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Revista Do Colegio Brasileiro de... 2017The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of... (Review)
Review
The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.
Topics: Humans; Negative-Pressure Wound Therapy; Treatment Outcome
PubMed: 28489215
DOI: 10.1590/0100-69912017001001 -
JSLS : Journal of the Society of... 2015To evaluate whether the route and surgical technique by which hysterectomy is performed influence the incidence of vaginal cuff dehiscence.
BACKGROUND AND OBJECTIVES
To evaluate whether the route and surgical technique by which hysterectomy is performed influence the incidence of vaginal cuff dehiscence.
METHODS
We performed a retrospective analysis of total hysterectomy cases performed at Brigham and Woman's Hospital or Faulkner Hospital during 2009 through 2011.
RESULTS
During the study period, 2382 total hysterectomies were performed; 23 of these (0.96%) were diagnosed with cuff dehiscence, and 4 women had recurrent dehiscence. Both laparoscopic (odds ratio, 23.4; P = .007) and robotic (odds ratio, 73; P = .0006) hysterectomies were associated with increased odds of cuff dehiscence in a multivariate regression analysis. The type of energy used during colpotomy, mode of closure (hand sewn, laparoscopic suturing, or suturing assisted by a device), and suture material did not differ significantly between groups; however, continuous suturing of the cuff was a protective factor (odds ratio, 0.24; P = .03). Women with dehiscence had more extensive procedures, as well as an increased incidence of additional major postoperative complications (17.4% vs 3%, P = .004).
CONCLUSION
The rate of cuff dehiscence in our cohort correlates with the current literature. This study suggests that the risk of dehiscence is influenced mainly by the scope and complexity of the surgical procedure. It seems that different colpotomy techniques do not influence the rate of cuff dehiscence; however, continuous suturing of the cuff may be superior to interrupted suturing.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Robotic Surgical Procedures; Surgical Wound Dehiscence; Suture Techniques
PubMed: 25901104
DOI: 10.4293/JSLS.2013.00351 -
Head & Face Medicine Sep 2022This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve...
PURPOSE
This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures.
METHODS
In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP).
RESULTS
The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment.
CONCLUSION
To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
Topics: Endoscopy; Humans; Optic Nerve; Sphenoid Bone; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 36057720
DOI: 10.1186/s13005-022-00336-z -
Dentistry Journal May 2022Implant soft tissue dehiscences compromise not only the aesthetics of the supported restorations but implant survival in the long run. The aim of this narrative review... (Review)
Review
Implant soft tissue dehiscences compromise not only the aesthetics of the supported restorations but implant survival in the long run. The aim of this narrative review was to briefly present the causative factors of buccal peri-implant soft tissue dehiscences (PSTDs), how these are classified, and the current therapeutic approaches. Implant malposition and the thin peri-implant phenotype are the two major determinants for the occurrence of PSTDs, but other risk factors have also been identified. The most common surgical procedure for treating PSTDs is the split-thickness coronally advanced flap combined with either a connective tissue graft or acellular dermal matrix materials. However, depending on the class and subtype of the dehiscence, the combination of surgical techniques with modifications in the restoration may further ameliorate the final result. In general, within a five-year follow-up period, most techniques lead to a satisfactory aesthetic result, although full coverage of the implant/abutment surface is not always achievable, especially in more extended lesions.
PubMed: 35621539
DOI: 10.3390/dj10050086 -
Langenbeck's Archives of Surgery Sep 2022Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to...
PURPOSE
Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to explore the impact of a structured introduction of guidelines for abdominal wall closure on the rates of incisional hernia and wound dehiscence.
METHODS
All procedures performed via a midline incision in 2010-2011 and 2016-2017 at Capio St Göran's Hospital were identified and assessed for complications and risk factors.
RESULTS
Six hundred two procedures were registered in 2010-2011, and 518 in 2016-2017. Four years after the implementation of new guidelines, 93% of procedures were performed using the standardized technique. There was no significant difference in the incidence of incisional hernia or wound dehiscence between the groups. In multivariate Cox proportional hazard analysis, BMI > 25, wound dehiscence, and postoperative wound infection were found to be independent risk factors for incisional hernia (all p < 0.05). In multivariate logistic regression analysis, male gender and chronic obstructive pulmonary disease were risk factors for wound dehiscence (both p < 0.05).
CONCLUSIONS
The present study failed to show a significant improvement in rates of incisional hernia and wound dehiscence after the introduction of Small Stitch Small Bites. When introducing a new standardized technique for closing the abdomen, education and structural implementation of guidelines may have an impact in the long run. The risk factors identified should be taken into consideration when closing a midline incision to identify patients with high risk.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Follow-Up Studies; Humans; Incisional Hernia; Laparotomy; Male; Retrospective Studies; Surgical Wound Dehiscence; Suture Techniques
PubMed: 35577975
DOI: 10.1007/s00423-022-02530-8 -
Annals of Medicine Dec 2021The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may...
BACKGROUND
The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may improve preoperative diagnostic accuracy in pregnant women with a caesarean scar. This study aimed to evaluate the ultrasonographic features of uterine scar dehiscence in pregnant women and maternal and neonatal outcomes.
MATERIALS AND METHODS
This was a retrospective review of the records of 23 women with a previous caesarean section found to have uterine scar dehiscence during surgery. The integrity and thickness of the lower uterine segment were recorded, ultrasonographic features were evaluated, and maternal and infant outcomes were analysed.
RESULTS
Of the 23 cases of uterine scar dehiscence, six were detected by preoperative ultrasonography, while 17 were missed. The ultrasonographic features of the 23 cases of uterine dehiscence included anechoic areas protruding through the caesarean section scar with an intact serosal layer (4/23), disappearance of the muscular layer (2/23), and a thinner lower uterine segment (17/23). There were no cases of maternal or neonatal mortality. One woman chose to undergo pregnancy termination.
CONCLUSION
Preoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality. However, the maximum benefit can only be obtained by scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence.KEY MESSAGESPreoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality.Scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence could be beneficial.Even when uterine dehiscence is detected by ultrasound during the second trimester, conservative management via strict observation alone is also feasible.
Topics: Adult; Cesarean Section; Cicatrix; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Retrospective Studies; Risk Assessment; Surgical Wound Dehiscence; Ultrasonography; Uterine Rupture; Vaginal Birth after Cesarean
PubMed: 34309465
DOI: 10.1080/07853890.2021.1959049 -
North American Spine Society Journal Oct 2020Wound complications, including dehiscence and surgical site infections, following spinal surgery have the potential to be devastating both to the patient and to the...
BACKGROUND
Wound complications, including dehiscence and surgical site infections, following spinal surgery have the potential to be devastating both to the patient and to the hospital system. Complications can occur in a wide range of patients including diabetics, those of low or high BMI and those of old age. Obese patients and those with increased subcutaneous fat are at particularly high risk for wound complications, which may be mitigated through use of local flap reconstruction by a Plastic Surgeon.
CASE DESCRIPTION
A 28 year-old female with morbid obesity presents with multiple lumbar transverse process fractures and complex sacral and pelvic fractures requiring closed reduction and percutaneous fixation of the pelvic ring followed by posterior spinal fusion. The patient was closed tension-free by the neurosurgery team and ultimately dehisced requiring consultation and management by Plastic Surgery.
OUTCOME
The patient underwent debridement and reconstruction with a gluteus maximus myocutaneous flap advancement without complication.
CONCLUSIONS
Wound management after spinal surgery is a complex problem, which may be prophylaxed through early identification of high-risk patients and preoperative consultation of Plastic Surgery. Patients with increased thickness of subcutaneous fat are at particularly high risk for postoperative complications, including infection and dehiscence, secondary to increased tissue manipulation and necrosis.
PubMed: 35141597
DOI: 10.1016/j.xnsj.2020.100029 -
Folia Morphologica 2020The study of the association between superior semicircular canal and other dehiscences in the temporal bone.
BACKGROUND
The study of the association between superior semicircular canal and other dehiscences in the temporal bone.
MATERIALS AND METHODS
We have studied computed tomography of radiologically diagnosed people with superior or posterior semicircular canal dehiscences, in four health centres. In addition, we have studied one isolated human temporal bone, one skull and one cadaver head belonging to the collection of the Department of Human Anatomy and Histology of the University of Zaragoza that had dehiscence in the superior semicircular canal.
RESULTS
The most frequent association that we observed was between superior semicircular canal dehiscence and tegmen tympani dehiscence (37.33%). Three cases (two clinical cases and one isolated temporal bone) showed multiple associated dehiscences (tegmen tympani, mastoid antrum, posterior semicircular canal, internal auditory canal, glenoid cavity, tympanum bone and geniculate ganglion) associated with superior semicircular canal dehiscence.
CONCLUSIONS
When the superior semicircular canal dehiscence is associated to other in the petrous bone (tegmen tympani, mastoid antrum, posterior semicircular canal, internal auditory canal) could be grouped into the same syndrome called "otic capsule syndrome", since they have the same origin and common aetiology (otic capsule).
Topics: Ear, Middle; Humans; Semicircular Canal Dehiscence; Semicircular Canals; Temporal Bone; Tomography, X-Ray Computed
PubMed: 31886879
DOI: 10.5603/FM.a2019.0138 -
PloS One 2013'Taishanzaoxia' fruit rapid softening and dehiscence during ripening stage and this process is very sensitive to endogenous ethylene. In this study, we cloned five...
'Taishanzaoxia' fruit rapid softening and dehiscence during ripening stage and this process is very sensitive to endogenous ethylene. In this study, we cloned five ethylene signal transcription factors (ZMdEIL1, ZMdEIL2, ZMdEIL3, ZMdERF1 and ZMdERF2) and one functional gene, ZMdPG1, encoding polygalacturonase that could loose the cell connection which associated with fruit firmness decrease and fruit dehiscence to illustrate the reasons for this specific fruit phenotypic and physiological changes. Expression analysis showed that ZMdERF1 and ZMdEIL2 transcription were more abundant in 'Taishanzaoxia' softening fruit and dehiscent fruit and their expression was inhibited by an ethylene inhibitor 1-methylcyclopropene. Therefore, ZMdERF1 and ZMdEIL2 expression were responses to endogenous ethylene and associated with fruit softening and dehiscence. ZMdPG1 expression was induced when fruit softening and dehiscence but this induction can be blocked by 1-MCP, indicating that ZMdPG1 was essential for fruit softening and dehiscence and its expression was mediated by the endogenously occurred ethylene. ZMdPG1 overexpression in Arabidopsis led to silique early dehiscence while suppressing ZMdPG1 expression by antisense ZMdPG1 prevented silique naturally opening. The result also suggested that ZMdPG1 related with the connection between cells that contributed to fruit softening and dehiscence. ZMdERF1 was more closely related with ethylene signaling but it was not directly regulated the ZMdPG1, which might be regulated by the synergic pattern of ethylene transcription factors because of both the ZMdERF1 and ZMdERF2 could interact with ZMdEIL2.
Topics: Arabidopsis; Base Sequence; DNA, Plant; Ethylenes; Fruit; Genes, Plant; Malus; Molecular Sequence Data; Plant Proteins; Plants, Genetically Modified; Promoter Regions, Genetic; Transcription Factors; Transcriptome
PubMed: 23527016
DOI: 10.1371/journal.pone.0058745 -
The Angle Orthodontist May 2016To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the...
OBJECTIVE
To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the same patients using cone beam computed tomography (CBCT).
MATERIALS AND METHODS
CBCT scans of 44 patients (26 males, 18 females; mean age, 14.04 ± 3.81 years) with unilateral cleft lip and palate (UCLP) were assessed to define dehiscences and fenestrations of the anterior teeth in both cleft and noncleft sides of the UCLP patients and a control group of noncleft patients (51 patients; 21 males, 30 females; mean age, 14.52 ± 1.16 years). Data were analyzed using Pearson's χ(2) and Student's t-test.
RESULTS
The prevalence of dehiscences at the maxillary central incisors, lateral incisors, and canines teeth were 43.2%, 70.6%, and 34.1% on the cleft side and 22.7%, 53.1%, and 27.3% on the noncleft side of UCLP patients, and 13.7%, 7.8%, and 13.7% in controls, respectively (statistically no difference between the sides of cleft patients). The cleft patients had a statistically significantly higher prevalence of dehiscences than did the controls on both the cleft and noncleft sides (P < .05), except for the maxillary central incisors. Fenestrations for these teeth were significantly more common on the cleft side in UCLP patients compared with controls (P < .05), whereas the difference for maxillary lateral incisors was not statistically significant.
CONCLUSIONS
Patients with UCLP showed a higher prevalence of dehiscence and fenestration defects around the maxillary anterior teeth.
Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Female; Humans; Male; Retrospective Studies
PubMed: 26284755
DOI: 10.2319/042715-289.1