The Impact of Glycosylated Hemoglobin and Diabetes Mellitus on Postoperative Wound Healing Complications and Infection Following Foot and Ankle Surgery

2014 ◽  
pp. 140626130507002 ◽  
Author(s):  
Jon Humphers ◽  
Naohiro Shibuya ◽  
Benjamin L. Fluhman ◽  
Daniel Jupiter
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Glycosylated Hemoglobin ◽  
Foot And Ankle ◽  
Postoperative Wound ◽  
Ankle Surgery ◽  
The Impact

The Impact of Glycosylated Hemoglobin and Diabetes Mellitus on Wound-Healing Complications and Infection After Foot and Ankle Surgery

2014 ◽  
Vol 104 (4) ◽  
pp. 320-329 ◽  
Author(s):  
Jon M. Humphers ◽  
Naohiro Shibuya ◽  
Benjamin L. Fluhman ◽  
Daniel Jupiter
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Odds Ratio ◽  
Hba1c Level ◽  
Foot And Ankle ◽  
Surgery Complications ◽  
Postoperative Wound ◽  
Ankle Surgery ◽  
Significant Factors

Background The relationship between hyperglycemia and adverse outcomes after surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate whether hemoglobin A1c (HbA1c) level was independently associated with postoperative complications in a retrospective cohort study. Methods Three hundred twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative foot and ankle surgery complications. Results Bivariate analyses showed that HbA1c level and having at least one comorbidity were associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c level, with each increment of 1% increasing the odds of infection by a factor of 1.59 (95% confidence interval [CI], 1.28–1.99). For postoperative wound-healing complications, bivariate analyses showed that body mass index, having at least one comorbidity, and HbA1c level were significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (odds ratio, 2.03; 95% CI, 1.22–3.37) and HbA1c level (each 1% increment) (odds ratio, 1.25; 95% CI, 1.02–1.53). Conclusions In this retrospective study, HbA1c level had the strongest association with postoperative foot and ankle surgery complications in patients with diabetes.

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

2021 ◽  
Author(s):  
Marcus Rickert ◽  
Michael Rauschmann ◽  
Nizar Latif-Richter ◽  
Mohammad Arabmotlagh ◽  
Tamin Rahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Negative Pressure Wound Therapy ◽  
Wound Infections ◽  
Wound Therapy ◽  
Postoperative Wound ◽  
Deep Wound ◽  
The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

scholarly journals The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl
Keyword(s):  
Orthopaedic Surgery ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Perceived Effectiveness ◽  
Educational Impact ◽  
Short Term ◽  
Surgical Mission ◽  
Ankle Surgery ◽  
Orthopaedic Residency ◽  
The Impact

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

Effect of Postoperative Oral Antibiotics on Infections and Wound Healing Following Foot and Ankle Surgery

2020 ◽  
Vol 41 (12) ◽  
pp. 1466-1473
Author(s):  
Jacob Carl ◽  
Trevor J. Shelton ◽  
Kevin Nguyen ◽  
Isabella Leon ◽  
Jeannie Park ◽  
...  
Keyword(s):  
Wound Healing ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Wound Complications ◽  
Oral Antibiotic ◽  
Foot And Ankle ◽  
Oral Antibiotics ◽  
Infection Rates ◽  
Level Of Evidence ◽  
Ankle Surgery

Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified. Methods: A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery. Results: The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health. Conclusion: This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries. Level of Evidence: Level III, retrospective comparative series.

Does Revascularization Prior to Foot and Ankle Surgery Reduce the Incidence of Surgical Site Infection (SSI)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 15S-16S
Author(s):  
Nima Heidari ◽  
Alexander Charalambous ◽  
Iris Kwok ◽  
Alexandros Vris ◽  
Yueyang Li
Keyword(s):  
Wound Healing ◽  
Beneficial Effect ◽  
Surgical Site Infection ◽  
Elective Surgery ◽  
Site Infection ◽  
Foot And Ankle ◽  
Peripheral Vascular ◽  
Level Of Evidence ◽  
Diabetic Foot Infection ◽  
Ankle Surgery

Recommendation: Several studies support the effect of peripheral vascular disease (PVD) on wound healing and surgical site infection (SSI). Despite this, there have been no specific studies proving the beneficial effect of revascularization on SSI prior to operative intervention in the setting of traumatic or elective foot and ankle surgery. The majority of studies on revascularization are in the setting of diabetic foot infection or established ischemia. We recommend that in the presence of an inadequate vascularization in the foot and ankle, vascular optimization should be undertaken prior to elective surgery. Level of Evidence: Limited. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Wound closure and special suture techniques

1995 ◽  
Vol 85 (1) ◽  
pp. 2-10 ◽  
Author(s):  
D Gusman
Keyword(s):  
Wound Healing ◽  
Wound Closure ◽  
Suture Techniques ◽  
General Knowledge ◽  
Foot And Ankle ◽  
Tissue Handling ◽  
Ankle Surgery

In this review, the author presents the physiologic events in wound healing. A discussion is provided with emphasis on proper tissue handling and suture techniques. A variety of methods are demonstrated as they are applied to specific clinical situations in foot and ankle surgery. It is the intent of this discussion to add information and techniques that may be used to complement general knowledge in wound and incision repair.

Influence of Complications and Revision Surgery on Fulfillment of Expectations in Foot and Ankle Surgery

2021 ◽  
pp. 107110072098523
Author(s):  
Bopha Chrea ◽  
Jonathan Day ◽  
Jensen Henry ◽  
Elizabeth Cody ◽  
Scott Ellis ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Initial Surgery ◽  
Ankle Surgery ◽  
Patient Reported ◽  
The Impact

Background: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied, and shown to be an effective modality in assessing patient-reported outcomes (PROs). Although this assessment has been shown to correlate well with patient satisfaction and other validated PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle Expectations Survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (return to operating room for revision, deep infection). FP in patients with a complication was compared to patients who did not experience a complication. In addition, the Foot and Ankle Outcomes Score (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication: 25 major (19 revisions, 6 deep infections requiring irrigation and debridement), 4 minor (4 superficial infections requiring antibiotics), and 2 major and minor (revision and superficial infection). Average time from complication to completion of fulfillment survey was 15 (±3.6) months. The groups were similar in diagnoses. Results: Complications were associated with significantly worse FP (0.69 ± 0.45 vs 0.86 ± 0.40, P = .02). Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP ( P < .001). FAOS domains were similar between groups preoperatively; postoperatively, patients without complications had significantly higher Activities of Daily Living and Quality of Life scores ( P < .05). Demographically, there was no difference in age, sex, body mass index, Charlson Comorbidity Index, depression/anxiety, or pain management between the 2 groups. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery were associated with worse patient-reported fulfillment of their operative expectations even after recovery from the initial surgery and complication. This finding is independent of preoperative expectations, and correlates with patient satisfaction with their procedure. Therefore, while patient-perceived fulfillment following foot and ankle surgery is multifactorial, the incidence of a postoperative complication negatively impacts fulfillment as well as satisfaction following surgery. Level of Evidence: Level II, prospective comparative series.

scholarly journals Teleconsultation for Pediatric Patients With Type 1 Diabetes Mellitus During the COVID-19 Pandemic: Experience of a University Hospital in Brazil.

2021 ◽  
Author(s):  
YASMIN EUGENIA SANTANA ◽  
Thais Milioni Luciano ◽  
Ana Carolina Maia Teodózio ◽  
Amanda Maria Barradas Monteiro de Santana ◽  
Letícia Rodrigues Ramos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Diseases ◽  
Glycosylated Hemoglobin ◽  
Admission Rate ◽  
University Hospital ◽  
Diabetic Patients ◽  
Pediatric Endocrinology ◽  
Hospital Admission Rate ◽  
Control And Prevention ◽  
The Impact

Abstract Background: The SARS-CoV-2 pandemic expanded rapidly around the world in 2020 and health services needed to be reconfigured to meet the new demand and ensure the care of patients with chronic diseases, whether or not aggravated by this COVID-19 (disease caused by SARS-Cov-2). For patients with chronic diseases - such as diabetes mellitus - the teleconsultation stood out as a tool for clinical management in this period. This study aims to evaluate the impact of teleconsultation on glycemic control and prevention of acute complications related to diabetes mellitus in children and adolescents treated by the pediatric endocrinology team at Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo (HC-FMRP -USP) during the COVID-19 pandemic in 2020. Method: Descriptive study of data from pediatric diabetic patients who received teleconsultation via messages in the months of April to September 2020. Results: Regarding the patients evaluated (N = 143), there were 3.4 teleconsultations per patient in the studied period; requiring adjustment of insulin doses in 84.6% of cases. The hospital admission rate was 17.5% due to diabetic decompensation and / or the opening of diabetes mellitus. The dosage of glycosylated hemoglobin showed a worsening in 46% of the sample and an improvement in 37%. Conclusion: The teleconsultation was effective in ensuring health care for patients with DM1 during the COVID-19 pandemic.

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