-
Neurology India 2016Craniovertebral junction (CVJ) abnormalities, such as atlantoaxial dislocation (AAD) with or without basilar invagination (BI), with or without associated Chiari...
BACKGROUND
Craniovertebral junction (CVJ) abnormalities, such as atlantoaxial dislocation (AAD) with or without basilar invagination (BI), with or without associated Chiari malformation (CM), may cause a high cervical myelopathy. Occasionally, mechanical factors such as inadequate canal decompression, torticollis, and/or scoliosis may lead to lack of improvement following the primary surgery. Furthermore, implant-related factors, requiring implant revision/removal, or the presence of surgical site infections may cause the patient to undergo resurgery.
AIMS
This study was aimed at highlighting the underlying etiopathogenesis of resurgery following the primary surgery undertaken in CVJ abnormalities.
SETTING AND DESIGN
This was a retrospective study from a tertiary care referral institute focusing on 414 operated cases of CVJ anomalies.
MATERIALS AND METHODS
The data of 55 patients who underwent resurgery included their clinicoradiological assessment and operative records. The inclusion criteria included failed primary procedure, repeat procedure for construct failure, infection at the surgical site, or wound dehiscence. Pure CM patients without bony anomalies were excluded from the study.
RESULTS
A total of 137 procedures were performed in 55/414 (13%) patients. Causes of resurgery could be divided into ventral [redo or denovo transoral decompression (TOD) or wound-related complications, n = 33, 40.2%] and dorsal causes (implant-related factors/wound infections, n = 49, 59.8%). De novo TOD was done in persisting myelopathy following posterior fusion (PF) with C1-2 distraction (n = 15,18.3%,). Redo TOD was done for residual anterior bony compression [n = 8, 9.6%, OR 0.61; [CI = 0.20-1.86]. Causes for oral wound reexplorations (n = 10, 12.2%) included velopharyngeal insufficiency, wound resuturing, oral bleeding, and cerebrospinal fluid (CSF) leak. Dorsal causes included: (A) Implant factors (n = 27, 32.7%) and (B) neck wound reexplorations (n = 22, 26.8%). Presence of subaxial spine scoliosis, torticollis, and asymmetric joints increased the incidence of reexploration. Occipitocervical fusion rather than C1-2 fusion was more prone towards construct loosening.
CONCLUSIONS
Patients undergoing distraction with PF may require transoral surgery due to persisting myelopathy, especially in the presence of torticollis, scoliosis, and symmetrical joints. Single stage TOD+PF increases the chances of implant infection due to tissue contamination, bacteremia, or transfacetal migration of microbes. Chronic/recurrent sinus is usually a harbinger of deeper infection and can be cured with implant removal.
Topics: Arnold-Chiari Malformation; Decompression, Surgical; Humans; Postoperative Complications; Reoperation; Retrospective Studies; Spinal Cord Compression
PubMed: 27841190
DOI: 10.4103/0028-3886.193781 -
Journal of Hand and Microsurgery Feb 2023Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay....
Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay. Reconstruction of these wounds presents a challenge, as the spine is dependent on these implants for stability and must be maintained throughout the wound dehiscence treatment protocol. We describe a method for extending the thoracodorsal pedicle with an arteriovenous loop to permit an increased excursion of the latissimus dorsi muscle in patients with exposed implants and present the results of this procedure. A retrospective review of patients treated with a latissimus free flap with saphenous vein pedicle extension for posterior spinal wounds from 2010 to 2020 were reviewed. Patient charts were reviewed for demographic information including comorbidities, previous spine operations, wound size and location, and postoperative complications including total flap loss, flap dehiscence, and need for secondary surgery. Six patients were identified who underwent a total of eight extended pedicle free flaps. Mean age was 64.8 years with a mean follow-up of 12.3 months (range, 6-20 months). Four wounds were in the cervicothoracic region with two wounds in the cervical region. Mean number of previous spine surgeries was 3.5 (range, 2-4). Mean wound size was 189 cm with a mean vein graft length of 28 cm. Wound coverage was successful in five of six patients. Major complications occurred in five of six patients. Total flap loss occurred in two patients (33%) and both underwent a second extended latissimus flap from the contralateral side. Three patients developed postoperative flap dehiscence which resolved with regular dressing changes. Extended pedicle latissimus flaps are an effective treatment for posterior spine wounds but are associated with a high complication rate, secondary to medically complex patients with multiple prior surgeries. Careful patient selection is critical for success.
PubMed: 36761048
DOI: 10.1055/s-0041-1726620 -
Aesthetic Surgery Journal Nov 2023Tension on healing wounds increases the risk of dehiscence and poor or pathologic scar formation. Force modulating tissue bridges (FMTBs) represent a new class of wound...
BACKGROUND
Tension on healing wounds increases the risk of dehiscence and poor or pathologic scar formation. Force modulating tissue bridges (FMTBs) represent a new class of wound closure and support devices designed to offload tension on healing wounds to improve wound healing and scar outcomes.
OBJECTIVES
The study was undertaken to assess the efficacy of FMTBs to reduce the risk of wound healing complications in elective breast surgery.
METHODS
One hundred twenty-two consecutive patients undergoing bilateral aesthetic breast surgery underwent intraoperative placement of FMTBs on the vertical limb closure site. A matched case-control cohort of 121 consecutive patients was established for comparison. Wounds were considered significant if larger than 3 mm in diameter. The primary outcome of breast wounds >3 mm was reported with a relative risk, and all outcomes were framed with number needed to treat.
RESULTS
The control and intervention cohorts had similar demographics, comorbidities, type of operation, and incision pattern utilized. Within the FMTB group, 96.7% (n = 118) patients completed treatment per protocol. Significant wounds occurred in 1.7% (n = 2) of patients in the tissue bridge vs 15.2% (n = 19) in controls on a per patient/per protocol basis (89% reduction, P < .001). Statistically significant improvements were maintained on sensitivity analyses with intention to treat, even when minor wounds were included. There were no complications noted related to FMTBs.
CONCLUSIONS
FMTBs are safe and highly effective at reducing the risk of wound formation in elective breast surgery. Results are consistent with sensitivity analyses based on clinical and methodological factors. Further research will assess long-term scar outcomes.
Topics: Humans; Female; Cicatrix; Wound Healing; Surgical Wound Dehiscence; Surgical Wound Infection; Breast Neoplasms
PubMed: 37652052
DOI: 10.1093/asj/sjad285 -
International Wound Journal Dec 2017In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic...
In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic wounds. Wound bed preparation consisted of surgical necrotectomy or sharp debridement, hyperbaric oxygen therapy, negative pressure wound therapy, compression therapy, platelet-rich plasma therapy and/or heparan sulphate agents. Epidermal grafts were harvested from the patient's thigh and applied to the wound. Wound and donor site healing was monitored. A total of 78 patients (average age = 64·1 ± 15·6 years) were included in the study. Common comorbidities included hypertension (47·4%), venous insufficiency (37·2%) and obesity (28·2%). Average wound duration was 13·2 months (range: 0·3-180 months). The most common wound types were dehiscence (29·5%), radiation ulcer (24·4%) and venous ulcer (17·9%). Total time from epidermal grafting to wound closure was 10·0 ± 7·3 weeks. Of the 78 wounds, 66 (84·6%) reached full wound closure (49 < 3 months, 16 > 3 months, 1 without time data). Of 78 wounds, 10 (12·8%) underwent partial wound healing, while 2 wounds (2/78; 2·6%) remained unhealed. These results suggest that wound surface reduction can be achieved by proactive early application of biological therapies and epidermal skin grafts, which may help decrease time to wound healing.
Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Epidermis; Female; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Skin Transplantation; Thigh; Wound Healing; Wounds and Injuries
PubMed: 29076239
DOI: 10.1111/iwj.12787 -
The Journal of the American College of... 2017The perimammary zone is a critical area for healing, due to high incidence of dehiscences, expecially sternal ones. Although deep sternal wound complications are...
The perimammary zone is a critical area for healing, due to high incidence of dehiscences, expecially sternal ones. Although deep sternal wound complications are nowadays less common after cardiac surgery, in some at risk patients, dehiscences still represent important complications of major cardiac or vascular surgeries and they are directly correlated to an increased risk of patient's morbidity and mortality. A heavy breast represents a source of tension on the perimammary wound, inhibiting or delaying a complete recovery. We report the case of a 66-year-old female patient with a critical post-surgical sternal dehiscence and multiple chronic comorbidities. The dehiscence was managed with a routinely performed primary intention closure combined with an innovative breast cerclage. To our opinion, this is the first reported description of a breast cerclage used as an expedient to reduce tension on the wound and minimize the risk of relapse, allowing a rapid and complete healing. This novel technique has proved to be effective and satisfactory in the achievement of both a functional and aesthetic results and we are confident that it could become a fully-fledged wound healing issue in chest wall reconstruction.
PubMed: 30591895
DOI: 10.1016/j.jccw.2018.05.001 -
Annals of Burns and Fire Disasters Dec 2017Modern warfare has seen advances in both weaponry and personnel protective material, thus allowing for better survival of injured individuals. As a result, the medical...
Modern warfare has seen advances in both weaponry and personnel protective material, thus allowing for better survival of injured individuals. As a result, the medical system is faced with an increasing number and diversity of non-life threatening wounds, to the extremities especially, sustained by multiple mechanisms. These wounds have a thermal injury component regardless of the mechanism, and there is often a delay in them being definitively treated, thus affecting final cosmetic and functional outcomes. Fourteen patients presented to our institution after sustaining blast injuries of different etiologies. Time of admission was between 0-10 days, and time of microvascular reconstruction after initial serial debridement was between 5-28 days. All patients were found to be infected with multiple organisms upon admission. Five patients were reconstructed with free vascularized skin flaps, three with osseous and osseocutaneous free flaps, four with free latissimus dorsi muscle flaps and two by toe-to-hand transfer. The follow-up period ranged from 4 to 52 weeks (mean, 26.7 weeks). Eleven free flaps survived completely. Two patients presented with minor dehiscence and were treated with secondary closure. Two patients developed a hematoma under the flap that required evacuation. One flap failed due to arterial thrombosis. Early free flap reconstruction proves to be a good option for the early reconstruction of blast injuries with thermal components after serial debridement and tangential excision of the wound beds.
PubMed: 29983687
DOI: No ID Found -
BioMed Research International 2021Incisional negative wound pressure therapy (iNPWT) is a relatively novel dressing technique with the aim of reducing postoperative wound infections and dehiscence in...
BACKGROUND
Incisional negative wound pressure therapy (iNPWT) is a relatively novel dressing technique with the aim of reducing postoperative wound infections and dehiscence in high-risk wounds after all kinds of surgical procedures. There is a lack of theoretical knowledge about the way those dressing would ameliorate wound healing. One aspect is the reduction of superficial tension, but significant remaining seroma might still cause deep wound infections. The aim of this study was the evaluation of technical modifications of the standard iNPWT dressing to increase seroma evacuation.
METHODS
iNPWT dressings were applied on the porcine abdominal wall, and an incremental pressure ramp from 50 to 200 mmHg was performed. The resulting wound pressures were measured using (i) balloon manometry and (ii) esophageal manometry catheter. Seroma evacuation was analyzed with a seroma model. All measurements were performed with (i) standard iNPWT dressing, (ii) wound gauze diverted through the incision, and (iii) placement of suction drain tube into iNPWT.
RESULTS
Due to the modifications of the iNPWT dressing, the vacuum applied by the iNPWT dressing could be transferred into the wound and was not only restricted to superficial layers. More importantly, placement of wound gauzes or suction drain tubes led to complete extraction of wound seroma. The placement of the suction drain tube showed the best combination of increased intrawound pressure as well as seroma evacuation.
CONCLUSION
Addition of a suction drain tube to the iNPWT dressing leads to an improved function of the iNPWT dressing in our model.
Topics: Abdominal Wall; Animals; Bandages; Models, Animal; Negative-Pressure Wound Therapy; Seroma; Suction; Surgical Wound; Surgical Wound Infection; Swine; Wound Healing
PubMed: 34722767
DOI: 10.1155/2021/5846724 -
New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section.Journal of Medical Ultrasonics (2001) Jan 2023We performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean...
PURPOSE
We performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations.
METHODS
This retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a "niche" in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16-21, 22-27, and 28-33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon's rank-sum and Mann-Whitney U test with a significance level of P < 0.05.
RESULTS
The lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22-27 weeks. At 22-27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22-27 and 28-33 weeks in cases with and without uterine dehiscence.
CONCLUSION
A model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.
Topics: Pregnancy; Female; Humans; Cesarean Section; Cicatrix; Retrospective Studies; Uterus; Uterine Rupture; Risk Assessment
PubMed: 36536061
DOI: 10.1007/s10396-022-01265-9 -
International Wound Journal Feb 2023As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications...
As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications of surgical incision healing is a real challenge in lumbar spine surgery. We performed a retrospective study to compare different types of wound closure in lumbar spine surgery. 4383 patients were included in this study. Wound dehiscence was more common in the intracutaneous suture group than in the far- near-near-far suture group. Delayed wound healing occurred more in the far-near near-far suture group than intracutaneous suture group. Also, the far-near near-far interrupted point suture group showed a higher ratio of delayed wound healing compared with crossover suture. The superficial wound infection rate was roughly the same in all types of sutures with an average value of 0.79% with 0.81% SD. This is a preliminary study to compare different types of operative wounds showing the pros and cons related to each option.
Topics: Humans; Retrospective Studies; Suture Techniques; Postoperative Complications; Wound Infection; Wound Healing; Surgical Wound; Sutures; Surgical Wound Infection
PubMed: 36317419
DOI: 10.1111/iwj.13875 -
Ultrasound in Obstetrics & Gynecology :... Aug 2013To evaluate the accuracy of antenatal sonographic measurement of lower uterine segment (LUS) thickness in the prediction of risk of uterine rupture during a trial of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the accuracy of antenatal sonographic measurement of lower uterine segment (LUS) thickness in the prediction of risk of uterine rupture during a trial of labor (TOL) in women with a previous Cesarean section (CS).
METHODS
PubMed and EMBASE were searched to identify articles published on the subject of sonographic LUS measurement and occurrence of a uterine defect after delivery. Four independent researchers performed identification of papers and data extraction. Selected studies were scored on methodological quality, and sensitivity and specificity of measurement of LUS thickness in the prediction of a uterine defect were calculated. We performed bivariate meta-analysis to estimate summary receiver-operating characteristics (sROC) curves.
RESULTS
We included 21 studies with a total of 2776 analyzed patients. The quality of included studies was good, although comparison was difficult because of heterogeneity. The estimated sROC curves showed that measurement of LUS thickness seems promising in the prediction of occurrence of uterine defects (dehiscence and rupture) in the uterine wall. The pooled sensitivity and specificity of myometrial LUS thickness for cut-offs between 0.6 and 2.0 mm was 0.76 (95% CI, 0.60-0.87) and 0.92 (95% CI, 0.82-0.97); cut-offs between 2.1 and 4.0 mm reached a sensitivity and specificity of 0.94 (95% CI, 0.81-0.98) and 0.64 (95% CI, 0.26-0.90). The pooled sensitivity and specificity of full LUS thickness for cut-offs between 2.0 and 3.0 mm was 0.61 (95% CI, 0.42-0.77) and 0.91 (95% CI, 0.80-0.96); cut-offs between 3.1 and 5.1 mm reached a sensitivity and specificity of 0.96 (95% CI, 0.89-0.98) and 0.63 (95% CI, 0.30-0.87).
CONCLUSIONS
This meta-analysis provides support for the use of antenatal LUS measurements in the prediction of a uterine defect during TOL. Clinical applicability should be assessed in prospective observational studies using a standardized method of measurement.
Topics: Female; Humans; Pregnancy; Prospective Studies; ROC Curve; Trial of Labor; Ultrasonography, Prenatal; Uterine Rupture; Uterus; Vaginal Birth after Cesarean
PubMed: 23576473
DOI: 10.1002/uog.12479