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BioMed Research International 2022The management of late-onset scalp wounds following irradiation is troublesome, especially in patients with a surgical history of intracranial neoplasms. It,...
OBJECTIVE
The management of late-onset scalp wounds following irradiation is troublesome, especially in patients with a surgical history of intracranial neoplasms. It, insidiously, starts with wound dehiscence or discharge and never heals spontaneously without appropriate surgical treatment. Nevertheless, definite treatment guidelines have not yet been established. Here, we present our clinical experience with radiation-induced scalp wounds and suggest a surgical principle for their treatment. . The medical records of 13 patients with brain tumors, who were treated for intractable scalp wounds after irradiation between January 2000 and August 2015, were retrospectively reviewed. All the patients underwent a craniotomy for brain tumor resection. Surgical treatment for a late-onset scalp wound was decided based on the "reconstructive ladder" and according to the status of bone flap and scalp tissue. The patients' clinical characteristics and information regarding irradiation, surgery, and postoperative complications were recorded.
RESULTS
Scalp wounds developed 4.4 years, on average, after the completion of irradiation. Revision operations were performed an average of 2.3 times, and 6 patients (46%) required more than 2 operations. The bone flap was removed in 11 patients (84.6%) to achieve complete wound healing. Among them, 3 patients underwent a cranioplasty using artificial materials, but 2 patients underwent removal due to recurrent wound problems.
CONCLUSIONS
Postirradiation scalp wounds are difficult to treat and have a high risk of recurrence. If osteoradionecrosis is suspected, the bone flap should be removed. It is important to debride unhealthy tissues aggressively and cover defects with robust tissue.
Topics: Brain Neoplasms; Craniocerebral Trauma; Humans; Postoperative Complications; Radiation Injuries; Plastic Surgery Procedures; Retrospective Studies; Scalp; Surgical Flaps
PubMed: 35663040
DOI: 10.1155/2022/3541254 -
Foot & Ankle International Dec 1998This retrospective study investigated outcomes of wound healing in a series of 63 consecutive patients with 64 fractures of the calcaneus who underwent open reduction...
This retrospective study investigated outcomes of wound healing in a series of 63 consecutive patients with 64 fractures of the calcaneus who underwent open reduction and internal fixation done by two surgeons experienced in this fracture during a 3-year period. Thirty-nine patients were managed preoperatively as outpatient referrals before surgery. Twenty-four patients were admitted directly to the trauma service and were managed as inpatients preoperatively. Minimum patient follow-up was 6 months, with an average follow-up of 18 months. A trend correlating the time between injury and operative intervention with the incidence of complications in wounds was noted; the incidence rose in patients who underwent surgery >5 days after their injury. Two-layered closures had a lower incidence of dehiscence compared to single-layered tension-relieving sutures. Patients with a higher body-mass index (BMI) (kg/ m2) took longer to heal their wounds. Strong trends were noted to link BMI and severity of fractures. In the outpatient group, a history of active smoking preoperatively correlated with increased time to wound healing. In 43 patients, there were no wound-healing complications. In 21 feet, there were varying degrees of wound dehiscence. Average wound healing took 47 days. Risk factors for complications in the wound after calcaneal open reduction and internal fixation include single layered closure, high BMI, extended time between injury and surgery, and smoking. Age, type of immobilization, medical illness (including diabetes), type of bone graft, or use of a Hemovac did not influence wound healing.
Topics: Adolescent; Adult; Aged; Calcaneus; Female; Fracture Fixation; Fractures, Closed; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Smoking; Surgical Flaps; Surgical Wound Dehiscence; Suture Techniques; Wound Healing
PubMed: 9872474
DOI: 10.1177/107110079801901211 -
The Cochrane Database of Systematic... 2002Primary repair of penetrating colon injuries is an appealing management option, however uncertainty about its safety persists. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary repair of penetrating colon injuries is an appealing management option, however uncertainty about its safety persists.
OBJECTIVES
The objective of this review was to compare the morbidity and mortality of primary repair to fecal diversion in the management of penetrating colon injuries using a meta-analysis of randomized controlled trials.
SEARCH STRATEGY
We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized.
SELECTION CRITERIA
Studies were included if they were randomized controlled trials comparing the outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries. Five studies were included.
DATA COLLECTION AND ANALYSIS
Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios for combined effect were calculated with a 95% confidence interval for each outcome. Heterogeneity was assessed for each outcome using a chi-squared test.
MAIN RESULTS
The Penetrating Abdominal Trauma Index (PATI) of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70, 95% CI 0.51,5.66). However, total complications (OR 0.28 95% CI 0.18,0.42), total infectious complications (OR 0.41, 95% CI 0.27, 0.63), abdominal infections including dehiscence (OR 0.59, 95% CI 0.38,0.94), abdominal infections excluding dehiscence (OR 0.52 95% CI 0.31,0.86), wound complications including dehiscence (OR 0.55, 95% CI 0.34,0.89), and wound complications excluding dehiscence (OR 0.43, 95% CI 0.25,0.76) all significantly favored primary repair.
REVIEWER'S CONCLUSIONS
Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.
Topics: Colon; Humans; Prospective Studies; Randomized Controlled Trials as Topic; Wounds, Penetrating
PubMed: 12137651
DOI: 10.1002/14651858.CD002247 -
The Cochrane Database of Systematic... 2003Primary repair of penetrating colon injuries is an appealing management option. However, uncertainty about its safety persists. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary repair of penetrating colon injuries is an appealing management option. However, uncertainty about its safety persists.
OBJECTIVES
The objective of this review was to compare morbidity and mortality rates after primary repair to the rates after fecal diversion, in the management of penetrating colon injuries, using a meta-analysis of randomized controlled trials.
SEARCH STRATEGY
We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized.
SELECTION CRITERIA
Studies were included if they were randomized controlled trials comparing the outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries. Five studies were included.
DATA COLLECTION AND ANALYSIS
Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios (ORs) for combined effect were calculated with a 95% confidence interval (95% CI) for each outcome. Heterogeneity was assessed for each outcome, using a chi-squared test.
MAIN RESULTS
PATI scores of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70; 95% CI 0.51-5.66). However, total complications (OR 0.28; 95% CI 0.18-0.42), total infectious complications (OR 0.41; 95% CI 0.27- 0.63), abdominal infections including dehiscence (OR 0.59; 95% CI 0.38-0.94), abdominal infections excluding dehiscence (OR 0.52; 95% CI 0.31-0.86), wound complications including dehiscence (OR 0.55; 95% CI 0.34-0.89), and wound complications excluding dehiscence (OR 0.43; 95% CI 0.25-0.76) all significantly favored primary repair.
REVIEWER'S CONCLUSIONS
Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.
Topics: Colon; Humans; Prospective Studies; Randomized Controlled Trials as Topic; Wounds, Penetrating
PubMed: 12917927
DOI: 10.1002/14651858.CD002247 -
Oral Surgery, Oral Medicine, Oral... Jan 2002Wound dehiscences after lower third molar surgery potentially extend the time of postsurgical treatment and may cause long-lasting pain. It was the aim of this... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
OBJECTIVES
Wound dehiscences after lower third molar surgery potentially extend the time of postsurgical treatment and may cause long-lasting pain. It was the aim of this prospective study to evaluate the primary wound healing of 2 different flap designs.
METHODS
Sixty completely covered lower third molars were removed. In 30 cases, the classic envelope flap with a sulcular incision from the first to the second molar and a distal relieving incision to the mandibular ramus was used, whereas the other 30 third molars were extracted after preparation of a modified triangular flap first similarly described by Szmyd. Wound healing was controlled on the first postoperative day, as well as 1 and 2 weeks after surgery.
RESULTS
The overall result was a total of 33% wound dehiscence. In the envelope-flap group, wound dehiscences developed in 57% of the cases. This represents a relative risk ratio of 5.67, with a 95% CI from 1.852 to 12.336. With the modified triangular-flap technique, only 10% of the wounds gaped during wound healing.
CONCLUSION
This study confirms evidence that the flap design in lower third molar surgery considerably influences primary wound healing. The modified triangular flap is significantly less conducive to the development of wound dehiscence.
Topics: Adolescent; Adult; Age Factors; Cranial Nerve Injuries; Female; Humans; Lingual Nerve Injuries; Male; Mandible; Middle Aged; Prospective Studies; Smoking; Surgical Flaps; Surgical Wound Dehiscence; Tooth Extraction; Wound Healing
PubMed: 11805771
DOI: 10.1067/moe.2002.119519 -
Pediatric Dermatology May 2017The use of collagenase for enzymatic wound debridement has been studied extensively and has been established as the standard of care for nonhealing and necrotic wounds...
BACKGROUND/OBJECTIVES
The use of collagenase for enzymatic wound debridement has been studied extensively and has been established as the standard of care for nonhealing and necrotic wounds in individuals for whom surgical intervention is not an option. Collagenase has been shown to be effective in adults but has been studied in a limited capacity in infants and neonates. The purpose of this study was to investigate the use of collagenase in the neonatal intensive care unit (NICU).
METHODS
Retrospective chart review of infants and neonates admitted to the NICU at Arkansas Children's Hospital with nonhealing wounds for which collagenase was used for wound healing over a 1-year time period. Six wounds were identified: five surgical wound dehiscence and one intravenous infiltrate.
RESULTS
Before the use of collagenase, five of the six wounds had been treated with an alternative dressing. Once collagenase was initiated, three of these wounds reached complete granulation and closure in less time than in the episode of prior therapy. The number of days to reach 100% granulation once treated with collagenase was 5 to 18 days (mean 12.2 days). Surgical intervention for the debridement and closure of these wounds was not required, providing cost savings to the patient. Daily wound care was completed with negligible pain recordings.
CONCLUSION
The use of collagenase for enzymatic debridement can be beneficial, safe, and effective for the treatment of nonhealing and necrotic wounds in infants and neonates.
Topics: Collagenases; Debridement; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Retrospective Studies; Wound Healing; Wounds and Injuries
PubMed: 28523889
DOI: 10.1111/pde.13118 -
The British Journal of Surgery Nov 2000The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma. (Review)
Review
BACKGROUND
The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma.
METHODS
The English language literature on duodenal trauma over the period 1970-1999 was reviewed.
RESULTS AND CONCLUSION
Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains the ultimate diagnostic test if a high suspicion of duodenal injury continues in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair. More complicated injuries require more sophisticated techniques. High-risk duodenal injuries are followed by a high incidence of suture line dehiscence and they should be treated by duodenal diversion. Pancreaticoduodenectomy should be considered only if no alternative is available. 'Damage control' should precede definitive reconstruction.
Topics: Duodenum; Hematoma; Humans; Pancreaticoduodenectomy; Risk Factors; Surgical Wound Dehiscence; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 11091233
DOI: 10.1046/j.1365-2168.2000.01594.x -
Wounds : a Compendium of Clinical... May 2020Unresolved wound healing represents a major health care cost with a negative impact on patient quality of life, especially among oncology patients who exhibit a delay in...
INTRODUCTION
Unresolved wound healing represents a major health care cost with a negative impact on patient quality of life, especially among oncology patients who exhibit a delay in the wound healing cascade due to chemotherapy and radiation. In order to address this problem, the author utilized negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) to cleanse wounds of debris and help promote healing.
OBJECTIVE
The author examines the impact of NPWTi-d on multiple indicators of wound healing progress in 6 cancer patients with complex wounds and multiple comorbidities.
MATERIALS AND METHODS
The NPWTi-d was initiated with instillation of normal saline or 0.125% hypochlorite solution, which was allowed to dwell for 3 to 20 minutes, followed by 2 to 3.5 hours of -125 mm Hg continuous negative pressure. Dressing changes were performed every 2 to 3 days. Debridements, incision and drainage, and antibiotics were administered as necessary.
RESULTS
A total of 1 woman and 5 men (average age, 62 years; range, 53-78 years) presented with the following wounds: surgical dehiscence (n = 3), pressure injury (n = 1), chronic seroma (n = 1), and abdominal wall abscess (n = 1). Malignancy was not detectable in any wounds. Patient comorbidities included diabetes, hypertension, and past treatment for cancers. The NPWTi-d was applied for 1 to 2 weeks, after which the wounds exhibited a reduction in slough, an improvement in granulation tissue, and a decrease in wound volume. Wounds were closed with a flap or transitioned to conventional NPWT prior to discharge home or to a rehabilitation facility for outpatient recovery.
CONCLUSIONS
As shown in this case series, NPWTi-d was a beneficial tool for cleansing the wound bed, thus creating a moist, closed wound environment conducive to healing. Using NPWTi-d supported the formation of a healthy wound bed and contributed to rapid, positive outcomes in this patient population.
Topics: Aged; Female; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Neoplasms; Pressure Ulcer; Surgical Wound; Therapeutic Irrigation; Wound Healing; Wounds and Injuries
PubMed: 32804665
DOI: No ID Found -
Surgery Dec 2015Retrorectus repairs (RR) of abdominal wall hernias are growing in popularity, yet wound morbidity and predictors in this context have been characterized poorly. Models...
BACKGROUND
Retrorectus repairs (RR) of abdominal wall hernias are growing in popularity, yet wound morbidity and predictors in this context have been characterized poorly. Models aimed at predicting wound morbidity typically do not control for technique and/or location of mesh. Our aim was to describe wound morbidity and risk factors specifically in the context of RR hernia repair. Our hypothesis was that the incidence of wound morbidity with mesh sublay would be less than predicted by a model that does not control for mesh position.
METHODS
Consecutive RR hernia repairs with at least a 90-day follow-up were identified in our prospective database and analyzed. The primary outcome measures were the incidence of surgical-site occurrence (SSO) and surgical-site infection (SSI) via modern, standardized definitions. For predictors of SSO, statistical analysis was performed with univariate analysis, χ(2), and logistic regression as well as multivariate regression.
RESULTS
A total of 306 patients met the inclusion criteria. Eighty-four SSOs identified in 72 (23.5%) patients included 48 (15.7%) SSIs, 14 (4.6%) instances of wound cellulitis, 12 (3.9%) skin dehiscences, 6 (2.0%) seromas, and 4 (1.3%) hematomas but no instances of mesh excision or fistula formation. Treatment entailed antibiotics alone in 30 patients, 14 bedside drainage procedures, 9 radiographically assisted drainage procedures, and 10 returns to the operating room for debridement. After multivariate analysis, diabetes (OR 2.41), hernia width >20 cm (OR 2.49), and use of biologic mesh (OR 2.93) were statistically associated with the development of a SSO (P < .05). Notably, the mere presence of contamination was not independently associated with wound morbidity (OR 1.83, P = .11). SSO and SSI rates anticipated by a recent risk prediction model were 50-80% and 17-83%, respectively, compared with our actual rates of 20-46% and 7-32%.
CONCLUSION
Based on a large cohort of patients, we identified factors contributing to SSOs specifically for RR hernia repairs. Paradoxically, biologic mesh was an independent predictor of wound morbidity. The development of clinically important mesh complications and rates of wound morbidity less than anticipated by recent predictive models suggest that the retromuscular (sublay) mesh position may be more advantageous.
Topics: Abdominal Muscles; Aged; Female; Follow-Up Studies; Herniorrhaphy; Humans; Incidence; Male; Middle Aged; Models, Statistical; Morbidity; Prospective Studies; Regression Analysis; Retrospective Studies; Risk Factors; Surgical Mesh; Treatment Outcome; Wounds and Injuries
PubMed: 26100569
DOI: 10.1016/j.surg.2015.05.003 -
Annals of Surgery Jun 2012The purpose of this study is to evaluate the effect of Negative Pressure Wound Therapy (NPWT) on closed surgical incisions. We performed a prospective randomized... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The purpose of this study is to evaluate the effect of Negative Pressure Wound Therapy (NPWT) on closed surgical incisions. We performed a prospective randomized controlled clinical trial comparing NPWT to standard dry dressings on surgical incisions.
METHODS
Patients presenting to a high-volume wound center were randomized to receive either a V.A.C. (KCI, San Antonio, TX) or a standard dry dressing over their incision at the conclusion of surgery. These were primarily high-risk patients with multiple comorbidities. The 2 groups were compared, and all incisions were evaluated for infection and dehiscence postoperatively.
RESULTS
Eighty-one patients were included for analysis. Thirty-seven received dry dressings, and 44 received NPWT. Seventy-four of these underwent lower extremity wound closure. Average follow-up was 113 days. There were no differences in demographic, preoperative, and operative variables between groups; 6.8% of the NPWT group and 13.5% of the dry dressing group developed wound infection, but this was not statistically significant (P = 0.46). There was no difference in time to develop infection between the groups. There was no statistical difference in dehiscence between NPWT and dry dressing group (36.4% vs 29.7%; P = 0.54) or mean time to dehiscence between the 2 groups (P = 0.45). Overall, 35% of the dry dressing group and 40% of the NPWT group had a wound infection, dehiscence, or both. Of these, 9 in the NPWT group (21%) and 8 in the dry dressing group (22%) required reoperation.
CONCLUSIONS
There is a significant rate of postoperative infection and dehiscence in patients with multiple comorbidities. There was no difference in the incidence of infection or dehiscence between the NPWT and dry dressing group. This study is registered with ClinicalTrials.gov. The unique registration number is NCT01366105.
Topics: Adult; Aged; Aged, 80 and over; Comorbidity; Female; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Prospective Studies; Risk Factors; Surgical Wound Dehiscence; Surgical Wound Infection; Wounds and Injuries
PubMed: 22549748
DOI: 10.1097/SLA.0b013e3182501bae