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Journal of the American Veterinary... Jul 2021To evaluate short-term risk factors associated with dehiscence and death in cats undergoing full-thickness large intestinal incisions.
OBJECTIVE
To evaluate short-term risk factors associated with dehiscence and death in cats undergoing full-thickness large intestinal incisions.
ANIMALS
84 client-owned cats that had undergone full-thickness large intestinal incisions and for which information regarding outcome through postoperative day 7 was available.
PROCEDURES
Medical records from 4 veterinary teaching hospitals were reviewed. For cats that met the inclusion criteria, signalment, history, laboratory test results, surgical and medical procedures, perioperative complications, and outcome were analyzed. A Fisher exact or Wilcoxon rank sum test was used to identify individual variables associated with dehiscence of intestinal incisions or patient nonsurvival to hospital discharge or both.
RESULTS
84 cats met the inclusion criteria. The overall dehiscence and survival to hospital discharge rates were 8.3% (7/84 cats) and 94% (79/84 cats), respectively. Factors associated with dehiscence and nonsurvival to hospital discharge included presence of band neutrophils, performance of partial colectomy with colonic resection and anastomosis, administration of blood products, postoperative cardiopulmonary arrest, and incisional inflammation or infection. Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence. Factors associated with dehiscence only included hypoalbuminemia, renal dysfunction, administration of blood products or > 2 classes of antimicrobials, and intra-abdominal fecal contamination.
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that intestinal dehiscence and mortality rates associated with large intestinal incisions in cats may be higher than previously proposed, although the risk of either outcome was still low. Factors suggestive of systemic illness were associated with colonic dehiscence or death, and focused prospective studies of risk factors are warranted.
Topics: Anastomosis, Surgical; Animals; Cats; Intestine, Large; Prospective Studies; Retrospective Studies; Risk Factors
PubMed: 34227864
DOI: 10.2460/javma.259.2.162 -
Annals of Medicine Dec 2021Abdominal wound dehiscence (AWD) is a major complication of abdominal surgery, and neonates are a group with a high risk of AWD, which has serious consequences or can...
BACKGROUND
Abdominal wound dehiscence (AWD) is a major complication of abdominal surgery, and neonates are a group with a high risk of AWD, which has serious consequences or can even result in death. The purpose of this study is to explore the risk factors for neonatal AWD and construct a predictive model.
METHODS
The clinical data of 453 cases that underwent neonatal laparotomy from June 2009 to June 2020 were retrospectively analyzed, among which 27 cases of AWD were identified. Nine factors, including gender, age at admission, weight at admission, preterm delivery, level of preoperative anaemia, hypoalbuminemia, operation time, incision length, and incision type, were analyzed to explore their correlation with neonatal AWD.
RESULTS
The incidence of neonatal AWD was 6.0% (27/453), among which partial wound dehiscence accounted for 4.9% (22/453) and complete wound dehiscence accounted for 1.1% (5/453). Hypoproteinemia and incision type were the independent risk factors for neonatal AWD, and weight at admission was a protective factor for AWD in the multivariate models. All these factors were incorporated to construct a nomogram, and a calibration curve was plotted. The result indicated that the actual risk was close to the predicted risk when the predicted risk rate was greater than about 35%.
CONCLUSIONS
Neonatal AWD is closely related to hypoproteinemia and incision contamination. Our predictive model showed the potential to provide an individualized risk estimate of AWD for neonatal patients undergoing abdominal surgery.Key messagesNeonatal abdominal wound dehiscence (AWD) has a serious consequence and the incidence of neonatal AWD was about 6.0% and the complete AWD morbidity is 1.1%.Hypoproteinemia and incision type were the independent risk factors for neonatal AWD.Our predictive model showed the potential to provide an individualized risk estimate of AWD for neonatal patients undergoing abdominal surgery.
Topics: Abdomen; Humans; Hypoproteinemia; Infant, Newborn; Postoperative Complications; Retrospective Studies; Risk Factors; Surgical Wound Dehiscence
PubMed: 34121552
DOI: 10.1080/07853890.2021.1938661 -
Journal of Maxillofacial and Oral... Mar 2023In the Indian subcontinent where tobacco chewing is rampant, composite 'bite' defects are common after oral cancer ablation, which comprise buccal mucosa, maxilla and...
INTRODUCTION
In the Indian subcontinent where tobacco chewing is rampant, composite 'bite' defects are common after oral cancer ablation, which comprise buccal mucosa, maxilla and mandible with or without skin. These are often reconstructed with soft tissue flaps like anterolateral thigh flaps, which provide ample soft tissue replacement. A common problem is palatal dehiscence where these flaps are inset, due to the dynamics of speaking and chewing, as well as the gravitational pull on the flap.
MATERIALS AND METHODS
We describe our technique of combining an early custom obturator for these patients in the post operative period, which helps support the palatal inset and prevent dehiscence. We describe in detail the indications and workflow for this technique, mechanism of action and outcomes.
RESULTS
We show the successful result of use in a single patient with an early dehiscence and how it can be incorporated into standard workflow in selected patients at risk of dehiscence.
CONCLUSIONS
This is a useful technique to prevent dehiscence in patients undergoing extensive buccal resections involving the maxilla. It allows for early oral intake and function while preventing dehiscence and dealyed wound healing, which is often costly.
PubMed: 37041948
DOI: 10.1007/s12663-022-01839-7 -
Journal of Medical Case Reports Jun 2023Omental Infarction (OI) is uncommon and mimics common causes of acute abdomen. It is important to differentiate it from other abdominal conditions that require emergency...
BACKGROUND
Omental Infarction (OI) is uncommon and mimics common causes of acute abdomen. It is important to differentiate it from other abdominal conditions that require emergency management. It was first reported in literature in 1896 and about 400 cases have been reported till date.
CASE PRESENTATION
We reported on a 41 year-old Para 0 Ibo house wife who presented with 10 years history of supra-pubic mass and five months history of excessive menstrual flow. After physical examination, a diagnosis of symptomatic uterine fibroid was made. She had myomectomy and the raw surface created after the excision of the myomas was covered with omentum. Wound infection developed on the 8th post-operative day leading to a wound breakdown and later partial extrusion of infarcted omental tissue through the dehisced wound. During re-exploration, the infarcted omental tissue was extracted and the residual abdominal abscess was drained. Surgical site wound infection occurred on the 3rd day after re-operation and a sub-acute intestinal obstruction developed on the 4th day thereafter which responded to conservative management.
CONCLUSION
Careful surgical technique is imperative when utilizing the omentum for reconstructive abdominal surgery. Torsion of the omentum and creation of excess tension while using the omentum for reconstructive procedures should be avoided and increase awareness of this uncommon disease condition by the surgeon is also important. This case is to report a rare finding of omental infarction following myomectomy.
Topics: Female; Humans; Adult; Uterine Myomectomy; Peritoneal Diseases; Abdomen, Acute; Diagnosis, Differential; Omentum; Infarction
PubMed: 37337268
DOI: 10.1186/s13256-023-03924-y -
Radiology Case Reports Aug 2021Vaginal cuff dehiscence is a rare but potentially life-threatening post-hysterectomy complication. Here we report two cases of vaginal cuff dehiscence with distinct...
Vaginal cuff dehiscence is a rare but potentially life-threatening post-hysterectomy complication. Here we report two cases of vaginal cuff dehiscence with distinct imaging features and describe the CT findings of vaginal cuff dehiscence. Both patients underwent repair surgery, and the diagnoses were confirmed. Radiologic features of vaginal cuff dehiscence are uncommonly described in the literature. Vaginal cuff mural discontinuity and omental fat tissue or bowel herniation into the vaginal canal are the most common appearances of vaginal cuff dehiscence. Pelvic hematoma, bowel obstruction, and pneumoperitoneum can accompany. These two cases highlight the CT appearances, potential presentations, and management of vaginal cuff dehiscence in the emergency setting.
PubMed: 34178197
DOI: 10.1016/j.radcr.2021.05.038 -
The Journal of Medical Investigation :... 2023The most common postoperative complication when treating a pressure ulcer with a flap or primary closure is early wound dehiscence. In this study, we aimed to...
AIMS
The most common postoperative complication when treating a pressure ulcer with a flap or primary closure is early wound dehiscence. In this study, we aimed to investigate the cause of early wound dehiscence and its associated risk factors. Early wound dehiscence was defined as the wound dehiscence within the post operation period where no weight or tension is applied to the wound.
METHODS
We conducted a retrospective study of 40 patients with pressure ulcers (69 sites). We calculated the significant difference in the incidence of wound dehiscence between the groups for the following 15 factors : age, obesity, emaciation, diabetes mellitus, smoking, ulcer site, musculocutaneous flap, methicillin-resistant Staphylococcus aureus, presence of two or more types of bacteria, albumin level, C-reactive protein level, white blood cell count, hemoglobin level, operative time, and ulcer size.
RESULTS
Bacteria were detected in all wounds with early dehiscence, which was found in 28 (40.6%) of the 69 cases. C-reactive protein level, albumin level, musculocutaneous flap, and operative time were found to be risk factors for early wound dehiscence using the χ2-test and t-test. (P?=?0.011, 0.045, 0.018, and 0.003, respectively).
CONCLUSION
The cause of dehiscence was considered to be surgical site infection. C-reactive protein level, albumin level, musculocutaneous flap, and operative time may be risk factors of the occurrence of early wound dehiscence. J. Med. Invest. 70 : 101-104, February, 2023.
Topics: Humans; Surgical Wound Infection; Pressure Ulcer; Retrospective Studies; Surgical Wound Dehiscence; Ulcer; Methicillin-Resistant Staphylococcus aureus; C-Reactive Protein; Risk Factors
PubMed: 37164703
DOI: 10.2152/jmi.70.101 -
Folia Morphologica 2020The study of the association between superior semicircular canal and other dehiscences in the temporal bone.
BACKGROUND
The study of the association between superior semicircular canal and other dehiscences in the temporal bone.
MATERIALS AND METHODS
We have studied computed tomography of radiologically diagnosed people with superior or posterior semicircular canal dehiscences, in four health centres. In addition, we have studied one isolated human temporal bone, one skull and one cadaver head belonging to the collection of the Department of Human Anatomy and Histology of the University of Zaragoza that had dehiscence in the superior semicircular canal.
RESULTS
The most frequent association that we observed was between superior semicircular canal dehiscence and tegmen tympani dehiscence (37.33%). Three cases (two clinical cases and one isolated temporal bone) showed multiple associated dehiscences (tegmen tympani, mastoid antrum, posterior semicircular canal, internal auditory canal, glenoid cavity, tympanum bone and geniculate ganglion) associated with superior semicircular canal dehiscence.
CONCLUSIONS
When the superior semicircular canal dehiscence is associated to other in the petrous bone (tegmen tympani, mastoid antrum, posterior semicircular canal, internal auditory canal) could be grouped into the same syndrome called "otic capsule syndrome", since they have the same origin and common aetiology (otic capsule).
Topics: Ear, Middle; Humans; Semicircular Canal Dehiscence; Semicircular Canals; Temporal Bone; Tomography, X-Ray Computed
PubMed: 31886879
DOI: 10.5603/FM.a2019.0138 -
Iranian Journal of Otorhinolaryngology Jul 2021Sphenoid sinus can be considered a key element in advanced sinus and skull base surgery. Due to its importance, many researchers tried to document its characteristics...
INTRODUCTION
Sphenoid sinus can be considered a key element in advanced sinus and skull base surgery. Due to its importance, many researchers tried to document its characteristics and evaluate possible differences among different races and populations.
MATERIALS AND METHODS
This study was conducted between March 2017 and December 2018 on 60 fresh adult cadavers in Tehran Forensic Medicine Center, Tehran, Iran. The evaluated variables were distances between nasal spines, posterior wall of the sphenoid, pituitary gland, and the distance between the anterior and posterior ethmoid artery and optic nerve, which were calculated using a flexible ruler through the direct length in millimeter. Another important variable was dehiscence, which was evaluated in optic and carotid artery canals.
RESULTS
After dissecting 120 sphenoid sinuses, the carotid artery was dehiscent in 24 (20%) cases, and optic nerve dehiscence was observed in 15 (12.5%) cadavers. The mean distance between the anterior wall of the sphenoid sinus and the anterior nasal spine was determined at 73.3±1.3 mm (rang: 58.3-87 mm), and the mean distance between the anterior part of the middle of the pituitary gland and the anterior nasal spine was estimated at 81.1±1.6 mm.
CONCLUSION
According to our finding, the dehiscence of the key structural organs may be more prevalent in the Persian sphenoid sinus, which should be considered carefully in the management of related pathologies.
PubMed: 34395324
DOI: 10.22038/ijorl.2021.47273.2554 -
Frontiers in Neurology 2023Superior semicircular canal dehiscence (SSCD) is the best-known and most common presentation of so-called "third window conditions." There are a variety of diagnostic...
INTRODUCTION
Superior semicircular canal dehiscence (SSCD) is the best-known and most common presentation of so-called "third window conditions." There are a variety of diagnostic measures and tests for this condition in the current literature, including air-bone gap, vestibular-evoked myogenic potentials, and electrocochleography (EcochG). The purpose of this study was to investigate the diagnostic utility of EcochG and its relationship to air-bone gap in a cohort of patients with confirmed SSCD.
METHODS
We reviewed data from 20 patients (11 female and 9 male subjects, age ranging 21-78 years), with confirmed unilateral or bilateral superior canal dehiscence. In total, 11 patients had unilateral SSCD and 9 patients had bilateral SSCD as determined by high-resolution CT scan. This resulted in the inclusion of twenty-nine ears with superior canal dehiscence and 11 normal ears.
RESULTS
Our results indicated that all confirmed SSCD ears presented with an abnormal EcochG SP/AP value and that there was a statistically significant difference between normal and dehiscent ears. There was no statistically significant relationship between air-bone gap and SP/AP ratio in the ears diagnosed with SSCD nor was there a significant difference between dehiscent and normal ears in terms of air-bone gap at three frequencies.
DISCUSSION
These results are consistent with previous studies showing the diagnostic utility of EcochG for this condition and the variability of air-bone gap. While an unexpected air-bone gap continues to be a red flag for SSCD, its absence along with the presence of subjective symptoms is a reasonable indicator for further clinical investigation to include EcochG.
PubMed: 38239317
DOI: 10.3389/fneur.2023.1263513 -
JSLS : Journal of the Society of... 2015To evaluate whether the route and surgical technique by which hysterectomy is performed influence the incidence of vaginal cuff dehiscence.
BACKGROUND AND OBJECTIVES
To evaluate whether the route and surgical technique by which hysterectomy is performed influence the incidence of vaginal cuff dehiscence.
METHODS
We performed a retrospective analysis of total hysterectomy cases performed at Brigham and Woman's Hospital or Faulkner Hospital during 2009 through 2011.
RESULTS
During the study period, 2382 total hysterectomies were performed; 23 of these (0.96%) were diagnosed with cuff dehiscence, and 4 women had recurrent dehiscence. Both laparoscopic (odds ratio, 23.4; P = .007) and robotic (odds ratio, 73; P = .0006) hysterectomies were associated with increased odds of cuff dehiscence in a multivariate regression analysis. The type of energy used during colpotomy, mode of closure (hand sewn, laparoscopic suturing, or suturing assisted by a device), and suture material did not differ significantly between groups; however, continuous suturing of the cuff was a protective factor (odds ratio, 0.24; P = .03). Women with dehiscence had more extensive procedures, as well as an increased incidence of additional major postoperative complications (17.4% vs 3%, P = .004).
CONCLUSION
The rate of cuff dehiscence in our cohort correlates with the current literature. This study suggests that the risk of dehiscence is influenced mainly by the scope and complexity of the surgical procedure. It seems that different colpotomy techniques do not influence the rate of cuff dehiscence; however, continuous suturing of the cuff may be superior to interrupted suturing.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Robotic Surgical Procedures; Surgical Wound Dehiscence; Suture Techniques
PubMed: 25901104
DOI: 10.4293/JSLS.2013.00351