wound complication
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2021 ◽  
Vol 15 (12) ◽  
pp. 3542-3544
Author(s):  
Maria Mahmood ◽  
Sameer Qureshi ◽  
Rehana, . ◽  
Najaf Abbas ◽  
Uneeba Rehman ◽  
...  

Objective: To determine frequency of complication of modified radical neck dissection in patients at a tertiary care hospital Karachi, Pakistan Material and Methods: Study design: This is a cross sectional section study, conducted at Department of ENT, for Six months from January 1, 2019 to July 1, 2019. All the patients who fulfilled the inclusion criteria and visited to department of ENT, were included in the study after taking informed consent. Patients were discharged by 48-72 hours postoperatively. Patients were assessed daily till the time of discharge for occurrence of nerve complication, wound complications and vascular complications. Data was entered and analyzed by SPSS 21 software. Mean, Frequency and percentage were given for continuous and discreet data respectively. Chi squire test was applied to detect significance. P value of < o.o5 was taken as significant. Results: Mean ± SD of age was 40.31±9.54 with C.I (38.62.......41.99) years. Out of 126 patients 84 (67%) were male and 42 (33%) were female. Out of 126 cases complication 46(37%) developed nerve complication, 47 (37%) had wound complication and vascular complication was documented in 27(21%) cases. Conclusion: surgical complications after modified radical neck surgery are not uncommon. Wound complication was found to be most common followed by nerve and vascular complication. Therefore proper antiseptic measures before, during and after surgery, patient care and careful surgical steps have a role in preventing these dreadful complications. Keywords: Modified Radical Neck Dissection, Complications, Nerve Complication, Wound Complication, Vascular Complication


Author(s):  
Vijay Kansara ◽  
Pinal Ambalal Pateliya ◽  
Jil Karia ◽  
Kunal Kadakar

Background: Tobacco is known to be an established cause of adverse pregnancy outcome. Scientific studies, encompassing various ethnic groups, cultures and countries, have shown that cigarette smoking during pregnancy significantly affects mother, unborn fetus and the newborn baby.Methods: A hospital based cross sectional study was performed on 933 patients, separated in two groups: tobacco users and tobacco non-users and findings from each group were compared.Results: Incidence of complications like anemia, PIH and abruption increase with maternal usage of tobacco during pregnancy, chances of preterm delivery and ectopic pregnancy was raised, rate of wound complication was more in tobacco user women. There was no significant difference in mode of delivery.Conclusions: In the present study may establish association of tobacco consumption with adverse neonatal and obstetrics outcome and may encourage administration to focus on IEC (information, education, communication) to reduce tobacco consumption during pregnancy. Incidence of complications like anemia, PIH, abruption increase with maternal usage of tobacco during pregnancy. Chances of preterm delivery and ectopic pregnancy, was raised usage with of tobacco. 


Author(s):  
Abdul Samad Tayyab ◽  
Maria Qurban ◽  
Maryam Mazhar ◽  
Zaid Tayyab ◽  
Mariam Tahir ◽  
...  

Introduction: Poorly controlled type II diabetes is associated with an array of micro-vascular, macro-vascular, and neuropathic complications. Objectives: The main objective of the study is to analyse the frequency of wound complications in type II diabetic patients undergoing abdominal surgery. Material and methods: This cross sectional study was conducted in THQ haveli lakha, Okara with the collaboration of Sir Ganga Ram Hospital, Lahore during March 2021 to August 2021. The data was collected through non-probability consecutive sampling technique. There were 120 patients which were enrolled in this study according to the inclusion and exclusion criteria. A systematically designed questionnaire was made for the collection of data. Results: The data was collected from 120 patients. The mean age was 55.5± 2.57 years. Most of the particpants was male (51.1%), non-smokers (95.6%) and didn't have hypertension (67.8%). The mean time of diabetes mellitus was 6.1±5.6 a long time. The majority didn't have neuropathy (81.1%), peripheral strokes (90.0%), pre-ulcerous states (90.0%), insensitive (89.9%), crevices on feet (64.4%), nail pathology (97.1%), injury disfigurement (93.3%) or incapacity (94.4%). Conclusion: It is concluded that it is difficult to treat the wound complication in diabetic patients. Diabetic patients are at an increased risk of postoperative surgical site infection while undergoing open surgery, laparoscopic cholecystectomy has no increased morbidity in diabetic patients as compared to non-diabetic patients.


Author(s):  
P. I. Nikulnikov ◽  
O. V. Liksunov ◽  
A. V. Ratushniuk ◽  
V. L. Severyn ◽  
A. G. Bicher ◽  
...  

The purpose of the work isto analyze and improve the results of treatment of patients with diabetes and anastomotic false aneurysm (FA) after reconstructive interventions. Materials and methods. The results of diagnostic examinations in 79 patients with 93 false anastomotic aneurysms were analyzed, the criteria of wound complication (hematoma, infiltrate), patency of shunts, bleeding, heart attack, stroke were evaluated. Among the patients there were 75 (94.9 %) men and 4 (5.1 %) women aged 40—75 years (mean age — (58.4 ± 2.9) years). 69 (87.3 %) patients underwent surgery for atherosclerotic lesions of the pelvic vessels and lower extremities, including 43 (54.4 %) patients with diabetes, 3 (3.8 %) — for abdominal aortic aneurysm, 4 (5.1 %) — after vascular injury, 3 (3.8%) — due to nonspecific aortic arteritis. A total of 79 patients underwent 93 reconstructive interventions. Results and discussion. The time of onset of clinical symptoms (pain, pulsation), which give reason to suspect the occurrence of FA, ranged from 8 days to 19 years: in 15 patients — less than 1 year, in 59 — up to 10 years, in 5 — up to 20 years. The average duration of FA formation after surgery is 62.5 months. The absence of pathological changes in the area of the proximal anastomosis and the presence of adequate outflow pathways in most cases allow us to limit the reconstruction of the distal anastomosis. Conclusions. Early diagnosis and surgical tactics for false anastomotic aneurysms in patients with diabetes can prevent complications and improve the results of surgical treatment. The optimal type of surgery for false aneurysms is their removal with re-prosthesis of the affected segment, which allows to save the limb and the patient's life. The use of modern pharmacological agents allows to reduce the progression of atherosclerosis, which is the main cause of false aneurysms. Dynamic ultrasound monitoring is required for patients who have undergone reconstructive vascular surgery.


Vascular ◽  
2021 ◽  
pp. 170853812110514
Author(s):  
Smilen Kuyumdzhiev ◽  
Galena Kuyumdzhieva ◽  
Alok Tiwari

Introduction Access to the femoral artery for a femoral endarterectomy and patchplasty (CFE) can be undertaken either through transverse (TI) or longitudinal incision (LI). LIs have been shown in previous studies to have higher groin complications though these were undertaken in multiple types of vascular procedures. We looked at wound complications for patients undergoing elective CFE procedures only with or without angioplasty via TI or LI. Methods All patients who had undergone CFE were retrospectively analysed from a prospective database. Length of stay, wound complications and readmission rates were recorded. Factors for wound complication were looked at using logistic regression with backward elimination. Results 122 CFE procedures were performed (30 TI) over the study period. 92 (76.7%) of patients had a prosthetic patch used, whilst 57 (46.7%) patients underwent an adjunctive endovascular procedure, namely, iliac angioplasty and stenting. Median length of stay was 3 days for both groups. The wound complication rate was 6.7% in the TI group and 22.6% in the LI group. 85.6% of the wound complications were identified after discharge. 6/122 (4.9%) were readmitted for intravenous antibiotics, whilst others were managed in the outpatient setting. TI (aOR = 0.15; 95% 0.03–0.75) and combined open FE with endovascular revascularisation (aOR = 0.33; 95% 0.11–0.95) had protective effects on wound complications. Type of the patch used was not associated with any wound complications ( p = 0.07). Conclusion Compared to traditional LI, TI for CFE and OTA have lower risk of wound complications and reduced readmission rates in our series. We advocate adopting TI as the standard for femoral artery procedures rather than LI.


Author(s):  
Iqra Sheikh ◽  
Kylie A Fuller ◽  
Kateena Addae-Konadu ◽  
Sarah Dotters-Katz ◽  
Megan Varvoutis

Background As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. Study Design The present study is a secondary analysis of women who underwent cesarean delivery and had BMI > 40 kg/m2 in the Maternal Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2). Results Rates of postpartum infectious morbidity increased with BMI category (11.7% body mass index 50-59.9 kg/m2; 13.7% BMI 60-69.9 kg/m2, 21.9%; and BMI >70+ kg/m2; p=0.001). Readmission for wound complications also increased with BMI (3.1% for BMI 50-59.9 kg/m2; 6.2% for BMI 60-69.9 kg/m2; and 9.4% for BMI >70+kg/m2; p=0.001). After adjusting for confounders, increased BMI 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared to women with BMI 40-49.9 kg/m2 (aOR 6.38; 95% CI 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR 2.33 (95%CI 1.35-4.02) BMI 50-59.9kg/m2, aOR 4.91 (95% CI 2.07-11.7) BMI 60-69.9kg/m2, aOR 36.2 (7.45-176) for BMI >70kg/m2). Conclusion Women with BMI 50-70+kg/m2 are at an increased risk of postpartum wound infections and complications compared to women with BMI 40-49.9kg/m2. These data provide increased guidance for counseling women with an extremely elevated body mass index and highlight the importance of postpartum wound prevention bundles.


Sarcoma ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Luca F. Valle ◽  
Nicholas Bernthal ◽  
Fritz C. Eilber ◽  
Jacob E. Shabason ◽  
Meena Bedi ◽  
...  

Introduction. Data supporting hypofractionated preoperative radiation therapy (RT) for patients with extremity and trunk soft tissue sarcoma (STS) are currently limited to phase II single-institution studies. We sought to understand the type and thresholds of clinical evidence required for experts to adopt hypofractionated RT as a standard-of-care option for patients with STS. Methods. An electronic survey was distributed to multidisciplinary sarcoma experts. The survey queried whether data from a theoretical, multi-institutional, phase II study of 5-fraction preoperative RT could change practice. Using endpoints from RTOG 0630 as a reference, the survey also queried thresholds for acceptable local control, wound complication, and late toxicity for the study protocol to be accepted as a standard-of-care option. Responses were logged from 8/27/2020 to 9/8/2020 and summarized graphically. Results. The survey response rate was 55.3% (47/85). Local control is the most important clinical outcome for sarcoma specialists when evaluating whether an RT regimen should be considered standard of care. 17% (8/47) of providers require randomized phase III evidence to consider hypofractionated preoperative RT as a standard-of-care option, whereas 10.6% (5/47) of providers already view this as a standard-of-care option. Of providers willing to change practice based on phase II data, most (78%, 29/37) would accept local control rates equivalent to or less than those in RTOG 0630, as long as the rate was higher than 85%. However, 51.3% (19/37) would require wound complication rates superior to those reported in RTOG 0630, and 46% (17/37) of respondents would accept late toxicity rates inferior to RTOG 0630. Conclusion. Consensus building is needed among clinicians regarding the type and threshold of evidence needed to evaluate hypofractionated RT as a standard-of-care option. A collaborative consortium-based approach may be the most pragmatic means for developing consensus protocols and pooling data to gradually introduce hypofractionated preoperative RT into routine practice.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yash P. Chaudhry ◽  
Efstratios Papadelis ◽  
Hunter Hayes ◽  
Philip F. Stahel ◽  
Erik A. Hasenboehler

Abstract Background Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries. Methods A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications. Results The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group. Conclusions At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.


2021 ◽  
Author(s):  
Haydn Hoffman ◽  
Katherine M Bunch ◽  
Tyler Paul ◽  
Satish Krishnamurthy

Abstract BACKGROUND Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results. OBJECTIVE To compare outcomes between pericranial autograft and AlloDerm (BioHorizons). METHODS Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement. RESULTS A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr (11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71). CONCLUSION In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.


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