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The Journal of Craniofacial SurgeryCup-shaped ear is a common congenital auricle deformity. There are many specific surgical methods, such as V-Y method, Barsky method, Musgrave method, etc., but there is...
BACKGROUND
Cup-shaped ear is a common congenital auricle deformity. There are many specific surgical methods, such as V-Y method, Barsky method, Musgrave method, etc., but there is no unified treatment method. The authors used the outer helix reconstruction method for cup-shaped ear and achieved remarkable therapeutic effects.
MATERIALS AND METHODS
The authors performed the outer helix reconstruction on 30 patients with cup-shaped ear. The authors followed up the patients after the stage II operation. The authors used the SPSAU data science analysis platform (https://spssau.com/) for statistical analysis of the data.
RESULT
The mean follow-up time was 14.43±4.5 months. The mean preoperative perimeter of auricle was 8.19±0.56 cm. The mean postoperative perimeter of auricle was 10.82±0.49 cm. The mean perimeter of the healthy auricle was 10.89±0.44 cm. Through data analysis, the authors found that the comparison between preoperative and postoperative auricle perimeters was statistically significant (P<0.05). The comparison between postoperative auricle perimeter and the perimeter of the healthy auricle was not statistically significant (P>0.05). In terms of postoperative satisfaction of patients and their families, the satisfaction rate was 100%. In terms of postoperative complications, there were 1 case of incision dehiscence, 0 cases of incision infection, 2 cases of incision hematoma, and 0 cases of postoperative skin flap ischemia and necrosis.
CONCLUSION
The outer helix reconstruction method is suitable for most cup-shaped ears, and the operation is simple and the effect is remarkable. It is worthy of promotion and application in plastic surgery clinical.
Topics: Humans; Research Design; Ear, External; Ear Auricle; Postoperative Period; Surgical Wound Dehiscence
PubMed: 36409879
DOI: 10.1097/SCS.0000000000008714 -
Khirurgiia 2022To study clinical manifestations and difficulties in diagnosis of liver echinococcosis in a non-endemic region and to assess the long-term results of surgical treatment...
OBJECTIVE
To study clinical manifestations and difficulties in diagnosis of liver echinococcosis in a non-endemic region and to assess the long-term results of surgical treatment and quality of life.
MATERIAL AND METHODS
The study included 36 residents of a non-endemic region with liver echinococcosis operated on in the Perm Regional Clinical Hospital over the past 15 years. IgG antibodies to echinococcal antigens were determined using enzyme immunoassay. Topical diagnosis was performed using ultrasound and contrast-enhanced computed tomography. We analyzed various difficulties of preoperative diagnosis. Long-term postoperative outcomes and quality of life were studied using the SF-36 questionnaire.
RESULTS
In the non-endemic Perm Region, 36% of patients with liver echinococcosis had complicated forms of disease. Sensitivity of detection of antibodies was 77%, ultrasound - 86.1%, CT - 91.7. Echinococcectomy was performed in 13.9% of cases, pericystecomy - 41.7%, liver resection - 30.6%, minimally invasive interventions - in 13.9% of patients. Long-term recurrence of liver echinococcosis (11.1%) developed after laparoscopic echinococcectomy (=2) and open surgery for multiple liver echinococcosis (=2). Median score of physical health in long-term period was slightly higher than mental health (67.51 and 62.75 points, respectively). Physical activity had a weak negative correlation with age (=0.001, = -0.251). Concomitant diseases significantly impaired vital activity (=0.001, = -0.332), role and emotional functioning (=0.002, = -0.494; =0.003, = -0.415).
CONCLUSION
In a non-endemic region, final diagnosis was established only during therapeutic measures in 8.33% of cases. Surgical treatment ensured favorable quality of life in long-term period.
Topics: Echinococcosis, Hepatic; Hepatectomy; Humans; Liver; Postoperative Period; Quality of Life
PubMed: 35920224
DOI: 10.17116/hirurgia202208161 -
Journal of Shoulder and Elbow Surgery Jul 2020The purpose of the present study was to examine the relationship between postoperative therapeutic anticoagulation, wound complications, infection, and revision.
BACKGROUND
The purpose of the present study was to examine the relationship between postoperative therapeutic anticoagulation, wound complications, infection, and revision.
METHODS
Using a national insurance database from 2007 to 2016, patients who underwent shoulder arthroplasty with an indication for postoperative therapeutic anticoagulation in the case of atrial fibrillation or acute postoperative venous thromboembolism were identified. Those with a prescription for a therapeutic anticoagulant within 2 weeks of surgery were identified and compared with controls without postoperative therapeutic anticoagulant prescriptions. Wound complications and postoperative infection at 3 and 6 months, and revision shoulder arthroplasty at 6 months and all time points were then compared in the database using a multivariable logistic regression analysis.
RESULTS
A total of 17,272 patients were included, including 684 patients who received therapeutic anticoagulation and 16,588 controls. Patients receiving therapeutic anticoagulation experienced increased wound complications at 3 months (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.0-4.6, P < .0001) and 6 months (OR 2.5, 95% CI 1.7-3.8, P < .0001). Patients receiving therapeutic anticoagulation also experienced increased rates of wound infection at 3 months (OR 1.5, 95% CI 1.1-2.0, P = .007) and 6 months (OR 1.8, 95% CI 1.4-2.3, P < .0001). Finally, patients receiving therapeutic anticoagulation experienced increased rates of revision surgery at 6 months (OR 1.8, 95% CI 1.3-2.5, P = .0003) and within 9 years (OR 1.5, 95% CI 1.1-2.0, P = .007).
CONCLUSIONS
Wound complications and revision rates in patients undergoing shoulder arthroplasty who require postoperative therapeutic anticoagulation are significantly elevated compared with controls.
Topics: Anticoagulants; Arthroplasty, Replacement, Shoulder; Case-Control Studies; Databases, Factual; Hematoma; Humans; Odds Ratio; Postoperative Period; Reoperation; Risk Factors; Seroma; Surgical Wound Infection; Time Factors; United States
PubMed: 32192881
DOI: 10.1016/j.jse.2019.11.029 -
Foot & Ankle International Dec 2020There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic... (Comparative Study)
Comparative Study
BACKGROUND
There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified.
METHODS
A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery.
RESULTS
The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health.
CONCLUSION
This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries.
LEVEL OF EVIDENCE
Level III, retrospective comparative series.
Topics: Adult; Anti-Bacterial Agents; Female; Foot Joints; Humans; Male; Middle Aged; Postoperative Complications; Postoperative Period; Retrospective Studies; Surgical Wound Infection; Wound Healing
PubMed: 32762356
DOI: 10.1177/1071100720946742 -
International Journal of Pediatric... Jul 2020Adenoidectomy and adenotonsillectomy are very common operations in childhood. It is important to clarify their effects on this age group; in this study, we aimed to...
INTRODUCTION
Adenoidectomy and adenotonsillectomy are very common operations in childhood. It is important to clarify their effects on this age group; in this study, we aimed to investigate the effects of the causative agent on children's mental health by using scales that help to screen for indications of mental disorders in children, who have had adenoidectomy or adenotonsillectomy, both before and after surgery. In this way, we aimed to investigate the effects of this factor on children's mental health.
MATERIALS AND METHODS
The study included 82 children aged 6-12 years with signs of upper respiratory tract obstruction or recurrent adenotonsilitis. Adenotonsillectomy was performed in 41 patients included in the study and adenoidectomy was performed in 41 patients included in the study. 40 healthy children matched with the patient groups in terms of age and gender were included in the control group. Patients, were divided into three groups, those who underwent adenoidectomy, patients undergoing adenotonsillectomy and those in the control group Preoperative and postoperative questionnaires were used to investigate the effect of tonsillectomy or adenoidectomy on the mental health of children. The Parents' Form for the Strengths and Difficulties Questionnaire, the Parental Form for the Children's Anxiety Screening Scale, the Sleeping Scale for Children and the Quality of Life Scale for Children were used in the screening.
RESULTS
In children, who underwent adenoidectomy/adenotonsillectomy due to recurrent infection and adeno/adenotonsillar hypertrophy; it was seen that there was a significant decrease in the scores for the Strengths and Difficulties Questionnaire, the Anxiety Screening Scale in Children, and the Sleep Scale in Children, and a significant increase in Quality of Life Scale for Children scores.
OUTCOME
In conclusion, adenoidectomy/adenotonsillectomy in children with sleep apnea due to recurrent episodes of infection and adeno/adenotonsillar hypertrophy was thought to prevent further neurobehavioral problems, likely to become more complex in the future, and to improve quality of life.
Topics: Adenoidectomy; Adenoids; Adolescent; Airway Obstruction; Child; Female; Humans; Hypertrophy; Male; Mental Disorders; Palatine Tonsil; Parents; Postoperative Period; Preoperative Period; Projective Techniques; Quality of Life; Sleep Apnea Syndromes; Surveys and Questionnaires; Tonsillectomy; Tonsillitis
PubMed: 32387709
DOI: 10.1016/j.ijporl.2020.110072 -
The Spine Journal : Official Journal of... Jul 2022Despite concerted efforts toward quality improvement in high-volume spine surgery, there remains concern that increases in case load may compromise the efficient and...
BACKGROUND CONTEXT
Despite concerted efforts toward quality improvement in high-volume spine surgery, there remains concern that increases in case load may compromise the efficient and safe delivery of surgical care. There is a paucity of evidence to describe the effects of spine case order and operating room (OR) team structure on measures of intraoperative timing and OR efficiency.
PURPOSE
This study aims to determine if intraoperative staff changes and surgical case order independently predict extensions in intraoperative timing after spinal surgery for spondylotic diseases.
STUDY DESIGN/ SETTING
Retrospective cohort analysis PATIENT SAMPLE: All patients over age 18 who underwent primary or revision decompression and/or fusion for degenerative spinal diseases between 2017 to 2019 at a single academic institution were retrospectively identified. Exclusion criteria included absence of descriptive data and intraoperative timing parameters as well as surgery for traumatic injury, infection, and malignancy.
OUTCOME MEASURES
Intraoperative timing metrics including total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. Postoperative outcomes included length of hospital stay and 90-day hospital readmissions.
METHODS
Surgical case order and intraoperative changes in staff (circulator and surgical scrub nurse or technician) were determined. Patient demographics, surgical factors, intraoperative timing and postoperative outcomes were recorded. Extensions in each operative stage were determined as a ratio of the actual duration of the parameter divided by the predicted duration of the parameter. Univariate and multivariate analyses were performed to compare outcomes within case order and staff change groups.
RESULTS
A total of 1,108 patients met the inclusion criteria. First, second, and third start cases differed significantly in intraoperative extensions of total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. On regression, decreasing case order predicted extension in wheels in to induction time. Surgeries with intraoperative staff changes were associated with increases in total theater time, induction start to cut time, cut to close time, close to wheels out time, and length of hospital stay. Switch in primary circulator predicted extended theater time and cut to close time. Relief of primary circulator or scrub predicted extended total theater time, induction start to cut time, cut to close time, and close to wheels out time.
CONCLUSIONS
Intraoperative staff change in spine surgery independently predicted extended operative duration. However, higher case order was not significantly associated with procedural time.
Topics: Adolescent; Humans; Length of Stay; Postoperative Complications; Postoperative Period; Retrospective Studies; Spinal Diseases; Spinal Fusion; Spine
PubMed: 35121151
DOI: 10.1016/j.spinee.2022.01.015 -
Pain Research & Management 2021To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy.
AIM
To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy.
METHODS
We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups.
RESULTS
A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3-30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3-62). The inflammatory indicators of Group A were significantly higher than those of Group B (all < 0.05), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. . The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.
Topics: Fracture Fixation, Internal; Humans; Lumbosacral Region; Postoperative Period; Retrospective Studies; Surgical Wound Infection
PubMed: 34659599
DOI: 10.1155/2021/2262837 -
Surgical Infections Oct 2019Patients increasingly use mobile devices to send text messages and photographic data to surgeons. There is potential to harness this patient-generated health data... (Review)
Review
Patients increasingly use mobile devices to send text messages and photographic data to surgeons. There is potential to harness this patient-generated health data (PGHD) for clinical and public health surveillance of surgical site infection (SSI). Leveraging PGHD collected via remote monitoring in the post-operative period has the potential to produce important benefits for patients, surgeons, care teams, and infection surveillance and prevention. We conducted a health technology assessment (HTA), drawing heavily on stakeholder engagement to better understand current and potential uses of PGHD in post-operative care. Stakeholder engagement activities included assembling an advisory board composed of stakeholder experts, interviewing key informants, and seeking out stakeholder guidance to synthesize evidence from interviews, literature review, and technical app review in order to develop recommendations on the use of PGHD in SSI surveillance. We conducted a review of the published literature, a technical/market scan of available apps for capturing post-operative PGHD, and two rounds of key informant interviews with stakeholders. In addition, we held a day-long workshop to solicit stakeholder feedback on initial findings of the project and to guide additional work. These activities culminated in an HTA report that provides guidance and recommendations on the use of PGHD in SSI surveillance, including practice, research, and public health surveillance, and identifies open issues on post-operative use of PGHD for which additional evidence and experience are needed to optimize application of those data for clinical and public health purposes. Stakeholders, individuals with direct experience, or interest in a given topic are critical to the HTA process. They provide insight to guide the work conducted, ensure that the topics addressed are relevant and important, and that products of the work are accessible and meaningful to the individuals who will be most impacted.
Topics: Electronic Data Processing; Epidemiological Monitoring; Health Services Research; Humans; Patient Generated Health Data; Patient Participation; Postoperative Period; Stakeholder Participation; Surgical Wound Infection
PubMed: 31347988
DOI: 10.1089/sur.2019.146 -
Brazilian Journal of Anesthesiology... 2020Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether... (Review)
Review
Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the postoperative period and provides safety to pati ents and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.
Topics: Anesthesia, Conduction; Anesthesia, Local; COVID-19; Coronavirus Infections; Humans; Pandemics; Pneumonia, Viral; Postoperative Period
PubMed: 32600800
DOI: 10.1016/j.bjan.2020.05.002 -
World Neurosurgery May 2022The surgical treatment of craniovertebral junction (CVJ) lesions remains a difficult process requiring advanced experience. The aim of this study was to present our...
INTRODUCTION
The surgical treatment of craniovertebral junction (CVJ) lesions remains a difficult process requiring advanced experience. The aim of this study was to present our experience and the clinical results of a posterior and posterolateral approach used for CVJ lesions in our clinic, and to discuss these in light of current literature.
METHODS
Clinical, radiologic, and surgical aspects of 30 patients with CVJ tumors were retrospectively evaluated. Age, sex, symptoms, tumor localizations, pre- and postoperative neurologic examinations, performed surgical techniques, postoperative complications, and tumor pathologies were analyzed. The modified McCormick classification was used in the evaluation of the neurologic examination.
RESULTS
There were 30 patients (12 men, 18 women; mean age: 41.8 years). Hemilaminectomy was performed in 14 cases, and total laminectomy or laminoplasty in 16 cases; additional suboccipital craniectomy was performed in 6. Postoperative mortality was observed in 1 (3.3%) patient in the early postoperative period following tetraparesis, motor deficit in 2 (6.6%), cerebrospinal fluid leakage in 2 (6.6%), and wound site infection in 1 (3.3%). A tumor rest was detected in 2 patients (6.6%).
CONCLUSIONS
A posterior or a posterolateral approach is a safe surgical technique that can provide total tumor resection for CVJ region lesions, including posterior, posterolateral, lateral, and anterolaterally located tumors. Isolated anterior and anterolateral tumors with small lateral extension may require a far lateral or extreme lateral approach combined with other cranial base techniques.
Topics: Adult; Ambulatory Care Facilities; Female; Humans; Male; Neoplasms; Neurologic Examination; Postoperative Period; Retrospective Studies
PubMed: 35189424
DOI: 10.1016/j.wneu.2022.02.044