525 Incidence and possible determinants of device-pocket haematoma after cardiac implantable electronic devices in patients treated with a pressure dressing

Aims Device-pocket haematoma (DPH) occurs in 2–15% of the implantations of cardiac rhythm devices. Major bleedings occur in 0.2–2% of the cases. The present study aims to evaluate the incidence of DPH in patients treated with a pressure dressing after implantation of a pacemaker and to investigate the impact of antiplatelet and anticoagulant therapy on DPH in the same cohort. Methods and results A retrospective evaluation on 446 consecutive patients who underwent implantation or replacement of pacemaker/ICD between 2017 and 2018 was performed. Cardiovascular risk factors, clinical parameters, medical history of the patients, as well as their drug history were collected. The presence or absence of perioperative DPH was investigated. All patients were treated with a pressure dressing immediately after the procedure and for the first 24 h. The preliminary results obtained after reviewing the medical records of the 446 patients (age 76.8 ± 10.4 years; 67% males; left ventricular ejection fraction 47.3 ± 12.2%) show an incidence of DPH of 8.1% (n = 36). 332 (74%) of the patients had documented hypertension, 131 (29%) diabetes, 213 (48%) were taking antiplatelet medications, and 150 (34%) were taking anticoagulants. No significant differences were found directly comparing the main variables under study between patients who experienced DPH and those who did not. However, at binomial logistic regression analysis, performed including antithrombotic therapies, sex, and age, a tendency of patients treated with warfarin to experience DPH emerged (OR : 3.25, 95% CI : 1.00–10.50; P = 0.049). Conclusions The preliminary results of the present study show an incidence of DPH of 8.1% in patients treated with a pressure dressing after pacemaker implantation. Between antithrombotic therapies, sex and age, anticoagulation therapy with warfarin appeared to be correlated with an increased risk of DPH.

Is There Utility in Using Mastoid Pressure Dressing in Children Undergoing a Mastoidectomy?

Objectives: To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and postoperative pain. Design: A retrospective controlled study. Setting: All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Participants: children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010-2020. Main outcome measures: Wound-related complications and visual analog scale (VAS) pain scores at discharge were compared between children who had a MPD applied following surgery and those who did not. Results: 119 cases were included. The demographic characteristics of the patients and surgical techniques employed similar for both groups. There were 91 patients in the MPD group and 28 in the non-mastoid dressing (NMPD) group. In the MPD group, 5 patients developed minor wound dehiscence, 8 experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had a SSI, while another had a local hematoma. Therefore, there were no differences between the groups in relation to postoperative complications (p = 0.47). Despite these similitudes, the NMPD patients suffered less postoperative pain, as measured by the VAS (p =.02). Conclusions: This study shows that no significant benefit is derived from using a MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent postoperative wound complications. Our study supports the abandonment of routine MPD on children following mastoidectomy.

Comparison of the Outcome of Drain Vs Pressure Dressing in Ventral Hernia Repair

OBJECTIVES: The purpose of this study was to compare the outcome of drain vs. pressure in ventral hernia repair. METHODOLOGY: A cross sectional comparative study conducted at the Department of General Surgery, Hayat Abad Medical Complex Peshawar from January 2018 till December 2019. One twenty six patients both male and female were admitted as elective cases through OPD and were divided into “A” and “B” groups. Experienced surgeons of the unit performed all surgeries. Postoperative pain, seroma/hematoma formation, wound infection and hospital stay was noted in both groups. RESULTS: Out of 126 patients, 32 (25.3%) were males while 94 (74.6%) were females with male to female ratio of 1:3. All types of hernia were more common in the age range of 31-50 years. The common complications in both groups were seroma/hematoma formation (7.1%) and wound infection (6.3%). Mean hospital stay was 2-4 days. CONCLUSION: Mesh repair is the standard procedure for ventral hernia repair. Postoperative complications are comparatively lesser in pressure dressing than those with drain placement group.

Efficacy of Transparent vs. Pressure Dressing in Prevention of Post-Cardiac Catheterization Pain, Discomfort and Hematoma: A Systematic Review and Meta-analysis of RCTs

ABSTRACT Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.

A comparative study of negative pressure dressing and conventional dressing in lower limb ulcers

Background: Lower limb ulcer is a common disease among the Indian population with a prevalence of approximately 1% to 2% which is slightly higher in the older population. There are various modalities of treatment with the main aim being early wound healing. This study is done to compare the results of negative pressure dressing and conventional dressing in lower limb ulcers.Methods: This study, done at the Department of Surgery, G. K. General Hospital and Gujarat Adani Institute of Medical Sciences, Bhuj, from October 2017 to September 2018 is a prospective study. A total of 120 patients were randomly divided in two group comprising of 60 patients each. The patients in Group A were treated with negative pressure dressing while those in Group B were treated with conventional dressing. The patients were assessed, in both test and control groups, with parameters like appearance of granulation tissue, bacterial clearance and wound healing.Results: 80% of the patients belonged to the age group of 41-60 years while others were less than 40 years. We observed that in Group A majority of the patients had wound healing in 11-40 days while in Group B majority patients took 31-60 days for their wounds to be healed.Conclusions: We conclude that negative pressure dressing is more efficient as compared to conventional dressing for healing of lower limb ulcers, enabling a shorter hospital stay and early resumption of daily activities to the patient.