scholarly journals Perineal reconstruction using an inferior gluteal artery perforator flap after abdominoperineal resection

2019 ◽  
Vol 12 (9) ◽  
pp. e228613
Author(s):  
Miguel Nico Albano ◽  
João Mendes Louro ◽  
Iris Brito ◽  
Sara Ramos
Keyword(s):  
Risk Factors ◽  
Abdominoperineal Resection ◽  
Perforator Flap ◽  
Perineal Wound ◽  
Wound Complication ◽  
Perineal Hernia ◽  
Wound Complications ◽  
Neoadjuvant Radiotherapy ◽  
Radiographic Findings ◽  
Persistent Perineal Sinus

The abdominoperineal resection is a surgical procedure which implies the removal of rectum, anal canal and the creation of a terminal colostomy. The most frequent complications of this type of surgery are haemorrhage, surgical wound complications, persistent perineal sinus and perineal hernia. Intraoperative haemorrhage or contamination and neoadjuvant radiotherapy are risk factors for the development of perineal complications. Perineal wound infection, with subsequent healing delay, has multifactorial aetiology and its incidence can reach up to 66% according to literature. The prevention of these complications requires adequate surgical technique to avoid or minimise the known risk factors. The treatment of a perineal wound complication depends on the clinical and radiographic findings. When there is no wound resolution in 6 months, it is considered a persistent sinus and treatment will probably require a flap. Several options of surgical treatment are available however, there are no randomised studies to determine which one is the best.

Risk Factors for Perineal Wound Complications Following Abdominoperineal Resection

2005 ◽  
Vol 48 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Caprice K. Christian ◽  
Mary R. Kwaan ◽  
Rebecca A. Betensky ◽  
Elizabeth M. Breen ◽  
Michael J. Zinner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominoperineal Resection ◽  
Perineal Wound ◽  
Wound Complications ◽  
Perineal Wound Complications

Correlation of Soft Tissue Swelling and Timing to Surgery With Acute Wound Complications for Operatively Treated Ankle and Other Lower Extremity Fractures

2019 ◽  
Vol 40 (5) ◽  
pp. 526-536 ◽  
Author(s):  
Matthew D. Riedel ◽  
Amber Parker ◽  
Mingxin Zheng ◽  
Jorge Briceno ◽  
Steven J. Staffa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Lower Extremity ◽  
Tobacco Use ◽  
Wound Complication ◽  
Timing Of Surgery ◽  
Ankle Fractures ◽  
Patient Specific ◽  
Wound Complications ◽  
Heel Pad

Background: Considerable debate exists regarding how soft-tissue edema should influence timing of surgery for ankle and other lower extremity fractures. Assessment of swelling is subjective, and timing varies among surgeons. However, timing of surgery is one of the few modifiable factors in fracture care. Ultrasonography can objectively measure swelling and help determine optimal timing. The purposes of this study were to determine whether objective measures of swelling, timing to surgery, and patient-specific risk factors correlated with wound complications and to try to create a prediction model for postoperative wound complications based on identified modifiable and nonmodifiable risk factors. Methods: Patients with closed ankle and other lower extremity fractures requiring surgery with an uninjured, contralateral extremity were included. Demographic information and sonographic measurements on both lower extremities were obtained pre-operatively. Subjects were followed for 3 months and wound complications were documented. A predictive algorithm of independent risk factors was constructed, determining wound complication risk. Given that patients with ankle fractures made up the majority of the study cohort (75/93 or 80%), a separate statistical analysis was performed on this group. A total of 93 subjects completed the study, with 75/93 sustaining ankle fractures. Results: Overall wound complication rate was 18.3%. Timing to surgery showed no correlation with wound complications. A heel-pad edema index >1.4 was independently associated with wound complications. Subgroup analysis of ankle fractures demonstrated a 3.4× increase in wound complications with a heel-pad edema index >1.4. Tobacco history and BMI >25 were independent predictors of wound complications. An algorithm was established based on heel-pad edema index, BMI >25, and tobacco history. Patients with none of the 3 factors had a 3% probability of a wound complication. Patients with 1/3, 2/3 and 3/3 factors had a 12-36%, 60-86% and 96% probability of a wound complication, respectively. Conclusions: Timing to surgery had no correlation with wound complications. Heel-pad edema index >1.4, BMI >25, and tobacco-use correlated with wound complications. When separately analyzing the cohort that sustained ankle fractures, the heel-pad edema index of >1.4 was still demonstrated to be predictive of wound complications corresponding to a 3.4× increase in wound complication rates (11.1% vs 37.5%). Risk of wound complications significantly increased with each factor. In patients with increased BMI and/or tobacco use, resolution of heel edema may significantly reduce wound complications in lower extremity trauma. Level of Evidence: Level II, prognostic, prospective cohort study.

Predictors of Perineal Wound Complications and Prolonged Time to Perineal Wound Healing After Abdominoperineal Resection

2016 ◽  
Vol 40 (7) ◽  
pp. 1755-1762 ◽  
Author(s):  
Azah A. Althumairi ◽  
Joseph K. Canner ◽  
Susan L. Gearhart ◽  
Bashar Safar ◽  
Justin Sacks ◽  
...  
Keyword(s):  
Wound Healing ◽  
Abdominoperineal Resection ◽  
Perineal Wound ◽  
Wound Complications ◽  
Perineal Wound Healing ◽  
Prolonged Time ◽  
Perineal Wound Complications

scholarly journals Operative wound-related complications after cranial revascularization surgeries

2015 ◽  
Vol 123 (5) ◽  
pp. 1145-1150 ◽  
Author(s):  
Keisuke Takanari ◽  
Yoshio Araki ◽  
Sho Okamoto ◽  
Hideyoshi Sato ◽  
Shunjiro Yagi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Supply ◽  
Operative Technique ◽  
Multivariate Logistic Regression Analysis ◽  
Wound Complication ◽  
Wound Complications ◽  
Multivariate Logistic Regression ◽  
The Relationship

OBJECT Intracranial revascularization surgeries are an effective treatment for moyamoya disease and other intracranial vascular obliterative diseases. However, in some cases, wound-related complications develop after surgery. Although the incidence of wound complication is supposed to be higher than that with a usual craniotomy, this complication has rarely been the focus of studies in the literature that report the outcomes of revascularization surgeries. Here, the relationship between intracranial revascularization surgeries and their complications is statistically assessed. METHODS Between October 2004 and February 2010, 71 patients were treated using cerebral revascularization surgeries on 98 sides of the head. The relationship between wound complications and operative technique was retrospectively assessed. Multivariate logistic regression analysis was performed to identify the risk factors of wound complication, including operative technique, age, sex, diabetes mellitus (DM), hypertension, hyperlipidemia, and smoking history. RESULTS In total, there were 21 (21.4%) operative wound complications. Of these 21 complications, there were 14 (66.7%) minor complications and 7 (33.3%) major complications. No statistically significant relationship was found between wound complications and any surgical procedure. A trend toward severer complications was demonstrated for the procedures that used both STA branches (“double” procedures) in comparison with the procedures that used only 1 STA branch (“single” procedures, p = 0.016, Cochran-Armitage trend test). Multivariate logistic regression analysis also revealed that double procedures demonstrated a significantly higher incidence of wound complications than single procedures (OR 3.087, p = 0.048). DM was found to be a risk factor for wound complication (OR 9.42, p = 0.02), but age, sex, hypertension, and hyperlipidemia were not associated with the incidence of complications. Even though the blood supply to the scalp is abundant due to 5 arteriovenous systems, sometimes cutaneous necrosis develops after intracranial revascularization surgeries. The galeal blood supply is thought to be crucial for preventing wound-related complications. Special care is also thought to be required for DM patients. CONCLUSIONS Revascularization surgeries seemed to demonstrate a higher risk of wound-related complications. Double-type procedures, which use both branches of the STA, and a history of DM were found to be risk factors for wound-related complications. Attention should be paid to the design of the galeal incision and vessel harvest line. Also, special attention should be paid to patients with DM.

scholarly journals What is Too Swollen? Correlation of Soft Tissue Swelling and Timing to Surgery with Acute Wound Complications for Operatively-Treated Lower Extremity Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Matthew D. Riedel ◽  
Amber Parker ◽  
Mingxin Zheng ◽  
Jorge Briceno ◽  
Steven J. Staffa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Lower Extremity ◽  
Tobacco Use ◽  
Wound Complication ◽  
Timing Of Surgery ◽  
Ankle Fractures ◽  
Patient Specific ◽  
Wound Complications ◽  
Heel Pad

Category: Trauma, Soft Tissue Introduction/Purpose: Considerable debate exists regarding how soft-tissue edema should influence timing of surgery for lower extremity fractures. Assessment of swelling is subjective and timing varies amongst surgeons. However, timing of surgery is one of the few modifiable factors in fracture care. Ultrasonography can objectively measure swelling and help determine optimal timing. The purposes of this study are: 1) determine whether objective measures of swelling, timing to surgery, and patient-specific risk factors correlate with wound complications and; 2) create a prediction model for post-operative wound complications based on identified modifiable and non-modifiable risk factors. Methods: Patients with closed lower extremity fractures requiring surgery with an uninjured, contralateral extremity were included. Demographic information and sonographic measurements on both lower extremities were obtained pre-operatively. Subjects were followed for 3 months and wound complications were documented. A predictive algorithm of independent risk factors was constructed, determining wound complication risk. Results: 93 subjects completed the study with 71/93 sustaining ankle fractures. Overall wound complication rate was 18.3%. Timing to surgery showed no correlation with wound complications. A heel-pad edema index >1.4 was independently associated with wound complications. Subgroup analysis of ankle fractures demonstrated a 3.4x increase in wound complications with a heel- pad edema index >1.4. Tobacco history and BMI >25 kg/m2 were independent predictors of wound complications. An algorithm was established based on heel-pad edema index, BMI >25, and tobacco history. Patients with none of the 3 factors had a 3% probability of a wound complication. Patients with 1/3, 2/3 and 3/3 factors had a 12-36%, 60-86% and 96% probability of a wound complication, respectively. Conclusion: Timing to surgery had no correlation with wound complications. Heel-pad edema index >1.4, BMI >25, and tobacco- use correlated with wound complications. Risk of wound complications significantly increased with each factor. In patients with increased BMI and/or tobacco-use, resolution of heel edema may significantly reduce wound complications in lower extremity trauma.

Long-term comorbidity of diabetes mellitus is a risk factor for perineal wound complications after an abdominoperineal resection

2008 ◽  
Vol 394 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Kenji Matsuda ◽  
Tsukasa Hotta ◽  
Katsunari Takifuji ◽  
Shozo Yokoyama ◽  
Takashi Higashiguchi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Abdominoperineal Resection ◽  
Perineal Wound ◽  
Wound Complications ◽  
Perineal Wound Complications
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