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Surgical Technology International Jun 2023In patients who require colorectal surgery, the rate of surgical site infection (SSI) is amongst the highest of any surgical specialty. Guided by the enhanced recovery...
INTRODUCTION
In patients who require colorectal surgery, the rate of surgical site infection (SSI) is amongst the highest of any surgical specialty. Guided by the enhanced recovery after surgery (ERAS) guidelines for colorectal surgery, there is a large focus on preoperative and intraoperative measures to reduce the risk of bacterial transmission and surgical site inoculation There are many novel and developing dressing types being explored for colorectal surgery. To date, no consensus guidelines for surgical dressings that optimize healing outcomes and reduce infection from postoperative incisions have been established. The purpose of this review is to discuss various dressings used for surgical site wound infection prophylaxis for patients who have colorectal surgery.
MATERIALS AND METHODS
The database, PubMed, was used for this literature review. Keywords included: colorectal surgery or abdominal surgery or clean-contaminated surgery + surgical site infection prophylaxis or negative-pressure wound therapy or bandages or biological dressings or occlusive dressings + surgical wound infection.
RESULTS
Five prophylactic dressings were selected for discussion. This article will review current use and research surrounding the utilization of negative pressure wound therapy devices, silver-containing dressings, mupirocin dressings, gentamicin-c sponge, and vitamin- e and silicon sponges.
CONCLUSION
Alternative dressings discussed in this article show significant promise in reducing SSI compared to conventional dressing. Additional studies to assess cost-benefit analysis and integration into general practice are needed to determine practical application.
PubMed: 37382589
DOI: 10.52198/23.STI.42.GS1697 -
International Journal of Biological... Dec 2023Uncontrollable acute bleeding and wound infection pose significant challenges in emergency treatment and surgical operations. Therefore, the research and development of...
Uncontrollable acute bleeding and wound infection pose significant challenges in emergency treatment and surgical operations. Therefore, the research and development of highly efficient antibacterial hemostatic agents are of great importance in reducing the mortality rate among patients with massive hemorrhage. In this study, we utilized hydrophobically modified chitosan (HM-CS) and gallic acid chitosan (GA-CS) to create a composite sponge (HM/GA-CS) that exhibits complementary advantages. The composite sponge combines the alkyl chain and polyphenol structure, allowing it to adsorb blood cells and plasma proteins simultaneously. This synergistic effect was confirmed through various tests, including blood cell adhesion, plasma protein barrier behavior, and in vitro hemostatic testing. Furthermore, experiments conducted on a rat liver injury model demonstrated that the composite sponge achieved rapid coagulation within 52 s, resulting in significantly lower bleeding volume compared with traditional gauze. In addition, the incorporation of GA-CS into HM-CS enhanced the antibacterial properties of the composite sponge. The antibacterial rate of the composite sponge against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) reached 100 % and 98.2 %, respectively. To evaluate its biocompatibility, the composite sponge underwent blood compatibility and cell activity tests, confirming its suitability. The HM/GA-CS sponge holds promising applications in managing cases of massive hemorrhage.
Topics: Humans; Rats; Animals; Hemostatics; Chitosan; Escherichia coli; Staphylococcus aureus; Hemostasis; Hemorrhage; Anti-Bacterial Agents
PubMed: 37586621
DOI: 10.1016/j.ijbiomac.2023.126344 -
Nature Communications Aug 2021Developing an anti-infective shape-memory hemostatic sponge able to guide in situ tissue regeneration for noncompressible hemorrhages in civilian and battlefield...
Developing an anti-infective shape-memory hemostatic sponge able to guide in situ tissue regeneration for noncompressible hemorrhages in civilian and battlefield settings remains a challenge. Here we engineer hemostatic chitosan sponges with highly interconnective microchannels by combining 3D printed microfiber leaching, freeze-drying, and superficial active modification. We demonstrate that the microchannelled alkylated chitosan sponge (MACS) exhibits the capacity for water and blood absorption, as well as rapid shape recovery. We show that compared to clinically used gauze, gelatin sponge, CELOX™, and CELOX™-gauze, the MACS provides higher pro-coagulant and hemostatic capacities in lethally normal and heparinized rat and pig liver perforation wound models. We demonstrate its anti-infective activity against S. aureus and E. coli and its promotion of liver parenchymal cell infiltration, vascularization, and tissue integration in a rat liver defect model. Overall, the MACS demonstrates promising clinical translational potential in treating lethal noncompressible hemorrhage and facilitating wound healing.
Topics: Alkylation; Animals; Bacterial Infections; Blood Coagulation; Chitosan; Hemorrhage; Hemostatic Techniques; Liver; Liver Diseases; Liver Regeneration; Male; Materials Testing; Microscopy, Electron, Scanning; Porosity; Rats; Surgical Sponges; Swine; Swine, Miniature; Wound Healing
PubMed: 34354068
DOI: 10.1038/s41467-021-24972-2 -
ANZ Journal of Surgery Oct 2021An under-recognized complication of gelatin-based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in... (Review)
Review
BACKGROUND
An under-recognized complication of gelatin-based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in the literature of intraoperative anaphylaxis secondary to locally applied haemostatic agents.
METHODS
An electronic search was performed on databases Medline, Embase, Pubmed and ProQuest. A total of 7671 articles were reviewed from title and abstract. After exclusion criteria and duplicates removed, 19 articles with 21 cases were included for analysis. Data extracted from each of the articles included patient demographics, haemostatic agent used, surgery type, known allergies and any objective evidence of hypersensitivity post anaphylactic episode, that is tryptase levels, IgE levels, skin prick testing.
RESULTS
Fifty-seven percent of cases involved patients <18 years of age; 57% of cases involved spinal surgery; 100% of cases displayed objective evidence of hypersensitivity (tryptase levels, bovine or porcine IgE levels, or skin prick testing). Thirty-three percent of patients had exposure preoperatively to a known agent causing anaphylaxis or allergy which would preclude the use of a gelatin-based haemostat. These products included vaccines, spam meats, red meat, Jell-O and CollaPlug. Gelatin-based haemostat agents included Floseal, Gelfoam, Surgiflo, fibrin glue, Avitene, haemofibrine sponge, topical bovine thrombin and thrombin-soaked gelatin.
CONCLUSION
Increased awareness of allergy to gelatin-based haemostats for surgical and anaesthetic is imperative, with 33% of cases having a known contraindication to gelatin-based haemostat. This review highlights important aspects in the pre-operative patient history and post-event patient investigation that could assist anaesthetists and surgeons in the prevention of future events.
Topics: Anaphylaxis; Animals; Cattle; Collagen; Gelatin; Gelatin Sponge, Absorbable; Hemostatics; Humans; Swine
PubMed: 33682323
DOI: 10.1111/ans.16716 -
Bulletin of Emergency and Trauma Apr 2021Wound debridement is necessary before skin grafting or wound closure. Inappropriate wound bed preparation will led to graft rejection and sometimes catastrophic results,...
INTRODUCTION
Wound debridement is necessary before skin grafting or wound closure. Inappropriate wound bed preparation will led to graft rejection and sometimes catastrophic results, especially in large wounds,. Usage of popular debridement and excision devices such as dermatomes has some difficulties and disadvantages. In this study we will introduce metallic scrub sponge as a safe and effective debridement device.
METHODS
The surgeon usually uses a sterile metallic scrub sponge over the wound with transverse or rotational repeated movement. Wound preparing with metallic sponge should be stopped when pinpoint bleeding occurs. We used sterile metallic sponge for more than 2500 burn patients.
RESULTS
The results are excellent for deep second degree burn (and deeper burns at least 5-10 days after burn when some eschar loosening occurs). Work with scrub sponge was effective, fast and safe.
DISCUSSION
Metallic scrub sponge is a useful device for wound preparation due to its some special characteristics. Debridement of the burn wound with metallic sponge can preserve the spontaneous epithelialization potential of skin in second degree burns and reduce additional injury to the viable tissue that is inevitable by surgical debridement. Cost effectiveness, easy accessibility, safety, softness, inertness and some others are among the other advantages of metallic sponge usage for wound preparation.
CONCLUSION
Due to metallic sponge's simplicity and capability to remove necrotic loose tissues and easy accessibility everywhere and minimal adverse effects, it is a good first line tool for wound preparation and debridement.
PubMed: 34150920
DOI: 10.30476/BEAT.2021.85912 -
BJS Open Sep 2022Anastomotic leaks represent one of the most significant complications of colorectal surgery and are the primary cause of postoperative mortality and morbidity....
BACKGROUND
Anastomotic leaks represent one of the most significant complications of colorectal surgery and are the primary cause of postoperative mortality and morbidity. Sponge-assisted endoluminal vacuum therapy (EVT) has emerged as a minimally invasive technique for the management of anastomotic leaks; however, there are questions regarding patient selection due to the heterogeneous nature of anastomotic leaks and the application of sponge-assisted EVT by surgeons.
METHOD
Seven colorectal surgical experts participated in a modified nominal group technique to establish consensus regarding key questions that arose from existing gaps in scientific evidence and the variability in clinical practice. After a bibliographic search to identify the available evidence and sequential meetings with participants, a series of recommendations and statements were formulated and agreed upon.
RESULTS
Thirty-seven recommendations and statements on the optimal use of sponge-assisted EVT were elaborated on and unanimously agreed upon by the group of experts. The statements and recommendations answer 10 key questions about the indications, benefits, and definition of the success rate of sponge-assisted EVT for the management of anastomotic leaks.
CONCLUSION
Although further research is needed to resolve clinical and technical issues associated with sponge-assisted EVT, the recommendations and statements produced from this project summarize critical aspects to consider when using sponge-assisted EVT and to assist those involved in the management of patients with colorectal anastomotic leaks.
Topics: Humans; Anastomotic Leak; Negative-Pressure Wound Therapy; Consensus; Vacuum; Colorectal Neoplasms
PubMed: 36268752
DOI: 10.1093/bjsopen/zrac123 -
Radiology Case Reports Mar 2023This is a case report of a 50-year-old woman with HIV/HCV coinfection who was diagnosed with an HPV-related well-differentiated squamous cell carcinoma of the vulva....
This is a case report of a 50-year-old woman with HIV/HCV coinfection who was diagnosed with an HPV-related well-differentiated squamous cell carcinoma of the vulva. After undergoing modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy, the patient developed a rectovaginal fistula and a diverting colostomy was placed. During a postoperative contrast enema study, a curvilinear hyperdense stripe was noted, representing the radiodense marker thread of a retained surgical sponge. This case report highlights the importance of awareness of this retained surgical item and its associated possible complications, as well as the importance of imaging modalities for diagnosis.
PubMed: 36655005
DOI: 10.1016/j.radcr.2022.12.035 -
Journal of Clinical and Experimental... Jul 2023The purpose was to evaluate the variation in thickness and early healing of the donor area of the palate with the placement of a collagen sponge and the use of...
BACKGROUND
The purpose was to evaluate the variation in thickness and early healing of the donor area of the palate with the placement of a collagen sponge and the use of fibrin-rich plasma (L-PRF).
MATERIAL AND METHODS
Thirty patients who required mucogingival surgery treatment were selected and distributed into 2 groups. After obtaining the free palate graft, L-PRF was placed in Group A, and a collagen sponge was placed in Group B. The healing process of the palate was evaluated at 24 hours and 7, 14, 21 and 28 days postsurgery. The thickness of the donor area (palate) was evaluated using an acrylic splint. These measurements were made before and 4 months after surgery.
RESULTS
In the collagen sponge group, less gain of the palatal mucosa was observed, with a mean difference of 0.1 ± 0.8 mm (CI: -0.341-0.518) (=0.691), whereas in the fibrin-rich plasma group, a mean difference of 0.0 ± 0.5 mm (CI: -0.229-0.229) (=0.934) was found; however, when comparing the gain of the palatal mucosa in both groups, no significant difference was observed (=0.932). The healing index at 24 hours indicated the presence of clots, on Day 28 vascularisation and total epithelialisation (100.0%), and finally, the collagen sponge group on Day 14 presented 93.3% partial vascularisation of connective tissue and 33.3% L-PRF (=0.001).
CONCLUSIONS
There was no statistically significant difference in the thickness of the palatal mucosa after the use of L-PRF and the collagen sponge. Palate thickness, connective tissue graft, fibrin-rich plasma, collagen sponge, palate healing.
PubMed: 37519316
DOI: 10.4317/jced.60549 -
Surgical Innovation Dec 2020Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using...
Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.
Topics: Foreign Bodies; Humans; Surgical Sponges
PubMed: 32723214
DOI: 10.1177/1553350620943349 -
International Journal of Computer... Aug 2023Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and...
PURPOSE
Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and surgical sponge, the association of the retained surgical item detectability with human visual evaluation has not been sufficiently examined. In this study, we investigated the association of retained surgical item detectability between deep learning and human subjective evaluation.
METHODS
A deep learning model was constructed from 2987 training images and 1298 validation images, which were obtained from post-processing of the image fusion between X-ray images of normal post-operative radiography and surgical sponge. Then, another 800 images were used, i.e., 400 with and 400 without surgical sponge. The detection characteristics of retained sponges between the model and a general observer with 10-year clinical experience were analyzed using the receiver operator characteristics.
RESULTS
The following values from the deep learning model and observer were, respectively, derived: Cutoff values of probability were 0.37 and 0.45; areas under the curves were 0.87 and 0.76; sensitivity values were 85% and 61%; and specificity values were 73% and 92%.
CONCLUSION
For the detection of surgical sponges, we concluded that the deep learning model has higher sensitivity, while the human observer has higher specificity. These characteristics indicate that the deep learning system that is complementary to humans could support the clinical workflow in operation rooms for prevention of retained surgical items.
Topics: Humans; Deep Learning; X-Rays; Radiography; Foreign Bodies
PubMed: 36583837
DOI: 10.1007/s11548-022-02816-8