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Healthcare (Basel, Switzerland) Mar 2024Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the... (Review)
Review
Effects of Perineal Warm Compresses during the Second Stage of Labor on Reducing Perineal Trauma and Relieving Postpartum Perineal Pain in Primiparous Women: A Systematic Review and Meta-Analyses.
Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.
PubMed: 38610125
DOI: 10.3390/healthcare12070702 -
Journal of Reconstructive Microsurgery May 2024Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of...
INTRODUCTION
Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of randomized controlled trials (RCTs) should be undertaken, accompanied by the execution of comprehensive statistical analyses, including confounder adjustment and power analysis. This systematic review aims to provide an encompassing overview of the validation methodologies employed in microsurgical studies, with a specific focus on innovative vessel anastomosis techniques.
METHODS
A literature search was conducted in PubMed for articles describing the validation of novel microsurgical vessel anastomosis techniques in animal or human subjects.
RESULTS
The literature search yielded 6,658 articles. A total of 6,564 articles were excluded based on title and abstract. Ninety-four articles were assessed for full-text eligibility. Forty-eight articles were included in this systematic review. Out of 30 comparative studies, 9 studies validated novel modified interrupted suture techniques, 6 studies modified continuous techniques, 6 studies modified sleeve anastomosis techniques, 1 study a modified vesselotomy technique, 7 studies sutureless techniques, and 1 study a modified lymphaticovenular anastomosis technique. Twenty-eight studies contained animals ( = 1,998). Fifteen animal studies were RCTs. Two studies contained human/cadaveric subjects ( = 29). Statistical power analysis and confounder adjustment were performed in one animal study. Out of 18 noncomparative studies, 5 studies validated novel modified interrupted suture techniques, 1 study a modified continuous technique, 2 studies modified sleeve anastomosis techniques, 4 studies modified vesselotomy techniques, 4 studies sutureless techniques, and 2 studies modified lymphaticovenular anastomosis techniques. Ten studies contained animal subjects ( = 320), with two RCTs. Eight studies contained human subjects ( = 173). Statistical power analysis and confounder adjustment were performed in none of the animal or human studies.
CONCLUSION
The current methods of microsurgical technique validation should be reconsidered due to poor study design. Statistical analysis including confounder adjustment and power analysis should be performed as a standard method of novel technique validation.
PubMed: 38593990
DOI: 10.1055/a-2302-7126 -
Aesthetic Surgery Journal. Open Forum 2024Seroma formation is the most common complication of abdominoplasties. Many preventive interventions have been proposed, but none have been recognized as a definitive...
BACKGROUND
Seroma formation is the most common complication of abdominoplasties. Many preventive interventions have been proposed, but none have been recognized as a definitive solution, partly due to varying levels of evidence (LOE) in the literature.
OBJECTIVES
We aimed to analyze seroma prevention methods supported by high-level evidence.
METHODS
The PubMed database was queried through August 2023. Primary articles of interest included randomized controlled trials (RCTs), prospective comparative studies, and meta-analyses of these studies. The LOE for each article was determined according to the American Society of Plastic Surgeons Rating Scale. The "seroma occurrence ratio," or ratio of seroma events in the interventional group to respective control group, was calculated to compare incidence rates between techniques.
RESULTS
Twenty articles and 9 categories of techniques were analyzed. Study designs included 10 RCTs, 2 prospective cohort studies, 7 prospective comparative studies, and 1 retrospective randomized study. The use of progressive-tension and quilting sutures had the most data supporting a statistically significant reduction in seroma (occurrence ratio 0.306, < .001). Tissue adhesives and preservation of Scarpa's fascia were also well reinforced (0.375, < .01 and 0.229, < .011, respectively), while increasing the number of drains was not ( = .7576). Meta-analysis demonstrated that compared with 2 drains alone, alternative techniques were more effective at reducing seroma occurrence (pooled risk ratio 0.33, 95% CI, 0.11-0.99).
CONCLUSIONS
This review highlights multiple seroma prevention techniques for abdominoplasty investigated in recent high-quality literature. We suggest future randomized comparative studies of the various seroma prevention methods to fully ascertain their efficacy following abdominoplasty.
PubMed: 38585023
DOI: 10.1093/asjof/ojae016 -
The Archives of Bone and Joint Surgery 2024The medial collateral ligament (MCL) injury is one of the possible complications of primary total knee arthroplasty (TKA), which can lead to coronal-plane instability... (Review)
Review
OBJECTIVES
The medial collateral ligament (MCL) injury is one of the possible complications of primary total knee arthroplasty (TKA), which can lead to coronal-plane instability that requires surgical revision. Injured MCL can result in joint instability and polyethylene wear. Different strategies have been proposed for MCL reconstruction based on the location of the injury. However, there is a lack of clarity regarding the optimal method for handling an iatrogenic MCL injury throughout a TKA.
METHODS
A PRISMA flow diagram was used to guide the systematic literature review. An extensive search was conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar. Newcastle Ottawa scale checklist was used to assess the methodological quality of the articles.
RESULTS
A total of 19 qualitative studies, including non-cadaveric patients with MCL injury during TKA, were identified after analyzing the full text of the articles. All included studies were either retrospective, observational cohort or case series. A total of 486 patients were studied to gather information on the methods used to repair the MCL and their results. Most injuries arose in the tibial attachment, which surgeons mostly realized during the final stages of surgery. Used techniques can be categorized into three main groups: Primary repair, Repair with augmentation, and changing prosthesis characteristics.
CONCLUSION
This systematic review demonstrated that the most popular management of iatrogenic MCL injury was using suture anchors, staples, screws and washers, and more constrained prostheses. The proper method should be decided considering the site of the MCL injury.
PubMed: 38577515
DOI: 10.22038/ABJS.2023.73563.3406 -
BMJ Open Ophthalmology Apr 2024Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower... (Meta-Analysis)
Meta-Analysis
Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis.
BACKGROUND
Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis compared the modified sutureless glue-free (MSGF) method with conventional sutures (CS) for conjunctival autograft fixation in primary pterygium surgery.
METHODS
A comprehensive search was conducted in MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing MSGF and CS conjunctival autografts. Outcome measures included operation time, recurrence and postoperative complications. Standardised mean difference (SMD) and risk ratio (RR) were used for continuous and dichotomous outcomes, respectively.
RESULTS
11 RCTs involving 833 participants were included. The analysis revealed that MSGF had a significantly shorter operation time compared with CS (SMD -3.704, 95% CI -5.122 to -2.287, p<0.001). CS was associated with a higher risk of foreign body sensation (RR 0.22, 95% CI 0.06 to 0.74, p=0.01). MSGF was associated with a higher risk of graft dehiscence (RR 9.01, 95% CI 2.74 to 29.68, p=0.000) and graft retraction (RR 2.37, 95% CI 1.17 to 4.77, p=0.02). No significant differences were found in recurrence, graft haemorrhage, granuloma, Dellen and conjunctival oedema.
CONCLUSION
Using the MSGF technique in conjunctival autograft fixation for pterygium surgery reduces operation time by relying solely on the patient's blood for fixation. However, it increases the risk of graft dehiscence and retraction. However, CS is linked to a higher likelihood of experiencing foreign body sensations. Understanding the learning curve and surgeon familiarity with novel techniques is crucial for optimising patient care and surgical outcomes, while individualised decision-making is necessary considering the advantages and disadvantages of each approach. Further research is warranted to minimise complications and optimise surgical outcomes.
Topics: Humans; Pterygium; Autografts; Fibrin Tissue Adhesive; Recurrence; Conjunctiva; Sutures; Foreign Bodies
PubMed: 38565231
DOI: 10.1136/bmjophth-2023-001621 -
Children (Basel, Switzerland) Mar 2024Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current... (Review)
Review
BACKGROUND
Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current evidence for the operative management of paediatric TSAFs.
METHODS
A search was carried out across four databases: MEDLINE, Embase, Scopus, and Google Scholar. Studies discussing the outcomes of the surgical management of paediatric TSAFs since 2000 were included.
RESULTS
Of 38 studies included for review, 13 studies reported outcomes of TSAF patients undergoing screw fixation only, and 12 studies used suture fixation only. In total, 976 patients underwent arthroscopic reduction and internal fixation (ARIF), and 203 patients underwent open reduction and internal fixation (ORIF). The risk of arthrofibrosis with the use of ARIF ( = 0.45) and screws ( = 0.74) for TSAF repair was not significant. There was a significantly increased risk of knee instability ( < 0.0001), reoperation ( = 0.01), and post-operative pain ( = 0.007) with screw fixation compared to sutures.
CONCLUSIONS
While the overall benefits of sutures over screws and ARIF over ORIF are unclear, there is clear preference for ARIF and suture fixation for TSAF repair in practice. We recommend large-scale comparative studies to delineate long-term outcomes for various TSAF fixation techniques.
PubMed: 38539382
DOI: 10.3390/children11030345 -
EXCLI Journal 2024Valve surgery is common in cardiac procedures, with fasteners like COR-KNOT® and hand-tied knots used for knot securing. This study compares their efficacy in valve... (Review)
Review
Valve surgery is common in cardiac procedures, with fasteners like COR-KNOT® and hand-tied knots used for knot securing. This study compares their efficacy in valve surgery patients. We searched PubMed, SCOPUS, and Cochrane Central until August 2023. Outcomes assessed included aortic cross-clamp time (AXT), cardiopulmonary bypass (CPB) time, valvular regurgitation, mortality, prolonged ventilatory support, atrial fibrillation, postoperative left ventricular ejection fraction (LVEF), and renal failure. Subgroup analysis was performed for minimally invasive and open cardiac surgery. We used a random effects model for analysis. We included eight observational studies and two randomized controlled trials (RCTs) with a total of 1.411 participants. COR-KNOT significantly reduced AXT [MD -15.14, 95 % CI (-18.57, -11.70), P<0.00001] and CPB time [MD -12.38, 95 % CI (-14.99, -9.77), P<0.00001]. Valvular regurgitation [RR 0.40, 95 % CI (0.26, 0.61), P<0.0001] and need for prolonged ventilatory support [RR 0.29, 95 % CI (0.13, 0.65), P=0.003] were significantly lower with COR-KNOT. There were no significant differences in mortality [RR 0.39, 95 % CI (0.09, 1.69), P=0.44], atrial fibrillation [RR 1.03, 95 % CI (0.83, 1.27), P=0.81], LVEF changes [MD 0.05, 95 % CI (-1.37, 1.47), P = 0.95], or renal failure [RR 0.87, 95 % CI (0.16, 4.80), P = 0.87]. COR-KNOT devices reduce operative time and valvular regurgitation without increasing mortality or adverse outcomes. This supports their use in enhancing surgical efficiency and patient outcomes. However, ongoing discussions about suturing techniques, especially in minimally invasive procedures, highlight the need for further research and consensus among practitioners. See also the graphical abstract(Fig. 1).
PubMed: 38487081
DOI: 10.17179/excli2023-6885 -
International Wound Journal Mar 2024Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the... (Meta-Analysis)
Meta-Analysis
Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the pharynx reduces fistula rates compared to hand-sewn techniques remains unclear. We conducted an updated systematic review and meta-analysis to clarify this question. Five databases were systematically searched from inception through November 2023 for studies comparing stapler versus suture closure for fistula outcomes after laryngectomy. Odds ratios (OR) were pooled using random-effects models and fixed-effects models. Subgroup and sensitivity analyses were performed. Risk of bias was appraised using NHLBI tools. Nine studies with 803 patients were included. Mechanical closure significantly reduced fistula incidence versus suture closure (OR = 0.57, 95% CI 0.34-0.95, p = 0.03). Subgroup analysis found that stapling's protective effect varied by patient age, country/region, linear stapler size and female percentage. Stapling reduced fistula odds by 80% in the Turkey subgroup (OR = 0.20, 95% CI 0.09-0.50) but showed no benefit in other regions. Patients <60 years showed an 84% fistula reduction with stapling (OR = 0.17, 95% CI 0.06-0.45), whereas older subgroups did not. Linear stapler size of 60 mm significantly reduced fistula occurrence while 75 mm did not. There was no evidence that low female percentage mitigated stapling benefits. Mechanical stapler closure after total laryngectomy meaningfully reduces the likelihood of postoperative PCF formation compared to hand-sewn closure, especially for patients younger than 60 years old. The absolute risk reduction supports its utility to prevent this complication.
Topics: Humans; Cutaneous Fistula; Laryngectomy; Pharyngeal Diseases; Postoperative Complications; Retrospective Studies; Suture Techniques; Wound Closure Techniques
PubMed: 38472132
DOI: 10.1111/iwj.14751 -
Chirurgia (Bucharest, Romania : 1990) Feb 2024Chronic postoperative inguinal pain (CPIP) is still the most frequent complication after open Lichtenstein repair and any strategy to reduce its incidence and... (Meta-Analysis)
Meta-Analysis
The Effectiveness of Cyanoacrylates versus Sutures for Mesh Fixation after Lichtenstein Repair (SCyMeLi STUDY) A Systematic Review and Meta-Analyze of Randomized Controlled Trials.
Chronic postoperative inguinal pain (CPIP) is still the most frequent complication after open Lichtenstein repair and any strategy to reduce its incidence and implications is a step forward to better outcomes. Between the means of mesh fixation atraumatic glue fixation has been explored as such possibility. A meta-analysis of randomized controlled trials comparing the performance of cyanoacrylate glue versus sutures fixation was conducted. the meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) published between January 2000 and December 2021 were searched for in MEDLINE, PubMed, Web of Science, and Google Scholars. The quality of RCTs and the potential risk of bias were assessed using MINORS criteria and the Cochrane risk of bias tool. of 269 papers the meta-analysis was performed on 19 RCTs including 3578 patients. In the glue fixation group, the operation was shorter (mean pooled difference 6 minutes; SE = 0.47; 95% CI = - 6.77 - - 4.92; t test = -12.36; p 0.0001) and immediate postoperative pain was lower (2.37% vs 13.3%OR - 0.158; 95% CI = 0.064 0.386; p = 0.0001). There was no difference in terms of chronic pain, recurrence rate and wound events. Conclusion: glue fixation of mesh in elective Lichtenstein repair of inguinal hernia seems to be a valid choice for a painful and safe procedure without increasing risk of recurrence.
Topics: Humans; Cyanoacrylates; Surgical Mesh; Treatment Outcome; Randomized Controlled Trials as Topic; Pain, Postoperative; Chronic Pain; Sutures; Hernia, Inguinal; Herniorrhaphy; Recurrence
PubMed: 38465719
DOI: 10.21614/chirurgia.2024.v.119.i.1.p.87 -
Annals of Medicine and Surgery (2012) Mar 2024The zipper device is a wound closure device that can be directly applied over the intact skin on either side of the wound edges and does not need anchoring into the skin... (Review)
Review
INTRODUCTION
The zipper device is a wound closure device that can be directly applied over the intact skin on either side of the wound edges and does not need anchoring into the skin or subcutaneous plane. The noninvasive nature of the zipper device makes it less time-consuming and less painful, but its effectiveness and related complications need to be studied.
METHODS
Prospective registration of the protocol followed in this study was done. Electronic databases were searched for relevant articles, and their screening was completed, followed by data extraction and analysis. The odds ratio, mean difference, or standardised mean difference were used as an effect measure per the nature of the variables. Surgical site infection, wound dehiscence, skin closure time, scar score, and patient satisfaction were compared in this study.
RESULTS
A total of 10 studies were identified, out of which eight compared zippers with sutures and two compared zippers with stapler devices. Compared to the suture, the zipper device took 4.9 min less to close the incision, and the scar scale outcome reported after one month was inferior, while other results were not significant. Staples showed a lower patient satisfaction level and no difference in complications.
CONCLUSION
The zipper device is a less technically demanding and less time-consuming method of skin closure, with no significant difference in the complication rate compared to conventional methods. The zipper device is an effective measure to use in settings with less expertise or at health institutions after assessing the cost at the local level.
PubMed: 38463064
DOI: 10.1097/MS9.0000000000001769