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Journal of Oncology 2019The profunda artery perforator (PAP) flap was first applied in breast reconstruction in 2010 by Robert J. Allen. It provided an alternative for autologous breast... (Review)
Review
BACKGROUND
The profunda artery perforator (PAP) flap was first applied in breast reconstruction in 2010 by Robert J. Allen. It provided an alternative for autologous breast reconstruction in addition to traditional donor sites. Currently, literature reporting its microsurgical safety and efficacy is relatively sparse and heterogeneous. To clarify the evidence regarding microsurgical safety and efficacy of PAP flap in breast reconstruction, which may contribute to future surgical decision-making.
METHODS
Multiple databases were systematically searched by two independent reviewers. The result was statistically analyzed with Meta command of R GUI 3.5.1. The proportions with 95% confidence intervals (CIs) were calculated by using random-effect model.
RESULTS
There were 12 studies including 516 PAP flaps meeting the inclusion criteria. The pooled surgical success rate was 99% (95% CI: 97%-100%) and overall rate of complications was 23% (95% CI: 18%-27%). The most common individual complication was wound dehiscence with incidence of 6% (95% CI: 4%-9%). The seroma rate was 2% (95%CI: 0%-6%). The hematoma rate was 1% (95% CI: 0%-2%). The partial necrosis rate was 2% (95% CI: 0%-5%). The rate of total flap loss was 1% (95% CI: 0%-3%).
CONCLUSION
To date, this study is the first meta-analysis of microsurgical efficacy and safety evaluation of the PAP flap in breast reconstruction. This present work confirmed that the PAP flap is safe and reliable in breast reconstruction with high success rate, but a relatively low complication rate. Moreover, it might be more than an alternative to the deep inferior epigastric perforator flap (DIEP) in microsurgical breast reconstruction in selected patients.
PubMed: 31467545
DOI: 10.1155/2019/9506720 -
International Wound Journal Dec 2020We performed an updated meta-analysis to compare the efficacy of the zipper device and sutures for wound closure after surgery. A computerised literature search was... (Meta-Analysis)
Meta-Analysis
We performed an updated meta-analysis to compare the efficacy of the zipper device and sutures for wound closure after surgery. A computerised literature search was performed for published trials in PubMed, Web of Science, the Cochrane Library, and Google Scholar. Two reviewers independently scrutinised the trials, extracted data, and assessed the quality of trials. The primary outcome was surgical site infections (SSI). The secondary outcomes were wound dehiscence, total wound complications, wound closure time, and scar score. Statistical analysis was performed in the Stata 12.0. Of the 130 citations, eight trials (1207 participants) met eligibility criteria and were included. The zipper device achieved a lower SSI rate (RR: 0.63, [95% CI: 0.41-0.96, P = 0.032]), a shorter wound closure time (SMD: -8.53 [95% CI: -11.93 to -5.13, P = 0.000]) and a better scar score (SMD: 0.42 [95% CI: 0.22-0.62, P = 0.000]) than sutures. No significant difference was shown in the incidence of wound dehiscence and total wound complications. Therefore, the zipper device provides the advantages of anti-infection, time-saving, and cosmesis for wound closure.
Topics: Humans; Surgical Procedures, Operative; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures; Wound Closure Techniques
PubMed: 32846047
DOI: 10.1111/iwj.13460 -
The Cochrane Database of Systematic... Feb 2014Most surgical procedures involve a cut in the skin, allowing the surgeon to gain access to the surgical site. Most surgical wounds are closed fully at the end of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most surgical procedures involve a cut in the skin, allowing the surgeon to gain access to the surgical site. Most surgical wounds are closed fully at the end of the procedure; this review focuses on these closed wounds. There are many ways to close the surgical incision, for example, using sutures (stitches), staples, tissue adhesives or tapes. Skin sutures can be continuous or interrupted. In general, continuous sutures are usually subcuticular and can be absorbable or non-absorbable, while interrupted sutures are usually non-absorbable and involve the full thickness of the skin - although some surgeons do use absorbable interrupted sutures.
OBJECTIVES
To compare the benefits and harms of continuous compared with interrupted skin closure techniques in participants undergoing non-obstetric surgery.
SEARCH METHODS
In August 2013 we searched the following databases: Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; and EBSCO CINAHL.
SELECTION CRITERIA
We included only randomised controlled trials (RCTs) that compared skin closure using continuous sutures with skin closure using interrupted sutures, irrespective of whether there were differences in the nature of the suture materials used in the two groups. We included all relevant RCTs in the analysis, irrespective of language of publication, publication status, publication year or sample size.
DATA COLLECTION AND ANALYSIS
Two review authors independently identified the trials and extracted data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing binary outcomes between the groups, and calculated the mean difference (MD) with 95% CI for comparing continuous outcomes. We performed meta-analysis using a fixed-effect model and a random-effects model. We performed intention-to-treat analysis whenever possible.
MAIN RESULTS
We included five RCTs with a total of 827 participants. Outcomes were available for 730 participants (384 participants randomised to continuous sutures and 346 participants to interrupted sutures). All the trials were of unclear or high risk of bias. The participants underwent abdominal or groin operations. The only outcomes reported in the trials were superficial surgical site infection, superficial wound dehiscence (breakdown) and length of hospital stay. Other important outcomes such as quality of life, long-term patient outcomes and use of healthcare resources were not reported in these trials.Overall, 6.5% (39/602 participants, four trials) developed superficial surgical site infections. There was no significant difference between the groups in the proportion of participants who developed superficial surgical site infections (RR 0.73; 95% CI 0.40 to 1.33). A total of 23 participants (23/625 (3.7%), four trials) developed superficial wound dehiscence. Twenty-two of the 23 participants belonged to the interrupted suture group.The proportion of participants who developed superficial wound dehiscence was statistically significantly lower in the continuous suture group compared to the interrupted suture group (RR 0.08; 95% CI 0.02 to 0.35). Most of these wound dehiscences were reported in two recent trials in which the continuous skin suture groups received absorbable subcuticular sutures while the interrupted skin suture groups received non-absorbable transcutaneous sutures. The non-absorbable sutures were removed seven to nine days after surgery in the interrupted sutures groups whilst sutures in the comparator groups were not removed, being absorbable. The continuous suture technique with absorbable suture does not require suture removal and provides support for the wound for a longer period of time. This may have contributed to the difference between the two groups in the proportion of participants who developed superficial wound dehiscence. There was no significant difference in the length of the hospital stay between the two groups (MD -1.40 days; 95% CI -7.14 to 4.34).
AUTHORS' CONCLUSIONS
Superficial wound dehiscence may be reduced by using continuous subcuticular sutures. However, there is uncertainty about this because of the quality of the evidence. Besides, the nature of the suture material used may have led to this observation, as the continuous suturing technique used suture material that did not need to be removed, whereas the comparator used interrupted (non-absorbable) sutures that did need to be removed. Differences in the methods of skin closure have the potential to affect patient outcomes and use of healthcare resources. Further well-designed trials at low risk of bias are necessary to determine which type of suturing is better.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Groin; Humans; Length of Stay; Randomized Controlled Trials as Topic; Surgical Wound Dehiscence; Surgical Wound Infection; Suture Techniques
PubMed: 24526375
DOI: 10.1002/14651858.CD010365.pub2 -
European Journal of Vascular and... Jul 2017Cardiac and vascular surgery benefit from percutaneous interventions. Arteriotomy closure devices (ACDs) enable minimally invasive access to the common femoral artery... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Cardiac and vascular surgery benefit from percutaneous interventions. Arteriotomy closure devices (ACDs) enable minimally invasive access to the common femoral artery (CFA). The objective of this review was to assess the differences between ACDs and surgical cut down (SCD) of the CFA regarding the number of complications, duration of surgery (DOS), and hospital length of stay (HLOS).
DESIGN
A systematic literature search with predefined search terms was performed using MEDLINE, Embase, and the Cochrane Library (2000-2016). All studies reporting on ACD and SCD for a puncture of the CFA of at least 12 French (Fr.) were assessed for eligibility.
METHODS
Included were randomised controlled trials and cohort studies comparing both techniques. Patient characteristics, exclusion criteria, and conversion rates were evaluated. Complications, DOS, and HLOS were compared.
MATERIALS
A total of 17 studies were included for meta-analysis, describing 7889 vascular access sites; four studies were randomised trials, two studies reported from a prospective database, and 11 studies reported retrospective cohorts.
RESULTS
ACD was associated with fewer post-operative seromas (odds ratio [OR] 0.15, 95% confidence interval [CI] 0.06-0.35), less wound dehiscence (OR 0.14, 95% CI 0.03-0.78), and fewer surgical site infections (OR 0.38, 95% CI 0.23-0.63). Post-operative pseudoaneurysms were significantly more common in the ACD group (OR 3.83, 95% CI 1.55-9.44). In five of 17 studies, DOS and HLOS were not reduced in the ACD group. When all studies reporting a mean DOS and/or HLOS were compared in a non-parametric analysis, neither was significantly different.
CONCLUSION
This meta-analysis favours ACD regarding the number of wound complications compared with SCD in endovascular aneurysm repair, thoracic endovascular aneurysm repair, and transcatheter aortic valve repair. Treatment duration (DOS and HLOS) was not reduced in ACD. The differences are of limited clinical significance and with this equivocal quality of evidence, the ACD may be considered safe for CFA access in suitable patients.
Topics: Blood Vessel Prosthesis Implantation; Endovascular Procedures; Equipment Design; Female; Femoral Artery; Hemorrhage; Hemostatic Techniques; Humans; Male; Odds Ratio; Punctures; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome; Vascular Closure Devices
PubMed: 28438400
DOI: 10.1016/j.ejvs.2017.03.015 -
Medicina (Kaunas, Lithuania) Feb 2023: Anecdotal evidence suggested variation in practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the...
: Anecdotal evidence suggested variation in practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the course prescribed (before, after or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics, and the use of loading doses. This review aims to investigate this disparity of practices and the absence of global and local recent consensus on the most appropriate antibiotic interventions around invasive dental procedures. : Following PRISMA-P methodology, a systematic review of randomised controlled clinical trials was designed, reviewed, and entered on the PROSPERO website prior to commencement. Ethics approval was gained from the University of Wolverhampton Committee. Searches were performed using PubMed, Science Directâ„¢, and the Cochrane Database, plus the bibliographies of studies identified. They investigated studies examining the efficacy and safety of any antibiotic regimen tested, independent of regimen used, versus a placebo, control, or no therapy, on outcomes in post third molar extraction. : The primary outcome of interest was postoperative infection and secondary outcomes were other post-surgical related complications of infectious nature and antibiotic adverse events. Sixteen RCTs were identified that met the selection criteria. Antibiotic use was reported to be safe, causing few adverse events. Meta-analysis of infection events showed antibiotics reduced the risk of an infection by 69%, but routine use for prophylaxis in uncomplicated procedures was not supported, and their role in patients with comorbidities or impaired immunity remains controversial. The effect on the incidence of dry socket showed no difference based upon regimen used. No significant benefit was found with respect to reduction of intraoral inflammation, wound dehiscence, haematoma, and lymphadenopathy. : The effect on postoperative pain reduction was inconclusive. Routine use of antibiotics around M3 extraction procedures is not supported, but their use in the presence of co-morbidities and or immunosuppression remains controversial to be confirmed by future studies.
Topics: Humans; Anti-Bacterial Agents; Antibiotic Prophylaxis; Meta-Analysis as Topic; Molar, Third; Postoperative Complications
PubMed: 36984426
DOI: 10.3390/medicina59030422 -
The Cochrane Database of Systematic... Jul 2007Closed suction drainage systems are frequently used to drain fluids, particularly blood, from surgical wounds. The aim of these systems is to reduce the occurrence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Closed suction drainage systems are frequently used to drain fluids, particularly blood, from surgical wounds. The aim of these systems is to reduce the occurrence of wound haematomas and infection.
OBJECTIVES
To evaluate the effectiveness of closed suction drainage systems for orthopaedic surgery.
SEARCH STRATEGY
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2006), and contacted the Cochrane Wounds Group. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), and MEDLINE (1966 to March 2006). Articles of all languages were considered.
SELECTION CRITERIA
All randomised or quasi-randomised trials comparing the use of closed suction drainage systems with no drainage systems for all types of elective and emergency orthopaedic surgery.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality, using a nine item scale, and extracted data. Where appropriate, results of comparable studies were pooled.
MAIN RESULTS
Thirty-six studies involving 5464 participants with 5697 surgical wounds were identified. The types of surgery involved were hip and knee replacement, shoulder surgery, hip fracture surgery, spinal surgery, cruciate ligament reconstruction, open meniscectomy and fracture fixation surgery. Pooling of results indicated no statistically significant difference in the incidence of wound infection, haematoma, dehiscence or re-operations between those allocated to drains and the un-drained wounds. Blood transfusion was required more frequently in those who received drains. The need for reinforcement of wound dressings and the occurrence of bruising were more common in the group without drains.
AUTHORS' CONCLUSIONS
There is insufficient evidence from randomised trials to support the routine use of closed suction drainage in orthopaedic surgery. Further randomised trials with larger patient numbers are required for different operations before definite conclusions can be made for all types of orthopaedic operations.
Topics: Hematoma; Humans; Orthopedic Procedures; Postoperative Complications; Randomized Controlled Trials as Topic; Suction; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 17636687
DOI: 10.1002/14651858.CD001825.pub2 -
Arthroplasty Today Aug 2021Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid...
BACKGROUND
Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events.
METHODS
A systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity.
RESULTS
Forty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates.
CONCLUSIONS
Considerable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
PubMed: 34527801
DOI: 10.1016/j.artd.2021.05.015 -
PloS One 2017Anorectal malformations (ARMs) are one of the commonest anomalies in neonates. Both laparoscopically assisted anorectal pull-through (LAARP) and posterior sagittal... (Comparative Study)
Comparative Study Meta-Analysis Review
Laparoscopically Assisted Anorectal Pull-Through versus Posterior Sagittal Anorectoplasty for High and Intermediate Anorectal Malformations: A Systematic Review and Meta-Analysis.
OBJECTIVE
Anorectal malformations (ARMs) are one of the commonest anomalies in neonates. Both laparoscopically assisted anorectal pull-through (LAARP) and posterior sagittal anorectoplasty (PSARP) can be used for the treatment of ARMs. The aim of this systematic review and meta-analysis is to compare these two approaches in terms of intraoperative and postoperative outcomes.
METHODS
MEDLINE, Embase, Web of Science and the Cochrane Library were searched from 2000 to August 2016. Both randomized and non-randomized studies, assessing LAARP and PSARP in pediatric patients with high/intermediate ARMs, were included. The primary outcome measures were operative time, length of hospital stay and total postoperative complications. The second outcome measures were rectal prolapse, anal stenosis, wound infection/dehiscence, anorectal manometry, Kelly's clinical score, and Krickenbeck classification. The quality of the randomized and non-randomized studies was assessed using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa scale (NOS) respectively. The quality of evidence was assessed by GRADEpro.
RESULTS
From 332 retrieved articles, 1, 1, and 8 of randomized control, prospective and retrospective studies, respectively, met the inclusion criteria. The randomized clinical trial was judged to be of low risk of bias, and the nine cohort studies were of moderate to high quality. 191 and 169 pediatric participants had undergone LAARP and PSARP, respectively. Shorter hospital stays, less wound infection/dehiscence, higher anal canal resting pressure, and a lower incidence of grade 2 or 3 constipation were obtained after LAARP compared with PSARP group values. Besides, the LAARP group had marginally less total postoperative complications. However, the result of operative time was inconclusive; meanwhile, there was no significant difference in rectal prolapse, anal stenosis, anorectal manometry, Kelly's clinical score and Krickenbeck classification.
CONCLUSION
For pediatric patients with high/intermediate anorectal malformations, LAARP is a better option compared with PSARP. However, the quality of evidence was very low to moderate.
Topics: Anal Canal; Anorectal Malformations; Humans; Infant, Newborn; Laparoscopy; Length of Stay; Postoperative Complications; Rectum; Treatment Outcome
PubMed: 28099464
DOI: 10.1371/journal.pone.0170421 -
PloS One 2024Wound healing monitoring for abnormality identification and intervention is crucial to securing a successful surgical outcome. Indices have been used to summarize the...
UNLABELLED
Wound healing monitoring for abnormality identification and intervention is crucial to securing a successful surgical outcome. Indices have been used to summarize the degree of healing. Given the increasing frequency of regenerative procedures which preserve dentition and implant stability, and the higher esthetic demands, an appraisal of the available indices is needed to identify the current knowledge gap. This study aimed to systematically review published oral wound healing indices and scores.
MATERIALS AND METHODS
A complete literature electronic search in 5 databases was conducted by two reviewers. A combination of keywords related to oral wound healing was used.
RESULTS
A total of 11 articles were included in the evaluation of various procedures (conventional periodontal procedures, guided tissue regeneration, soft tissue reconstruction procedures, and tooth extractions), at different time points (1 day to 12 weeks), with a focus on diverse clinical signs and symptoms. Frequently evaluated parameters included wound dehiscence/epithelialization (91%), tissue color (redness) (73%), suppuration (55%), swelling/edema (55%), and hemostasis (55%). Other less commonly used parameters include esthetics-related and patient-centered outcomes.
CONCLUSION
The available indices evaluate a diverse group of subjective clinical signs and symptoms to estimate the underlying biological healing events and assess the degree of clinical success. The majority of the included indices are not validated. Quantitative and objective subclinical parameters including blood perfusion, biomaterial stability, and completeness of epithelialization, are needed for customized wound healing care and better outcome prediction.
Topics: Humans; Wound Healing; Plastic Surgery Procedures; Tooth; Biocompatible Materials
PubMed: 38330054
DOI: 10.1371/journal.pone.0290050 -
Journal of Visceral Surgery Sep 2017Operative injury to the hepatic artery is a serious complication of pancreaticoduodenectomy and guidelines to manage this complication are lacking. (Review)
Review
BACKGROUND
Operative injury to the hepatic artery is a serious complication of pancreaticoduodenectomy and guidelines to manage this complication are lacking.
METHODS
A systematic search performed in PubMed database identified eleven studies overall including 20 patients having sustained injury to the hepatic artery during pancreaticoduodenectomy (n=18) or total pancreatectomy (n=2). One further unpublished personal observation following pancreaticoduodenectomy was also included.
RESULTS
Sixteen of 21 patients (76%) experienced serious complications including liver necrosis/abscess (n=14), acute liver failure (n=3), and biliary anastomotic dehiscence (n=6). Eleven patients (52%) were reoperated and 5 patients died (24%). Arterial injury was recognized and repaired immediately in five patients, four recovering uneventfully and one dying from acute liver failure (20%). In contrast delayed or conservative treatment in 16 patients was associated with serious early morbidity in 15 patients (94%), leading to death in 4 patients and late biliary complications in four others.
CONCLUSIONS
Accidental interruption of arterial flow to the liver during pancreaticoduodenectomy often results in serious short and long-term consequences. Immediate restoration of arterial flow is indicated whenever technically feasible and may prevent early life-threatening complications as well as late biliary stenosis.
Topics: Hepatic Artery; Humans; Intraoperative Complications; Pancreatectomy; Pancreaticoduodenectomy; Postoperative Complications; Vascular System Injuries
PubMed: 28668523
DOI: 10.1016/j.jviscsurg.2017.05.013