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Ear, Nose, & Throat Journal Sep 2021Cochlear implants have successfully improved hearing in severe and profoundly deaf patients in addition to improving their quality of life. Implant extrusion and wound...
Cochlear implants have successfully improved hearing in severe and profoundly deaf patients in addition to improving their quality of life. Implant extrusion and wound infection of a cochlear implant are one of the most common postoperative complications, although it does not occur frequently (1.5%-5% of cases). We present a case of an extruding cochlear implant with dehiscence that was successfully reimplanted, a procedure of which there have been few previous reports in the literature.
Topics: Aged; Cochlear Implantation; Cochlear Implants; Deafness; Humans; Male; Replantation; Surgical Flaps; Surgical Wound Dehiscence
PubMed: 34420408
DOI: 10.1177/01455613211039042 -
Journal of the American Veterinary... Oct 2019To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during...
OBJECTIVE
To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients.
ANIMALS
90 dogs.
PROCEDURES
Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests).
RESULTS
Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized.
CONCLUSIONS AND CLINICAL RELEVANCE
Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.
Topics: Anastomosis, Surgical; Animals; Digestive System Surgical Procedures; Dog Diseases; Dogs; Postoperative Complications; Retrospective Studies; Risk Factors; Surgical Wound Dehiscence; Treatment Outcome
PubMed: 31573871
DOI: 10.2460/javma.255.8.915 -
Progress in Orthodontics Mar 2020Correcting posterior crossbite in adult patients using nonsurgical methods may involve buccolingual tooth movement. Knowing the extent of the pretreatment alveolar bony...
BACKGROUND
Correcting posterior crossbite in adult patients using nonsurgical methods may involve buccolingual tooth movement. Knowing the extent of the pretreatment alveolar bony dehiscences and fenestrations in the posterior area will aid orthodontists in planning posterior crossbite patients accordingly to minimize posttreatment bony defects. Before the advent of cone beam computed tomography (CBCT), observing buccal and lingual bony defects was not possible unless other treatment needs allowed for an open-flap procedure. With CBCT technology, we can now detect posterior defects with some accuracy. The aim of the present study was to determine the prevalence of posterior alveolar bony dehiscence and fenestration in adults with posterior crossbite compared with noncrossbite adults.
METHODS
The study group consisted of pretreatment CBCTs of 28 samples with at least one or more teeth in posterior crossbite or edgebite. The comparison group consisted of pretreatment CBCTs of 28 samples with no posterior crossbite or edgebite. All buccal and lingual sides of the upper and lower posterior segments were measured for the presence of dehiscence, fenestration, and combined total bony defects.
RESULTS
The prevalence of total bony defects was higher in the study group (61.6%) than in the comparison group (52.1%) (p < 0.05). While there was no difference in prevalence between crossbite teeth in the study group and noncrossbite teeth in the comparison group, the noncrossbite teeth in the study group showed a higher prevalence of total bony defects, dehiscence, and fenestration than the noncrossbite teeth in the comparison group (p < 0.05). The prevalence of dehiscence was higher in the study group (41.2%) than in the comparison group (33.3%) (p < 0.05). Neither the prevalence of fenestration nor the mean bony defect size showed statistical significance between the two groups. First premolars showed a higher prevalence of dehiscence than other posterior teeth, and maxillary posterior teeth had a higher prevalence of fenestration than mandibular posterior teeth. Among the maxillary posterior teeth, second premolars had the least amount of fenestration.
CONCLUSIONS
Adult subjects with posterior crossbite had a higher prevalence of total bony defects and dehiscence, especially buccal dehiscence, in the posterior region than subjects with no posterior crossbite. This was due to the high prevalence observed in the noncrossbite teeth in posterior crossbite subjects.
Topics: Adult; Alveolar Process; Cone-Beam Computed Tomography; Humans; Malocclusion; Prevalence; Spiral Cone-Beam Computed Tomography
PubMed: 32173764
DOI: 10.1186/s40510-020-00308-6 -
PloS One 2018The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore...
BACKGROUND
The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore the potential of 3 charge-coupled device (3CCD) imaging values to distinguish between traumatic wounds that heal following closure and those that fail. Previous studies demonstrate that normalized 3CCD imaging values exhibit a high correlation with oxygen saturation and allow for comparison of values between diverse clinical settings, including utilizing different equipment and lighting.
METHODS
We screened 119 patients at Walter Reed National Military Medical Center and at Grady Memorial Hospital with at least one traumatic extremity wound of ≥ 75 cm2. We collected images of each wound during each débridement surgery for a total of 66 patients. An in-house written computer application selected a region of interest in the images, separated the pixel color values, calculated relative values, and normalized them. We followed patients until the enrolled wounds were surgically closed, quantifying the number of wounds that dehisced (defined as wound failure or infection requiring return to the operating room after closure) or healed.
RESULTS
Wound failure occurred in 20% (19 of 96) of traumatic wounds. Normalized intensity values for patients with wounds that healed successfully were, on average, significantly different from values for patients with wounds that failed (p ≤ 0.05). Simple thresholding models and partial least squares discriminant analysis models performed poorly. However, a hierarchical cluster analysis model created with 17 variables including 3CCD data, wound surface area, and time from injury predicts wound failure with 76.9% sensitivity, 76.5% specificity, 76.6% accuracy, and a diagnostic odds ratio of 10.8 (95% confidence interval: 2.6-45.9).
CONCLUSIONS
Imaging using 3CCD technology may provide a non-invasive and cost-effective method of aiding surgeons in deciding if wounds are ready for closure and could potentially decrease the number of required débridements and hospital days. The process may be automated to provide real-time feedback in the operating room and clinic. The low cost and small size of the cameras makes this technology attractive for austere and shipboard environments where space and weight are at a premium.
Topics: Adult; Cohort Studies; Female; Humans; Image Processing, Computer-Assisted; Male; Multivariate Analysis; Postoperative Complications; Preoperative Period; Prognosis; Spectrum Analysis; Wound Healing; Wounds and Injuries
PubMed: 30261011
DOI: 10.1371/journal.pone.0204453 -
The Journal of Small Animal Practice Sep 2017The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2)...
OBJECTIVES
The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors.
METHODS
Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon.
RESULTS
Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors.
CLINICAL SIGNIFICANCE
Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence.
Topics: Abdomen; Animals; Biopsy; Cats; Digestive System Surgical Procedures; Dogs; Incidence; Retrospective Studies; Risk Factors; Surgical Wound Dehiscence
PubMed: 28762502
DOI: 10.1111/jsap.12696 -
Indian Journal of Otolaryngology and... Dec 2021The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed...
The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed a retrospective cross-sectional study, in which the pattern of sphenoid sinus pneumatization was studied on high-resolution computed tomography scans (n = 400), and association of the optic nerve, vidian canal and foramen rotundum along with related morphometric measurements were studied. Out of 400 CT scans, 60.5% were males. Majority had sellar type of pneumatization (89.5%) and single intersinus septum (68%). The most common configuration of relation of optic nerve canal was DeLano type 2 (34.75%). Vidian canal (VC) and Foramen rotundum (FR) were found dehiscent in 40.5% and 6.38% respectively. Average distance of FR from midline on right and left side was 16.3 ± 2.19 mm and 16.7 ± 2.23 mm respectively. Average distance of VC from midline on right and left side was 12.4 ± 5.84 mm and 12.4 ± 4.18 mm respectively. Average right FR to VC distance was 4.17 ± 2.16 mm and left FR to VC was 4.44 ± 2.20 mm. Anatomical variations of the sphenoid sinus are well known. In the present study, we have tried to highlight the importance of knowledge of various anatomical variations in relations to sphenoid sinus as they are critical in planning of surgery. Pre-operative radiological study and correlation is inevitable to assess type and extent of sinus pneumatisation, bony dehiscence and septal terminations to avoid injury to vital structures.
PubMed: 34722226
DOI: 10.1007/s12070-020-01966-y -
Journal of Oral Biology and... 2022Placement of dental implant in narrow alveolar ridge is challenging to be treated. GBR procedure is currently most widely used to augment the deficient alveolar ridges...
BACKGROUND
Placement of dental implant in narrow alveolar ridge is challenging to be treated. GBR procedure is currently most widely used to augment the deficient alveolar ridges and to treat the fenestration and dehiscence around dental implant. Thus, the objectives of the present study were to evaluate as well as compare the clinical performance of collagen membrane and titanium mesh for horizontal bone augmentation at dehisced implant sites.
METHODS AND MATERIAL
Total 12 single edentulous implant sites with buccal bone deficiency in 8 subjects were equally divided and treated simultaneously with either of the two membranes and DBBM(Bio-Oss) bone graft. Primary outcome measurements in terms of defect height and defect width were made using calibrated plastic periodontal probe. Re-entry surgery was performed to remeasure augmented site and to remove Ti-mesh at 6th months. Independent paired -test for the inter-group comparison and student paired -test for intra-group comparison were performed. The differences were considered to be significant at p 0.05.
RESULTS
Mean defect fill with respect to height and width was 3.50 ± 0.54 mm (87%) and 2.33 ± 0.51 mm (82%) for collagen membrane and 3.83 ± 0.75 mm (92%) and 2.50 ± 0.54 mm (88%) for Ti-mesh group respectively.
CONCLUSIONS
Within the limitation of the study, it was concluded that mean defect height and width after 6 months were statistically significant within the group without significant difference between them, Although defect resolution was better in Ti-mesh.
PubMed: 35733847
DOI: 10.1016/j.jobcr.2022.06.003 -
Frontiers in Neurology 2017Superior canal dehiscence syndrome (SCDS) can be treated surgically in patients with incapacitating symptoms. However, the ideal treatment has not been determined. (Review)
Review
BACKGROUND
Superior canal dehiscence syndrome (SCDS) can be treated surgically in patients with incapacitating symptoms. However, the ideal treatment has not been determined.
OBJECTIVES
This systematic literature review aims to assess available evidence on the comparative effectiveness and risks of different surgical treatments regarding: (1) symptom improvement; (2) objectively measurable auditory and vestibular function; (3) adverse effects, and (4) length of hospitalization.
SEARCH METHOD AND DATA SOURCES
A systematic database search according to PRISMA statement was conducted on Pubmed, Embase, and Cochrane library. In addition, reference lists were searched. No correspondence with the authors was established. The last search was conducted on June 9, 2017.
STUDY ELIGIBILITY CRITERIA
Retrospective and prospective cohort studies were held applicable under the condition that they investigated the association between a surgical treatment method and the relief of vestibular and/or auditory symptoms. Only studies including quantitative assessment of the pre- to postoperative success rate of a surgical treatment method were included. Case reports, reviews, meta-analysis, and studies not published in English, Dutch, or German were excluded.
DATA COLLECTION AND ANALYSIS
The first author searched literature and extracted data; the first and last analyzed the data.
MAIN RESULTS
Seventeen studies (354 participants, 367 dehiscences) met the eligibility criteria and were grouped according to surgical approach. Seven combinations of surgical approaches and methods for addressing the dehiscence were identified: plugging, resurfacing, or a combination of both through the middle fossa (middle fossa approach); plugging, resurfacing, or a combination of both through the mastoid (transmastoid approach); round window reinforcement through the ear canal (transcanal approach). Several studies showed high internal validity, but quality was often downgraded due to study design (1). Outcome measures and timing of postsurgical assessment varied among studies, making it unfeasible to pool data to perform a meta-analysis.
CONCLUSION
A standardized protocol including outcome measures and timeframes is needed to compare the effectiveness and safety SCDS treatments. It should include symptom severity assessments and changes in vestibular and auditory function before and after treatment.
PubMed: 28790965
DOI: 10.3389/fneur.2017.00347 -
Sultan Qaboos University Medical Journal Aug 2019Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening... (Review)
Review
Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening complications. This narrative review aimed to present the available methods of wound closure and preferential factors for using each technique. Viable and non-infected wounds were most often treated by gradual approximation techniques, such as the simple or modified shoelace technique, the prepositioned intracutaneous suture or several commercially-available mechanical devices. In addition, applying negative pressure therapy was found to be feasible, particularly when combined with approximation techniques. Skin grafting was reserved for severely-dehiscent wounds while other non-invasive approaches were considered for other subsets of patients with inadvisable surgical interventions. Treatment decision should be made in view of the patient's condition, ease of application, availability of resources, cost of treatment and aesthetic outcomes.
Topics: Compartment Syndromes; Dermatologic Surgical Procedures; Fasciotomy; Humans; Negative-Pressure Wound Therapy; Skin Transplantation; Suture Techniques; Tissue Expansion; Wound Healing
PubMed: 31728216
DOI: 10.18295/squmj.2019.19.03.004 -
Journal of Plastic, Reconstructive &... Jan 2022Despite government restrictions during the coronavirus (COVID-19) pandemic, cosmetic tourism continued to occur. The authors present the impact of cosmetic tourism on...
BACKGROUND
Despite government restrictions during the coronavirus (COVID-19) pandemic, cosmetic tourism continued to occur. The authors present the impact of cosmetic tourism on their plastic surgery unit.
METHODS
Retrospective case note review of two cohorts was performed: COVID-19 (March 2020-April 2021) and a pre COVID-19 comparator (January 2019-February 2020). Patients presenting with complications from cosmetic tourism were included and their hospital notes were reviewed.
RESULTS
Seven patients were identified in the COVID-19 cohort compared with four patients in the comparator. In the COVID-19 patient group, six underwent their procedure overseas. The final patient was operated on in the UK by a visiting surgeon. Cases consisted of two abdominoplasties, two breast augmentations, two gluteal augmentations, and the final patient had a hernia repair. The most common presenting complaint in the COVID-19 cohort was a post-operative wound infection (n = 5), of which two had deeper associated collections, with two further wound dehiscences. In the pre-pandemic group, four patients underwent their procedure overseas. Cases consisted of an abdominoplasty, a blepharoplasty, a breast augmentation and a gluteal augmentation. Two patients presented with a wound infection, and two with simple wound dehiscence.
CONCLUSION
Cosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. These patients are a potentially vulnerable group who exhibit risk-taking behaviours, such as going abroad amidst a pandemic and acceptance of not having appropriate follow up care.
Topics: COVID-19; Humans; Medical Tourism; Pandemics; Postoperative Complications; Retrospective Studies; SARS-CoV-2; Surgery, Plastic
PubMed: 34838496
DOI: 10.1016/j.bjps.2021.11.013