Is There Utility in Using Mastoid Pressure Dressing in Children Undergoing a Mastoidectomy?

Objectives: To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and postoperative pain. Design: A retrospective controlled study. Setting: All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Participants: children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010-2020. Main outcome measures: Wound-related complications and visual analog scale (VAS) pain scores at discharge were compared between children who had a MPD applied following surgery and those who did not. Results: 119 cases were included. The demographic characteristics of the patients and surgical techniques employed similar for both groups. There were 91 patients in the MPD group and 28 in the non-mastoid dressing (NMPD) group. In the MPD group, 5 patients developed minor wound dehiscence, 8 experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had a SSI, while another had a local hematoma. Therefore, there were no differences between the groups in relation to postoperative complications (p = 0.47). Despite these similitudes, the NMPD patients suffered less postoperative pain, as measured by the VAS (p =.02). Conclusions: This study shows that no significant benefit is derived from using a MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent postoperative wound complications. Our study supports the abandonment of routine MPD on children following mastoidectomy.

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P100 EARLY POSTOPERATIVE WOUND COMPLICATIONS AFTER MIDLINE LAPAROTOMY CLOSURE WITH SMALL BITES TECHNIQUE: EXPERIENCE FROM A TERTIARY REFERRAL CENTRE

British Journal of Surgery ◽

10.1093/bjs/znab395.093 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Adomas Gudelis ◽

Gintaras Simutis ◽

Julius Pacevicius

Keyword(s):

Abdominal Wall ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Patient Characteristics ◽

University Hospital ◽

Wound Complications ◽

Tertiary Referral Centre ◽

Midline Laparotomy ◽

Group A ◽

Wound Length

Abstract Aim To analyze the incidence and risk factors of surgical site infections (SSI) and wound dehiscence (WD) after closure of primary midline laparotomies with small-bites (SB) technique. Material and Methods Retrospective analysis using hospital prospective database of all midline abdominal wall closures (AWC) with SB technique performed in a University Hospital between December 2019 and February 2021. To achieve a proper protocol of AWC with SB technique, it is advised to have suture/wound length (SL/WL) – ratio of more than 4:1. Statistical analysis of the incidence of SSI and AWD, comparing the results when the protocol was properly used (A group) or not (B group), was performed. Between groups, no relevant differences were observed for patient characteristics. Results A total of 108 midline laparotomies were included for analysis. 55.5% of patients were male. The mean age was 62.8 years, mean body mass index was 24.3 kg/m2. 78.7% (85/108) were operated electively. SSI and WD have been recorded in 7 (6.5%) and 8 (7,4%) cases respectively. In 65 (60,2%) patients abdominal wall closure after primary laparotomy was achieved with proper protocol (group A). Median SL/WL in A and B group was 4.57 and 3.43 respectively. The rate of WD in A group (n = 1, 1,5%) was significantly (P=.006) lower than in B group (n = 7, 16,3%). Incidence of SSI was 7,7% (n = 5, A group) vs. 4,7% (n = 2; B group) (P=.420). Conclusions Using a proper AWC protocol has been effective to prevent WD in midline laparotomy.

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ADHESIVE GLUE Vs SUBCUTICULAR SUTURING IN THYROIDECTOMY

10.36106/7815145 ◽

2021 ◽

pp. 16-17

Author(s):

Anil Kumar K N ◽

Ashwin Kumar H

Keyword(s):

Postoperative Pain ◽

Clinical Outcome ◽

Wound Closure ◽

Medical Science ◽

Wound Dehiscence ◽

Wound Complications ◽

P Value ◽

Skin Closure ◽

Post Operative Pain ◽

Needle Prick

BACKGROUND: Suturing has been the commonest method of surgical wound closure that is being practiced because of good results of skin closure. With adhesive glue being an alternative for skin closure which is less time consuming, comfortable, without the risk of needle prick injury and leaves behind a cosmetically acceptable scar. OBJECTIVES: The aim of this study is to compare subcuticular suturing versus adhesive glue for skin closure in thyroidectomy with respect to clinical outcome which included postoperative pain, wound complications, wound dehiscence and cosmesis. MATERIALAND METHODS: This prospective study of 100 cases of skin closure using subcuticular suturing versus adhesive in thyroidectomy was carried out at BGS Global institute of medical science and Hospital, Bangalore with the aim of comparing suturing versus adhesive glue, with respect to clinical outcome which included postoperative pain, wound complications, wound dehiscence and cosmesis. RESULT: 100 patients divided into 2 groups, randomly underwent subcuticular suturing and adhesive glue skin closure. Post- operative pain was less in glue group (p value <0.001) and wound complications were comparable in both groups. CONCLUSION: Octylcyanoacrylate provides an effective and reliable means of skin closure and yields similar cosmetic results as with subcuticular skin sutures. The incidences of wound complications are comparable in both the groups. However the severity of postoperative pain is lesser in the adhesive group.

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Coagulation Laboratory Testing Is Predictive of Wound Complications Following Microdiscectomy

Global Spine Journal ◽

10.1177/2192568218764677 ◽

2018 ◽

Vol 9 (2) ◽

pp. 138-142

Author(s):

Vadim Goz ◽

Nikita Lakomkin ◽

Ali Jalali ◽

Darrel S. Brodke ◽

William R. Spiker

Keyword(s):

Postoperative Complications ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Cost Effective ◽

International Normalized Ratio ◽

Wound Complications ◽

Improvement Program ◽

Logistic Regression Models ◽

American Society ◽

Tract Infections

Study Design: Retrospective review. Objective: To determine whether abnormal preoperative testing is associated with postoperative complications in patients undergoing a microdiscectomy. Methods: Patients undergoing a microdiscectomy between 2006 and 2013 were identified in the National Surgical Quality Improvement Program database based on appropriate current procedural terminology coding. Thirty-day postoperative complications were analyzed in addition to patient demographics, comorbidities, and abnormal preoperative laboratory values. A series of over 650 univariate analyses to determine which independent variables to include for each complication were completed. Based on those analyses, 12 logistic regression models were built, one for each specific complication. Each model adjusted for age, gender, comorbidities, American Society of Anesthesiologists classification, as well as operative time. Results: A total of 5947 patients undergoing a microdiscectomy were included in the study. Abnormal preoperative international normalized ratio (odds ratio [OR] = 5.85, P < .05) was associated with any wound infection, superficial or deep, and abnormal partial thromboplastin time was significantly associated with wound dehiscence (OR = 6.80, P < .05). Postoperative urinary tract infections were associated with abnormal preoperative hematocrit (OR = 8.00, P < .05). None of the identified preoperative labs were independently associated with pulmonary embolism, organ space surgical site infections, or intubation. Conclusions: Abnormal preoperative coagulation labs were significantly associated with postoperative wound complications. However, the majority of tests were not associated with adverse events following microdiscectomy. Further study is necessary to conclude whether these tests provide information that can modify perioperative management and whether widespread testing is cost-effective.

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Efficacy of Abductor Pollicis Longus Suspensionplasty Compared to Ligament Reconstruction and Tendon Interposition

Hand ◽

10.1177/1558944720906565 ◽

2020 ◽

pp. 155894472090656

Author(s):

Ellen S. Satteson ◽

Cassie Driscoll ◽

Mija Khan ◽

Nicholas J. Walker ◽

David Person ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Ligament Reconstruction ◽

Surgical Techniques ◽

Wound Dehiscence ◽

Postoperative Pain Relief ◽

Pinch Strength ◽

Exact Test ◽

Abductor Pollicis Longus ◽

Tendon Interposition

Background: Multiple surgical techniques are described for basal joint osteoarthritis. This study compares clinical outcomes and patient satisfaction with trapeziectomy and abductor pollicis longus (APL) suspensionplasty compared to trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when performed by 2 fellowship-trained hand surgeons. Methods: A retrospective review of 51 consecutive patients undergoing APL suspensionplasty (53 hands) was performed. With this technique, a distally based APL slip is brought through and sewn to the flexor carpi radialis (FCR). The remaining APL is placed in the trapeziectomy void. This technique was compared to 151 patients (166 hands) who underwent LRTI using the FCR tendon. Outcomes assessed included postoperative pain relief, grip and pinch strength, complications, and need for reoperation. Two-tailed, Fisher’s exact test was used for data analysis. Results: APL suspensionplasty resulted in postoperative pain relief in 92.5% (n = 49) compared to 94.0% (n = 156) with LRTI ( P = .758). Mean postoperative grip and pinch strengths with APL suspensionplasty were 41.2 and 10.4 kg, respectively. With LRTI, average grip strength was 42.0 kg, and pinch was 10.1 kg. Both techniques were well tolerated with minimal complications. In the APL group, 1 patient had a postoperative infection requiring drainage. Among the LRTI cases, 1 wound dehiscence required closure, and 2 minor postoperative wound infections resolved with oral antibiotics. Mean follow-up time among APL suspensionplasty patients was 3.3 months compared to 8.4 months following LRTI. Conclusions: APL suspensionplasty is a safe, effective procedure which provides similar pain relief and functional outcomes compared to LRTI.

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Abdominal Wall Thickness is a Predictor for Surgical Site Infections in Patients Undergoing Colorectal Operations

The American Surgeon ◽

10.1177/0003134820956932 ◽

2020 ◽

pp. 000313482095693

Author(s):

Yu-Wei W. Chang ◽

Kyle Murphy ◽

Daniel Yackzan ◽

Sarah Thomas ◽

Danielle Kay ◽

...

Keyword(s):

Risk Factor ◽

Abdominal Wall ◽

Wall Thickness ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Abdominal Circumference ◽

Fat Percentage ◽

University Of Kentucky ◽

Improvement Project ◽

Acs Nsqip Database

Background Surgical site infections (SSIs) are an established complication following colorectal operations, with rates up to 30% reported in the literature. Obesity is a known risk factor for SSI; however, body mass index (BMI), body fat percentage, waist-hip ratio, or abdominal circumference are imperfect measures. The purpose of our study was to determine whether abdominal wall thickness (AWT) is predictive of SSI. Methods We queried our American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database for patients (age ≥18 years) undergoing a colectomy at the University of Kentucky (UK) from January 1, 2013 to December 31, 2018. The exclusion criteria included patients with open abdomens or the lack of preoperative computed tomography (CT) within 3 months of their operation. AWT was measured at the level of the anterior superior iliac spine (ASIS) on abdominal CT. SSI was defined by superficial SSI, deep SSI, and wound dehiscence. Results Of 1261 patients enrolled, 52.2% were female, with an average age of 57.4 years. More patients had laparoscopic operations (51%), and the median length of stay was 7 days. Our study demonstrated an SSI rate of 9.4% and a 30-day readmission rate of 11%. The overall mean AWT was 2.6 cm (range .1-13.1), and patients with the highest AWT quintile were more likely to develop an SSI than the lowest quintile (12% vs. 5%). After controlling for risk factors and confounders, the odds of an SSI were 3.6 times higher for patients with the highest AWT than patients with the lowest AWT. Conclusions Among colorectal surgery patients, AWT is an independent risk factor predictive for SSI.

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Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1722733 ◽

2021 ◽

Author(s):

Taehee Jo ◽

Joon Hur ◽

Eun Key Kim

Keyword(s):

Negative Pressure Wound Therapy ◽

Wound Dehiscence ◽

Surgical Debridement ◽

Wound Complications ◽

Approximation Technique ◽

Invasive Approach ◽

Nonsurgical Management ◽

Single Use ◽

Sternal Wound Infections ◽

Deep Sternal Wound Infections

Abstract Background Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device. Methods Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed. Results Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6–26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11–29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures. Conclusion We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.

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Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211016252 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110162

Author(s):

Matthew S. Broggi ◽

Philip O. Oladeji ◽

Syed Tahmid ◽

Roberto Hernandez-Irizarry ◽

Jerad Allen

Keyword(s):

Risk Factor ◽

Hip Fracture ◽

Postoperative Complications ◽

Hip Fractures ◽

Depressive Disorders ◽

Surgical Site Infections ◽

Wound Complications ◽

Non Union ◽

Hip Fracture Surgery ◽

Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

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Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0015

Author(s):

Paolo Ceccarini ◽

Rosario Petruccelli ◽

Michele Bisaccia ◽

Giuseppe Rinonapoli ◽

Auro Caraffa

Keyword(s):

Wound Dehiscence ◽

Deep Infection ◽

Ankle Fractures ◽

Bone Union ◽

Wound Complications ◽

Fisher Exact Test ◽

Superficial Infection ◽

Operative Care ◽

Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

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