Random pattern hatchet flap as a reconstructive tool in the treatment of pressure sores: clinical experience with 36 patients

Introduction Pressure sores represent a reconstructive challenge, and the high recurrence rate and need for reoperations should always be considered. Sacrifice of muscle and fascia in primary reconstruction may compromise options for future repairs. The objective of this study was to evaluate the reliability of muscle- and fascia-sparing random pattern hatchet flap reconstruction of pressure sores in different body regions. Methods From November 2017 to December 2019, 36 participants with grade III and IV pressure sores underwent random pattern hatchet flap reconstruction. Early postoperative complications and flap survival were evaluated in follow up for 6–12 months. Results Thirty-six participants with an age range of 15 to 67 years who presented with pressure sores (13 sacral, 12 ischial, 10 trochanteric, and 1 scapular) underwent surgery. Complete healing of sores was observed within 21 days of surgery in 32 cases and within 30 days for the remaining four cases. Postoperative complications (11.2%) were recorded in only four participants: two experienced partial wound dehiscence, one seroma developed in a trochanteric case, and there was one infection in a sacral sore. Conclusions Random pattern hatchet flap is a reliable tool that results in minimal complications for treatment of pressure sores of limited dimensions.

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Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1521 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Yawar Sajjad ◽

Beenish Rahat ◽

Salman Hameed

Keyword(s):

Case Series ◽

Gluteus Maximus ◽

Wound Dehiscence ◽

Island Flap ◽

Wound Management ◽

Medical Institute ◽

High Recurrence Rate ◽

Pressure Sores ◽

Retrospective Case ◽

Grade 3

Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.Objective: To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.Methods: A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.Results: In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent reoperation and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.Conclusion: Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.

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The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1727200 ◽

2021 ◽

Author(s):

Taehee Jo ◽

Dong Nyeok Jeon ◽

Hyun Ho Han

Keyword(s):

Donor Site ◽

Wound Dehiscence ◽

Diep Flap ◽

Separate Analysis ◽

Flap Reconstruction ◽

Average Body Mass Index ◽

Deep Inferior Epigastric Perforator ◽

Average Body Mass ◽

Artery Perforator ◽

Average Body

Abstract Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

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Management of surgical wound dehiscence by oxygen-ozone therapy in a FIV-positive cat – a case report

Acta Veterinaria Brno ◽

10.2754/avb202089020189 ◽

2020 ◽

Vol 89 (2) ◽

pp. 189-194

Author(s):

Călin Cosmin Repciuc ◽

Corina Gina Toma ◽

Ciprian Andrei Ober ◽

Liviu Ioan Oana

Keyword(s):

Case Report ◽

Wound Dehiscence ◽

Complete Healing ◽

Limb Amputation ◽

X Rays ◽

Surgical Wound ◽

Ozone Therapy ◽

Contraction Phase ◽

Surgical Wound Dehiscence ◽

Low Efficiency

Patients infected with the feline immunodeficiency virus (FIV) are frequently victims of postoperative wound dehiscence due to low efficiency of the immune system that predisposes to delayed scaring and epithelization processes. This case report aimed to describe the successful use of medical ozone in the treatment of a dehisced wound in a feline patient that presented this type of FIV-associated complication. Here we present a case of a 12-year-old, mixed-breed, male, FIV-positive cat with purulent arthritis affecting the shoulder, elbow, and the carpal joints with subsequent periostitis and arthrogryposis affecting the right forelimb. After a thorough investigation (clinical examination, X-rays) it was decided that limb amputation would be the proper choice. The surgical wound did not tend to heal, followed by rejection of the suture material, skin necrosis, and wound dehiscence. After 13 days following the surgery with allopathic treatment and no improvement, oxygen-ozone-therapy was started. Clinically, oxygen-ozone therapy showed significant results after the first session: borders of the wound got into the contraction phase, got attached to the underlying tissues, and exudates were significantly diminished. The therapy continued every 2 days showing improved blood perfusion of the affected area and a visible advancement of the contraction phase daily with complete healing in 1.5 months.

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OV09 ROBOTIC REPAIR OF SUBXIPHOID INCISIONAL HERNIA POST CABG

British Journal of Surgery ◽

10.1093/bjs/znab396.060 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Moamena El-Matbouly ◽

Yaser Janahi ◽

Ahmed Suliman ◽

Hany Atalah ◽

Ahmed Albahrani

Keyword(s):

Incisional Hernia ◽

Abdominal Wall ◽

Complex Structure ◽

Median Sternotomy ◽

Wound Dehiscence ◽

High Recurrence Rate ◽

Linea Alba ◽

Prolonged Intubation ◽

Sternal Wound Dehiscence ◽

Upper Abdominal

Abstract Aim A median sternotomy that extends toward the epigastric area can weaken the upper abdominal wall and result in the development of subxiphoid incisional hernia. We aim to assess the efficacy and the feasibility of repair of subxiphoid incisional hernia post CABG robotically. In this video; we will also review the surgical technique and the steps for robotic repair of subxiphoid incisional hernia Material and Methods 57-year-old female presented with subxiphoid swelling post CABG in 2019. Her surgery was complicated with sternotomy wound infection with VAC dressing application and ARDS with prolonged intubation. She had 5x7 cm hernia defect that showed on the CT thorax along with sternal wound dehiscence. She underwent robotic repair of her hernia with phasix mesh and recovered well after surgery. Results The subxiphoid hernia is known for its repair complexities and high recurrence rate because the subxiphoid area is a complex structure consisting of boney structures, the rectus abdominis muscles, linea alba, and the diaphragm. The Da Vinci platform allows for accessing hard-to reach area with enhanced precision in dissection and superior dexterity compared to laparoscopy. The Robotic platform allows for manipulation of the camera to assess and operate on the abdominal wall with ease as compared to laparoscopy. Conclusions robotic repair of subxiphoid incisional hernia with mesh is safe and effective method of repair. There are no short-term or long- term side effects of the procedure with no recurrence at 6 months follow up.

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The Effect of Quilting Sutures on the Tension Required to Advance the Abdominal Flap in Abdominoplasty

Aesthetic Surgery Journal ◽

10.1093/asj/sjab395 ◽

2021 ◽

Author(s):

Maria Roberta Cardoso Martins ◽

Betina Zimmermann Fontes de Moraes ◽

Daniel Capucci Fabri ◽

Hugo Alexandre Sócrates de Castro ◽

Lucas Rostom ◽

...

Keyword(s):

Body Mass Index ◽

Postoperative Complications ◽

Anterior Abdominal Wall ◽

Subcutaneous Tissue ◽

Tensile Force ◽

Wound Dehiscence ◽

Seroma Formation ◽

Hypertrophic Scars ◽

Before And After ◽

Number Of Births

Abstract Background Quilting sutures attaching the abdominal flap to the aponeurosis contribute to the prevention of seroma formation post-abdominoplasty. The sutures distribute the tension over the subcutaneous tissue along the flap length, theoretically decreasing tension at the distal (cutaneous) end of the flap. This is expected to reduce the risks of necrosis, dehiscence, and enlarged or hypertrophic scars. Objectives The study sought to verify whether quilting sutures decrease the tension required to advance the dermal-fat flap in abdominoplasty. Methods Thirty-four women undergoing abdominoplasty with quilting sutures participated in the study. The tensile force required for flap advancement was measured before and after the placement of quilting sutures, using a digital force gauge, and then compared. Differences in tensile force were tested for correlations with body mass index (BMI), age, weight of flap tissue removed, number of previous pregnancies, and postoperative complications, including seroma formation, hematoma, necrosis, dehiscence, and enlarged or hypertrophic scars. Results A mean reduction in tension of 27.7% was observed at the skin suture after the placement of quilting sutures (p < 0.001). No significant correlation was found of reduced flap tension with BMI, age, weight of tissue removed, and number of births. A case of seroma formation and two cases of enlarged scars were observed, but no case of hematoma, necrosis or wound dehiscence was detected. Conclusions The use of quilting sutures to attach the abdominal flap to the aponeurosis of the anterior abdominal wall reduced tension at the advancing edge of the flap in abdominoplasty.

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Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup7.s28 ◽

2021 ◽

Vol 30 (Sup7) ◽

pp. S28-S34

Author(s):

Abigail E Chaffin ◽

Shane G Dowling ◽

Mychajlo S Kosyk ◽

Brandon A Bosque

Keyword(s):

Extracellular Matrix ◽

Postoperative Complications ◽

Pilonidal Sinus ◽

Case Series ◽

Surgical Reconstruction ◽

Pilonidal Sinus Disease ◽

Surgical Approaches ◽

Flap Reconstruction ◽

Recurrence Rates ◽

Sinus Disease

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. Method: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. Results: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. Conclusion: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.

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The association between hospital ownership and postoperative complications: Does it matter who owns the hospital?

Health Informatics Journal ◽

10.1177/1460458219899827 ◽

2020 ◽

Vol 26 (3) ◽

pp. 2193-2201

Author(s):

Robby Atala ◽

Philip J Kroth

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Care Delivery ◽

Wound Dehiscence ◽

General Information ◽

Hospital Ownership ◽

Ownership Type ◽

For Profit ◽

Complication Score ◽

The Government

Postoperative complications place a major burden on the healthcare systems. The type of hospital’s ownership could be one factor associated with this adverse outcome. Using CMS’s publicly available “Complications and Deaths—Hospitals” and “Hospital General Information” datasets, we analyzed the association between four postoperative complications (venous thromboembolism, joint replacement complications, wound dehiscence, postoperative sepsis) and hospital ownership. These data were collected by Medicare between April 2013 and March 2016. We found a significant association ( p = 0.029) between ownership types and the postoperative complication score. A 6-percent drop in the share of not-for-profit ownership, accompanied by a 3-percent increase in each of the government and for-profit ownership, resulted in a 20-percent drop in postoperative complication scores (from 5.75 to 4.6). There is an association between hospital ownership type and postoperative complications. Creating this awareness in leadership should prompt for redesigning of hospitals’ operations and workflows to become more compatible with safe and effective care delivery.

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Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

Otolaryngology ◽

10.1177/0194599818777240 ◽

2018 ◽

Vol 159 (5) ◽

pp. 817-823 ◽

Cited By ~ 7

Author(s):

Meghan M. Crippen ◽

Jacob S. Brady ◽

Alexander M. Mozeika ◽

Jean Anderson Eloy ◽

Soly Baredes ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Postoperative Complications ◽

Head And Neck ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Flap Surgery ◽

Free Flap Surgery ◽

Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

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HASTE INTRAMEDULAR DE POLIPROPILENO, COMBINADA OU NÃO A BIOMATERIAIS, NO TRATAMENTO DE FRATURAS INDUZIDAS NO ÚMERO DE POMBOS

Archives of Veterinary Science ◽

10.5380/avs.v9i1.4048 ◽

2004 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

C.R. TEIXEIRA ◽

S.C. RAHAL ◽

A.F.M. LIMA ◽

M.A. CORREA ◽

P. QUEIROZ ◽

...

Keyword(s):

Postoperative Complications ◽

Fracture Healing ◽

Bone Morphogenetic Proteins ◽

Complete Healing ◽

The Body ◽

Group I ◽

Intramedullary Rod ◽

Group Ii ◽

Dislocation Group ◽

Transverse Fractures

O trabalho teve por objetivo avaliar a utilização da haste intramedular de polipropileno, combinada ou não a biomateriais de origem bovina, no tratamento de fraturas transversas induzidas no terço médio do úmero direito de pombos-domésticos. No grupo I (n=7), a fratura foi estabilizada por meio de haste intramedular de polipropileno aplicada em ambos os fragmentos da fratura, sem ultrapassar as articulações. No grupo II (n=7) utilizou-se a mesma fixação, porém foi aplicado junto ao foco de fratura uma mistura de biomateriais, constituída de proteínas morfogenéticas do osso e aglutinante de colágeno liofilizado. Em ambos os grupos, a asa foi imobilizada junto ao corpo com bandagem em forma de 8 por um período de 30 dias. Com seis semanas de pós-operatório, cinco fraturas do grupo I e quatro do grupo II estavam totalmente consolidadas. Foram observadas uma não consolidação hipertrófica (grupo I) e duas não consolidações com deslocamento do eixo ósseo (grupo II). Exceto as três aves que apresentaram complicações nas fraturas, as demais recuperaram a capacidade de vôo. Foi possível concluir que a haste intramedular de polipropileno foi um método de imobilização de eficácia limitada e os biomateriais utilizados não estimularam a consolidação das fraturas. Use of polypropylene intramedullary rod alone or combined with biomaterials for treatment of induced humeral transverse fractures in pigeons Abstract The aim of this study was to evaluate a polypropylene intramedullary rod alone or combined with biomaterials from bovine origin for the treatment of transverse fractures induced in the midshaft of right humerus in pigeons. In group I (n=7) the fracture was immobilized using a polypropylene intramedullary rod inserted into both fractured extremities without entering the joints. The same device was used in group II (n=7). Additionally, the fractured site in group II animals received a mixture of biomaterials composed by bone morphogenetic proteins and lyophilized collagen. In both groups a cast was applied to the affected wing, which was immobilized with a figure-of-8 bandage applied to the body and wing during 30 days. Complete healing was observed after six weeks of surgery in five and four animals from groups I and II, respectively. Observed complications included one hypertrophic nonunion (group I) and two nonunion with bone shaft dislocation (group II). Except for the three pigeons that showed postoperative complications, the remaining animals recovered the ability of flight. It was possible to conclude that the polypropylene intramedullary rod is a limited method of immobilization and the biomaterials used in this study did not stimulate fracture healing.

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An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.03.08 ◽

2021 ◽

Vol 14 (3) ◽

pp. 383-387

Author(s):

Faried Wagdy ◽

◽

Hisham Elsorogy ◽

Ahmed Alnagdy ◽

Dina Abd Elfattah ◽

...

Keyword(s):

Postoperative Complications ◽

Open Angle Glaucoma ◽

Implant Surgery ◽

Late Failure ◽

Group I ◽

The Mean ◽

The Difference ◽

One Year ◽

Age Range

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

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