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European Journal of Cardio-thoracic... Oct 2021Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and...
OBJECTIVES
Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones.
METHODS
A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape.
RESULTS
Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence.
CONCLUSIONS
Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Prosthesis Design; Treatment Outcome; Tricuspid Valve Insufficiency
PubMed: 33880496
DOI: 10.1093/ejcts/ezab178 -
Wound Repair and Regeneration :... 2015The Agency for Healthcare Research and Quality patient safety indicators (PSI) were developed as a metric of hospital complication rates. PSI-14 measures postoperative...
The Agency for Healthcare Research and Quality patient safety indicators (PSI) were developed as a metric of hospital complication rates. PSI-14 measures postoperative wound dehiscence and specifically how often a surgical wound in the abdominal or pelvic area fails to heal after abdominopelvic surgery. Wound dehiscence is estimated to occur in 0.5-3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%. Postoperative wound dehiscence has been adopted as a surrogate safety outcome measure as it impacts morbidity, length of stay, healthcare costs and readmission rates. Postoperative wound dehiscence cases from the Nationwide Inpatient Sample demonstrate 9.6% excess mortality, 9.4 days of excess hospitalization and $40,323 in excess hospital charges relative to matched controls. The purpose of the current study was to investigate the associations between PSI-14 and measurable medical and surgical comorbidities using the Explorys technology platform to query electronic health record data from a large hospital system serving a diverse patient population in the Washington, DC and Baltimore, MD metropolitan areas. The study population included 25,636 eligible patients who had undergone abdominopelvic surgery between January 1, 2008 and December 31, 2012. Of these cases, 786 (2.97%) had postoperative wound dehiscence. Patient-associated comorbidities were strongly associated with PSI-14, suggesting that this indicator may not solely be an indicator of hospital safety. There was a strong association between PSI-14 and opioid use after surgery and this finding merits further investigation.
Topics: Comorbidity; Humans; Middle Aged; Patient Safety; Postoperative Period; Predictive Value of Tests; Surgical Wound Dehiscence; United States; United States Agency for Healthcare Research and Quality; Wound Healing
PubMed: 25683272
DOI: 10.1111/wrr.12268 -
Annals of Medicine Dec 2021The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may...
BACKGROUND
The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may improve preoperative diagnostic accuracy in pregnant women with a caesarean scar. This study aimed to evaluate the ultrasonographic features of uterine scar dehiscence in pregnant women and maternal and neonatal outcomes.
MATERIALS AND METHODS
This was a retrospective review of the records of 23 women with a previous caesarean section found to have uterine scar dehiscence during surgery. The integrity and thickness of the lower uterine segment were recorded, ultrasonographic features were evaluated, and maternal and infant outcomes were analysed.
RESULTS
Of the 23 cases of uterine scar dehiscence, six were detected by preoperative ultrasonography, while 17 were missed. The ultrasonographic features of the 23 cases of uterine dehiscence included anechoic areas protruding through the caesarean section scar with an intact serosal layer (4/23), disappearance of the muscular layer (2/23), and a thinner lower uterine segment (17/23). There were no cases of maternal or neonatal mortality. One woman chose to undergo pregnancy termination.
CONCLUSION
Preoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality. However, the maximum benefit can only be obtained by scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence.KEY MESSAGESPreoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality.Scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence could be beneficial.Even when uterine dehiscence is detected by ultrasound during the second trimester, conservative management via strict observation alone is also feasible.
Topics: Adult; Cesarean Section; Cicatrix; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Retrospective Studies; Risk Assessment; Surgical Wound Dehiscence; Ultrasonography; Uterine Rupture; Vaginal Birth after Cesarean
PubMed: 34309465
DOI: 10.1080/07853890.2021.1959049 -
The Neuroradiology Journal Dec 2022Cartilage cap resurfacing is a method to seal a superior semicircular canal dehiscence. The purpose of this study was to evaluate the detection of new bone formation...
PURPOSE
Cartilage cap resurfacing is a method to seal a superior semicircular canal dehiscence. The purpose of this study was to evaluate the detection of new bone formation after surgical placement of a cartilage cap over a dehiscent semicircular canal.
METHODS
In this retrospective review, two neuroradiologists blinded to each other's interpretation reviewed the temporal bones of 20 patients, five of which had a pre-operative computed tomography (CT) exam which was interpreted as unilateral superior semicircular canal dehiscence and with new bone formation following repair on follow-up CT. There were also 15 control subjects. Each neuroradiologist was blinded to history, including post-operative changes, and asked to determine if there was a dehiscence or no dehiscence.
RESULTS
Out of the 15 controls, there was 100% inter-observer agreement. On the five post-operative patients, there was agreement in 4/5 that there was no dehiscence post-operatively and 1/5 agreement of dehiscence post-operatively, but ectopic bone adjacent to the dehiscence.
CONCLUSION
Our results indicate that new bone formation can be seen at the site of cartilage cap placement over the dehiscence and be interpreted as bony closure of the dehiscence.
Topics: Humans; Semicircular Canal Dehiscence; Osteogenesis; Semicircular Canals; Temporal Bone; Retrospective Studies; Cartilage
PubMed: 35506568
DOI: 10.1177/19714009221096820 -
International Journal of Surgery Case... 2017Wound dehiscence is one of the most common complications of surgical ulcer, involving the breaking open of the surgical incision along the stitch. This condition is a...
INTRODUCTION
Wound dehiscence is one of the most common complications of surgical ulcer, involving the breaking open of the surgical incision along the stitch. This condition is a severe complication of total knee arthroplasty.
PRESENTATION OF CASE
We report a case of a 59-year-old female patient with diabetes who underwent a total knee arthroplasty in which all layers of wounds were dehiscence and prosthetic was exposed.
DISCUSSION
Wound dehiscence is a complication after total knee arthroplasty especially in diabetic patient. So, patients with diabetes more susceptible to development of wound dehiscence following total knee arthroplasty and should be followed particularly postoperatively care.
CONCLUSION
Postoperative care after knee replacement should be more considered in diabetic patients. Finally the patient was successfully treated with irrigation and debridement (I&D) and polyethylene insert exchange.
PubMed: 28854408
DOI: 10.1016/j.ijscr.2017.08.032 -
Head & Face Medicine Sep 2022This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve...
PURPOSE
This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures.
METHODS
In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP).
RESULTS
The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment.
CONCLUSION
To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
Topics: Endoscopy; Humans; Optic Nerve; Sphenoid Bone; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 36057720
DOI: 10.1186/s13005-022-00336-z -
Langenbeck's Archives of Surgery Sep 2022Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to...
PURPOSE
Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to explore the impact of a structured introduction of guidelines for abdominal wall closure on the rates of incisional hernia and wound dehiscence.
METHODS
All procedures performed via a midline incision in 2010-2011 and 2016-2017 at Capio St Göran's Hospital were identified and assessed for complications and risk factors.
RESULTS
Six hundred two procedures were registered in 2010-2011, and 518 in 2016-2017. Four years after the implementation of new guidelines, 93% of procedures were performed using the standardized technique. There was no significant difference in the incidence of incisional hernia or wound dehiscence between the groups. In multivariate Cox proportional hazard analysis, BMI > 25, wound dehiscence, and postoperative wound infection were found to be independent risk factors for incisional hernia (all p < 0.05). In multivariate logistic regression analysis, male gender and chronic obstructive pulmonary disease were risk factors for wound dehiscence (both p < 0.05).
CONCLUSIONS
The present study failed to show a significant improvement in rates of incisional hernia and wound dehiscence after the introduction of Small Stitch Small Bites. When introducing a new standardized technique for closing the abdomen, education and structural implementation of guidelines may have an impact in the long run. The risk factors identified should be taken into consideration when closing a midline incision to identify patients with high risk.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Follow-Up Studies; Humans; Incisional Hernia; Laparotomy; Male; Retrospective Studies; Surgical Wound Dehiscence; Suture Techniques
PubMed: 35577975
DOI: 10.1007/s00423-022-02530-8 -
European Journal of Radiology Open 2017To determine the use of multi-detector computed tomography (MDCT) in the diagnostic interpretation of superior semicircular canal dehiscence (SSCD) or thinning and its...
OBJECTIVE
To determine the use of multi-detector computed tomography (MDCT) in the diagnostic interpretation of superior semicircular canal dehiscence (SSCD) or thinning and its association with ear pathologies and to find whether it is an acquired condition and its association with increase in age.
MATERIALS AND METHODS
study was performed in a tertiary care institute present in a village, following approval of the institutional ethical committee. Retrospective review of temporal bone CT examinations performed between September 2016 and March 2017 was done. 1 mm interval axial images with sagittal and coronal reformatted images were reviewed for the presence of canal dehiscence and thinning by investigators. We characterised the Superior semicircular canal status as normal, frank dehiscence or thinning. Frank dehiscence was further classified anatomically as anterior limb, apex and posterior limb dehiscence.The patient list was then subcategorized into 5 age groups, and the prevalence of SSCD was calculated for each group.
RESULTS
Retrospective review yielded 80 positive cases which included SSC dehiscence (N = 39) and thinning (N = 41). 80 normal scans were selected as control group retrospectively. Statistical analysis was performed to assess for differences between the groups studied. Pearson chi-square test applied. there was a significant association of SSC pathologies prevalence with increasing age (p = < 0.001). No significant relationship was found between SSCD and presence of either CSOM or Cholesteatoma (p = 0.285). Vertigo rather than Tullio phenomenon was the statistically significant complaint (p = <0.001). which brought the patient to the hospital.
CONCLUSIONS
The SSCD and thinning belong to the same spectrum and are acquired conditions. Increasing prevalence in old age suggests it to be an acquired condition rather than a congenital one. No significant association of these condition was seen with CSOM and cholesteatoma. Vertigo is the predominat symptom bringing the patient to hospital along with Tullio phenomenon.
PubMed: 29234688
DOI: 10.1016/j.ejro.2017.10.003 -
Revista Do Colegio Brasileiro de... 2017The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of... (Review)
Review
The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.
Topics: Humans; Negative-Pressure Wound Therapy; Treatment Outcome
PubMed: 28489215
DOI: 10.1590/0100-69912017001001 -
Journal of Clinical Medicine Apr 2023This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who...
This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who underwent hysterectomies at a tertiary academic medical center between 2014 and 2018. The incidence and clinical factors of vaginal cuff dehiscence after minimally invasive versus open hysterectomy were compared. Vaginal cuff dehiscence occurred in 1.0% (95% confidence interval [95% CI], 0.7-1.3%) of women who underwent either form of hysterectomy. Among those who underwent open (n = 1458), laparoscopic (n = 3191), and robot-assisted (n = 423) hysterectomies, vaginal cuff dehiscence occurred in 15 (1.0%), 33 (1.0%), and 3 (0.7%) cases, respectively. No significant differences in cuff dehiscence occurrence were identified in patients who underwent various modes of hysterectomies. A multivariate logistic regression model was created using the variables indication for surgery and body mass index. Both variables were identified as independent risk factors for vaginal cuff dehiscence (odds ratio [OR]: 2.74; 95% CI, 1.51-4.98 and OR: 2.20; 95% CI, 1.09-4.41, respectively). The incidence of vaginal cuff dehiscence was exceedingly low in patients who underwent various modes of hysterectomies. The risk of cuff dehiscence was predominantly influenced by surgical indications and obesity. Thus, the different modes of hysterectomy do not influence the risk of vaginal cuff dehiscence.
PubMed: 37109333
DOI: 10.3390/jcm12083001