Damage Control Laparotomy Wound Incisions Can Be Closed With Low Rates of Superficial Surgical Site Infections

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.

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

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.

MEDIAL SURAL ARTERY FLAP RECONSTRUCTION FOR DIABETIC FOOT ULCER : A CASE REPORT

Diabetes is the leading cause of non traumatic lower extremity amputations resulting from atherosclerosis of the arteries. According to the International Working Group on the Diabetic Foot (IWGDF), a diabetic foot ulcer (DFU) is a fullthickness wound penetrating through the dermis (the deep vascular and collagenous inner layer of the skin) located below the ankle in a diabetic patient. The sural fasciocutaneous ap is useful for the treatment of severe and complex injuries in diabetic lower limbs. It is simple to dissect , does not compromise a major artery and has low donor morbidity. We present the case of a 38 year old gentleman who presented to us with Right foot diabetic ulcer progressing over a duration of 2 months . After initial debridement of wound patient underwent a trans metatarsal (foot) amputation followed by vacuum dressing and a delayed primary closure of wound using a medial sural artery ap.

A randomised study to evaluate wound outcome following delayed primary vs primary closure of skin in duodenal perforation peritonitis

Background: This study aimed to evaluate wound outcome following delayed primary versus primary closure of skin in duodenal perforation peritonitis.Methods: The present study was a randomised interventional study that included 90 patients on accrual of duodenal perforation peritonitis which were divided into primary closure (PC) and delayed primary closure (DPC) groups comprising 45 patients each. The outcome measures were complications, surgical site infections, hospital stay and final wound status during the follow up of 30 days. Data collected was compared taking P-value <0.05 as significant.Results: The patients were in the age group of 12–60 years, with men in majority in both groups. Mean SSI score in PC and DPC was comparable (2.67 SD 1.58 vs. 2 SD1.61, P=0.058). SSI was more in PC group than DPC group (11.11% vs. 2.22%, P<0.05). Wound/pus culture was positive in 62.22% in PC and 46.67% in DPC. Major complications like wound dehiscence was noticed mainly in PC group while minor Complications like Stitch abscess, granuloma, sinus was more in DPC group. Mean of duration of stay (days) was comparable between PC and DPC group (14.07 SD 7.64 vs. 13.96 SD 6.94, P=0.805). Final wound outcome after 30 days was healthy scar in majority of patients in PC and DPC group (57.78% vs. 66.67%) with no significant difference between them (p=0.434).Conclusions: In conclusion, DPC showed comparable results with PC with similar SSI and wound healing without significant complications.

The technique for less infectious and earlier healing of stoma closure wound: negative pressure wound therapy with instillation and dwelling followed by primary closure

Background Temporary stomas have been widely used to avoid the risk of complications such as anastomotic leakage after colorectal resection. Stoma closure is relatively easy; however, postoperative surgical site infection (SSI) may be a problem. Various methods have been used to reduce the incidence of SSI. We aimed to evaluate a new technique for stoma wound closure. Methods We enrolled patients who underwent stoma closure at our hospital between September 2019 and May 2020. We selected patients who lived far from our hospital and had difficulty visiting the hospital regularly and who agreed to undergo this surgical technique. We used negative pressure wound therapy with instillation and dwelling (NPWTi-d) and delayed primary closure for these patients. Results Four patients underwent NPWTi-d and delayed primary closure without the occurrence of SSI. The median postoperative hospital stay was 9 days (range: 7–14 days), and the median number of days to confirmation of epithelialization was 11.5 days (range: 10–16 days). Conclusion The combined use of NPWTi-d and delayed primary closure for the stoma wound was very effective. This method may be a valuable new technique for wound management after stoma closure.

Superficial Surgical Site Infection after Primary Closure Versus Delayed Primary Closure of Wound in Perforated Appendicitis

Objective: To assess the superficial surgical site infection after primary closure versus delayed primary closure of wound in perforated appendicitis. Study Design and Setting: This was an observational study conducted at Darul Sehat Hospital & Civil Hospital Karachi during March 2019 to August 2019 Methodology: All patients of either gender between 18-50 years of age undergoing open Appendectomy through standard gridiron incision in emergency having consented for participation in the study prior to surgery and with per-operative finding of perforated appendix in emergency were included. Patients on steroids or immunosuppressive agents, smoker staking 5 or more cigarettes per day, patients with history of Diabetes Mellitus, chronic liver disease and chronic renal failure were excluded from the study. Patients with perforated appendix were randomly allocated into two Groups. Group A received delayed primary closure at 3rd post-operative day while in Group B primary closure was done immediately after appendectomy. All patients were examined for signs and symptoms of superficial surgical site infection at the 5th postoperative day before discharge from the hospital. SPSS version 13 was used for data analysis. Chi square test was applied to compare the outcome (superficial surgical site infection) in both groups. P-value <0.05 was considered as significant. Results: A total sixty patients were allocated in each group. Wound infection was very high among patients with immediate closure (40%) as compared to group which received delayed primary closure (15%) (p=0.020). Conclusion: The superficial surgical site infection was significantly higher after primary closure versus delayed primary closure of wound in perforated appendicitis.

Rare complication of four extremity compartment syndrome requiring fasciotomy from influenza A viral myositis

Influenza A and B commonly cause benign respiratory disease in humans, but can cause more severe illness in high-risk populations. We report an unusual case of a previously healthy adult patient who presented with myositis and severe rhabdomyolysis secondary to influenza A infection that resulted in atraumatic compartment syndrome of all four extremities, each requiring emergent fasciotomy. The patient was subsequently managed with delayed primary closure and skin grafting in the operating room. Prompt recognition of this rare complication by the team resulted in no limb amputations. On his first follow-up appointment, 1 month after discharge, he had regained full functionality in both his hands and his feet were both close to 50% of baseline and improving with physical therapy.