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Plastic and Reconstructive Surgery.... Aug 2023Wound healing complications present a significant burden on both patients and health-care systems, and understanding wound healing principles is crucial across medical...
Wound healing complications present a significant burden on both patients and health-care systems, and understanding wound healing principles is crucial across medical and surgical specialties to help mitigate such complications. One of these longstanding principles, specifically delayed primary closure (DPC), described as mechanically closing a wound after several days of secondary intention healing, lacks clear consensus on its definition, indications, and outcomes. This practical review examines wound healing fundamentals, focusing on DPC, its execution, indications, and comparative outcomes. A PubMed literature search was conducted to retrieve studies on DPC. Inclusion criteria included comparative studies assessing outcomes and complications between DPC and other closure techniques, as well as articles investigating DPC's underlying physiology. Twenty-three comparative studies met inclusion criteria. DPC wounds have significantly higher partial pressure of oxygen, higher blood flow, and higher rates of collagen synthesis and remodeling activity, all of which help explain DPC wounds' superior mechanical strength. DPC seems most beneficial in contaminated wounds, such as complicated appendectomies, postcardiac surgery wounds, and complicated abdominal wall reconstructions, where it has been associated with lower rates of surgical site infections. This practical review provides an evidence-based approach to DPC, its physiology, technique, and indications. Based on the existing literature, the authors recommend that DPC wounds should be dressed in saline/betadine soaks, changed and irrigated daily, with delayed closure lasting between 3 and 5 days or until the infection has resolved. The clearest indications for DPC are in the context of contaminated abdominal surgery and sternal wound dehiscence post cardiac surgery.
PubMed: 37547342
DOI: 10.1097/GOX.0000000000005172 -
Plastic and Reconstructive Surgery.... Oct 2023Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing surgical wound complications. Among its numerous benefits, it allows for exudate...
BACKGROUND
Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing surgical wound complications. Among its numerous benefits, it allows for exudate management and tension offloading from wound edges. The purpose of this systematic review and meta-analysis was to assess the efficacy of prophylactic ciNPWT versus conventional dressings on abdominal donor site complications in microsurgical breast reconstruction (MR).
METHODS
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in January 2023. PubMed and Embase were searched to identify all relevant studies. Data collected included rates of total wound complications, wound dehiscence, infection, seroma, and length of hospital stay.
RESULTS
A total of 202 articles were screened, and eight studies (1009 patients) met the inclusion criteria. Use of ciNPWT was associated with a significantly lower rate of wound dehiscence (OR, 0.53; 95% confidence interval, 0.33-0.85; = 0.0085, = 0%). There was no significant difference in the rate of total wound complications [odds ratio (OR), 0.63; 95% CI, 0.35-1.14; = 0.12, = 69%], donor site infection (OR, 0.91; 95% CI, 0.42-1.50; = 0.47, = 13%), seroma (OR, 0.74; 95% CI, 0.22-2.49; = 0.63, = 57%), or length of hospital stay (SMD, 0.089; 95% CI, -0.13-0.35; = 0.37, = 29%).
CONCLUSIONS
Although exudate management by ciNPWT fails to reduce surgical site infection, seroma formation, and overall length of stay, ciNPWT tension offloading properties seem to be associated with lower rates of wound dehiscence when compared with conventional dressings in abdominal-based autologous breast reconstruction.
PubMed: 37817928
DOI: 10.1097/GOX.0000000000005326 -
Aesthetic Surgery Journal Nov 2023Tension on healing wounds increases the risk of dehiscence and poor or pathologic scar formation. Force modulating tissue bridges (FMTBs) represent a new class of wound...
BACKGROUND
Tension on healing wounds increases the risk of dehiscence and poor or pathologic scar formation. Force modulating tissue bridges (FMTBs) represent a new class of wound closure and support devices designed to offload tension on healing wounds to improve wound healing and scar outcomes.
OBJECTIVES
The study was undertaken to assess the efficacy of FMTBs to reduce the risk of wound healing complications in elective breast surgery.
METHODS
One hundred twenty-two consecutive patients undergoing bilateral aesthetic breast surgery underwent intraoperative placement of FMTBs on the vertical limb closure site. A matched case-control cohort of 121 consecutive patients was established for comparison. Wounds were considered significant if larger than 3 mm in diameter. The primary outcome of breast wounds >3 mm was reported with a relative risk, and all outcomes were framed with number needed to treat.
RESULTS
The control and intervention cohorts had similar demographics, comorbidities, type of operation, and incision pattern utilized. Within the FMTB group, 96.7% (n = 118) patients completed treatment per protocol. Significant wounds occurred in 1.7% (n = 2) of patients in the tissue bridge vs 15.2% (n = 19) in controls on a per patient/per protocol basis (89% reduction, P < .001). Statistically significant improvements were maintained on sensitivity analyses with intention to treat, even when minor wounds were included. There were no complications noted related to FMTBs.
CONCLUSIONS
FMTBs are safe and highly effective at reducing the risk of wound formation in elective breast surgery. Results are consistent with sensitivity analyses based on clinical and methodological factors. Further research will assess long-term scar outcomes.
Topics: Humans; Female; Cicatrix; Wound Healing; Surgical Wound Dehiscence; Surgical Wound Infection; Breast Neoplasms
PubMed: 37652052
DOI: 10.1093/asj/sjad285 -
World Journal of Clinical Cases Nov 2023Laparoscopic gastrectomy (LG) is widely accepted as a minimally invasive approach for the treatment of early gastric cancer. However, its role in locally advanced...
BACKGROUND
Laparoscopic gastrectomy (LG) is widely accepted as a minimally invasive approach for the treatment of early gastric cancer. However, its role in locally advanced gastric cancer (LAGC) after neoadjuvant therapy (NAT) remains controversial. This study aimed to compare the efficacy and safety of LG open gastrectomy (OG) after NAT for the treatment of LAGC.
AIM
To compare the efficacy and safety of LG OG after NAT for LAGC.
METHODS
We conducted a prospective study of 76 patients with LAGC who underwent NAT followed by LG ( = 38) or OG ( = 38) between 2021 and 2023. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS), surgical complications, and quality of life (QOL).
RESULTS
The two groups had comparable baseline characteristics, with a median follow-up period of 24 mo. The 3-year OS rates in the LG and OG groups were 68.4% and 60.5%, respectively ( = 0.42). The 3-year DFS rates in the LG and OG groups were 57.9% and 50.0%, respectively ( = 0.51). The LG group had significantly less blood loss ( < 0.001), a shorter hospital stay ( < 0.001), and a lower incidence of surgical site infection ( = 0.04) than the OG group. There were no significant differences in other surgical complications between the groups, including anastomotic leakage, intra-abdominal abscess, or wound dehiscence. The LG group had significantly better QOL scores than the OG group regarding physical functioning, role functioning, global health status, fatigue, pain, appetite loss, and body image at 6 months postoperatively ( < 0.05).
CONCLUSION
LG after NAT is a viable and safe alternative to OG for the treatment of LAGC, with similar survival outcomes and superior short-term recovery and QOL. LG patients had less blood loss, shorter hospitalizations, and a lower incidence of surgical site infections than OG patients. Moreover, the LG group had better QOL scores in multiple domains 6 mo postoperatively. Therefore, LG should be considered a valid option for patients with LAGC who undergo NAT, particularly for those who prioritize postoperative recovery and QOL.
PubMed: 38073690
DOI: 10.12998/wjcc.v11.i32.7795 -
Journal of Spine Surgery (Hong Kong) Dec 2023Wound dehiscence is a known postoperative complication, but in cervical spine surgery it is rare and there is a lack of documented literature. This case report discusses...
BACKGROUND
Wound dehiscence is a known postoperative complication, but in cervical spine surgery it is rare and there is a lack of documented literature. This case report discusses novel complications of wound dehiscence in three patients who were treated with spinous process ostectomies after posterior cervical surgeries.
CASE DESCRIPTION
In total three cases are reported in these reports. Case one documents the management of a patient with full-thickness cervical wound dehiscence following a cervical paraspinal infection corrected with posterior spinal fixation and fusion. This patient was treated with resection of the prominent spinous processes. Case two documents the management of a patient with an odontoid fracture requiring revision surgery. The patient developed a full-thickness wound dehiscence and was treated with resection of the prominent spinous processes. Case three was a patient suffering from a T9 spinal cord injury who was also treated for multiple vertebral fractures. The patient eventually developed internal cervical wound dehiscence which resulted in removal of the prominent spinous processes.
CONCLUSIONS
This case report documents the successful treatment of cervical wound dehiscence which is a rare postoperative complication of cervical spinal surgery. This information is valuable as treatment strategies and research into cervical wound dehiscence are limited to a single case report.
PubMed: 38196732
DOI: 10.21037/jss-23-91 -
Aesthetic Plastic Surgery Oct 2023Tumescent local anesthesia (TLA) describes the practice of injecting a very dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into the...
BACKGROUND
Tumescent local anesthesia (TLA) describes the practice of injecting a very dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into the tissue until it becomes firm and tense to obtain local anesthesia and vasoconstriction. The use of TLA in augmentation intramuscular gluteoplasty has never been described for implants positioning. Advantages of the TLA technique include a reduction in blood loss through epinephrine-induced vasoconstriction and hydrostatic compression from the tumescent effect. We describe TLA technique for primary intramuscular gluteal augmentation, reporting our experience during the last 5 years.
METHODS
From 2017 to 2021, 20 patients underwent bilateral primary gluteal augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated with a cannula inside the gluteus maximus muscle intra-operatively.
RESULTS
The mean age of the patients was 39, 15 years. The average amount of tumescent solution infiltrated was 240 mL per gluteus. Operating time was 1 h and 40 min, and recovery room time averaged 240 min. Major surgery-related complications were found in 15% of patients (2 hematomas and 1 seroma) and minor complications were described in a total of 8 patients (4 wound dehiscence and 1 dystrophic scar formation). No signs of adrenaline nor lidocaine toxicity were reported and conversion to general anesthesia was never required.
CONCLUSIONS
The tumescent local anesthesia technique represents a safe and efficacious technique for performing gluteal augmentation surgery with an intramuscular implant positioning. The advantages of this technique are safety, reasonable pain control during and after surgery and a low incidence of postoperative side effects due to general anesthesia avoidance.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Anesthesia, Local; Treatment Outcome; Sodium Bicarbonate; Lidocaine; Epinephrine
PubMed: 37069350
DOI: 10.1007/s00266-023-03342-x -
Plastic and Reconstructive Surgery.... Sep 2023Acellular fish skin grafts (FSGs) are tissue-based products created by minimally processing the skin of the Atlantic cod (). The FSG is rich in omega-3 and facilitates...
Acellular fish skin grafts (FSGs) are tissue-based products created by minimally processing the skin of the Atlantic cod (). The FSG is rich in omega-3 and facilitates tissue regeneration by supporting revascularization and ingrowth in the proliferation and remodeling phases of wound healing. FSG is structurally more similar to human skin than antiviral-processed skin substitutes such as amniotic membrane, and there are no known prion, bacterial, or viral diseases that can be transmitted from North-Atlantic cod to humans. The FSG is processed using a proprietary method that preserves the structure and lipid composition of the skin. FSG is CE marked, and US Food and Drug Administration cleared for multiple clinical applications in partial and full-thickness wounds. FSG is currently the only acellular dermal matrix product that does not originate from mammalian tissues. For this narrative review, Medline and UpToDate were used to include a total of 21 articles published from 2015 to 2022 about fish skin graft use. We also reported a case of a 7-year-old boy who underwent treatment with FSG for abdominal wall dehiscence at our department of pediatric surgery, IRCCS Sant'Orsola-Malpighi, Alma Mater Studiorum, University of Bologna, University Hospital of Bologna. FSG provides a valuable and sustainable treatment that improves wound healing in both adult and pediatric populations. We described the first application of an FSG for wound dehiscence of the abdominal wall in a pediatric patient, reporting how FSG was completely reabsorbed and improved the skin's repair.
PubMed: 37718992
DOI: 10.1097/GOX.0000000000005244 -
Cureus Sep 2023Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including... (Review)
Review
Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms of blood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include a prolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation rates and higher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties and develop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.
PubMed: 37900519
DOI: 10.7759/cureus.45962 -
Indian Journal of Plastic Surgery :... Oct 2023Breast augmentation in transwomen is a surgical challenge as there is no available guideline for preoperative assessment of breast implant size, which caters to them...
Breast augmentation in transwomen is a surgical challenge as there is no available guideline for preoperative assessment of breast implant size, which caters to them specifically. The aim of our study is to derive a formula for preoperative breast implant size estimation, which would remove the personal bias, help in one-to-one discussion, and better understanding, reducing operative time, cost, and revision surgery rate. This is a retrospective study conducted from October 2018 to December 2020. We maintained a routine protocol for measurements in our patients, which has been previously published. Linear multivariate regression equation was applied to derive a formula using minimum of parameters, namely, CC (chest circumference at the inframammary fold [IMF]), POMP (circumference at the point of maximum projection of breast mound), and LOWERDIFF (lower value of difference in each breast between the stretched nipple [IMF] and the nonstretched nipple [IMF distance]). A total of 51 transwomen underwent surgery in this period. The mean volume of implant used was 354.51 mL. Complications consisted of pain and discomfort in six patients, delayed healing in two patients, and wound dehiscence in one. A formula for preoperative calculation of breast implant was obtained with these data. A mathematical correlation was found between complications encountered and the percentage by which the inserted implants exceeded the calculated size. We could estimate the breast implant size preoperatively through a simple formula that require only four anthropometric measurements. This equation is a significant advantage for the surgeon and a useful tool for patient education. Its usefulness will be established if applied in prospective studies. From our study, it appears 9% above the calculated size is better avoided.
PubMed: 38026778
DOI: 10.1055/s-0043-1775552 -
International Wound Journal Mar 2024This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence....
This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence. Both of them were open field and laparoscope. In this research, we looked into four databases: PubMed, Web of Science, Embase and Cochrane Library. Research was conducted on various operative methods for hysterectomy in obese patients between 2000 and October 2023. Two independent investigators performed an independent review of the data, established the inclusion and exclusion criteria, and managed the results with Endnote software. It also evaluated the quality of the included literature. Finally, the data were analysed with RevMan 5.3. This study involved 874 cases, 387 cases received laparoscopy and 487 cases received open access operation. Our findings indicate that there is a significant reduction in the rate of post-operative wound infection among those who have received laparoscopy compared with who have received open surgical procedures (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.15; p < 0.001); There was no statistical difference between the rate of post-operative wound dehiscence and those who received laparotomy compared with those who received open surgical procedures (OR, 0.33; 95% CI, 0.10-1.11; p = 0.07); The estimated amount of blood lost during the operation was less in the laparoscopy group compared with the open procedure (mean difference, -123.72; 95% CI, -215.16 to -32.28; p = 0.008). Generally speaking, the application of laparoscopy to overweight women who have had a hysterectomy results in a reduction in the expected amount of bleeding during surgery and a reduction in the risk of post-operative wound infections.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Laparotomy; Obesity; Surgical Wound Infection
PubMed: 38439170
DOI: 10.1111/iwj.14664