-
Cureus May 2023Background In this study, we aimed to determine if there is a difference in the rates of wound dehiscence, delayed union, nonunion, and unanticipated surgery after the...
Background In this study, we aimed to determine if there is a difference in the rates of wound dehiscence, delayed union, nonunion, and unanticipated surgery after the use of bioabsorbable local antibiotic-delivery systems (LADS), specifically comparing antibiotic-impregnated calcium sulfate pellets (Osteoset-T, Wright Medical Technology Inc., Arlington, TN, USA, hereafter referred to as beads) and chitosan sponge (Sentrex BioSponge, Bionova Medical, Germantown, TN, USA, hereafter referred to as sponges) in the management of acute and chronic extremity wounds. Methodology We conducted a retrospective comparative cohort study in the setting of a level 1 trauma center. All patients who received either beads or sponges as an adjunct to surgical debridement from January 2010 to December 2017 were included, and 136 patients met the inclusion criteria. The intervention studied was extremity wounds that were treated with bioabsorbable LADS, either beads or sponges. The main outcome measurement was wound dehiscence and the need for unanticipated surgery. Results Of the 136 patients in the study cohort, 78% (106/136) were treated with beads, and 22% (30/136) were treated with sponges. Of the 136 patients, 50 (37%) experienced wound dehiscence, and 49 patients required unanticipated surgery. Overall, 62% (31/50) of patients with wound dehiscence and 67.4% (33/49) of patients requiring unanticipated surgery were seen in the bead cohort (p = 0.0001 and 0.025, respectively). However, in multivariable analyses, we found that the odds of having wound dehiscence and undergoing unanticipated surgery were, respectively, 4.9 (p = 0.001) and 2.8 (p = 0.021) times more likely to occur in the sponge than in the bead group. Conclusions Sentrex sponges appear to be associated with higher rates of wound dehiscence and the need for unanticipated surgery compared to Osteoset beads.
PubMed: 37273303
DOI: 10.7759/cureus.38490 -
The Journal of International Advanced... Jun 2023Postoperative adhesion is an important complication after middle-ear surgeries. Although many materials have been tried to prevent this complication, the use of Poly...
BACKGROUND
Postoperative adhesion is an important complication after middle-ear surgeries. Although many materials have been tried to prevent this complication, the use of Poly (dl-lactide ε-caprolactone) as an anti-adhesive material after middle-ear surgery has not yet been reported. The aim of this study was to evaluate the anti-adhesive effect of poly (dl-lactide ε-caprolactone) on the ears of rats with middle-ear mucosa damage.
METHODS
In our study, 14 Wistar albino rats and 28 ears in total were used. The rats were randomly divided into 4 groups. Middle ear mucosa damage was performed in all groups with a transcanal approach under otomicroscopy in sterile conditions. The effects of poly (dl-lactide ε-caprolactone), silicone sheet, and absorbable gelatin sponge were compared histologically with the secondary healing group. In addition, hearing evaluation was performed before the procedure and on the 28th postoperative day.
RESULTS
No significant difference was observed in transient otoacoustic emission and distortion product otoacoustic emissions tests performed before and after the surgical procedure when the groups were compared. While adhesion was observed in the tympanic membrane in the absorbable gelatin sponge group, no adhesion was observed in the other groups. In the absorbable gelatin sponge group, increased fibroblastic activity, inflammation, and neovascularization were observed in the middle-ear mucosa. No significant difference was observed in silicone sheet, poly (dl-lactide ε-caprolactone), and control groups in terms of fibroblastic activity, inflammation, and neovascularization.
CONCLUSION
It can be concluded that absorbable poly (dl-lactide ε-caprolactone) is nonototoxic and biocompatible with the rat's middle ear cavity by short-term evaluation.
Topics: Animals; Rats; Absorbable Implants; Rats, Wistar; Ear, Middle; Silicones; Inflammation; Mucous Membrane
PubMed: 37272637
DOI: 10.5152/iao.2023.22883 -
Orthopaedic Surgery Jul 2023Bone cement leakage is a major complication of percutaneous vertebroplasty (PVP) while treating Kümmell's disease and it is a focus of close attention during the... (Randomized Controlled Trial)
Randomized Controlled Trial
Feasibility Analysis of the Bone Cement-Gelatine Sponge Composite Intravertebral Prefilling Technique for Reducing Bone Cement Leakage in Stage I and II Kümmell's Disease: A Prospective Randomized Controlled Trial.
OBJECTIVE
Bone cement leakage is a major complication of percutaneous vertebroplasty (PVP) while treating Kümmell's disease and it is a focus of close attention during the surgical procedure. The study aimed to investigate whether pre-injecting a composite of bone cement and gelatine sponge (the "bone cement-gelatine sponge composite") before injecting bone cement during PVP aids in lowering the leakage rate in stage I and II Kümmell's disease.
METHODS
This prospective analysis evaluated 74 patients with stage I and II Kümmell's disease who underwent PVP treatment at our hospital from December 2019 to December 2021. The participants were divided randomly into groups based on whether the bone cement-gelatine sponge composite was used during the surgery. The two groups were the bone cement-gelatine sponge composite group (GS group, comprising 37 patients) and the no bone cement-gelatine sponge composite group (N-GS group, comprising 37 patients). The independent samples t-test and chi-square test were employed to compare general information, operative time, cement injection volume, intraoperative bleeding, and bone cement leakage between the two groups. Additionally, the visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior vertebral height ratio (AVHR), and the kyphotic Cobb angle were compared between the two groups at the preoperative, 2 days postoperative, and 6 months postoperative stages using repeated measures analysis of variance.
RESULTS
All patients were followed up for more than 6 months, with an average of (11.19 ± 2.21) months. No significant differences were observed in terms of the operative time, cement injection volume, and intraoperative bleeding between the two groups (P > 0.05). The incidence of bone cement leakage in the N-GS group (32.43%) was significantly higher than that in the GS group (5.41%), and the difference was statistically significant (P < 0.05). The VAS score and ODI of the two groups at postoperative 2 days and 6 months improved significantly (P < 0.05). The AVHR and kyphotic Cobb angle were corrected to a certain extent (P < 0.05); however, no significant difference was observed between the two groups (P > 0.05).
CONCLUSION
The bone cement-gelatine sponge composite intravertebral prefilling technique can lower bone cement leakage in stage I and II Kümmell's disease and can also relieve pain and improve vertebral body height.
Topics: Humans; Spinal Fractures; Vertebroplasty; Bone Cements; Feasibility Studies; Treatment Outcome; Kyphosis; Spondylosis; Fractures, Compression; Retrospective Studies; Osteoporotic Fractures; Kyphoplasty
PubMed: 37254237
DOI: 10.1111/os.13764 -
JPGN Reports May 2023Surgical repair of type C esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is complicated by an anastomotic leak in 10%-30% of cases with associated...
Surgical repair of type C esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is complicated by an anastomotic leak in 10%-30% of cases with associated morbidity. A novel procedure in the pediatric population, endoscopic vacuum-assisted closure (EVAC), accelerates the healing of esophageal leaks by using the effects of VAC therapy, including fluid removal and stimulation of granulation tissue formation. We report 2 additional cases of chronic esophageal leak treated with EVAC in EA patients. The first is a patient with a previously repaired type C EA/TEF and left congenital diaphragmatic hernia complicated by an infected diaphragmatic hernia patch erosion into the esophagus and colon. Additionally, we discuss a second case using EVAC for early anastomotic leak following type C EA/TEF repair in a patient who was later found to have a distal congenital esophageal stricture.
PubMed: 37200717
DOI: 10.1097/PG9.0000000000000314 -
Eplasty 2023Periprosthetic infections are a debilitating complication of alloplastic breast reconstruction. Local antibiotic delivery for prophylaxis and infection clearance has... (Review)
Review
BACKGROUND
Periprosthetic infections are a debilitating complication of alloplastic breast reconstruction. Local antibiotic delivery for prophylaxis and infection clearance has been used by other surgical specialties but rarely in breast reconstruction. Because local delivery can maintain high antibiotic concentrations with lower toxicity risk, it may be valuable for infection prophylaxis or salvage in breast reconstruction.
METHODS
A systematic search of the Embase, PubMed, and Cochrane databases was performed in January 2022. Primary literature studies examining local antibiotic delivery systems for either prophylaxis or salvage of periprosthetic infections were included. Study quality and bias were assessed using the validated MINORS criteria.
RESULTS
Of 355 publications reviewed, 8 met the predetermined inclusion criteria; 5 papers investigated local antibiotic delivery for salvage, and 3 investigated infection prophylaxis. Implantable antibiotic delivery devices included polymethylmethacrylate, calcium sulfate, and collagen sponges impregnated with antibiotics. Non-implantable antibiotic delivery methods used irrigation with antibiotic solution into the breast pocket. All studies indicated that local antibiotic delivery was either comparable or superior to conventional methods in both the salvage and prophylaxis settings.
CONCLUSIONS
Despite varied sample sizes and methodologies, all papers endorsed local antibiotic delivery as a safe, effective method of preventing or treating periprosthetic infections in breast reconstruction.
PubMed: 37187864
DOI: No ID Found -
Diagnostics (Basel, Switzerland) Apr 2023Both musculoskeletal gossypibomas and chronic expanding hematomas have been rarely reported; the reports that do exist are usually case reports. Our objective is to...
Both musculoskeletal gossypibomas and chronic expanding hematomas have been rarely reported; the reports that do exist are usually case reports. Our objective is to demonstrate problematic imaging diagnostics of an unusual presentation mimicking a malignant lesion. We report the case of a 47-year-old man who underwent bone graft harvesting from the iliac crest for spinal fusion due to scoliosis at 18 years of age, and 29 years later, he developed a growing, painful tumor at the original donor site (a bone defect in the iliac crest). It was challenging to differentiate a hematoma from a malignant tumor based solely on clinical and radiological workup, including an ultrasound-guided needle biopsy focused on viable tissue. The definitive diagnosis of a gossypiboma with a chronic expanding hematoma was based on histopathological assessment after wide surgical resection-a chronic expanding hematoma with multiple foamy macrophages and giant cells engulfing foreign material (original surgical hemostatic sponge).
PubMed: 37174983
DOI: 10.3390/diagnostics13091592 -
Cancers May 2023The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and...
The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.
PubMed: 37174122
DOI: 10.3390/cancers15092657 -
Cureus Apr 2023A retained foreign body (RFB) is a rare but possible complication of surgery. Among the most common retained foreign bodies are sponges, which may include lap pads and...
A retained foreign body (RFB) is a rare but possible complication of surgery. Among the most common retained foreign bodies are sponges, which may include lap pads and gauze pieces. Surgical never events are errors in medical care that are identifiable and preventable but have serious consequences for the patient, making it an important problem in terms of the safety and credibility of a healthcare facility. They also pose a major medicolegal threat to healthcare organizations and a diagnostic challenge for surgeons. Herein, we present the case of a 35-year-old woman who presented with signs and symptoms of acute intestinal obstruction. She revealed a history of Caesarean section 11 months prior. She had a stormy postoperative course then and had to undergo a diagnostic laparoscopy for pus aspiration three months after surgery, where no finding other than pus was reported. Upon presentation at our tertiary care center, she was examined and found to have an RFB for 11 months. She was managed surgically with successful laparoscopic removal of the gossypiboma and consequent resolution of all her symptoms. Though rare, the possibility of an RFB, especially after open surgery, should be kept in mind when diagnosing patients who present with pain, mass in the abdomen, or symptoms of an infection. Laparotomy is the mainstay of treatment for gossypiboma, but successful laparoscopic removal of the RFB provides a definite treatment with the super-added benefits of laparoscopy. Laparoscopic removal of gossypiboma has been reported in the literature and demonstrated in our tertiary care center.
PubMed: 37168161
DOI: 10.7759/cureus.37185 -
Turkish Neurosurgery 2024To explore the clinical efficacy of percutaneous vertebroplasty (PVP) combined with the polymethyl methacrylate-gelatin sponge (PMMA-GS) complex in the treatment of...
Percutaneous Vertebroplasty with the Polymethyl Methacrylate - Gelatin Sponge Complex in the Treatment of Patients with Osteoporotic Vertebral Compression Fractures Accompanied by Superior Endplate Injurie.
AIM
To explore the clinical efficacy of percutaneous vertebroplasty (PVP) combined with the polymethyl methacrylate-gelatin sponge (PMMA-GS) complex in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs) accompanied by superior endplate injuries MATERIAL and METHODS: A total of 77 OVCF patients with superior endplate injuries who were treated with PVP from January 2017 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and injured vertebral height ratio at one day (1d) before surgery, three days (3d) after surgery, and one year (1y) after surgery were compared between both groups. Besides, the surgical duration, PMMA (polymethyl methacrylate) injection volume, PMMA leakage rate, and adjacent vertebral fracture rate were compared between these two groups.
RESULTS
Among these patients, there were 39 individuals treated with PVP combined with the PMMA-GS complex (the observation group) and 38 individuals treated with PVP (the control group). These patients in both groups completed the surgery successfully. There were no such complications as pulmonary embolism, hemopneumothorax, rib fracture, spinal cord nerve injuries, and vital organ injuries. In these two groups, the VAS score, ODI, and injured vertebral height ratio 1d before surgery were significantly different from those 3d and 1y after surgery (p < 0.05). However, there was no significant difference in these indexes between both groups (p > 0.05). There was no significant difference in the surgical duration and PMMA injection volume between both groups (p > 0.05). However, the PMMA leakage rate and adjacent vertebral fracture rate in the observation group were significantly lower than those in the control group (p < 0.05).
CONCLUSION
Compared with traditional PVP, this therapy PVP combined with PMMA-GS complex in the treatment of OVCF patients with superior endplate injuries can effectively reduce the incidence of PMMA leakage and the incidence of adjacent vertebral fracture rate.
Topics: Humans; Polymethyl Methacrylate; Vertebroplasty; Bone Cements; Spinal Fractures; Fractures, Compression; Gelatin; Retrospective Studies; Osteoporotic Fractures; Kyphoplasty; Treatment Outcome
PubMed: 37144650
DOI: 10.5137/1019-5149.JTN.41797-22.2