-known complication and is usually associated with a testicular malignancy. Torsed intraabdominal testis compressing the large bowel leading to a mechanical gut obstruction is still an unreported entity. A 27 years old young patient presenting with nonspecific abdominal pain after 48 hours of delay. Due to features of gut obstruction, an emergency laparotomy was done. A large torsed intraabdominal testis was found with an empty right scrotum which was compressing the sigmoid colon leading to a complete gut obstruction. Interestingly, two of his siblings also were also suffering from undescended testicles.

Forecasting the impossible: The status quo of estimating traffic flows with static traffic assignment and the future of dynamic traffic assignment

Roadway expansion proposals are evaluated primarily with travel time metrics including vehicle hours traveled (VHT) and vehicle hours of delay (VHD). Travel time metrics have been criticized for ignoring other travel modes, over-emphasizing mobility over accessibility, and failing to account for economic externalities. However, there is an even more fundamental problem. The travel time metrics are inaccurate because they rely on Static Traffic Assignment (STA), a 40-year old approach that routinely forecasts unfeasible future traffic flows that exceed capacity. Basing metrics on these impossible volumes produces invalid results. The common practice of exporting link volumes or subarea trip tables to microsimulation fails to address the STA problem because the unrealistically high STA traffic forecasts are forced onto a capacity-constrained network. Inaccurate travel time modeling helps to explain why so many roadway projects fail to deliver promised travel time savings. Replacing STA with Dynamic Traffic Assignment (DTA) produces more realistic metrics. A case study from the Portland Maine region is presented where STA and DTA are compared with the same inputs. The DTA model fits base year count traffic count much better. The DTA model produces more much lower and more realistic estimates of congestion relief from freeway widening.

“Snowmelt Sign” and “Corkscrew Microvessels” Predicting Epithelium Regeneration After Acute Rejection of Small-Bowel Transplantation: A Case Report

Intestinal failure characterized by inadequate maintenance of nutrition via normal intestinal function comprises a group of disorders with many different causes. If parenteral nutrition dependency develops, which is associated with higher mortality and complications, it is considered for intestine transplantation. However, the graft failure rate is not low, and acute cellular rejection is one of the most important reasons for graft failure. As a result, early identification of rejection and timely modification of anti-rejection medications have been considered to be associated with better graft and patient survival rates. The diagnostic gold standard for rejection is mainly based on histology, but hours of delay by pathology may occur. Some researchers investigated the association of endoscopic images with graft rejection to provide timely diagnosis. In this study, we present the first case report with characteristic features under magnifying endoscopy with a narrow-band imaging system to predict epithelial regeneration and improvement of graft rejection in a patient with small-bowel transplantation.

Stimulated Raman Imaging Reveals Aberrant Lipogenesis as a Metabolic Marker for Azole-Resistant Candida albicans.

Candida albicans is the single most prevalent cause of fungal bloodstream infections worldwide causing significant mortality as high as 50 percent. This high mortality rate is, in part, due to the inability to initiate an effective antifungal therapy early in the disease process. Mortality rates significantly increase after 12 hours of delay in initiating the appropriate antifungal therapy following a positive blood culture. Early administration of appropriate antifungal therapy is hampered by the slow turnovers of the conventional antimicrobial testing techniques, which require days of incubation. To address this unmet need, we explored the potential of employing stimulated Raman scattering (SRS) imaging to probe for metabolic differences between fluconazole-susceptible and -resistant strains at a single cell level in search of a metabolic signature. Metabolism is integral to pathogenicity. Since only a few hours are needed to observe a full metabolic cycle in C. albicans, metabolic profiling provides an avenue for rapid antimicrobial susceptibility testing. C-H frequency (2850 cm-1) SRS imaging revealed a substantial difference in lipogenesis between the fluconazole-susceptible and -resistant C. albicans. Exposure to fluconazole, an antimicrobial drug that targets ergosterol biosynthesis, only affected the lipogenesis in the susceptible strain. These results show that single cell metabolic imaging via SRS microscopy can be used for rapid detection of antimicrobial susceptibility.

Evaluating Vehicular Delay Cost of Congested Road Networks in Akure Ondo State, Nigeria

Estimate of the impact of congestion such as economic and productivity loss was evaluated along three selected routes namely RA, RB and RC in Akure using cost and delay. Travel speed, and Average Daily Traffic (ADT) were measured using cine camera; while fuel consumption was measured per litre using the vehicles fuel gauge. The annual person hours of delay (APHD) of 626.25 hrs, 918.51 hrs and 140.91 hrs was obtained for route A, B and C respectively. The daily wasted fuel cost for vehicle on RA, RB and RC are N785.83/day, N 959.9/day and N 130.5/day respectively, while N6,506.42/ day, N 7,676.63 and N 2,110.92 was obtained for total delay cost (TDC) on the RA, RB and RC. Also, fuel wasted associated with congestion for RA, RB and RC are 1,642,352.40 naira per year, 1,937,735.8 naira per year, and 532,838.80 naira per year respectively; this amount to economic loss. Provision of effective public transit, efficient off-street parking system, and enforcement of traffic rule and regulation were recommended as a panacea to traffic congestion problem in the study area.

Clinical patterns of presentation and attenuated inflammatory response in octo- and nonagenarians with perforated gastroduodenal ulcers

Perforated gastrodudenal ulcer (PGDU) is an operative emergency with high mortality rates. The growing elderly population increasingly presents with need for geriatric acute operative care. Current knowledge of age-specific characteristics in presentation, diagnosis, and outcome for PGDU in the elderly is scarce. We reviewed a consecutive, population-based cohort of patients with PGDU, octa- and nonagenarians were compared with younger patients for variation in patterns of presentation and outcomes. Patterns and outcomes observed included 30-day mortality, serious complications (Clavien-Dindo 3 and 4), and duration of stay. Of the 244 patients, 127 were women (52%); median age was 68years; and 59 patients (24.2%) were ≥80years. Two thirds had gastric ulcers (n=168; 67.2%). On admission, hemoglobin levels, white blood cell count, and serum levels of C-reactive protein, bilirubin, and albumin differed significantly between the age groups. Diagnosis, treatment, and the occurrence of severe complications did not differ with age. The median hours of delay to definitive treatment did not differ significantly for all ages, but patients ≥80years had a greater proportion (44.1% compared with 25.8%) of delay >12hours (odds ratio 2.26, 95% confidence interval 1.22-4.17; P=.008). Overall mortality was 38 (15.6%); no deaths occurred in patients <55years. Over one half of deaths occurred in those ≥80years (odds ratio 4.76, 2.30-9.83; P<.001). Duration of hospital stay was significantly greater in elderly survivors, and fewer were discharged within a week. Octa- and nonagenarians with PGDU present with fewer signs of peritonitis and have an attenuated inflammatory response. The very elderly have twice the risk of long delays to definitive treatment and almost 5 times increased risk of mortality.

Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus.

Infections in lower extremities are sometimes concerned with systemic immunological disorders such as idiopathic thrombocytopenic purpura and systemic lupus erythematosus, which are treated with systemic steroids. Steroid therapy impairs the epithelial wound healing and with systemic condition, especially with systemic lupus erythematosus, the wound is susceptible for infection. Even a pyoderma gangrenosum sometimes occurs in a patient with idiopathic thrombocytopenic purpura with an incisional wound of hernia. The severe signs and symptoms are the deep skin and soft tissue infections, mainly caused by group A streptococcus, composed of necrotizing fasciitis and muscle necrosis. Medically suspected necrotizing fasciitis patients should be empirically and immediately administered with broad-spectrum antibiotics, which may cover the common suspected pathogens. In type I (polymicrobial) infection, the selection of antimicrobial should be based on medical history and Gram staining and culture. The coverage against anaerobes is important in type I infection. Metronidazole, clindamycin, or beta-lactams with beta-lactamase inhibitor or carbapenems are the treatment of choice against anaerobes, while early surgical debridement-wide enough and deep enough-is the core treatment of necrotizing fasciitis and results in significantly better mortality compared with those who underwent surgery after a few hours of delay. When necrotizing fasciitis is considered and the patient is brought to the operation room, aggressive and extensive surgical debridement is explored. Tissue involved should be completely removed until no further evidence of infection is seen. When further debridement is required, the patient must return to the operating room immediately. In this context, the temporal coverage using the artificial dermis after debridement is useful because there is no loss of the patient's own tissue and yet it is easier for "second-look" surgery or secondary reconstruction, and extensive enough debridement is always the mainstay of the therapy.