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Medicine Dec 20212-octyl cyanoacrylate (2OCA) is a high-viscosity medical-grade tissue adhesive that is routinely used. However, no studies have evaluated its use in musculoskeletal... (Observational Study)
Observational Study
2-octyl cyanoacrylate (2OCA) is a high-viscosity medical-grade tissue adhesive that is routinely used. However, no studies have evaluated its use in musculoskeletal surgery.We enrolled 99 patients who underwent musculoskeletal surgery. 2OCA was chosen for wound closure and was performed by a specific surgeon for all patients. The drying times for the adhesive were recorded, and photographs were obtained intra-operatively. Posttreatment follow-up consisted of queries regarding pain level and recording incisional dehiscence, wound infection, hematoma, and incisional bleeding. Data collection was performed postoperatively at 48 hours, 5 to 10 days, 14 days, and 30 days. Other adverse events were documented.2OCA was applied to 110 incisions in 99 patients, comprising 62 female and 37 male patients. The mean age of patients was 50.41 (±16.83) years; mean incision length was 10.24 (±5.7) cm, and the mean pain score using a visual analogue scale was 2.37 on a postoperative day 7. The mean drying time was 1.81 (±0.59) minutes; 91 (91%) patients reported excellent and superior satisfaction, and the remaining patients reported "good" (6%) and "fair" (2%) satisfaction. The percentages of dehiscence, hematoma and keloid formation were considerably low.In this study, 2OCA was safe for musculoskeletal oncology surgical incisions. The incidence of postoperative adverse events was low. However, some patients develop hematomas. Postoperative pain was low, and patient satisfaction was high. 2OCA can be a practical alternative to traditional suture closure for skin incisions after musculoskeletal surgery.
Topics: Administration, Topical; Adult; Aged; Cyanoacrylates; Female; Hematoma; Humans; Keloid; Male; Middle Aged; Pain; Surgical Wound; Surgical Wound Dehiscence; Sutures; Tissue Adhesives; Wound Healing
PubMed: 34918713
DOI: 10.1097/MD.0000000000028326 -
Journal of Orthopaedic Surgery and... Dec 2019This meta-analysis was performed to determine the efficacy of negative pressure wound therapy (NPWT) versus conventional wound dressings for closed incisions in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis was performed to determine the efficacy of negative pressure wound therapy (NPWT) versus conventional wound dressings for closed incisions in orthopedic trauma surgery.
METHODS
A systematic search was performed in PubMed, Embase, and the Cochrane Library databases. The outcome measures included deep surgical site infection (SSI), superficial SSI; wound dehiscence and length of hospital stay. Cochrane collaboration's tool and the Newcastle-Ottawa Scale (NOS) were used to evaluate literature qualities. Meta-analysis was performed using RevMan 5.3 software.
RESULTS
A total of 6 studies including 2 randomized controlled trials (RCTs) and 4 cohort studies met our inclusion criteria. NPWT resulted in a significantly lower incidence of deep SSI, superficial SSI, and wound dehiscence than conventional wound dressings. However, no statistically significant difference was found in the length of hospital stay.
CONCLUSIONS
NPWT appeared to be an efficient alternative to help prevent SSIs and wound dehiscence on closed incisions in orthopedic trauma surgery. Rational use of NWPT should be based on the presence of patient's condition and risk factors.
Topics: Cohort Studies; Humans; Length of Stay; Negative-Pressure Wound Therapy; Randomized Controlled Trials as Topic; Surgical Wound; Surgical Wound Infection
PubMed: 31829217
DOI: 10.1186/s13018-019-1488-z -
Canadian Journal of Surgery. Journal... 2023The rate of major surgical complications for high-volume orthopedic surgeons using the direct anterior approach (DAA) in Ontario, Canada, is not known. The purpose of...
BACKGROUND
The rate of major surgical complications for high-volume orthopedic surgeons using the direct anterior approach (DAA) in Ontario, Canada, is not known. The purpose of this study was to investigate the rate of major surgical complications after total hip arthroplasty (THA) using DAA performed by experienced orthopedic surgeons at a high-volume tertiary care centre in Ontario.
METHODS
We conducted a retrospective cohort review of primary THA through DAA performed by 2 experienced fellowship-trained surgeons at an academic hospital in London, Ontario, between Jan. 1, 2012, and May 1, 2019. We excluded the first 100 cases to allow for surgeon learning curves. We recorded major surgical complications (intraoperative events, postoperative periprosthetic fractures, dislocation requiring closed or open reduction, implant failure [aseptic loosening or subsidence], early (< 6 wk) deep wound infection requiring irrigation and débridement, late (≥ 6 wk) deep wound infection requiring irrigation and débridement, and wound complications [wound dehiscence, stitch abscess, erythema, hematoma or seroma]) within 1 year of THA.
RESULTS
A total of 875 primary DAA THA procedures were included. The rates of surgical complications were 0.9% for intraoperative events, 1.5% for postoperative periprosthetic fractures, 0.8% for implant failure, 0.7% for early deep wound infection, 0.1% for late deep wound infection and 3.2% for wound complications; there were no cases of dislocation. The rate of revision for implant failure within 1 year was 0.1%. Male sex was associated with a greater risk of implant failure ( = 0.01), and having a higher body mass index was associated with both increased rates of infection ( < 0.01) and having a wound complication ( < 0.01).
CONCLUSION
Intraoperative events, postoperative periprosthetic fractures, implant failure, deep wound infection and wound complications accounted for the major surgical complications within 1 year of THA through DAA. The low revision rate suggests that DAA is a safe approach for THA.
Topics: Humans; Male; Arthroplasty, Replacement, Hip; Periprosthetic Fractures; Retrospective Studies; Ontario; Tertiary Care Centers; Reoperation; Postoperative Complications; Wound Infection; Hip Prosthesis
PubMed: 38056903
DOI: 10.1503/cjs.005223 -
Journal of Orthopaedics and... May 2022Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is...
INTRODUCTION
Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture.
PATIENTS AND METHODS
In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up.
RESULTS
No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results.
CONCLUSION
Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.
Topics: Femoral Fractures; Femur Head; Fracture Fixation, Internal; Hip Dislocation; Hip Fractures; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35538323
DOI: 10.1186/s10195-022-00643-w -
Journal of the American Veterinary... Sep 2019To report the intestinal incisional dehiscence rate following enterotomy for foreign body removal in dogs.
OBJECTIVE
To report the intestinal incisional dehiscence rate following enterotomy for foreign body removal in dogs.
ANIMALS
247 client-owned dogs with intestinal foreign bodies treated with enterotomy between November 2001 and September 2017.
PROCEDURES
Medical records were reviewed, and data were collected regarding signalment, history, surgery, clinicopathologic findings, hospitalization, intestinal incisional dehiscence, and survival to hospital discharge. Dogs were grouped according to whether intestinal incisional dehiscence occurred (dehiscence group) or did not occur (nondehiscence group) following enterotomy, and the rate of dehiscence for the total number of enterotomies during the study period was calculated. Univariable analysis was performed to identify variables associated with intestinal incisional dehiscence.
RESULTS
8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge. Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge. Duration of hospitalization was longer for dogs in the dehiscence group than for dogs in the nondehiscence group.
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that enterotomy for intestinal foreign body removal had a lower rate of dehiscence in dogs during the study period, compared with rates previously reported; however, the low rate should not be used as a reason to perform an enterotomy rather than an enterectomy when needed. Surgeons should thoroughly evaluate the bowel and perform an enterotomy only when indicated.
Topics: Anastomosis, Surgical; Animals; Digestive System Surgical Procedures; Dog Diseases; Dogs; Foreign Bodies; Retrospective Studies
PubMed: 31478820
DOI: 10.2460/javma.255.6.695 -
European Review For Medical and... Dec 2015The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for... (Review)
Review
OBJECTIVE
The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap.
MATERIALS AND METHODS
The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg.
RESULTS
A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps.
CONCLUSIONS
No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients' preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible.
Topics: Adult; Aged; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators; Leg; Limb Salvage; Male; Middle Aged; Postoperative Complications; Plastic Surgery Procedures; Surgical Flaps; Surgical Wound Dehiscence; Wounds and Injuries
PubMed: 26744862
DOI: No ID Found -
Wounds : a Compendium of Clinical... Jan 2018Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response....
INTRODUCTION
Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients.
CASE REPORT
The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis. Several perforations and dehiscences were observed and necessitated an end ileostomy and an open abdomen treated with negative pressure wound therapy. Multiple surgical interventions in the abdomen were performed and negative pressure was maintained until all fistulas were sealed and granulation tissue formed. Patient was discharged after 134 days of hospitalization with both the abdomen and the ileostomy closed. After several months, a hernia repair was performed with bilateral component separation and polypropylene mesh without complications.
CONCLUSIONS
Anastomotic dehiscence after intestinal resection can lead to an abdominal catastrophe. Severe peritonitis with enteric fistulas and an open abdomen demands a multidisciplinary approach. Negative pressure wound therapy and nutritional support are key treatments. In these patients, stoma closure and abdominal wall reconstruction after recovery from the acute event represents another surgical challenge.
Topics: Abdominal Wound Closure Techniques; Anastomotic Leak; Crohn Disease; Digestive System Surgical Procedures; Female; Humans; Ileum; Laparoscopy; Middle Aged; Peritonitis; Postoperative Complications; Treatment Outcome
PubMed: 29406296
DOI: No ID Found -
International Journal of Nursing Studies Jan 2019Surgical wounds healing by secondary intention can be difficult and costly to manage and are profoundly under researched. This prospective inception, cohort study aimed...
BACKGROUND
Surgical wounds healing by secondary intention can be difficult and costly to manage and are profoundly under researched. This prospective inception, cohort study aimed to derive a better understanding of surgical wounds healing by secondary intention and to facilitate the design of future research investigating effective treatments.
OBJECTIVES
To investigate the clinical characteristics of patients with surgical wounds healing by secondary intention and the surgeries that preceded their wounds; to clearly delineate the clinical outcomes of these patients, specifically focusing on time to wound healing and its determinants; to explore the types of treatments for surgical wounds healing by secondary intention; and to assess the impact surgical wounds healing by secondary intention have on patients' quality of life.
DESIGN
Prospective, inception cohort study.
SETTING
Acute and community settings in eight sites across two large centres in the United Kingdom (Hull and Leeds, UK).
METHODS
Patients with a surgical wounds healing by secondary intention (an open wound, <3 weeks' duration, resulting from surgery), were recruited and followed up for at least 12 months. Key outcome events included: time to healing; treatment type; infection; hospital re-admission and further procedures; health-related quality of life and pain.
RESULTS
In total, 393 patients were recruited. Common co-morbidities were cardiovascular disease (38%), diabetes (26%) and peripheral vascular disease (14.5%). Baseline median SWHSI area was 6 cm (range 0.01-1200). Abdominal (n = 132), foot (n = 59), leg (n = 58) and peri-anal (n = 34) wounds were common. The majority of wounds (236, 60.1%) were intentionally left open following surgery; the remainder were mostly dehisced wounds. Healing was observed in 320 (81.4%) wounds with a median time to healing of 86 days (95% CI: 75-130). Factors associated with delayed healing included wound infection at any point and baseline wound area above the median. Health-related quality of life scores were low at baseline but improved with time and healing.
CONCLUSIONS
This is the first inception cohort study in patients with surgical wounds healing by secondary intention. Patient characteristics have been clearly defined, with prolonged healing times and adverse events being common impacting on patient's health-related quality of life. Areas for, and factors crucial to the design of, future research have been identified.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Surgical Procedures, Operative; Surgical Wound; Time Factors; Wound Closure Techniques; Wound Healing; Young Adult
PubMed: 30343210
DOI: 10.1016/j.ijnurstu.2018.09.011 -
PloS One 2018The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore...
BACKGROUND
The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore the potential of 3 charge-coupled device (3CCD) imaging values to distinguish between traumatic wounds that heal following closure and those that fail. Previous studies demonstrate that normalized 3CCD imaging values exhibit a high correlation with oxygen saturation and allow for comparison of values between diverse clinical settings, including utilizing different equipment and lighting.
METHODS
We screened 119 patients at Walter Reed National Military Medical Center and at Grady Memorial Hospital with at least one traumatic extremity wound of ≥ 75 cm2. We collected images of each wound during each débridement surgery for a total of 66 patients. An in-house written computer application selected a region of interest in the images, separated the pixel color values, calculated relative values, and normalized them. We followed patients until the enrolled wounds were surgically closed, quantifying the number of wounds that dehisced (defined as wound failure or infection requiring return to the operating room after closure) or healed.
RESULTS
Wound failure occurred in 20% (19 of 96) of traumatic wounds. Normalized intensity values for patients with wounds that healed successfully were, on average, significantly different from values for patients with wounds that failed (p ≤ 0.05). Simple thresholding models and partial least squares discriminant analysis models performed poorly. However, a hierarchical cluster analysis model created with 17 variables including 3CCD data, wound surface area, and time from injury predicts wound failure with 76.9% sensitivity, 76.5% specificity, 76.6% accuracy, and a diagnostic odds ratio of 10.8 (95% confidence interval: 2.6-45.9).
CONCLUSIONS
Imaging using 3CCD technology may provide a non-invasive and cost-effective method of aiding surgeons in deciding if wounds are ready for closure and could potentially decrease the number of required débridements and hospital days. The process may be automated to provide real-time feedback in the operating room and clinic. The low cost and small size of the cameras makes this technology attractive for austere and shipboard environments where space and weight are at a premium.
Topics: Adult; Cohort Studies; Female; Humans; Image Processing, Computer-Assisted; Male; Multivariate Analysis; Postoperative Complications; Preoperative Period; Prognosis; Spectrum Analysis; Wound Healing; Wounds and Injuries
PubMed: 30261011
DOI: 10.1371/journal.pone.0204453 -
BMC Surgery Jan 2023The reconstruction of nonhealing lumbosacral spinal defects remains a challenge, with limited options. The aim of this article was to review the authors' technique and... (Review)
Review
BACKGROUND
The reconstruction of nonhealing lumbosacral spinal defects remains a challenge, with limited options. The aim of this article was to review the authors' technique and experience with the modified fourth lumbar artery local perforator (MFLALP) flap for the coverage of nonhealing lumbosacral defects after spinal surgery.
METHODS
Between August 2012 and May 2021, we reviewed all MFLALP flaps performed for lumbosacral spinal defects. Patient demographics, wound aetiologies, surgical characteristics, and outcomes were reviewed retrospectively.
RESULTS
A total of 31 MFLALP flaps were performed on 24 patients during the research period. The median flap size was 152 cm (range, 84-441 cm). All flaps survived successfully, although there were two cases of minor complications. One patient had a haematoma and required additional debridement and skin grafting at 1 week postoperatively. The other patient suffered wound dehiscence at the donor site at 2 weeks postoperatively and required reclosure. The follow-up time ranged from 6 months to 5 years.
CONCLUSIONS
The MFLALP flap has the advantages of a reliable blood supply, sufficient tissue bulk and low complication rate. This technique is an alternative option for the reconstruction of nonhealing lumbosacral spinal defects.
Topics: Humans; Perforator Flap; Retrospective Studies; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Arteries; Treatment Outcome
PubMed: 36639778
DOI: 10.1186/s12893-023-01909-8