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Eplasty 2024Postsurgical pyoderma gangrenosum (PSPG) is a highly uncommon and unpredictable wound healing complication. Rapid progression of ulcers at incisions can cause unfettered...
BACKGROUND
Postsurgical pyoderma gangrenosum (PSPG) is a highly uncommon and unpredictable wound healing complication. Rapid progression of ulcers at incisions can cause unfettered dehiscence. Most commonly, PSPG involves breast procedures; however, in this work, we detail a case of a patient who developed PSPG 10 days postoperatively after penile inversion vaginoplasty.
METHODS
The patient in this case underwent a penile inversion vaginoplasty with orchiectomy in the standard fashion. She had no risk factors for PSPG. Following an uncomplicated hospital stay, the patient developed difficulty with pain control and increasing serous drainage on the 10th postoperative day. On readmission, the patient was found to have developed large, mildly purulent ulcers throughout the perineal wound edges. On exam under anesthesia, the neovaginal canal was found to be patent and intact. The dehisced portions of the incisions were left open and redressed with occlusive bismuth-petrolatum dressing. Dermatology was promptly consulted with suspicion for PSPG. The patient was started on an 18-day prednisone taper with cyclosporine, along with doxycycline and ciprofloxacin.
RESULTS
After 5 days of immunosuppressive treatment, the ulcers visibly converted to healthy granulation tissue and were no longer actively purulent. Following another washout, the dehisced wound edges were reapproximated. At follow-up, the patient had no evidence of PSPG recurrence and continued dilating on schedule. Our patient recovered from PSPG without further complications and a satisfactory aesthetic result.
CONCLUSIONS
This unique case highlights the importance of prompt dermatological consultation, immunosuppression, and avoidance of further pathergy in the setting of suspicion for PSPG.
PubMed: 38846503
DOI: No ID Found -
Eplasty 2024Nearly half a million interbody fusions are estimated to be performed in the US each year, many of which involve complex reconstruction. The ability to limit seroma...
BACKGROUND
Nearly half a million interbody fusions are estimated to be performed in the US each year, many of which involve complex reconstruction. The ability to limit seroma formation is vital to a seamless postoperative recovery.
METHODS
A retrospective review was performed for patients undergoing fusion procedures along with flap reconstruction over a period of 20 months. Cohorts reflect a temporal practice shift where use of hydrolyzed collagen powder (HCP) was initiated for hypothesized seroma prevention. Outcomes and associated metrics were used for intergroup comparison.
RESULTS
The study included 76 patients, of whom 47 were treated with HCP and 29 were not. Control patients had significantly fewer postoperative seromas than experimental ones (6.9% vs 27.7%; = .03). The cohorts had no significant differences in time until final drain removal or in number of spinal levels involved (7.8 vs 7.1 days; = .33, 8.5 vs 8.4 levels; = .90). Rates of wound dehiscence, hematoma, or infection did not differ significantly between control and experimental patients (3.4% vs 12.8%, = .17; 0% vs 0%; and 6.9% vs 10.6%, = .58, respectively).
CONCLUSIONS
The use of HCP led to a 4-fold increase in postoperative seromas in patients undergoing spinal fusion with flap reconstruction. This was regardless of all analyzed demographic and procedural factors, with the exception of age, whereby control patients were found to be on average slightly younger than experimental counterparts.
PubMed: 38846501
DOI: No ID Found -
Frontiers in Plant Science 2024var. , a well-known Chinese medicinal herb, shows a unique physiological trait characterized by the cyclic opening and closing of its anthers after pollen maturation....
var. , a well-known Chinese medicinal herb, shows a unique physiological trait characterized by the cyclic opening and closing of its anthers after pollen maturation. The aim of this study was to explore the implications of this phenomenon on breeding. RNA sequencing coupled with methylation sequencing was used to scrutinize and compare gene expression profiles and methylation alterations in pollen and seeds during anther opening and closing, along with cold exposure. Genes enriched within Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were examined to identify gene clusters susceptible to temperature-related methylation changes in both pollen and seeds. Four pollen treatment models, namely, normal control, "pollen protected from low temperatures," "pollen from just-opened anther," and "pollen from close-blocked anther," were used to produce corresponding seeds via artificial pollination. Subsequently, qRT-PCR was used to validate modifications in the expression patterns of marker genes in pollinated seeds under diverse treatment scenarios. Genes exhibiting significant differences in expression between anthers and normal tissues, along with gene regions linked to methylation variations attributed to low-temperature-treated pollen and seeds, were identified through transcriptomic analysis. Convergence was observed in three signaling pathways: oxidative phosphorylation (ko00190), plant hormone signal transduction (Ko04075), and zeatin biosynthesis (ko00908). Notably, gene clusters prone to temperature-induced methylation changes, such as NADH-ubiquinone oxidoreductase chain 5, plasma membrane ATPase 4, cytochrome c oxidase subunit 2, cis-zeatin O-glucosyltransferase, ABSCISIC ACID-INSENSITIVE 5-like protein 4, and indole-3-acetic acid-amido synthetase (IAAS), were identified. Evaluation using various pollen pollination models revealed altered expression patterns of five dormancy-regulating marker genes: IAAS, sucrose synthase (SUS), gibberellin 2-oxidase (GA2ox), ABA INSENSITIVE 2 (ABI2), and auxin-repressed protein (ARP), in seeds pollinated with pollen from close-blocked anthers, cold-protected pollen, and pollen from freshly opened anthers. The close-blocked anther treatment led to significantly upregulated expression of IAAS, SUS, GA2ox, and ABI2, whereas ARP expression decreased markedly, indicating a propensity toward prolonged seed dormancy. Conversely, in the low-temperature-protected anther model, SUS, ARP, GA2ox, and IAAS exhibited reduced expression levels, whereas the expression of ABI2 was upregulated, overall facilitating seed germination.
PubMed: 38841278
DOI: 10.3389/fpls.2024.1389357 -
Cureus May 2024The decision and timing of surgical exploration of intestinal obstruction depend on the clinical findings and probable etiology of the symptoms. Patients with intestinal...
BACKGROUND
The decision and timing of surgical exploration of intestinal obstruction depend on the clinical findings and probable etiology of the symptoms. Patients with intestinal obstruction often have intra-abdominal hypertension (IAH), which is associated with a poor prognosis.
PURPOSE OF THE STUDY
The purpose of the study is to evaluate the surgical outcomes in patients with intestinal obstruction in relation to intra-abdominal pressure (IAP).
MATERIALS AND METHODS
The study was conducted on 50 patients with intestinal obstruction undergoing surgery. Preoperatively, IAP was measured in all the patients and was allocated into two groups based on the presence or absence of IAP. Patients were assessed for the postoperative length of hospital or ICU stay, surgical site infection, wound dehiscence, and recovery following surgery.
RESULTS
The patients with preoperative IAH had significantly longer postoperative stays, with a median stay of eight days in these patients compared to four days in patients without IAH (p=0.009). A significantly higher number of patients (24%) had gangrenous changes on the bowel wall (p=0.042) and fascial dehiscence (p=0.018) in the group associated with raised IAP. A total of 75% of patients who required ventilator support belonged to the raised IAP group. The mean IAP in patients admitted to the ICU was significantly higher than in patients not admitted to the ICU (p=0.027).
CONCLUSION
Preoperative IAH in intestinal obstruction is a significant factor in predicting the possibility of bowel ischemia with gangrene, perforation, intra-abdominal sepsis, surgical site infections, and prolonged hospital stay. Early surgical exploration and abdominal decompression must be considered in such cases.
PubMed: 38841048
DOI: 10.7759/cureus.59736 -
Cureus May 2024Sternal non-union and fractured sternal wires are rare but devastating complications of median sternotomy for cardiac surgery, and these can lead to chronic pain,...
Sternal Complications Following Coronary Artery Bypass Grafting and Robicsek Repair: Comprehensive Sternal Reconstruction With Sternal Plating and the Use of Novel Biologic Therapies.
Sternal non-union and fractured sternal wires are rare but devastating complications of median sternotomy for cardiac surgery, and these can lead to chronic pain, instability, and impaired quality of life. Patients may present with various symptoms such as clicking sensations, chest wall discomfort, and even respiratory difficulties. The underlying causes are multifactorial, including patient comorbidities, surgical technique, and postoperative management. The treatment options range from conservative measures to complex surgical interventions, such as sternal debridement, rewiring, and reconstruction with rigid fixation systems. Novel therapeutic technologies, including amniotic membranes and platelet-rich plasma, have shown promise in promoting wound healing and reducing complications in these challenging cases. We present the case of a 58-year-old male who underwent coronary artery bypass grafting (CABG) and subsequently developed sternal dehiscence requiring Robicsek repair. Despite undergoing this procedure, the patient experienced poor sternal healing, and hence he was referred to our center, presenting with shortness of breath, pain due to fractured sternal wires, and sternal non-union. The patient underwent a complex sternal reconstruction involving redo full median sternotomy, removal of sternal wires, and sternal plating, along with the application of amniotic membranes and platelet-rich plasma to the sternal wound. The procedure successfully stabilized the sternum. This report highlights the benefits of a multifaceted approach to addressing repeated sternal breakdown following CABG and the potential therapeutic benefits of novel technologies in promoting wound healing.
PubMed: 38841045
DOI: 10.7759/cureus.59719 -
Foot & Ankle Orthopaedics Apr 2024Diabetic foot ulcers (DFUs) are serious complications that induce a high risk of lower extremity amputations and mortality. Compared with the standard of care, few...
BACKGROUND
Diabetic foot ulcers (DFUs) are serious complications that induce a high risk of lower extremity amputations and mortality. Compared with the standard of care, few reports analyzed the outcome of surgical treatment mainly for diabetic toe deformities and ulcers. The aim of this study is to collate evidence on the outcomes of interphalangeal resection arthroplasty (IP-RA) in preventing and treating diabetic toe ulcers distal to the metatarsophalangeal joint.
METHODS
A search strategy has been developed including electronic databases from inception. Only ulcers distal to the metatarsophalangeal joints were included. Noninfected and infected ulcers were also included at any toe location (dorsal/side/plantar). Outcomes were defined as healing rate, time to heal, ulcer recurrence, ulcer transfer, postintervention infection, wound dehiscence, and additional surgeries including amputation. Proportional meta-analysis was conducted for frequency outcomes.
RESULTS
Six observational studies comprising 217 patients with 244 IP-RA procedures were included. The mean follow-up period was 23.4 ± 8.2 months. Weighted frequencies were as follows: healing rate (93.6%), ulcer recurrence frequency (4.3%), ulcer transfer frequency (15.4%), postoperative infection (10.5%), wound dehiscence (17.8%), revision surgery (5%), and amputation rate (3.4%). The mean healing time was 4.3 ± 1.8 weeks.
CONCLUSION
This review suggests that IP-RA is effective in preventing and treating diabetic toe deformities and ulcers with a modest rate of complications for this specific and often challenging clinical presentation.
PubMed: 38840785
DOI: 10.1177/24730114241256373 -
Cureus May 2024Introduction The ideal abdominal wound closure provides strength and a barrier to infection. The major cause of morbidity following any laparotomy is abdominal wound...
Introduction The ideal abdominal wound closure provides strength and a barrier to infection. The major cause of morbidity following any laparotomy is abdominal wound dehiscence. For prompt patient recovery and outcome factors influencing wound healing following mass closure of post-laparotomy, wound dehiscence patients are evaluated in this present study. The aim of the study was to evaluate the outcome and various complications following mass closure of post-laparotomy wound dehiscence. Materials and methods A prospective study was conducted among 50 patients admitted to the Department of General Surgery, Tamil Nadu, India, with wound dehiscence following emergency and elective laparotomy surgeries managed with mass closure during the study period from 2021 to 2022. The chi-square test and Fischer's exact test were done. Results Mass closure of post-laparotomy wound dehiscence was more common among males (74%, n=37) and less common in the age group 20-30 years (12%, n=6). Prolonged bleeding time and clotting time post-surgery were associated with the type of surgery with a significant p-value of 0.007 and 0.001, respectively, by Fischer's exact test. The presence of urine albumin was also associated with the type of surgery with a significant p-value of 0.02. Surgical site infection (postoperative complication) was associated with the type of surgery and operating time with a significant p-value of 0.004 and 0.03, respectively. Conclusion Abdominal wound dehiscence is a serious and challenging postoperative complication that necessitates immediate intervention. Strict postoperative care places emphasis on reducing the risk of wound infection and other factors related to wound dehiscence.
PubMed: 38832180
DOI: 10.7759/cureus.59642 -
EFORT Open Reviews Jun 2024For many decades, patients recovering from wound closure have been instructed not to bathe. Although studies have shown that earlier postoperative bathing does not...
PURPOSE
For many decades, patients recovering from wound closure have been instructed not to bathe. Although studies have shown that earlier postoperative bathing does not increase the risk of wound infection, it remains rare in practice for patients to be allowed earlier postoperative bathing. We performed this meta-analysis to determine how earlier bathing affected rates of wound infection, other complications, and patient satisfaction.
METHODS
This systematic review conforms to PRISMA guidelines. The PubMed, EMBASE, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception dates to December 31, 2022. We estimated pooled values for the efficacy of trial of earlier bathing versus delayed bathing using the odds ratio and their associated 95% CI, and we used the I 2 statistic to assess heterogeneity between studies contributing to these estimates.
RESULTS
Of the 1813 articles identified by our search, 11 randomized controlled trials including 2964 patients were eligible for inclusion. The incidence of wound infection did not differ significantly between the earlier bathing and delayed bathing groups, nor did rates of other wound complications such as redness and swelling, or wound dehiscence. However, the incidence of hematoma in the delayed bathing group was higher than in the earlier bathing group. Reported patient satisfaction was significantly higher in the earlier bathing group.
CONCLUSION
The medical community, health authorities, and government should create and disseminate clinical practice guidelines to guide patients to evidence-based beneficial treatment.
PubMed: 38828978
DOI: 10.1530/EOR-23-0062 -
Clinical Case Reports Jun 2024Vaginal cuff dehiscence post-hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel...
KEY CLINICAL MESSAGE
Vaginal cuff dehiscence post-hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel infarction. Consider second-look laparotomy in cases of uncertain bowel viability.
ABSTRACT
Vaginal cuff dehiscence (VCD) is a rare but potentially life-threatening complication following a hysterectomy characterized by the separation of the vaginal vault. This condition, which may result in vaginal evisceration (VE), presents a significant risk of pelvic contents, particularly the small bowel, protruding into the vagina. Early diagnosis and prompt surgical intervention are paramount to prevent severe complications, including bowel infarction, obstruction, and peritonitis. Although VCD and VE are rare, they require urgent surgical management to avoid adverse outcomes. We reported a case of small bowel evisceration in a woman with a history of total abdominal hysterectomy 6 months ago. VCD and VE are very rare but life-threatening complications of hysterectomy. Discussing the symptoms with patients who have multiple risk factors is crucial to avoid severe sequels following hysterectomy. Based on our experience, performing a second-look laparotomy is a reliable approach to ensure the viability of the intestinal loop. However, it will likely increase the risk of infection.
PubMed: 38827941
DOI: 10.1002/ccr3.8910 -
Innovative Surgical Sciences Mar 2024Various techniques of closure of surgical incisions have been described ranging from various suture materials, staples and tapes to adhesive compounds. Cyanoacrylate is...
OBJECTIVES
Various techniques of closure of surgical incisions have been described ranging from various suture materials, staples and tapes to adhesive compounds. Cyanoacrylate is an adhesive compound available for surgical incision closure. Although sutures have been the preferred universal choice for surgical incision closure, glue is gaining popularity in specific places like pediatric injuries, facial injuries, laparoscopic incision closure, etc. This study aimed to compare the results between the application of cyanoacrylate and conventional suturing.
METHODS
In this randomized control study, patients were divided into two groups of 100 each. The surgical incisions were closed using cyanoacrylate glue in Group A patients and polyamide (EthilonTM 2-0) in Group B patients. Post-operative pain was assessed using Visual Analogue Scale on the first, third, and seventh day. The wounds were evaluated for complications on post-op days 1, 3, 7, and 30 using the ASEPSIS score. Cosmetic outcome was assessed at the end of first month using the Modified Hollander Cosmesis Scale.
RESULTS
Post-operative pain was significantly less in the glue group on days 1, 3, and 7. Wound infection with dehiscence occurred in 4 cases (4 %) in Group A and one patient (1 %) in Group B, which was statistically insignificant. There was no significant difference in cosmetic outcomes in either Group.
CONCLUSIONS
Cyanoacrylate is a good alternative to sutures in skin closure of clean and clean-contaminated surgical wounds.
PubMed: 38826631
DOI: 10.1515/iss-2023-0060