Post exenteration surgery rehabilitation with orbital prosthesis – A case report

Orbital defects with total loss of eyelids and the eyeball cannot be satisfactorily repaired by reconstructive surgery. Therefore, a prosthetic placement is the treatment of choice to return the individual’s confidence by producing an acceptable and lifelike appearance. Male patient, 31 years old, came with history of exenteration surgery four months ago on right eye because of infection few years before. Patient wanted orbital prosthesis to improve esthetic and self-confidence. He lost his right eye ball and some part of right eyelid. Treatment of choice that would be fabricated was orbital prosthesis with medical adhesive retention support. Orbital prosthesis was one of the alternative that can be chose to reconstruct orbital defect. The success of the prosthesis was determined by the exactness of diagnosis, treatment plan determination, material selection, determination of prosthesis retention, and technique in processing the prosthesis.

Pressure dressings versus nonpressure dressings after hemorrhoidectomy: study protocol for a randomized controlled trial

Background Pressure dressings have been used after open hemorrhoidectomy to protect surgical wounds and manage postoperative bleeding for many years. However, pressure dressings may increase the incidence of postoperative complications, such as urinary retention, medical adhesive-related skin injury, and pain. A previous controlled trial included 67 patients who underwent Milligan-Morgan hemorrhoidectomy. The data indicated that the use of a nonpressure dressing after hemorrhoidectomy reduces the incidence of urinary retention and catheterization. However, the incidence of severe postoperative bleeding and other postoperative complications was not assessed. There is no consensus on whether it is necessary and beneficial to use a nonpressure dressing after hemorrhoidectomy. The results of this randomized clinical study will help answer this question. Methods In this study, we plan to include 186 patients who have undergone modified Milligan-Morgan hemorrhoidectomy, which only sutured external hemorrhoids to reduce the risk of bleeding. The purpose is to determine whether the use of nonpressure dressings after open hemorrhoidectomy is inferior to the use of pressure dressings in terms of severe postoperative bleeding and postoperative complications. The primary endpoints of the trial are the incidence of urinary retention within 24 h after surgery and the incidence of severe postoperative bleeding 1 h after dressing removal, which requires revision surgery within 24 h after the surgery. The secondary endpoints of the study are the pain score, anal distension score, postoperative use of analgesics, and incidence of medical adhesive-related skin injury, all of which will be assessed before removing the dressings. The length of hospitalization in days and hospitalization expenses will be recorded. Safety will be assessed with consideration of all adverse and severe adverse events related to the study treatment. Discussion The study received full ethics committee approval. The first patient was enrolled on 27 November 2020. The results of this trial will finally answer the question of whether a nonpressure dressing after open hemorrhoidectomy is necessary and beneficial. Trial registration Chinese Clinical Trial Registry ChiCTR2000040283. Registered on 28 November 2020.

Medical Adhesive-Related Skin Injury Associated with Surgical Wound Dressing among Spinal Surgery Patients: A Cross-Sectional Study

The aim of this cross-sectional study was to determine the incidence, types, and factors associated with medical adhesive-related skin injuries (MARSIs) among spinal surgery patients. Adult patients who underwent planned spinal surgery under general anesthesia at a tertiary hospital in Seoul, Korea were enrolled. Data were collected from March through April 2019. Skins under surgical wound dressings were evaluated for MARSI once every morning until discharge. Skin injuries lasting for 30 min or more were considered as MARSIs. Logistic regression was performed to identify factors associated with MARSI. The incidence of MARSIs in surgical areas was 36.4% and the rate per 100 medical adhesives was 9.8%. All MARSIs occurred on postoperative day 1 or 2. A history of contact dermatitis (OR = 10.517, 95% CI = 3.540–31.241, p < 0.001) and late ambulation (OR = 1.053, 95% CI = 1.012–1.095, p = 0.010) were identified as risk factors for MARSI. Spinal surgery patients were at high risk of MARSIs associated with surgical wound dressings. Patients with a history of contact dermatitis or prolonged bed rest periods need more active skin assessment and more careful skin care to prevent MARSIs after spinal surgery.

Preventing medical adhesive-related skin injury (MARSI)

Medical adhesive-related skin injury (MARSI) is an overlooked and underestimated problem. While awareness of this issue is growing, it is not fully understood by health professionals in a variety of clinical settings. Medical adhesive products are often applied and removed incorrectly, which, albeit unintentionally, causes skin damage. In many cases, MARSI should be considered a preventable injury. Organisations should have processes in place to educate health professionals in acute and community facilities in preventing MARSI; these processes should include the use of products that help to prevent these injuries, including medical adhesive removers. This article will explore this topic and relate it to the most recent consensus document.

Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications

Objective: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. Methods: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. Results: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (β = 1.12, p = 0.018), total insertion depth (β = −0.41, p = 0.013), pleura-needle angle (β = −0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (β = −0.96, p = 0.030) were independently associated with pneumothorax, while age (β = −0.94, p = 0.018), tumor size (β = 0.29, p = 0.007) and its distance from the pleural surface (β = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. Conclusion: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. Advances in knowledge: This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.

Efficacy of a Novel Medical Adhesive for Sealing Lung Parenchyma: An in vitro Study in Rabbit Lungs

<b><i>Introduction:</i></b> During thoracic resection procedures, complete hemostasis and aerostasis are priorities. A persistent alveolar air leak is associated with increased morbidity and mortality rates. This study aimed to evaluate whether the novel medical adhesive VIVO (Adhesys Medical GmbH Aachen, Germany) is a reliable alternative sealing technique to routine surgical procedures. <b><i>Methods:</i></b> We conducted an in vitro animal study by analyzing 21 lungs of New Zealand (<i>n</i> = 19) and Chinchilla Bastard (<i>n</i> = 2) rabbits (age, 11–18 weeks; weight, 2,400–3,600 g). Three groups, each comprising 7 animals, were evaluated. VIVO (VIVO-group) was compared with standard surgical lung parenchymal lesion closure with a polypropylene suture (Suture-group) and TachoSil® (TachoSil-group). We adopted a stable, pressure-controlled ventilation protocol. After explantation, a surgical incision 0.5-cm deep and 1.5-cm wide was made in the lungs using a customized template. Air leak was measured quantitatively (mL/min) using a respirator and visualized qualitatively by 2 observers who made independent judgments. Next, the leak was closed using VIVO, suture, or TachoSil® as specified by the manufacturer. Subsequently, positive end-expiratory pressure (PEEP) and inspiratory pressure were gradually increased until a maximum of 15 and 30 mbar were attained, respectively. <b><i>Results:</i></b> At PEEPs of 8, 10, and 15 mbar, VIVO achieved complete sealing of the profound parenchymal defect in all (<i>n</i> = 7) lungs. After closure of the incision, we observed an air leak variation of 127 ± 114 mL/min (Suture-group), 31 ± 49 mL/min (VIVO-group), and 114 ± 134 mL/min (TachoSil-group). VIVO showed a significantly lower air leak than surgical sutures (<i>p</i> = 0.031) and TachoSil® (<i>p</i> = 0.046). <b><i>Conclusion:</i></b> VIVO offers sufficient closure of the lung parenchymal lesions. The novel adhesive enabled significantly better sealing with lower persistent air leakage than TachoSil® or surgical sutures. Further investigation using in vivo models is strongly encouraged to confirm our findings.

Pressure Dressings Versus Nonpressure Dressings After Hemorrhoidectomy: Study Protocol for a Randomized Controlled Trial

BackgroundPressure dressings have been used after open hemorrhoidectomy to protect surgical wounds and manage postoperative bleeding for many years. However, pressure dressings may increase the incidence of postoperative complications, such as urinary retention, medical adhesive-related skin injury, and pain. A previous controlled trial included 67 patients who underwent Milligan-Morgan hemorrhoidectomy. The data indicated that the use of a nonpressure dressing after hemorrhoidectomy reduces the incidence of urinary retention and catheterization. However, the incidence of severe postoperative bleeding and other postoperative complications was not assessed. There is no consensus on whether it is necessary and beneficial to use a nonpressure dressing after hemorrhoidectomy. The results of this randomized clinical study will help answer this question.MethodsIn this study, we plan to include 186 patients who have undergone Milligan-Morgan hemorrhoidectomy. The purpose is to determine whether the use of nonpressure dressings after open hemorrhoidectomy is inferior to the use of pressure dressings in terms of severe postoperative bleeding and postoperative complications. The primary endpoints of the trial are the incidence of urinary retention within 24 hours after surgery and the incidence of severe postoperative bleeding one hour after dressing removal, which requires revision surgery within 24 hours after the surgery. The secondary endpoints of the study are the pain score, anal distension score, postoperative use of analgesics, and incidence of medical adhesive-related skin injury, all of which will be assessed before removing the dressings. The length of hospitalization in days and hospitalization expenses will be recorded. Safety will be assessed with consideration of all adverse and severe adverse events related to the study treatment.DiscussionThe study received full ethics committee approval. The first patient was enrolled on 27 November 2020. The results of this trial will finally answer the question of whether a nonpressure dressing after open hemorrhoidectomy is necessary and beneficial.Trial registrationChinese Clinical Trial Registry (registration ID: ChiCTR2000040283). Registered on 28 November. 2020. {2} http://www.chictr.org.cn/edit.aspx?pid=58894&htm=4 {2b}