Usefulness of a needleless suture technique for midline laparotomy wound dehiscence: a case report

Surgical wound dehiscence after a laparotomy is a serious complication, and it presents the mechanical wound healing failure of surgical incisions. Since the development of needleless suture techniques, there have been attempts to use a needleless suture for wounds from several surgery types. Recently, many studies have shown that a needleless suture technique leads to good wound healing results. It is rapid, cost effective, can minimize ventilator dependency, and is well tolerated by patients. Here, we report a case of a patient who received a needleless suture technique for midline laparotomy wound dehiscence.

Surgical Wound Dehiscence Treatment With Low-Level Laser Therapy and Barbatimão: A Case Report

BACKGROUND: Low-level laser therapy (LLLT) and a gel containing an extract of Barbatimão, a native Brazilian tree, have shown promising results in both preclinical and clinical wound healing studies. PURPOSE: To describe the treatment of surgical wound dehiscence with LLLT and Barbatimão gel. CASE STUDY: A 54-year-old woman without comorbidities underwent abdominoplasty at another health facility. Three (3) weeks later she presented to the authors’ clinic after an episode of syncope, abrupt dyspnea, purulent exudate, and necrotic tissue in the surgical incision. She reported that wound redness, warmth, and swelling started 8 days postoperatively. The patient was admitted; on day 3 of that hospital stay, her condition improved and surgical debridement was performed. Follow-up care of wound dehiscence was provided in the outpatient clinic. The treatment involved daily application of Barbatimão gel and weekly application of LLLT. The wound healed after 84 days. CONCLUSION: This case report suggests that LLLT may be a beneficial adjunctive therapy, together with Barbatimão gel, for the treatment of surgical wound dehiscence.

Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty

Prosthetic joint infection (PJI) is a possible complication occurring after prosthesis implantation. We describe the case of a patient with early postoperative multidrug-resistant polymicrobial PJI and mixed infection of the surgical wound. Despite the removal of the prosthesis, the positioning of double-stage exchange, and dehiscence debridement of the surgical wound, the infection continued. Positioning of an external fixator, plastic reconstruction with a skin graft, and continuous (two years) multiple antimicrobial therapy led to the resolution of the knee infection; a knee prosthesis was implanted, but a new infection of the extensus apparatus by multidrug-resistant Klebsiella pnumoniae followed. It was complicated by surgical wound dehiscence, forcing us to remove the prosthesis, put a new external fixator, and continue with the antibiotic treatment, with no results, and, finally, proceed to a leg amputation. Fourteen days after, the patient was discharged in good clinical condition but, fifteen days later, during rehabilitation in another hospital, the patient developed a severe Clostridium difficilis infection with profuse, intense diarrhea, toxic megacolon, and septic shock; despite colectomy and treatment in an intensive care unit, he died four months later. Patients affected by polymicrobial PJI are at high risk of treatment failure and, therefore, should be given a warning, in good time and appropriate form, of the likelihood of leg amputation.

Medical-Grade Honey as an Alternative Treatment for Antibiotics in Non-Healing Wounds—A Prospective Case Series

Non-healing wounds are usually colonised by various types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical-grade honey (MGH), which favourably affects the healing process with its antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory properties. The objective of this study was to evaluate the effect of MGH therapy on the healing process of non-healing wounds of various aetiologies and different wound colonisations. Prospective, observation–intervention case studies (n = 9) of patients with wounds of various aetiologies (venous leg ulcers, diabetic foot ulcers, surgical wound dehiscence) are presented. All wounds were treated with MGH and the healing trajectory was rigorously and objectively monitored. In all cases, pain, odour, and exudation were quickly resolved, which led to an improvement in the quality of life of patients. Despite the proven bacterial microflora in wounds, antibiotic treatment was not necessary. The effects of MGH alleviated the signs of local infection until their complete elimination. In eight out of nine cases, the non-healing wound was completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in wounds of various aetiologies and forms an effective alternative for the use of antibiotics for treating locally infected wounds.

Enhanced Skin Incisional Wound Healing With Intracellular ATP Delivery via Macrophage Proliferation and Direct Collagen Production

This study sought to use a newly developed intracellular ATP delivery to enhance incisional wound healing to reduce surgical wound dehiscence and to explore possible mechanism for this effect. Thirty-five adult New Zealand white rabbits were used. Skin incisions were made on the back and closed. ATP-vesicles were mixed with a neutral cream for one side of the wounds while the neutral cream alone was used on the other side of the wounds. Laser speckle contrast imaging (LSCI), biomechanical, histological, and immunohistochemical analyses were performed 7 and 14 days after surgery, and macrophage culture was used to test the enhanced collagen production ability. Among them, 10 were used for wound perfusion study and 25 were used for wound biomechanical and histological/immunohistochemical studies. Wound tissue perfusion was reduced after surgery especially in early days. Wound tissue tensile strength, breaking stress, and elasticity were all much higher in the ATP-vesicle treated group than in the cream treated group at days 7 and 14. The healing was complemented by earlier macrophage accumulation, in situ proliferation, followed by direct collagen production. The results were further confirmed by human macrophage culture. It was concluded that intracellular ATP delivery enhanced healing strength of incisional wounds via multiple mechanisms.

Komplikasi Bedah, Luaran Fungsi Seksual dan Menstruasi dari Prosedur Vaginoplasti Sigmoid pada Pasien dengan Agenesis Vagina

Background: Vaginal agenesis is one form of abnormality found in the uroginecology with a prevalence of 1: 4000 births. Various reconstruction techniques, both non-surgical and surgical, have been introduced, one of which is sigmoid vaginoplasty. Research on the complications and outcomes of sigmoid vaginoplasty procedure is still limited.Objective: To assess surgical complications, sexual and menstrual function outcomes of sigmoid vaginoplasty procedure.Method: This is a prospective study. A total 11 patients with a variety of genital tract malformations have been performed for sigmoid vaginoplasty during January 2017 to January 2019. Data are described descriptively-analytically. All patients were assessed for surgical complications, menstrual and sexual function after surgery.Results and Discussion: A total of 10 cases (90.9%) were diagnosed with vaginal agenesis and 1 case (9.1%) was diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Durante surgery complications are severe bleeding and rectum injury, occurred in 2 cases (18.2%). Postoperative complication is surgical wound dehiscence, occurred in 2 cases (18.2%). All patients who have uterus (100%) showed good menstrual function outcomes. Of the 3 married patients, all patients (100%) showed good postoperative sexual function outcomes (FSFI score 27-30.4). Conclusion: The sigmoid vaginoplasty procedure is an effective procedure for patients with agenesis vaginal. This procedure has low surgical complications with good outcomes of menstrual and sexual function. Keywords: Sigmoid vaginoplasty; vaginal agenesis; menstrual function; sexual function.

Dacryocystectomy with Lacrimal Silicone Intubation in Challenging Patients Affected by Recurrent Dacryocystitis and Epiphora: Expanding Minimally Invasive Approach Indications

Objective: In this study, we evaluated the feasibility and safety of dacryocystectomy associated with lacrimal intubation, for the treatment of recurrent dacryocystitis and epiphora secondary to lacrimal obstruction with compromised lacrimal sac, was evaluated. Subjects and Methods: 32 patients underwent dacryocystectomy with Crawford tubes canalicular insertion, performed by a single surgeon. Post-operative visits were scheduled at 1st and 10th day, 1, 3, and 6 months. At each follow-up visit, the prevalence of epiphora and dacryocystitis was evaluated and compared with baseline data. Also, we evaluated the prevalence of local and systemic post-operative adverse events during the follow-up period. Results: 11 patients (34.38%) reported persistent epiphora, which lasted for 30 days after surgery. Among them, 9 subjects (28.13%) complained occasional epiphora even at the six months follow-up. In the event of dacryocystitis or subacute phlogosis before surgery, patients reported a definitive symptom resolution. Other reported adverse events were epithelial corneal erosion due to Crawford tube protrusion (4 cases, 12.5%), a Crawford tube extrusion case (3.13%), 3 cases of surgical wound dehiscence (9.36%), and a case of mild local bleeding persisting for 15 days Conclusion: A significative epiphora reduction was observed after surgery with an acceptable safety profile, expanding dacryocystectomy indications. This procedure provides a satisfactory resolution of recurrent dacryocystitis. However, this approach should be performed only in well-selected cases: elderly/frail patients with altered lacrimal sacs, epiphora associated with recurrent infections, and failure after dacryocystectomy.

Surgical wound dehiscence in dermatologic surgery.

e22101 Background: Surgical wound dehiscence (SWD) describes separation of wound edges due to mechanical failure of a healing wound. The rate of SWD following dermatology office-based surgery and factors associated with its occurrence are poorly characterized in the current literature. This study aims to elucidate factors contributing to SWD following cutaneous excisions of malignant and non-malignant through a novel data mining methodology. The utility of this methodology in quality assurance and risk management applications will be concomitantly explored. Methods: An electronic query directed at the electronic medical record (EMR) database of a large national dermatology practice employing over 400 providers yielded 22,548 instances of cutaneous excision meeting inclusion criteria between 1 January 2018 and 9 September 2019. To control for confounding, procedures positive for SWD were randomly matched in 1:4 ratio with procedures negative for SWD on the basis of sex, age, and precise anatomic location. Procedures were then statistically analyzed to elucidate factors associated with SWD. Results: Of 22,548 procedures analyzed, 123 were positive for wound dehiscence, yielding an incidence of 0.54%. Age ( Χ2 ( df = 1, N = 615) = 2.49, p = 0.039), smoking history ( Χ2 ( df = 2, N = 534) = 9.97, p = 0.007), wound location on the distal extremities ( Χ2 ( df = 1, N = 615) = 9.54, p = 0.002), presence of postoperative infection ( Χ2 ( df = 1, N = 600) = 34.87, p < 0.001), and presence of postoperative bleeding ( Χ2 ( df = 1, N = 600) = 62.73, p < 0.001) are all significantly associated with SWD. A wound positive for postoperative infection or bleeding has 14.48 times the odds of being positive for SWD (95% CI: 4.62 - 45.21). A wound positive for postoperative bleeding has 20.15 times the odds of being positive for SWD (95% CI: 7.42 – 54.73). No significant relationship between SWD and sex, diabetes, or provider type is evident. Conclusions: Age, smoking history, wound location on the distal extremities, and especially other postoperative complications such as bleeding and infection are associated with SWD. There is no association between SWD and sex, diabetes, or provider type. Forthcoming multifactorial, nonlinear, non-time-dependent analysis of variables may allow for the development of a statistical model to provide greater insight into SWD following dermatologic surgery.

Use of Lateral Calcaneal Flap for the Reconstruction of Posterior Heel Defect

Soft tissue defect of the lateral malleolus and achilles tendon is very challenging for reconstruction due to the bony prominence and limited local tissue availability. The purpose of this study to describe our early experience of 30 patients treated with this flap for reconstruction of posterior heel defects with or without exposure of tendo-achilles. The study was conducted at department of plastic surgery, National Institute of Traumatology and Orthopedic Rehabilitation between 2015 to 2018. Twenty five patients (20 male and 5 females) with soft tissue defects over the posterior heel underwent reconstruction using a lateral calcaneal flap. The etiology is trauma in twelve patients, chronic ulcer in four and surgical wound dehiscence for repair of Tendo-Achilles in nine patients. Patients age range from 15 to 60 years (mean 35yrs) and follow up period ranged from 6 months to 2 years(mean 1 yr). All flaps had good perfusion and survived completely. In 3 cases there was partial loss of skin graft managed conservatively. The lateral calcaneal flap can be used safely to provide sensory skin coverage of posterior heel in single stage J Bangladesh Coll Phys Surg 2020; 38(3): 116-120