-
Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2018The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes.
BACKGROUND
The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes.
METHODS
The medical records of patients who experienced blunt traumatic wound dehiscence after PK between 1995 and 2015 were analyzed retrospectively. The incidence and etiology of the trauma, the time interval between PK and globe rupture, final graft clarity, best-corrected visual acuity, complications, secondary surgeries, and factors potentially affecting wound dehiscence size were recorded.
RESULTS
This study included a total of 39 patients with a mean age of 42.66±16.66 years, of whom 23 patients were male and 16 patients were female. The incidence of wound dehiscence was 2.3%. The mean interval between the PK procedure and wound dehiscence was 25.91±47.24 months and the mean follow-up time was 34.43±51.02 months. The most common trauma mechanism was force with a blunt object (53.8%) and the most frequent site of wound dehiscence was the temporal quadrant (30.8%), the wound ranging from 30° to 270° in size. The patients were divided into 4 groups according to wound dehiscence size. As the size of the wound dehiscence size increased, the male ratio increased, wound dehiscence was more commonly located in the nasal and superior quadrants, lens injury and posterior segment complications were more frequent, and graft transparency was achieved at a lower rate.
CONCLUSION
Traumatic wound dehiscence after PK is rare, but may lead to serious, lifelong consequences, including eye loss. Patients should be well informed about the risks and potential sequelae of wound dehiscence.
Topics: Adult; Eye Injuries; Female; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Retrospective Studies; Surgical Wound Dehiscence; Wounds, Nonpenetrating
PubMed: 30516257
DOI: 10.5505/tjtes.2018.44450 -
Scientific Reports Sep 2021Longitudinal trends on traumatic cataract wound dehiscence are scant. In this study, we present the characteristics of traumatic cataract wound dehiscence using...
Longitudinal trends on traumatic cataract wound dehiscence are scant. In this study, we present the characteristics of traumatic cataract wound dehiscence using 15 years of longitudinal trend in one of the largest medical centers in Taiwan for a period when cataract surgeries were gradually shifting from extracapsular cataract extraction (ECCE) to phacoemulsification. All patients with a prior cataract surgery who suffered from blunt open globe trauma between 2001 and 2015 at a tertiary referral center in Taiwan were included. The number of cases per year; type of prior cataract surgery; visual acuity (VA); mechanism and place of injury were analyzed. The risk factors associated with final VA were investigated in patients followed up for ≥ 1 month. Seventy-six eyes of 75 patients were included and all of them were traumatic cataract wound dehiscence with a prior ECCE (65 eyes) or phacoemulsification. The most common mechanism and place of injury was fall and at home in both cataract surgical types. The mean log of the minimal angle resolution (logMAR) of final VA was 2.15 ± 0.88 (ECCE) and 1.61 ± 0.83 (phacoemulsification) (P = .026). The most significant risk factors associated with worse final VA were retinal detachment at the initial visit and low ocular trauma score (both P < .001). Long-term visual outcome of phacoemulsification wound dehiscence was better than that of ECCE wound after a blunt trauma.
Topics: Accidental Falls; Accidental Injuries; Aged; Aged, 80 and over; Cataract Extraction; Eye Injuries; Female; Humans; Male; Middle Aged; Surgical Wound Dehiscence; Visual Acuity
PubMed: 34521923
DOI: 10.1038/s41598-021-97723-4 -
International Wound Journal Jun 2014Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since... (Review)
Review
Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since development of negative pressure wound therapy (NPWT), new indications have been consistently added to the original field of application. Recently, NPWT has been applied directly over high-risk closed surgical incisions. Review of the literature indicates that this therapy has shown positive effects on incisions after total ankle replacement or calcaneal fractures, preventing haematoma and wound dehiscence. In those cases reduced swelling, decreased pain and healing time of the wound were seen. Additionally, NPWT applied on incisions after acetabular fractures showed a decreased rate of infection and wound healing problems compared with published infection rates. Even after total hip arthroplasty, incisional NPWT reduced incidence of postoperative seroma and improved wound healing. In patients with tibial plateau, pilon or calcaneus fractures requiring surgical stabilisation after blunt trauma, reduced risk of developing acute and chronic wound dehiscence and infection was observed when using incisional NPWT. To conclude, incisional NPWT can help to reduce risk of delayed wound healing and infection after severe trauma and orthopaedic interventions.
Topics: Humans; Negative-Pressure Wound Therapy; Orthopedic Procedures; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 24851728
DOI: 10.1111/iwj.12252 -
Wounds : a Compendium of Clinical... Dec 2021Achilles tendon rupture is a common injury requiring surgical repair. Re-ruptures, infections, delayed wound healing, and hematomas have been reported postoperatively.
INTRODUCTION
Achilles tendon rupture is a common injury requiring surgical repair. Re-ruptures, infections, delayed wound healing, and hematomas have been reported postoperatively.
OBJECTIVE
This case series described the use of ultraportable negative pressure wound therapy (NPWT) and compression bandaging following postoperative dehiscence of Achilles tendon repair.
MATERIALS AND METHODS
Retrospective records were reviewed to identify patients who underwent wound management for Achilles tendon dehiscence between January 2014 and January 2018. Patient demographics, wound size at first and last visit, number of visits, and previous treatment data were extracted. Wound management included wound irrigation, surgical debridement, and application of silver dressings, as needed. Therapy was transitioned to ultraportable NPWT with twice-weekly dressing changes. When possible, patients with an ankle-brachial index greater than 0.8 received multilayer, multicomponent compression. Treatment response was evaluated using a wound imaging system at 2-week to 4-week intervals for a total of 24 weeks.
RESULTS
Nine male patients with a mean age of 69.7 years presented for care. One patient sustained injury during sports activities, and the other 8 patients sustained injuries resulting from household accidents. Six patients achieved complete wound closure. Three patients achieved a mean 90% wound closure. No adverse effects were observed during treatment with NPWT and compression therapy.
CONCLUSIONS
In the current study, ultraportable NPWT and compression bandaging were found to be effective in the management of wounds with critical local vascularity. Larger, randomized controlled studies are necessary to fully assess the potential clinical benefit of NPWT and compression therapy in the management of postoperative wounds of the Achilles tendon.
Topics: Achilles Tendon; Aged; Humans; Male; Negative-Pressure Wound Therapy; Retrospective Studies; Rupture; Tendon Injuries
PubMed: 35100134
DOI: No ID Found -
Wounds : a Compendium of Clinical... Dec 2020The treatment of complex wounds often requires multiple surgical debridements and, eventually, reconstruction with skin grafts or flaps. Topical negative pressure...
BACKGROUND
The treatment of complex wounds often requires multiple surgical debridements and, eventually, reconstruction with skin grafts or flaps. Topical negative pressure therapy with a vacuum-assisted closure device can achieve wound healing with a reduction in healing time and easier management of the wound.
OBJECTIVE
With a step-by-step closure protocol developed by the authors from July 2017 to the present, this case series highlights the advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d).
MATERIALS AND METHODS
The authors report the treatment of 13 patients undergoing emergency abdominal surgery. In total, 5 patients (38.46%) had hollow bowel perforation, 4 patients (30.77%) had intestinal occlusion, 3 patients had cancer (23.08%), and 1 patient (7.69%) underwent extensive ileal resection due to intestinal infarction.
RESULTS
The use of NPWTi-d reduced the number of dressing changes compared with saline-soaked gauze dressings. Instillation resulted in faster and better wound bed cleansing compared with traditional dressings. Exudate management was better, and the average complete wound closure time was faster than with traditional dressings. The step-by-step closure protocol made it possible to accelerate wound healing; in synergy with NPWTi-d, tension at the edges of the middle third of the wound, especially in the xipho-pubic wounds, had reduced significantly.
CONCLUSIONS
The synergistic action of step-by-step closure and NPWTi-d obtain excellent results in management of wound dehiscence, even in patients with muscle fascia defect and loop exposure.
Topics: Bandages; Debridement; Humans; Negative-Pressure Wound Therapy; Therapeutic Irrigation; Wound Healing
PubMed: 33476292
DOI: No ID Found -
Medicine Jul 2022Obesity is a risk factor for total knee arthroplasty (TKA). Wound dehiscence and surgical site infections (SSIs) are the main complications of TKA in patients with...
Negative pressure wound therapy reduces the incidence of postoperative wound dehiscence and surgical site infections after total knee arthroplasty in patients with obesity.
Obesity is a risk factor for total knee arthroplasty (TKA). Wound dehiscence and surgical site infections (SSIs) are the main complications of TKA in patients with obesity. They can profoundly affect patients because they often require readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue. This study aims to assess the incidence of wound dehiscence and SSIs in patients with obesity undergoing TKA after the routine use of NPWT. This sduty enrolled adult patients with obesity who underwent TKA within 8 years. A total of 360 adult patients with obesity (NPWT: 150, non-NPWT: 210) underwent TKA, and the baseline characteristics were similar between the 2 groups. Compared with the non-NPWT group, the NPWT group had a 50% lower incidence of wound dehiscence (3.33% vs 9.52%; P < .05) and a significantly lower incidence of SSIs (11.33% vs 25.24%; P < .05), including prosthetic joint infection (4.0% vs 10.0%; P < .05) and superficial wound infection (7.33% vs 15.24%; P < .05). In addition, the NPWT group had a lower need to return to the operating room for new interventions for any reason (2.67% vs 9.05%; P = .0107) than the non-NPWT group. Conventional incision NPWT can significantly reduce the incidence of wound dehiscence and SSIs in patients with obesity after TKA.
Topics: Adult; Arthroplasty, Replacement, Knee; Humans; Incidence; Negative-Pressure Wound Therapy; Obesity; Surgical Wound; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 35801735
DOI: 10.1097/MD.0000000000029641 -
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 -
Acta Ortopedica Mexicana 2022surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection.
INTRODUCTION
surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection.
OBJECTIVE
presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate.
CASE PRESENTATION
39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months.
CONCLUSION
although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.
Topics: Male; Adult; Humans; Surgical Wound Dehiscence; Fracture Fixation, Internal; Fractures, Open; Wound Healing; Joint Dislocations; Bone Plates; Ulna Fractures; Treatment Outcome; Surgical Wound Infection
PubMed: 37669659
DOI: No ID Found -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2016The aim of this study was to evaluate risks and consequences of traumatic wound dehiscence after penetrating keratoplasty (PK).
BACKGROUND
The aim of this study was to evaluate risks and consequences of traumatic wound dehiscence after penetrating keratoplasty (PK).
METHODS
Data regarding 34 eyes of 34 patients who were treated for traumatic wound dehiscence after PK between 1995 and 2014 were studied. Patient records were reviewed for type and time of insult, corrected distance visual acuity (CDVA), clinical presentation signs, operative method, and outcome.
RESULTS
The interval between PK and trauma ranged from 1 month to 100 months, with median of 14 months. Median age at trauma was 31.5 years (range: 5-81 years). Wound dehiscence occurred at donor-recipient interface in all patients. In 58.8% of patients, extent of dehiscence was ≥6 clock hours. Most frequent type of trauma was blunt trauma by hand/finger (35.2%). Median CDVA before and just after trauma were 0.5 logMAR (range: 0.1-3.0 logMAR) and 3.0 logMAR (range: 0.7-3.0 logMAR), respectively. Wound dehiscence was managed with primary wound closure in all patients. Most frequent additional surgical procedure was anterior vitrectomy (26.4%). Anatomical globe loss occurred in 2 patients. Median CDVA was 0.7 logMAR (range: 0.1-3.0 logMAR) at final visit. Most common complication after primary suturation was graft failure (23.5%). Graft remained clear in 67.6% of patients.
CONCLUSION
Traumatic wound dehiscence is one of the potentially devastating postoperative complications that can occur following PK. Prognosis depends on existence and severity of additional anterior/posterior segment damage. In order to prevent this catastrophic condition, patients should be warned against ocular trauma after undergoing PK.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Eye Injuries; Female; Humans; Keratoplasty, Penetrating; Male; Medical Records; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Surgical Wound Dehiscence; Turkey; Visual Acuity; Wounds, Nonpenetrating; Young Adult
PubMed: 27849319
DOI: 10.5505/tjtes.2016.26963 -
Surgery Research and Practice 2020Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of...
Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
BACKGROUND
Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of postoperative morbidity and mortality in sub-Saharan Africa including Ethiopia, and little is known about its prevalence and related factors in the study area.
OBJECTIVES
The aim of this study is to assess the magnitude of abdominal wound dehiscence and related factors on patients operated at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
METHODS
A hospital-based retrospective review of the chart was carried out by using the data covering three years (September 2014-September 2017) period. Data were collected from hospital medical records of sampled patients such as operation room logbooks and individual patient medical records. The collected data were checked for consistency, coded, and entered into SPSS version 20 for data processing and analysis. Descriptive analysis was conducted, and tables and graphs and summary statistics were used to depict data.
RESULTS
A total of 41 patients developed abdominal wound dehiscence from among 4137 patients who underwent abdominal laparotomy in the hospital. Among the patients, 51.2% were in the age range of 41 and above with mean age 29.8 (SD = 1.21) and 70.7% of them were male. Abdominal wound dehiscence was more common in emergency patients (90%) and vertical incision was the most common type of incision. Over half (58.5%) of the wound dehiscence occurred within 6-10 postoperative days. The majority (95.2%) of dehisced patients underwent relaparotomy for the management of the wound dehiscence, and 48.8% of them were treated with tension suture during the second operation of abdominal closure. Four of the patients (9.7%) died after the management of the second operation.
CONCLUSION
The current study revealed that the overall magnitude of abdominal wound dehiscence in the study area was 0.99%. Most of the dehiscence has occurred in male patients, and older age groups were highly affected than the younger ones. Emergency admission is the most common form of admission identified in the study, and this signifies appropriate preoperative preparation of patients for an optimal outcome. However, regarding the management outcome, 9.8% of patients died in our study within the institution after the second operation which is the high mortality rate.
PubMed: 32232116
DOI: 10.1155/2020/1379738