Complicações Cirúrgicas em Bichectomia: Revisão de Literatura / Surgical Complications in Bichectomy: Literature Review

A bichectomia é um procedimento cirúrgico em que remove-se a parte correspondente ao coxim adiposo do Bichat, com finalidades estética e funcional. Tal procedimento está cada vez mais popular na Odontologia. Objetivo: Apresentar uma revisão narrativa da literatura sobre complicações associadas às cirurgias de bichectomia. Materiais e Métodos: Foi realizada uma busca de publicações sem restrição em relação ao ano de publicação em que foram realizados, incluído artigos científicos, relatos de caso clínicos, revisões de literatura, estudos descritivos e observacionais e excluindo cartas ao editor, editorias, teses e manografias a partir dos descritores em saúde (DeCS) “anatomia” (anatomy), “bichectomia” (bichectomy), “odontologia” (dentistry). Usando as bases de dados Lilacs, SciELO e Pubmed. Conclusão: Bichectomia é um procedimento estético-funcional, que apresenta riscos de complicações potencialmente graves, destacando-se lesão do ducto de Stenon ou do ramo bucal do nervo facial, que provocam, respectivamente, sialocele, fístulas salivares e paralisia bucal temporária ou definitiva, além de hematomas, assimetria facial e infecções pós-operatórias.---Bichectomy is a surgical procedure in which the part corresponding to the fat pad of Bichat is removed, with aesthetic and functional purposes. Such procedure is increasingly popular in dentistry. Objective: To present a narrative review of the literature on complications associated with bichectomy surgery. Materials and Methods: A search for publications was performed without restriction regarding the year of publication, including scientific articles, clinical case reports, literature reviews, descriptive and observational studies and excluding letters to the editor, editorials, theses and manographies from the health descriptors (DeCS) “anatomy” (anatomy), “bichectomy” (bichectomy), “dentistry” (dentistry). Using Lilacs, SciELO and Pubmed databases. Conclusion: Bichectomy is an aesthetic-functional procedure that presents risks of potentially serious complications, especially damage to the Stenon's duct or the buccal branch of the facial nerve, which cause, respectively, sialocele, salivary fistulas and temporary or permanent buccal paralysis, in addition to bruises, facial asymmetry and postoperative infections.

How the COVID-19 pandemic changed postoperative infections in urology wards: A retrospective cohort study from two urology departments

Introduction: We aimed to compare the rate of postoperative infection and drug-resistant organism (DRO) before and during the COVID-19 pandemic in urology departments. Methods: A retrospective cohort study was carried out. Data from all elective surgical procedures carried out in two urology departments between April and June 2018 and the homologous period in 2020 were collected. Main outcomes were the number of postoperative infections during the pandemic, and the number of DROs. Sample size was calculated based on a 50% relative reduction of infections during the pandemic. Variables were compared by Chi-squared test, and multivariable logistic regression was used to estimate predictors. Results: A total of 698 patients undergoing elective surgery were included. The postoperative infection rate during the pre-pandemic period was of 14.1% compared to 12.1% during the pandemic (p=0.494). DROs were lower during the pandemic (92.3% vs. 52.4%, p=0.002). The pandemic period was the main predictor for reduced multi-drug-resistant isolates, with an odds ratio of 0.10 (p=0.010, 95% confidence interval 0.016–0.57). Conclusions: Postoperative infection rates were not significantly reduced during the COVID-19 pandemic, despite the adoption of enhanced infection preventive measures. There was, however, a decrease in the rate of DROs during this period, suggesting a secondary benefit to enhanced infection prevention practices adopted during the COVID-19 era.

The pencil eraser swab technique to quantify <i>Cutibacterium acnes</i> on shoulder skin

Introduction: Cutibacterium acnes is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures. Newer strategies focus on reducing bacterial load on the skin before surgery. Several previous studies have used a large number of both described and undescribed sampling techniques. The purpose of this study was to compare three previously described swab techniques to obtain bacterial cultures: Levine's (L) technique, the Z technique and the pencil eraser swab (PES) technique. Methods: Three consecutive skin swabs were collected from the right shoulder, on 15 healthy male volunteers, using Levine's technique, Z technique and PES technique from each participant. To determine the number of living bacteria, serial dilutions were made, and after culturing for 5 d, viable count (VC) was expressed as CFU/mL (with CFU representing colony-forming unit). Results: The PES technique yielded significantly higher VC than the two others. PES: median 3700 CFU/mL, L: 200 CFU/mL and Z: 220 CFU/mL (p=0.003). There was no significant difference between the methods regarding the number of positive cultures. PES: 14/15, L: 11/15 and Z: 12/15. Conclusions: There is a need to harmonise sampling techniques of C. acnes in order to compare the efficacy of different measures to reduce the bacterial load on the skin before and during surgery. Of the three tested methods, the PES technique is simple and produces the highest bacterial counts.

PLASMA COAGULATING AND NON-COAGULATING STAPHYLOCOCCUS SPP. IN SKIN SAMPLES FROM DOGS AND THEIR RESISTANCE TO ANTIBIOTICS

Staphylococci are human and animal mucosal surface and skin commensals that can cause a variety of infections, such as purulent skin infections, otitis externa, pyoderma, urinary tract infections, and postoperative infections. Dog skin is one of the protective barriers for animals. However, dogs can have and transmit a variety of microorganisms on their skin, including staphylococci. Most studies have compared plasma coagulating and non-coagulating Staphylococcus spp. by dog breeds, sex, and coat length. The aim – to identify plasma coagulating and non-coagulating Staphylococcus spp. in skin samples from dogs and its resistance to antibiotics by place of residence. Staphylococci were detected in more than half of the samples tested, one third of which were plasma coagulating and the remaining two thirds were non-coagulating plasma. Plasma non-coagulating staphylococci were mainly increased among dogs living at home and plasma coagulating – among dogs living outdoors, the difference between these groups is statistically significant. Staphylococcus aureus was predominantly resistant to penicillin and clindamycin, while plasma non-coagulants were resistant to fusidic acid.

Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study

ObjectiveThis paper reports perioperative mortality and postoperative infection rates of surgical patients who underwent operations at district-level hospitals in Malawi and Zambia, and the associations of these outcomes with patient characteristics based on routinely available data.DesignProspective cohort study.SettingEight government district hospitals in Malawi and nine mission and government district hospitals in Zambia.Outcome measuresPerioperative mortality and postoperative infection were used as primary outcome measures in this study. Logistic regression and penalised maximum likelihood logistic regression were used to examine the factors correlated with surgical outcomes.ResultsThe average perioperative mortality rates were 0.19% and 0.43% in Malawi and Zambia, respectively. Penalised maximum likelihood logistic regression showed that age (OR=1.046, 95% CI 1.016 to 1.078) and American Society of Anesthesiologists physical status score II (OR=6.658, 95% CI 2.363 to 18.762) were significantly associated with perioperative deaths. General surgery procedures were significantly more likely than obstetrical procedures to result in perioperative deaths (OR=3.821, 95% CI 1.226 to 11.908). The average rates of postoperative infections in Malawi and Zambia were 2.69% and 2.24%, respectively. Age (OR=1.010, 95% CI 1.000 to 1.020) and male sex (OR=0.407, 95% CI 0.260 to 0.637) were significantly associated with postoperative infections. Additional factors, general procedures (OR=2.319, 95% CI 1.397 to 3.850) and trauma-related procedure (OR=5.490, 95% CI 2.632 to 11.449) were significantly associated with infection rates. There was no significant correlation between surgical outcomes and cadre of lead surgeon (a non-physician clinician or doctor).ConclusionRates of mortality and postoperative infections in this sample of district-level hospitals in Malawi and Zambia were relatively low, with poorer preoperative physical status as the main predictor of both greater postoperative infection and mortality. The study demonstrates that outcomes of major surgical cases do not depend on the cadre (type) of surgeon performing it, and outcomes can be monitored using routine data, at district level in these countries.Trial registration numberISRCTN66099597.

FAKTOR YANG MEMPENGARUHI KEJADIAN INFEKSI POST OPERASI DI RUANG RANAP WIJAYA KUSUMAH RSUD KOTA BANJAR

Status gizi, usia dan faktor ekonomi merupakan faktor internal pasien yang mempengaruhi frekuensi infeksi. Masyarakat masih belum mengetahui status gizinya dan tidak dapat memperbaikinya, dengan penyebab yang bervariasi baik dari keadaan ekonomi maupun dari kurangnya pengetahuan masyarakat tentang gizi. Faktor internal lain dalam frekuensi infeksi adalah usia, pada pasien yang lebih tua dari 70 tahun. Faktor usia di atas 70 dapat menurunkan pertahanan tubuh. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi kejadian infeksi post operasi di bangsal Vijaya Kusumah RSUD Kota Banjar. Penelitian ini menggunakan beberapa jenis penelitian korelasi. Populasi penelitian ini terdiri dari seluruh pasien pasca operasi dan sampel sebanyak 21 responden. Alat yang digunakan dalam penelitian ini adalah kuesioner, dan analisis data yang digunakan dalam penelitian ini adalah univariat dan bivariat. Hasil penelitian menunjukkan bahwa tidak ada pengaruh faktor status gizi terhadap kejadian infeksi post operasi, pengaruh faktor status gizi terhadap kejadian infeksi post operasi dan pengaruh faktor ekonomi terhadap kejadian infeksi post operasi. Akibatnya, faktor status gizi tidak mempengaruhi angka infeksi pasca operasi, tetapi faktor status gizi dan tingkat ekonomi ditemukan mempengaruhi angka infeksi pasca operasi. Hasil penelitian ini dimaksudkan untuk digunakan sebagai buku teks dan literatur untuk mengatasi masalah infeksi pasca operasi.Nutritional status, age and economic factors are internal patient factors that affect the frequency of infection. The community still does not know their nutritional status and cannot improve it, with various causes, both from economic conditions and from a lack of public knowledge about nutrition. Another internal factor in the frequency of infection is age, in patients older than 70 years. The age factor over 70 can lower the body's defenses. The purpose of this study was to determine the factors that influence the incidence of postoperative infection in the Vijaya Kusumah ward, Banjar City Hospital. This study uses several types of correlation research. The population of this study consisted of all postoperative patients and a sample of 21 respondents. The instrument used in this study was a questionnaire, and the data analysis used in this study was univariate and bivariate. The results showed that there was no influence of nutritional status factors on the incidence of postoperative infections, the influence of nutritional status factors on the incidence of postoperative infections and the influence of economic factors on the incidence of postoperative infections. As a result, nutritional status factors did not affect postoperative infection rates, but nutritional status factors and economic level were found to influence postoperative infection rates. The results of this study are intended to be used as a textbook and literature to address the problem of postoperative infection.

Diagnostic value of routine chest tube tip culture in surgery for noninfectious lung disease

Background Evaluation of the diagnostic value of routine chest tube tip culture for detection of postoperative infection after surgery for noninfectious lung disease. Methods Included subjects were patients who underwent lung surgery between January 1st 2013 and January 1st 2018 in University Medical Centre Utrecht and of whom a chest tube tip was cultured. Postoperative outcomes included pneumonia, surgical site infection, and empyema within 30 days after surgery. Univariable analysis for diagnostic accuracy of chest tube tip culture results predicting these postoperative outcomes was performed, as well as multivariable analysis using penalized firth logistic regression. Results Patients developed one or more postoperative infections in 42 out of 210 (20%) lung surgeries. Pneumonia, surgical site infection, and empyema were found in 36 (17%), 8 (4%), and 2 (1%) cases respectively. Chest tube tip culture had a sensitivity of 31%, a specificity of 83%, a positive predictive value of 32%, and a negative predictive value of 83% for postoperative infections. In the subgroup of patients who did not have evidence of postoperative infection at the time of chest tube removal, the drain tip culture’s positive and negative predictive value changed to 18% and 92% respectively. Adding additional variables to chest tube tip culture in a prediction model resulting in only limited improvement in diagnostic performance. Conclusions We found insufficient diagnostic performance to support the practice of routine chest tube tip culture after surgery for noninfectious lung disease. Therefore, routine chest tube tip culture is not advisable and should be omitted to unburden the healthcare process and prevent low value care together with extra costs.

Word of caution: negative impact of mouthwashes on folded Platelet-Rich Fibrin (F- PRF) membrane viability

Backround: The number of clinical application of different platelet-rich fibrin (PRF) membranes has increased in regenerative medicine including regenerative dentistry. Intact platelets, leukocytes and stem cells of PRF play a crucial role in the local bone augmentation releasing cytokines and growth factors. An integral part of the postsurgical management is the application of mouthwashes especially chlorhexidine-digluconate, which is recommended in order to prevent postoperative infections. In some cases there is possibility that there is contact between the mouthwash and PRF membrane. The impact of mouthwashes on cell viability of folded F-PRF was tested. Methods: 3 mouthwash brands were tested: Chorsodyl, Listerine 6 in 1 and Elmex Sensitive Plus using MTT viability assay after 30 seconds treatment and 72 hours treatment (twice daily for 30 seconds). The membrane samples were incubated in cell culture conditions. Results: 30 seconds of mouthwash treatment diminished the fresh F-PRF viability significantly by 15-21% depending on the agent. After 72 hours of treatment the viability loss was ~50%. Conclusion: The decreased number of platelets and other blood cells can not launch optimal bone morphogenesis. The MTT assay is cheap, reliable and simple method to assess the platelet and cellular viability and potential regenerative capacity of F-PRF membrane, or any platelet-rich product. The isolation of the PRF membrane from oral liquids and/or application of less aggressive mouthwashes is recommended for at least 5-7 days after PRF surgery.