scholarly journals Lumbodorsal flap for repair of meningomyelocele- a procedure matched controlled study

2017 ◽  
Vol 4 (5) ◽  
pp. 1678
Author(s):  
Gungi Raghavendra Prasad ◽  
Deepak Sharma ◽  
J. V. Subba Rao ◽  
P. Siva Kumar ◽  
Amtul Aziz
Keyword(s):  
Soft Tissue ◽  
Neural Tube ◽  
Wound Dehiscence ◽  
Csf Leak ◽  
Controlled Study ◽  
Skin Closure ◽  
Fascial Flap ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: Open neural tube defects have been approached by innumerable surgical techniques. Hitherto, excision of the exposed neural tube component, water tight closure of dura, approximation of paraspinal soft tissue and skin closure repair was stressed. Support of vertebral defect was not adequately addressed. Objectives were to introduce lumbodorsal/thoraco dorsal fascial flap as an effective answer to the vertebral defect component of MMC. To compare conventional paraspinal soft tissue closure with lumbodorsal/ thoracodorsal fascial flap.Methods: This was a procedure matched controlled study conducted from 1984-2015. A total of 121 procedures were performed by the same team formed the cohort of the study. Conventional muscle mobilization group A (n=50) and lumbodorsal flap group B (n=71) were the two groups. Demographic data, CSF leak, CSF collection, wound dehiscence, duration of drain and duration of surgery were the parameters evaluated with statistically blinded method.Results: The series mostly constituted lumbar (28%) and lumbo-sacral meningomyelocele (56%). Most of the children in both the groups are either at birth or <1 month. Only few patients in group B with lipo-meningocele presented beyond the age of 5 years (7%). 12% in group A had hydrocephalus, whereas 15.4% had in group B. The patients underwent similar technique at all sites of MMC. Grossly it appears that there is less wound dehiscence, less CSF leak, less hygroma formation in group B cases. Duration of surgery is similar in both the groups, most of them requiring 60 to 120 minutes. The duration of drainage was more than 7 days in group A (34%) as compared to group B (20%).Conclusions: Lumbodorsal/thoraco dorsal fascial flap adequately supports the vertebral defect and skin flaps. They seem to be superior in addressing the vertebral defect component.

scholarly journals Abdominal Wound Closure in Gynaecological or Obstetrical Surgery with Vicryl® (Polyglactin910) Versus Vicryl Plus® (Polyglactin910 with Triclosan Added): A Comparative Study

2019 ◽  
Vol 17 (1) ◽  
pp. 10-12
Author(s):  
Binod Kumar Mahaseth
Keyword(s):  
Surgical Site Infection ◽  
Surgical Complication ◽  
College Teaching ◽  
Controlled Study ◽  
Skin Closure ◽  
Site Infection ◽  
Comparative Efficacy ◽  
Group A ◽  
Group B ◽  
Johnson Company

Background: Surgical site infection is the most common post-surgical complication in surgical patients. The incidence of surgical site infection varies from 3-20% (or even more) in different part of the world. To date, the best method and material for skin closure has not been recommended by anybody. Triclosan is an antiseptic agent used for coating a suture material to prevent the infections. This case-controlled study was carried out to determine the comparative efficacy of sutures; Objective: This case-controlled study was carried out to determine the comparative efficacy of sutures: vicryl® and vicryl plus® (triclosan, an antiseptic incorporated with suture), in reducing surgical site infection in laparotomy for clean Gyn/Obs operations. Material and method: This case-controlled study was carried out in Dept. Of Gynae/Obs at Nepalgunj Medical College Teaching Hospital, Kohalpur. The period of the study was from Jan 2018 to January 2019. A total of 50 participants were enrolled in the study, who met the inclusion criteria. The patients were divided into two groups A and B, each consisting of 25 patients. The patients were allocated in the groups alternately to remove bias. The Group A consisted of patients where Vicrylplus® (Ethicon, Johnson & Johnson Company, Ahmadabad, India) polyglactin910 with triclosan) was used and Group B consisted of patients where vicryl ® (Ethicon, Johnson & Johnson Company, Ahmadabad, India) polyglactin910 alone) was used. Patients whose abdominal wounds were found infected, pus swab for culture were taken and sent for aerobic culture and sensitivity. All patients received ceftriaxone and metronidazole single dose before operations prophylactically. Result: Surgical site infection ingroup A was 3 cases out of 25 (12%) and in group B it was 6 cases out of 25(24%). Triclosan added polyglactin910 suture found to be statistically non significant concerning prevention of SSI as compared to polyglactin910 (p=0.472). The mean age of the study population was in group A was (29.76±7.47) and in group B was (27.12±7.42).

LIMBERG FLAP A BETTER METHOD OF CLOSURE OF LUMBAR MYELOMENINGOCELE DEFECTS: A PROSPECTIVE STUDY

2021 ◽  
pp. 3-4
Author(s):  
Prem Shanker ◽  
Raghavendra Gupta ◽  
Rajesh Kumar ◽  
Adiveeth Deb
Keyword(s):  
Tertiary Care ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
Csf Leak ◽  
Controlled Study ◽  
Limberg Flap ◽  
Tertiary Care Centre ◽  
Direct Repair ◽  
Group B ◽  
A Prospective Study

Background: Myelomeningocele is the most common and complex congenital malformation of the central nervous system with an incidence of approximately 1 in 1000 live births. The lumbosacral area is the commonest site for defect. Early closure of a myelomeningocele defect is advocated because it reduces infection rates even though it is not associated with an improved neurological outcome. Aims & objectives: The aim of this study was to evaluate the effectiveness and outcome of direct repair and a Limberg ap repair for skin defects that occur in myelomeningocele. Settings and Design: This was a prospective, randomized controlled study. Material and methods: A tertiary care centre based, non-randomized, prospective, comparative study was conducted in the Department of Neurosurgery, GSVM Medical College, Kanpur, from January 2018 to October 2019, in 22 patients with lumbar myelomeningocele. 7 patients who underwent Limberg ap repair constituted Group A and 15 patients who underwent direct repair constituted Group B. Post operatively the outcomes were compared at 6 months, on the basis of cosmetic appearance and complications such as wound dehiscence, CSF leak, neurological decit, hydrocephalus, necrosis and wound infection. Results : Lesser complications and a better cosmetic outcome were seen post operatively at 6 months with Limberg ap technique compared to direct repair. Our study show better result with Limberg ap over direct repair of myelomeningocele defect closure up to the follow up period of 6 months. Conclusion: Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of myelomeningocele defects. Most lumbar myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local aps may be used to cover the defect. Overall, Limberg ap is a better technique for closure in these patients.

scholarly journals Comparison of prophylactic versus regular use of antibiotics in elective major obstetrical and gynecological surgeries

2019 ◽  
Vol 8 (2) ◽  
pp. 580
Author(s):  
Ramya Sreevarshni Shunmugha Sundharam ◽  
Hiremath P. B. ◽  
Sankareswari R.
Keyword(s):  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Mean Value ◽  
Controlled Study ◽  
Therapeutic Drug ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Surgical site infections better prevented by parenteral antibiotic in sufficient doses generally should be given before the operation which helps to achieve the therapeutic drug level both in the blood and related tissue during the operation. Ceftriaxone, when administered together as a prophylaxis can fulfil the above criteria of a good antibiotic. Thus, this study was planned to assess the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective surgeries.Methods: This randomized controlled study was conducted in a tertiary care teaching hospital during the study period of June 2017 to April 2018 with 140 cases. Group A received a single dose of Injection Ceftriaxone 1g. Group B, received Injection Ceftriaxone 1 gm and Injection Metronidazole 500 mg for five days. The data was entered in excel sheet and analyzed using SPSS (Version 16).Results: The mean age group in Group A and Group B was found to be 34.24±10.5 and 35.97±11.89, respectively. There was no statistical significance between group A and B for incidence of infection in the post-operative period and duration of hospital stay. The mean value in group A for duration of surgery was found to be 67.5±13.5 and in group B mean value was 72.1±14.9. (p value <0.05).Conclusions: This study demonstrated that administration of prophylactic antibiotic rather than conventional antibiotic at caesarean and gynecological surgeries are not associated with significant difference in post-operative morbidities.

scholarly journals The Improved TBW Versus the Standard TBW for Olecranon Fractures in the Aged: a Retrospectively Comparative Study

2021 ◽  
Author(s):  
Xiaoyong Lin ◽  
Hai Liao
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Internal Fixation ◽  
Intraoperative Blood Loss ◽  
Fracture Union ◽  
Duration Of Surgery ◽  
Group A ◽  
Elbow Function ◽  
Group B ◽  
Olecranon Fractures

Abstract Objectivession: Olecranon fractures of the aged are traditionally managed operatively with Tension Band Wire (TBW). We compared clinical outcomes of treatment of the improved TBW versus the standard TBW for the treatment of the senile Olecranon fractures patients. Methods: A retrospective study was conducted on senile olecranon fractures patients in our hospital from June 2016 to January 2019. After appropriate exclusion, 62 olecranon fractures patients (29 patients in group A of the improved TBW, 33 patients in group B of the standard TBW) were reviewed in this study. All reviewed patients underwent preoperative immobilization and detumescence, open reduction and internal fixation, and postoperative function exercise. Duration of surgery, intraoperative blood loss, times of fluoroscopy intraoperatively, postoperative pain score, fracture union time, soft tissue irritation, failure of fixation and Broberg Morrey score of elbow function were recorded and compared.Results: The duration of surgery, intraoperative blood loss, postoperative pain score, Broberg Morrey score of elbow function had no significant difference between the two groups. The improved TBW (group A) was better than the standard (group B) in terms of the fixation loosening, fracture union time, the skin irritation, and the difference was significant ( all p< 0.05) .Conclusions: On the basis of no additional surgical trauma, the improved TBW was not only benefit for the fracture union, but also benefit for reducing the incidence of internal fixation loosening and soft tissue irritation. This improved internal fixation is not an unattractive option for senile olecranon fractures patients.

scholarly journals A comparative study between onlay and sublay meshplasty in ventral hernias: a randomized controlled trial

2019 ◽  
Vol 6 (4) ◽  
pp. 1264
Author(s):  
Tharun Ganapathy Chitrambalam ◽  
Preetham Anguraj ◽  
Jeyakumar Sundaraj ◽  
Manimaran Pethuraj
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Ventral Hernia ◽  
Controlled Study ◽  
Post Operative Pain ◽  
Duration Of Surgery ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Ventral Hernias

Background: Ventral hernias are one of the most common surgical problems of the modern age. About 15-18% of all the surgical procedures performed around the world comprises of hernia repair. This study aims to compare the two common options of mesh placement in open ventral hernia repairs; over the anterior rectus sheath, the ‘Onlay meshplasty’ and in the retrorectus plane, the ‘Sublay meshplasty’.Methods: A prospective controlled study was done between March 2017 to August 2018 on 150 patients with ventral hernia randomizing patients into 2 groups. Group A (Onlay meshplasty) and Group B (Sublay meshplasty). Duration of surgery, post-operative pain, wound infection, duration of hospital stay and recurrences were analysed with 12 months follow up.Results: The mean duration of surgery in group A was 48.49±0.71 minutes and in group B was 72.84±0.72 minutes. Group B experienced significantly lesser pain when compared with group A. The mean asepsis score in group A was 3.60±1.09 and in group B was 0.47±0.30 with a p value of 0.006. Group A had significantly longer hospital stay (9.39 days) than group B (5.71 days). The recurrences in both the groups were statistically insignificant (Group A- 2 patients; Group B- 1 patient).Conclusions: Sublay meshplasty although requires longer time to perform, proves to be a better alternate in terms of post-operative pain, wound infection and hospital stay.

scholarly journals Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries

2018 ◽  
Vol 5 (4) ◽  
pp. 1368
Author(s):  
G. V. Manoharan ◽  
T. Sivakumar ◽  
M. Ashok Kumar
Keyword(s):  
Hospital Stay ◽  
Abdominal Wall ◽  
Subcutaneous Tissue ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Skin Closure ◽  
Abdominal Wall Closure ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay. 

scholarly journals SKIN CLOSURE IN LAPAROTOMY

2011 ◽  
Vol 18 (04) ◽  
pp. 552-556
Author(s):  
GHULAM SHABBIR ◽  
M. SUHAIL AMER ◽  
MUHAMMAD UMAIR RASHID
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Wound Dehiscence ◽  
Skin Closure ◽  
Significant Group ◽  
Qualitative Variable ◽  
Wound Closure Techniques ◽  
Group A ◽  
The Difference ◽  
Group B

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Design and Duration: Quasi experimental study from September, 2006 to March, 2007. Setting: Surgical floor of Allied Hospital, (Punjab Medical College) Faisalabad. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Results: Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients (group A) were left open and closed on 4th day while that of next thirty patients (group B) closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence (16.66 %). Four belonged to group A(13.33%) and six belonged to group B(20 %) (p<0.05). In advancing age the infection rate was significantly high in the same group (p <0.01). Regarding hospital stay of patients of two groups the difference was statistically significant. Group A (mean=7.77, std. dev=2.029 and std. error of mean=0.370). Group B (mean=10.30, std. dev=4.822 and std. error of mean=0.880). Regarding age the difference was not statistically significant between two groups. Group A (mean 30.47, std. dev=10.099 and std error of mean=1.844). The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. Conclusions: No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care.

scholarly journals Effectiveness of tissue adhesive versus conventional sutures in the closure of inguinal hernia skin incisions: a prospective randomized controlled trial

2018 ◽  
Vol 5 (5) ◽  
pp. 1797
Author(s):  
A. P. Bellad ◽  
Katkar Akash Pratap
Keyword(s):  
Inguinal Hernia ◽  
Clinical Characteristics ◽  
Controlled Trial ◽  
Tissue Adhesive ◽  
Skin Closure ◽  
Tissue Adhesives ◽  
Randomized Controlled ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: Several surgical wound closure techniques are used including conventional sutures and skin adhesive compounds. However, tissue adhesives have evolved as an improved alternative to sutures. Few data are available on the tissue adhesives in the closure of inguinal hernia skin incisions. The aim of this study was to determine the effectiveness of tissue adhesive in the closure of inguinal hernia skin incisions compared to conventional sutures.Methods: A 1-year randomized controlled trial was conducted including 60 patients with inguinal hernia. Based on closed envelope method, patients were randomly allocated into two groups: group A and B. Patients of group A underwent skin closure with cyanoacrylate glue and that of group B underwent skin closure with conventional sutures. Demographics and clinical characteristics of the patients were recorded. On postoperative day 3, the patients were evaluated for swelling, fever, redness and discharge from the wound. SPSS 20 was used to analyze the data. Chi-square test, Fisher’s exact test, and independent sample t-test were employed in the analysis of data.Results: All the patients included in the present study were men. The age of the patients ranged between 18 and 50 years in both the groups. All patients had chief complaint of swelling in the inguinal area. The clinical characteristics of the study population including sex, mean age, weight, pulse rate, systolic blood pressure, and diastolic blood pressure were comparable in group A and group B (P>0.050). The mean duration of surgery was significantly lower in group A (66.67±4.61 min) compared to group B (71.21±6.90 min; P=0.004). On Postoperative day 3, very few patients in group B had swelling (6.67% vs. 16.67%; P = 0.228), fever (6.67% vs. 16.67%; P = 0.228), discharge (6.67% vs. 16.67%; P = 0.228), and redness (6.67% vs. 10.00%; P = 0.640) than in group A.Conclusions: Tissue adhesive is superior and equally safe as compared to conventional suture in terms of duration of surgery and postoperative surgical complications. However, large studies should be conducted focusing on infection, follow-up period, and cosmesis as the outcomes.

Pregabalin As A Premedicant To Attenuate Pressor Response In Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

2020 ◽  
Vol 11 (3) ◽  
pp. 3418-3423
Author(s):  
Sweety Agrawal ◽  
Shubdha Bhagat ◽  
Pratibha Deshmukh ◽  
Amol Singham
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pressor Response ◽  
Controlled Study ◽  
Double Blind ◽  
Co2 Insufflation ◽  
Ramsay Sedation Scale ◽  
Minute Interval ◽  
Group A ◽  
Group B ◽  
Induction Of Anaesthesia

The present study was done to evaluate the ability of oral pregabalin to attenuate the pressor response to airway instrumentation in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty-four adult patients aged between 25-55 year of either gender belonging to ASA-1 or ASA2 physical status weighing 50-70 kg were enrolled in this study. Thirty-two patients each were randomized to group A, or group B. Patients in group A received tablet Pregabalin (150mg) and those in group B received placebo orally one hour before induction of anaesthesia. Heart rate, blood pressure, and sedation were assessed preoperatively before giving the tablets and after 30 minutes, and just before induction of anaesthesia. Intraoperative, pulse rate, mean arterial pressure, ECG in the lead II, SPO2 and ETCO2 were monitored. All the above parameters were noted during laryngoscopy and intubation, 3 minutes after CO2 insufflation, and then at every 10-minute interval till the end of surgery. These parameters were also recorded after extubating the patient. The Ramsay sedation scale was used to assess the sedation at the baseline, one hour after drug intake , one hour after extubation and 4 hour after surgery. Any adverse effects in the postoperative period were recorded. The result of our study shows that pre-emptive administration of oral pregabalin 150 mg significantly reduced the pressor response at the time of laryngoscopy and intubation, after CO2 insufflation and just after extubation. We conclude that oral pregabalin premedication is effective in successful attenuation of hemodynamic pressor response to laryngoscopy, intubation and pneumoperitoneum in patients undergoing laparoscopic cholecystectomy

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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