scholarly journals Comparative study of delayed primary closure by shoelace technique versus conventional secondary suturing method in closure of fasciotomy wounds, done for spreading cellulitis with compartment syndrome

2020 ◽  
Vol 7 (2) ◽  
pp. 471
Author(s):  
Hareesh H. D. ◽  
Thrishuli P. B. ◽  
Girish Kumar N. M.
Keyword(s):  
Hospital Stay ◽  
Compartment Syndrome ◽  
Primary Closure ◽  
Wound Closure ◽  
Wound Complications ◽  
Delayed Primary Closure ◽  
Wide Range ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fasciotomy is a standard treatment for acute compartment syndrome. Historically, fasciotomy incisions were usually left open till oedema settles down. In literature, there is a wide range of wound closure techniques published, but none of them is deemed to be the best. In this study, focus is laid on whether delayed primary closure (DPC) by shoelace technique, is as effective as conventional secondary suturing, in closure of fasciotomy wounds, done for spreading cellulitis.Methods: All those patients who met below mentioned inclusion criteria and underwent fasciotomy, were allocated into 2 groups (A and B) where Group A consists of 30 patients undergoing conventional secondary suturing, whereas Group B consists of 30 patients undergoing DPC by shoelace technique for closure of fasciotomy wounds. Parameters such as duration of hospital stay, time taken for complete wound closure, local wound complications, hospital expenses, anaesthesia related complications between the two groups were compared.Results: Patients who underwent DPC for fasciotomy wound closure achieved wound closure ~7 days earlier with 5 days lesser hospital stay than that of those who underwent conventional secondary suturing. Average health care cost of Group B was significantly lower compared to Group A, but there was no statistically significant difference in incidence of wound infections between the two groups.Conclusions: DPC by shoelace technique, takes less time for wound closure and hence the need for nursing care and hospital stay is significantly reduced in comparison to the conventional secondary suturing method.

scholarly journals Octyl 2-cyanoacrylate versus conventional suturing of port site skin closure in laparoscopic appendicectomy: a prospective study

2021 ◽  
Vol 8 (4) ◽  
pp. 1094
Author(s):  
Swapnil Annasaheb Pattanshetti ◽  
Abhijit S. Gogate ◽  
Vidya M. Mahalmani ◽  
Kannikanti Nageswara Rao
Keyword(s):  
Prospective Study ◽  
Wound Closure ◽  
Port Site ◽  
Cosmetic Outcome ◽  
Laparoscopic Appendicectomy ◽  
Wound Complications ◽  
Skin Closure ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: With rapidly developing minimally invasive surgery, the laparoscopic appendectomy has become a preferred method for appendicectomy. Tissue adhesives have become an ideal alternative to conventional sutures and could possibly become the preferred standard of care in many procedures. However, this concept remains unexplored due to scanty data comparing the use of adhesive glues and sutures. The present prospective study was done to compare octyl-2-cyanoacrylate with conventional suturing of port site wound closure in laparoscopic appendicectomy in terms of wound complications, time taken for wound closure and cosmetic outcome.Methods: 60 patients diagnosed to have appendicitis (acute, chronic and recurrent) undergoing laparoscopic appendicectomy were divided into two groups (group A-octyl-2-cyanoacrylate) and (group B- conventional sutures) with 30 in each group. Time taken for wound closure, Wound complications and cosmetic outcome were compared in both groups.Results: Patient demographics were comparable in both the groups. The complications were significantly lower in group A compared to group B. Mean surgical time for wound closure in group A was less compared to group B (p<0.001). Wound closure using octyl-2-cyanoacrylate had lower rate of complications compared to conventional suturing but results obtained were not statistically significant. No significant difference in cosmetic outcome was noted in both groups.Conclusions:  Wound closure using octyl-2-cyanoacrylate required significantly less time for skin closure compared to conventional suturing in patients undergoing laparoscopic appendicectomy. However, wound complications and cosmetic outcome using octyl-2-cyanoacrylate did not show statistically significant results compared to conventional suture.

CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 189-192 ◽  
Author(s):  
Anis Dosani ◽  
Sameer K. Khan ◽  
Sheila Gray ◽  
Steve Joseph ◽  
Ian A. Whittaker
Keyword(s):  
Carpal Tunnel ◽  
Wound Closure ◽  
Unit Cost ◽  
Cost Effective ◽  
Cost Comparison ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
A Prospective Study

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.

Clinical Results Of A Lamina With Spinous Process And An Iliac Graft As Bone Grafts In The Surgical Treatment Of Single-Segment Lumbar Pyogenic Discitis: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Weiyang Zhong ◽  
Xinjie Liang ◽  
Xiaolin Wang ◽  
Ke Tang ◽  
Tianji Huang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Spinous Process ◽  
Bone Grafts ◽  
Clinical Results ◽  
Single Segment ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Segmental Angle

Abstract Background: A retrospective study investigated and compared the results of a lamina withspinous process (LSP) and an iliac graft (IG) as bone grafts in single-segment lumbar pyogenic discitis (LPD) through one-stage-posterior-only approach with radical debridement and internal instrumentation.Methods: Data from 37 patients were reviewed. A LSP was placed in 17 patients (group A), and an IG was implemented in 20 patients (group B). The surgery time, surgery hemorrhage, hospital stay, drainage, and follow-up (FU) were reviewed. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, segmental angle, intervertebral height and bony fusion time were compared preoperatively and at the final FU.Results: All patients were followed-up for a mean of 27.94±2.35 months in group A and 30.29±1.89 months in group B, without a difference. The mean age was younger in group A than in group B (P<0.05). The surgery time, surgery hemorrhage, and hospitalization cost were lower in group A than in group B (P<0.05), except for the hospital stay and drainage time. Fever occurred in 10 patients in group A and 12 patients in group B. The ESR, CRP level, and VAS and ODI scores were significantly decreased, and there were no significant differences between the groups at the final FU. The distribution of bacterial agents in blood culture was 1 case of Aerobacter cloacae, 2 of Staphylococcus aureus, 2 of Escherichia coli, and 1 of Streptococcus viridis in group A and 1 of S. aureus，1 of Staphylococcus warneri and 2 of Klebsiella pneumoniae in group B. Pyogenic infection was observed in the pathological findings of all patients. No significant difference was found in the mean segmental angle or mean intervertebral height preoperation and at the final FU between the groups.Conclusion: The use of LSP as a new bone graft is reliable, safe, and effective for surgical management for the LPD while surgery is proposed as a good management strategy for LPD in carefully selected patients.

scholarly journals Immediate vs. delayed toe-to-thumb transfer: Is the infection rate greater?

2019 ◽  
Vol 51 (06) ◽  
pp. 434-439
Author(s):  
Matteo Ornelli ◽  
Giovanni Ruocco ◽  
Juste Kaciulyte ◽  
Lara Lazzaro ◽  
Nicola Felici
Keyword(s):  
Infection Rate ◽  
Infection Rates ◽  
Immediate Reconstruction ◽  
Wide Range ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Toe Transfer ◽  
Delayed Reconstruction ◽  
Reconstruction Group

Abstract Background After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence. Patients and Methods From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection. Results 29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes. Conclusion For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

2020 ◽  
pp. 000313482094739
Author(s):  
Wan Zhen ◽  
Wang Xu-Zhen ◽  
Fu Nan-Tao ◽  
Li Yong ◽  
Xiao Wei-Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Common Bile Duct Exploration ◽  
Biliary Surgery ◽  
Tube Drainage ◽  
T Tube ◽  
Significant Difference ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

scholarly journals Comparative Study of Efficiency between Povidone Iodine and Normal Saline Lavage in the Treatment of Acute Peritonitis

2018 ◽  
Vol 4 (1) ◽  
pp. 15-20
Author(s):  
Haridas Saha ◽  
Mohammad Ibrahim Khalil ◽  
Aminul Islam ◽  
Abdullah Al Mamun ◽  
Md Margub Hossain
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Normal Saline ◽  
Povidone Iodine ◽  
Medical College ◽  
Acute Peritonitis ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Saline Lavage

Background: Control of the primary site of sepsis is the main determinant of good surgical outcome. Objective: The purpose of the present study was to compare the efficiency between povidone iodine and normal saline lavage in the treatment of acute peritonitis. Methodology: This was a randomized clinical trial conducted in the Department of Surgery at Dhaka Medical College & Hospital, Dhaka, Bangladesh. Patients with acute peritonitis due to gastrointestinal causes who were admitted in the different units of Dhaka Medical College Hospital during the study period were selected as study population. Among them patients who were treated with povidone iodine were enrolled in the present study in group A and patients who were treated with conventional normal saline were in group B. Results: A total number of 1050 patients were recruited for this study. Among them 100 patients were enrolled in the present study of which group A (50 patients) for povidone iodine and group B (50 patients) for conventional normal saline. On 7th POD wound infection was found in Group A and Group B were 11(22.4%) and 21(44.7%) respectively. Statistically significant difference in post operative complication of wound infection was observed on 7th POD between the groups (p<0.05). Post operative hospital stay in Group A and Group B were 11.50 ± 4.48 and 13.46 ± 5.13 days respectively. There is statistically significant difference in post operative hospital stay between the groups (p<0.05). Conclusion: Statistically significant difference observed in post operative complication of wound infection and burst abdomen on 7th POD between the groups. The present study there is statistically significant difference in post operative hospital stay between the groups also observed. Bangladesh Journal of Infectious Diseases 2017;4(1):15-20

Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

2014 ◽  
Vol 80 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Hong-Wei Zhang ◽  
Ya-Jin Chen ◽  
Chang-Hao Wu ◽  
Wen-Da Li
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Primary Closure ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Tube Drainage ◽  
T Tube ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

scholarly journals SURGICAL SITE INFECTION;

2017 ◽  
Vol 24 (12) ◽  
pp. 1770-1774
Author(s):  
Syed Muhammad Asar Hussain ◽  
Saadat Ali Janjua ◽  
Amna Fareed ◽  
Asrar Ahmad ◽  
Irum Saleem
Keyword(s):  
Surgical Site Infection ◽  
Study Design ◽  
Primary Closure ◽  
Military Hospital ◽  
Site Infection ◽  
Trial Duration ◽  
Primary Wound Closure ◽  
Delayed Primary Closure ◽  
Group A ◽  
Group B

Objectives: To compare the frequency of surgical site infection after primaryand delayed primary wound closure in dirty abdominal wounds. Study Design: Randomizedcontrolled trial. Duration and Setting: This study was carried out over a period of six monthsfrom 07-02-2014 to 06-08-2014 in the department of surgery combined military hospital Quetta.Methodology: A total of 190 patients were included in this study. wound was observed fordevelopment of surgical site infection post operatively within seven days by the assignedinvestigator who was unaware of the wound study design. surgical site infection was assessedusing Southampton wound grading. Results: Mean age of the patients was 30.89±10.38 and32.74±9.52 in group A and B, respectively. in group-A, 73 patients (76.8%) and in group-B 66patients (69.5%) were male while 22 patients (23.2%) of group-A and 29 patients (30.5%) ingroup-B were female.in group-A surgical site infection was observed in 29 patients (30.5%)and in group-B 12 patients (12.6%) were having surgical site infection. statistically significantdifference was found between two groups (p=0.003). Conclusion: The frequency of surgicalsite infection was significantly lower after delayed primary closure of dirty wounds as comparedto primary closure.

Alvimopan as an essential component of ERAS protocol to decrease length of hospital stay.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 517-517
Author(s):  
Peter Hanna ◽  
Arveen Kalapara ◽  
Subodh Regmi ◽  
Kalyana Srujana ◽  
Joseph Zabell ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Smoking Status ◽  
Length Of Hospital Stay ◽  
Significant Difference ◽  
Bowel Movements ◽  
Group A ◽  
Group B ◽  
Eras Protocol

517 Background: Radical cystectomy for muscle invasive bladder cancer is the gold standard. However, it is frequently associated with a prolonged length of hospital stay (LOS). We study the effect of ERAS protocol implementations and Alvimopan use in patients undergoing radical cystectomy and its impact on length of hospital stay (LOS). Methods: Retrospective cohort study involving consecutive patients undergoing radical cystectomy for bladder cancer at our institution from 2010 through 2018. We evaluated Alvimopan use plus an ERAS protocol post radical cystectomy versus patients who underwent ERAS protocol alone versus those who were managed prior to ERAS protocol implementation. Primary outcome of interest was LOS, controlling for age, sex, smoking status and Charleson comorbidities index. Results: 146 patients (49.32 %) received standard care (non-ERAS) (group A), 102 patients (34.45 %) underwent ERAS protocol alone (group B) and 47 patients (15.87 %) underwent ERAS protocol plus Alvimopan (group C). There was no significant difference in length of stay between group A and group B (p=0.856). However, group C experienced a shorter LOS (16.6%) compared to group A (p=0.015). Similarly, group B was not significantly associated with the days to bowel movements compared to group A (p=0.112), however, group C demonstrated a significantly shorter time (16.3%) to bowel movements compared to group A (p=0.015). On other hand, group c wasn’t significantly associated with time tolerance to regular diet (p=0.068). Limitations include retrospective nature of some of the data, non-randomized approach and confounders such as a mix of robot and open approaches to cystectomy. Conclusions: Of all ERAS protocol components, Alvimopan appeared to be the most significant contributor in accelerating GI recovery and decrease LOS in our cohort.

Shoe-Lace Technique Hasten Delayed Primary Closure In Fasciotomy Wound For Forearm Compartment Syndrome

2021 ◽  
Vol 7 (2) ◽  
pp. 76-78
Author(s):  
Mohd Asha'ari Bain ◽  
Mohd Shaffid Md Shariff ◽  
Mohamad Hilmi Mohamad Nazarallah ◽  
Nur Dina Azman ◽  
Abu 'Ubaidah Amir Norazmi
Keyword(s):  
Compartment Syndrome ◽  
Primary Closure ◽  
Open Fracture ◽  
Wound Closure ◽  
Skin Grafting ◽  
Delayed Primary Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Forearm Compartment Syndrome ◽  
Good Cosmesis

We report a case of acute compartment syndrome of the forearm in a 51-year-old man with open fracture distal third radius (Gustilo I).  Decompressive fasciotomy was performed promptly. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a shoe-lace technique: silastic vessel loop were interlaced held together with skin staplers placed at the edge of the fasciotomy wound and were then tightened daily. Delayed primary closure of the fasciotomy wound was performed after 8 days post fasciotomy with complete opposition of skin edges without tension. Shoelace closure is a good option for atraumatic fasciotomy wound closure with good cosmesis result.

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