Postoperative Wound Complications in Cardiac Surgery: What Exactly Are We Reporting (or Not Reporting)?

Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

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Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

Foot & Ankle Specialist ◽

10.1177/1938640018810422 ◽

2018 ◽

Vol 12 (5) ◽

pp. 409-417 ◽

Cited By ~ 1

Author(s):

Hesham Saleh ◽

Sanjit Konda ◽

Adam Driesman ◽

John Stranix ◽

Catherine Ly ◽

...

Keyword(s):

Wound Healing ◽

Ankle Fracture ◽

Wound Complications ◽

Management Options ◽

Original Cohort ◽

Surgical Interventions ◽

Postoperative Wound ◽

Trimalleolar Fractures ◽

Medical Histories ◽

Fracture Surgery

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

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Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation

The Scientific World JOURNAL ◽

10.1155/2014/548687 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Hyung-Sup Shim ◽

Dong-Hwi Kim ◽

Ho Kwon ◽

Sung-No Jung

Keyword(s):

Range Of Motion ◽

Chart Review ◽

Patient Comfort ◽

Wound Complications ◽

Dash Score ◽

Postoperative Wound ◽

Medical Chart Review ◽

Lower Abdominal Quadrant ◽

The Mean ◽

Abdominal Quadrant

Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.

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Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy

Otolaryngology ◽

10.1177/0194599817722938 ◽

2017 ◽

Vol 158 (1) ◽

pp. 103-109 ◽

Cited By ~ 2

Author(s):

Aru Panwar ◽

Oleg Militsakh ◽

Robert Lindau ◽

Andrew Coughlin ◽

Harlan Sayles ◽

...

Keyword(s):

Total Laryngectomy ◽

Attributable Risk ◽

Wound Complications ◽

Medical Complications ◽

Improvement Program ◽

Data Set ◽

Surgical Quality ◽

Postoperative Wound ◽

Tracheoesophageal Puncture ◽

Length Of Hospitalization

Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of “superficial” and “deep or organ space” surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for “superficial” or “deep or organ space” surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.

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Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications

Annals of Surgery ◽

10.1097/sla.0000000000003644 ◽

2019 ◽

Vol 272 (1) ◽

pp. 81-91 ◽

Cited By ~ 5

Author(s):

Pieter R. Zwanenburg ◽

Berend T. Tol ◽

Miryam C. Obdeijn ◽

Oren Lapid ◽

Sarah L. Gans ◽

...

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Meta Analysis ◽

Wound Complications ◽

Wound Therapy ◽

Postoperative Wound ◽

Meta Regression ◽

Grade Assessment

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Relationship to postoperative wound complications

The Journal of Arthroplasty ◽

10.1016/s0883-5403(06)80125-7 ◽

1993 ◽

Vol 8 (1) ◽

pp. 103

Author(s):

K. Greene ◽

A. Wilde ◽

B.N. Stulberg

Keyword(s):

Wound Complications ◽

Postoperative Wound

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The Association of Cesarean Skin Incision Length and Postoperative Wound Complications

American Journal of Perinatology ◽

10.1055/s-0040-1716889 ◽

2020 ◽

Author(s):

Akila Subramaniam ◽

Victoria Jauk ◽

George Saade ◽

Kim Boggess ◽

Sheri Longo ◽

...

Keyword(s):

Secondary Analysis ◽

Skin Incision ◽

Wound Complications ◽

Skin Closure ◽

Double Blind ◽

Incision Length ◽

Postoperative Wound ◽

Membrane Rupture ◽

Increased Risk ◽

Duration Of Surgery

Objective This study was aimed to evaluate the relationship between cesarean skin incision length and wound complications. Study Design Planned secondary analysis of a multicenter double-blind randomized trial of adjunctive azithromycin versus placebo (in addition to standard cefazolin) in women ≥24 weeks undergoing cesarean delivery during labor or ≥4 hours after membrane rupture. Skin incision length (cm) was measured just prior to skin closure. The primary outcome was a composite of wound complications (wound infection, separation, seroma, hematoma, or dehiscence) up to 6 weeks of postpartum. Individual components of the composite were examined as secondary outcomes. Outcomes were compared between groups defined by the lowest (≤25th), middle (25–75th) and highest (>75th) incision length quartiles. Logistic regression was used to adjust for potential confounding variables. Results Of the 2,013 women enrolled in the primary trial, 1,916 had recorded incision lengths and were included in this secondary analysis. The overall rate of composite wound complications was 7.8%. Median incision length was 15.0 cm (interquartile range: 14.0–16.5) with the lowest quartile defined as ≤14, middle as >14 to ≤16.5, and highest as >16.5 cm. Mean BMI, parity, use of staples, and duration of surgery differed significantly between the three incision length groups. In unadjusted analysis, the longest incision lengths were associated with an increased risk of the wound composite and wound infections (odds ratio [OR] = 2.27, 95% confidence interval [CI]: 1.43–3.60 and OR = 2.30, 95% CI: 1.27–4.15, respectively) compared with the shortest incision lengths. However, after multivariable adjustments, these associations were nullified. Additional analyses considering incision length as a continuous variable and using 10th/90th percentile cut-offs still did not suggest any associations with outcomes. Conclusion Increasing skin incision length is not independently associated with an increased risk of postoperative wound complications. Key Points

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