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Foot & Ankle International May 2024The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon...
BACKGROUND
The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair.
METHODS
A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables ( < .05) were included in a multivariate regression.
RESULTS
Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, = .03) and VTE (OR = 0.32, = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, < .01) and shorter TTS with reruptures (OR = 0.02, .02).
CONCLUSION
Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications.
LEVEL OF EVIDENCE
Level IV, case series.
PubMed: 38798118
DOI: 10.1177/10711007241250021 -
The American Journal of Case Reports May 2024BACKGROUND Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe...
BACKGROUND Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe complications, notably puerperal sepsis. In this report, we present a case that exemplifies the onset of puerperal sepsis and the emergence of intra-abdominal abscesses attributed to uterine dehiscence following a lower segment cesarean section (LSCS). CASE REPORT Our patient, a 28-year-old woman in her third pregnancy, underwent LSCS 1 week earlier. Subsequently, she returned to the hospital with lower abdominal pains, fever, and malodorous vaginal discharge. Computed tomography (CT) scan of whole abdomen verified uterine dehiscence and pus collection at the subhepatic region and right paracolic gutter. After referral to a specialized hospital, laboratory findings indicated an elevated white blood cell count and alkaline phosphatase levels, and coagulation abnormalities. She underwent an exploratory laparotomy, which unveiled uterine dehiscence, abscesses, and adhesions, necessitating a total abdominal hysterectomy and abdominal toileting. Pus culture analysis identified the presence of E. coli, which was susceptible to ampicillin/sulbactam. Complications were encountered after surgery, including wound dehiscence and pus re-accumulation. Successful management involved vacuum dressings and percutaneous drainage. Eventually, her condition improved and she was discharged, without additional complications. CONCLUSIONS This report underscores the importance of considering cesarean scar dehiscence as a diagnosis in women with previous cesarean deliveries who present during subsequent pregnancies with symptoms such as abdominal pain or abdominal sepsis. Diagnostic tools, such as CT, play pivotal roles, and the timely performance of an exploratory laparotomy is paramount when suspicion arises.
Topics: Humans; Female; Adult; Cesarean Section; Surgical Wound Dehiscence; Pregnancy; Abdominal Abscess
PubMed: 38796696
DOI: 10.12659/AJCR.943027 -
Journal of Clinical Medicine May 2024: The global popularity of gluteal augmentation has risen significantly, driven by the desire for enhanced buttocks size and shape to align with individual patient...
: The global popularity of gluteal augmentation has risen significantly, driven by the desire for enhanced buttocks size and shape to align with individual patient preferences. This increased demand has prompted extensive research into diverse techniques and their safety. : A retrospective analysis was conducted to evaluate the outcomes of a gluteal augmentation technique involving ultrasound-assisted liposuction, submuscular implants, and ultrasound-guided fat grafting. Our study involved a review of the medical records of 50 consecutive patients who underwent this procedure between February 2020 and July 2023. : Data related to patient demographics, the quantity of fat grafts, and any complications were analyzed. Additionally, a brief survey was conducted to evaluate patient satisfaction. The Polytech implants were used in forty-four patients, and Sebbin implants in six. The implant size varied from 285 to 560. Most of the Polytech implants were 390 cc (25/44; 56.8%). Two patients had a minor infection at the incision sites and subsequent wound dehiscence. No revision surgeries were needed. : The presented technique incorporates ultrasonic liposuction, submuscular silicone implants, and ultrasound-guided fat grafting to achieve safe and aesthetic gluteal enhancements. This method is especially suitable for patients looking to augment both the central and lateral areas of the buttocks, particularly when they lack adequate fat tissue for augmentation through fat grafting. With the addition of ultrasound guidance, the fat grafting step is significantly safer.
PubMed: 38792398
DOI: 10.3390/jcm13102856 -
Diagnostics (Basel, Switzerland) May 2024The impact of radiation on wound healing after metastatic spine surgery remains an active area of research. In patients undergoing metastatic spine surgery, we sought to...
INTRODUCTION
The impact of radiation on wound healing after metastatic spine surgery remains an active area of research. In patients undergoing metastatic spine surgery, we sought to (1) assess the relationship between preoperative and/or postoperative radiation on wound complications, and (2) evaluate the relationship between the timing of postoperative radiation and wound complications.
METHODS
A single-center, retrospective, cohort study of patients undergoing metastatic spine surgery was conducted from 2010 to 2021. The primary exposure variable was the use/timing of radiation. Radiation included both external beam radiotherapy (EBRT) and stereotactic body radiotherapy (SBRT). Patients were trichotomized into the following groups: (1) preoperative radiation only, (2) postoperative radiation only, and (3) no radiation. The primary outcome variable was wound complications, which was defined as dehiscence requiring reoperation, infection requiring antibiotics, or infection requiring surgical debridement. Multivariable logistic/linear regression controlled for age, tumor size, primary organ of origin, and the presence of other organ metastases.
RESULTS
A total of 207 patients underwent surgery for extradural spinal metastasis. Participants were divided into three groups: preoperative RT only (N = 29), postoperative RT only (N = 91), and no RT (N = 178). Patients who received postoperative RT only and no RT were significantly older than patients who received preoperative RT only ( = 0.009) and were less likely to be white ( < 0.001). No other significant differences were found in basic demographics, tumor characteristics, or intraoperative variables. Wound-related complications occurred in two (6.9%) patients with preoperative RT only, four patients (4.4%) in postoperative RT only, and 11 (6.2%) patients with no RT, with no significant difference among the three groups ( = 0.802). No significant difference was found in wound-related complications, reoperation, and time to wound complications between patients with preoperative RT only and no RT, and between postoperative RT only and no RT ( > 0.05). Among the postoperative-RT-only group, no difference in wound complications was seen between those receiving SBRT (5.6%) and EBRT (4.1%) ( > 0.999). However, patients who received preoperative RT only had a longer time to wound complications in comparison to those who received postoperative RT only (43.5 ± 6.3 vs. 19.7 ± 3.8, = 0.004). Regarding timing of postoperative RT, the mean (SD) time to RT was 28.7 ± 10.0 days, with a median of 28.7 (21-38) days. No significant difference was found in time to postoperative RT between patients with and without wound complications (32.9 ± 12.3 vs. 29.0 ± 9.7 days, = 0.391).
CONCLUSION
In patients undergoing metastatic spine surgery, a history of previous RT or postoperative RT did not significantly affect wound complications. However, those with previous RT prior to surgery had a longer time to wound complications than patients undergoing postoperative RT only. Moreover, timing of RT had no impact on wound complications, indicating that earlier radiation may be safely employed to optimize tumor control without fear of compromising wound healing.
PubMed: 38786357
DOI: 10.3390/diagnostics14101059 -
Heliyon May 2024Dehiscence is a common complication of corneal transplant surgery involving separating the graft from the host eye. The present article aims to investigate fundamental...
Dehiscence is a common complication of corneal transplant surgery involving separating the graft from the host eye. The present article aims to investigate fundamental insights into the mechanical and structural aspects of the graft-host junction (GHJ) of a graft that survived in a patient for 13 years after penetrating keratoplasty (PK). Additionally, it adopts the sutur retention strength (SRS) test procedure defined in ISO:7198-2016 and aims to provide a comprehensive test protocol to study the biomechanics of the GHJ in extracted PK buttons. A 9 mm corneal button with GHJ was extracted from a 46-year-old patient who underwent PK 13 years back. The strength of the GHJ was quantified using the SRS test. Corresponding control results were obtained from the SRS tests of a corneoscleral button with no history of any refractive procedure. Birefringence, histological, and scanning electron microscopy (SEM) imaging were used to visualize the microstructural details of the GHJ. The strength of the GHJ was observed to be ten times lower than the native cornea. Histopathological features, such as fragmented Bowman's layer, and fibrosis with a clear demarcation line between host and graft tissue, were observed at the GHJ, suggesting a weak bond across the GHJ. The low strength of the GHJ in PK indicates the high susceptibility of the GHJ towards wound dehiscence.
PubMed: 38784531
DOI: 10.1016/j.heliyon.2024.e30871 -
Cureus Apr 2024Sternal dehiscence and other post-sternotomy complications, viz. superficial and deep sternal wound infection, mediastinitis, and sternal instability increase the risk...
A Randomized Study Evaluating Clinical Efficacy and Safety of Trusteel® and Ethisteel® Surgical Steel Sutures for Sternal Closure in Subjects Undergoing Surgical Procedures by Sternotomy.
INTRODUCTION
Sternal dehiscence and other post-sternotomy complications, viz. superficial and deep sternal wound infection, mediastinitis, and sternal instability increase the risk of mortality. Sternotomy closure with steel sutures results in a low complication rate. Therefore, this study compared the clinical equivalence of Trusteel (Healthium Medtech Limited, Bengaluru, India) and Ethisteel (Ethicon, Johnson & Johnson, Cincinnati, USA) surgical steel sutures for sternal closure following median sternotomy.
METHODS
The primary endpoint of this prospective, single-blind, multicentric, two-arm, randomized (1:1) study (April 2021-April 2023) was a comparison of the proportion of subjects having sternal dehiscence within 26 weeks of the median sternotomy closure between Trusteel (n=33) and Ethisteel (n=34) groups. Secondary endpoints comprised an assessment of intraoperative suture handling, the incidence of mortality and other complications of sternal closure, operative time, intensive care unit (ICU)/hospital stay, return to normal day-to-day activities and work, subject satisfaction and general well-being, and adverse events in both groups. A statistically significant result between the groups was considered at p<0.05.
RESULTS
No incidence of sternal dehiscence or other post-operative complications were recorded. A significant difference (p<0.05) in the stretch capacity of Trusteel and Ethisteel sutures was noted; otherwise, ease of passage, knot holding, knot security, knot tie-down smoothness, and memory of both sutures had comparable ratings. Operative time, ICU/hospital stay, and return to normal day-to-day activities and work were comparable between the groups. Improvement in post-operative functional abilities, quality of life, and health status was evident in both groups and was comparable.
CONCLUSION
Trusteel surgical steel suture is clinically equivalent to Ethisteel surgical steel suture and is safe and effective for sternal closure following median sternotomy.
PubMed: 38779234
DOI: 10.7759/cureus.58715 -
Clinics (Sao Paulo, Brazil) 2024Approximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Approximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed recovery compared with men. Breast size is related to operative wound complications, such as incisional pain, sternum dehiscence, and infection, which may affect hospital costs due to prolonged hospital stays.
OBJECTIVE
To evaluate breast size and operative wound complications and the effect of breast support on the incidence of pain, infection, and quality of life in women after coronary artery bypass grafting.
METHOD
Women were randomly assigned to one of three groups: group A (surgical breast support), group B (ordinary breast support), and group C (no-support). Observations were taken daily between the second and seventh postoperative days and at 30, 60, and 180 days. Pain was assessed using the Short-Form 36 Health Survey (SF36) for quality of life and a verbal numerical scale. The authors used the nonparametric Kruskal-Wallis and Friedman tests to examine variance. The authors used the Pearson correlation coefficient or the Spearman correlation for correlations between variables. A multivariate study was conducted to evaluate the occurrence of infection, and the logistic regression model with "stepwise" variable selection was used. A linear regression model with the "stepwise" variable selection was also used for hospitalization. The authors used SPSS 17.0 software for Windows, with a significance level of p < 0.05.
RESULTS
There was no difference in pain evaluation between the groups in 190 women (p > 0.05). When comparing quality of life, there was a statistically significant difference in the functional capacity domain at 30 and 60 days, with group A having the best functional capacity (p < 0.05). The larger the breast size, the longer the hospital stay (p < 0.001) and the higher the probability of infection (p = 0.032). Patients with a history of stroke had a 3.8 higher incidence of infection (p = 0.040).
CONCLUSION
The use of surgical support did not affect acute pain or sternal infection rate in the 6-month follow-up. However, it was effective in the functional capacity domain 30 days after surgery and maintained at 60 days.
Topics: Humans; Female; Coronary Artery Bypass; Quality of Life; Middle Aged; Surgical Wound Infection; Pain, Postoperative; Aged; Breast; Time Factors
PubMed: 38772100
DOI: 10.1016/j.clinsp.2024.100370 -
JPRAS Open Jun 2024Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator... (Review)
Review
Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
PubMed: 38770115
DOI: 10.1016/j.jpra.2024.03.013 -
Cell Transplantation 2024Pressure injuries, or pressure ulcers, are a common problem that may lead to infections and major complications, besides being a social and economic burden due to the...
Pressure injuries, or pressure ulcers, are a common problem that may lead to infections and major complications, besides being a social and economic burden due to the costs of treatment and hospitalization. While surgery is sometimes necessary, this also has complications such as recurrence or wound dehiscence. Among the newer methods of pressure injury treatment, advanced therapies are an interesting option. This study examines the healing properties of bone marrow mononuclear cells (BM-MNCs) embedded in a plasma-based scaffold in a mouse model. Pressure ulcers were created on the backs of mice (2 per mouse) using magnets and assigned to a group of ulcers that were left untreated (Control, n = 15), treated with plasma scaffold (Plasma, n = 15), or treated with plasma scaffold containing BM-MNC (Plasma + BM-MNC, n = 15). Each group was examined at three time points (3, 7, and 14 days) after the onset of treatment. At each time point, animals were subjected to biometric assessment, bioluminescence imaging, and tomography. Once treatment had finished, skin biopsies were processed for histological and wound healing reverse transcription polymerase chain reaction (RT-PCR) array studies. While wound closure percentages were higher in the Plasma and Plasma + BM-MNC groups, differences were not significant, and thus descriptive data are provided. In all individuals, the presence of donor cells was revealed by immunohistochemistry on posttreatment onset Days 3, 7, and 14. In the Plasma + BM-MNC group, less inflammation was observed by positron emission tomography-computed tomography (PET/CT) imaging of the mice at 7 days, and a complete morphometabolic response was produced at 14 days, in accordance with histological results. A much more pronounced inflammatory process was observed in controls than in the other two groups, and this persisted until Day 14 after treatment onset. RT-PCR array gene expression patterns were also found to vary significantly, with the greatest difference noted between both treatments at 14 days when 11 genes were differentially expressed.
Topics: Animals; Wound Healing; Pressure Ulcer; Mice; Disease Models, Animal; Bone Marrow Cells; Male; Tissue Scaffolds; Mice, Inbred C57BL; Bone Marrow Transplantation; Leukocytes, Mononuclear
PubMed: 38761062
DOI: 10.1177/09636897241251619 -
Trials May 2024The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial...
Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial.
BACKGROUND
The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed.
METHODS
We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery.
DISCUSSION
This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates.
TRIAL REGISTRATION
UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.
Topics: Humans; Prospective Studies; Abdominal Wound Closure Techniques; Abdominal Wall; Suture Techniques; Surgical Wound Infection; Digestive System Surgical Procedures; Incisional Hernia; Elective Surgical Procedures; Treatment Outcome; Incidence; Wound Healing; Equivalence Trials as Topic; Randomized Controlled Trials as Topic; Time Factors
PubMed: 38760769
DOI: 10.1186/s13063-024-08167-w