7th Postoperative Day Research Articles

A STUDY ON BACTERIOLOGICAL PROFILE OF SURGICAL SITE INFECTION AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN AT A TERTIARY CARE HOSPITAL IN TIRUPATI

Objective: Surgical Site Infections (SSIs) are defined as infections apparent within 30days of an operative procedure and most often between the 5th and 10th postoperative days. It constitutes a major public health problem worldwide; It is one of the most common causes of nosocomial infection. They are responsible for increasing the treatment cost, length of hospital stays and significant morbidity and mortality. Despite the technical advances in infection control and surgical practices, SSI still continue to be a major problem, even in hospitals with most modern facilities. The present study conducted to isolate and identify microbes from pus samples collected from patients who were suspected for SSI and to determine their antimicrobial susceptibility profiles in a tertiary care hospital. Methods: This is a cross-sectional study conducted in the Department of Microbiology, Sri Venkateswara Medical College, Tirupati for a period of 6 mo. A total of 390 various clinical samples were collected and processed. Isolates were tested for antibiotic susceptibility by a Kirby-Bauer disk diffusion method. Results: Out of 390 pus/wound discharge samples processed, 132 (34%) samples were culture positive, among which 107 (81%) were Gram-negative bacilli and 25 (19%) were Gram-positive cocci. Male to female ratio was 2:1. Most common age group affected was>50yrs. Predominant isolates were Klebsiella pneumoniae (73.47%) followed by Pseudomonas aeruginosa (26.53%) and Staphylococcus aureus (17.4%). Gram-negative bacilli showed maximum susceptibility to Imipenam, Piperacillin-Tazobactam and Amikacin and Gram-positive cocci showed 100% to Linezolid, Vancomycin. Conclusion: SSI remains to be a significant challenge for the surgeon’s inspite of sterile surgical techniques and prophylactic use of antibiotics. Hospital infection control measures like hand hygiene, strict adherence to pre-operative measures, rational use of antibiotics and establishing active surveillance can reduce the prevalence of SSIs.

Robot-assisted Kidney Transplantation: The 8-year European Experience.

Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30d) and late (from 31 to 90d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. A total of 624 patients with a median age of 35yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.

The effect of unilateral endoscopic arytenoid abduction lateropexy on swallowing in cases of bilateral vocal fold palsy.

Endoscopic arytenoid abduction lateropexy (EAAL) is a minimally invasive surgical technique for the immediate management of bilateral vocal fold palsy (BVFP). Specifically, it achieves a stable and adequate airway by lateralizing the arytenoid cartilage without resecting laryngeal structures. Thus, this study evaluated the effect of EAAL on swallowing in cases of BVFP. The participants consisted of 17 adult patients (15 female, 2 male) who underwent unilateral EAAL for BVFP. Swallowing function was evaluated by using the fiberoptic endoscopic evaluation of swallowing (FEES) on the 6th postoperative day and in the 6th postoperative month. The results were assessed by using the pharyngeal residue severity scale (PRSS) and the modified penetration-aspiration scale (mPAS). Additionally, the M.D. Anderson Dysphagia Inventory (MDADI) questionnaire was self-administered during the 6th postoperative month. Overall, 16 of the 17 patients demonstrated normal swallowing function during the early and late postoperative periods. Moreover, one patient experienced mild fluid aspiration early on, but initially managed it with dietary adjustments and eventually resolved it with a head flexion compensatory maneuver. There was no significant deterioration in swallowing-related quality of life according to the MDADI assessments. Based on this evaluation of unilateral EAAL, our results confirmed that this procedure is not only a reliable solution for BVFP from the perspective of respiratory function and phonation but also in terms of swallowing quality. 4.

Perioperative D-dimer levels and head and neck cancer surgery: a prospective observational study

Abstract Objectives D-dimer molecules are formed as a result of fibrinolysis and elevation of D-dimer levels are suggestive for thrombosis. The elevation of D-dimer levels and its correspondence with thromboembolism in orthopedic and general surgeries are well studied, but there are only a few studies in literature that investigates this issue in head and neck surgery. We aimed to investigate D-dimer levels and its course throughout the perioperative period in patients who underwent head and neck cancer surgery. Methods We conducted a prospective, observational study in patients who underwent neck dissection along with primary tumor resection in our otorhinolaryngology clinic between January 2022 and June 2023. D-dimer levels were measured from blood samples preoperatively and postoperatively days 0–7 and on postoperative 14th day. D-dimer levels were compared statistically. Results Twenty-one patients were included in the study. D-dimer values peaked on the first day then gradually decreased and reached a level slightly below 2 times of the preoperative values on the 14th day. The change in D-dimer levels between preoperative and postoperative days 1–14 was statistically significant. The difference between D-dimer levels measured on each day of the first week and levels on 14th day was found to be significant. Also, difference of D-Dimer levels between postoperative day 0 and day 7 was statistically significant. Conclusions The trend of D-Dimer levels following surgery in head and neck cancer patients may prove useful in clinical practice to rule out thrombotic events, in accordance with other risk factors and symptomatology.

Evaluation of Carbohydrate-Containing Fluid Preloading in Pregnant Women Using the Obstetric Quality of Recovery Scale after Caesarean Section.

To test the short and long-term effects of consuming carbohydrate-rich beverages on patient-centred outcomes after caesarean delivery under spinal anaesthesia. A prospective randomised controlled study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Karaman Training and Research Hospital, Karaman, Turkiye, between May 2023 and February 2024. A total of one hundred parturients were randomly assigned to two groups. Fifty parturients were in the control group (Group C) and 50 in the oral carbohydrate preloading group (Group OCH). Group OCH were given carbohydrate-rich fluids, while those in Group C received distilled water before undergoing elective caesarean surgery. The primary outcome of this study was to evaluate the Obstetric Quality of Recovery-10 scores (ObsQoR-10) at the postoperative 24th hour. Secondary outcomes were ObsQoR-10 scores on the postoperative 3rd and 7th day, postoperative pain scores, VAS scores, opioid consumption, and sensation of breast fullness. Welch's t-test and mixed-effect models were employed to analyse the outcomes. The total recovery scores of both groups at the 24th hour, 3rd day, and 7th day were similar (Group C: 80.08 ± 15.58, Group OCH: 80.18 ± 14.6; Group C: 93.98 ± 7.45, Group OCH: 94.12 ± 8.86; Group C: 97.2 ± 5.16, and Group OCH: 98.16 ± 3.18, respectively). The sensation of breast fullness was significantly higher in the Group OCH (p <0.05). No difference was recorded between the groups regarding postoperative tramadol consumption, VAS scores, and the presence of postdural puncture headache (p >0.05). Although carbohydrate-rich beverages did not affect the ObsQoR-10 score, they may have a notable influence on the increase of breast fullness and tenderness, which promotes breastfeeding among postoperative mothers. Carbohydrate-containing fluid, Caesarean section, ObsQoR-10 scale, Postpartum recovery, Spinal anaesthesia.

Spontaneous Vulvar Hematoma in Pregnancy: A Case Report

Spontaneous vulvar hematoma is a rare occurrence during pregnancy but can be seen as an uncommon complication of childbirth or may present after traumatic injury. Here we present a case of a 19-year-old female with a vulvar hematoma who presented with complaints of vulvar swelling and pain with no preceding traumatic event at 32 weeks of pregnancy. The diagnosis was made through physical examination and radiological evaluation. Due to increasing size and unbearable pain, surgical evacuation of the hematoma along with blood transfusion was done. The postoperative period was uneventful, vulval swelling resolved, and she was discharged on the 4th postoperative day.

Local anaesthesia vs. brachial plexus block in trapeziometacarpal joint arthroplasty

IntroductionAn established anaesthetic procedure used during total trapeziometacarpal joint (TMCJ) arthroplasty is the brachial plexus block (BPB). It was hypothesized that local anaesthesia (LA) provides advantages in overall cost, enables intraoperative assessment of the prosthesis, and minimises the anaesthetic risk. In this study, LA to BPB was compared and outcomes, safety, and overall patient satisfaction were analyzed.Materials and methodsIn this single-center cohort study, 32 patients (34 operated thumbs) who underwent total TMCJ arthroplasty between February 2018 and July 2021 were included. Two groups were formed depending on the anaesthetic method used. One group was operated under LA, and the other under BPB. Functionality scores were assessed preoperatively and three month postoperatively. Additionally, pain was assessed on the 1st and 12th postoperative day. Data on intraoperative pain and anxiety, overall satisfaction, pain medication use, and willingness to undergo the procedure again were gathered through a retrospective telephone survey.ResultsNo significant differences between LA and BPB were found in terms of functional outcomes, pain reduction, and willingness to repeat the procedure. The analysis further showed significant differences in intraoperative anxiety (higher in the LA group; LA 1.69, SD: 2.65; BPB 0.28, SD: 0.58; measured using a numeric rating scale 0–10; p = 0.045), operation length (higher in BPB group; LA 39 min, SD: 7.46; BPB 45 min, SD: 7.02; p = 0.018) and overall setup time (higher in BPB group; LA 76 min, SD: 15.85; BPB 102 min, SD: 19.66; p < 0.001). No conversion from LA to another anaesthetic method was necessary.ConclusionThe use of LA in total TMCJ arthroplasty is a practical and reliable alternative to the well-established BPB. LA reduces the cost of the procedure, necessity of an anaesthesiology team and the duration of the patients´ hospital stay. Patients should be actively involved in selecting the anaesthetic method to optimize the operative procedure and overall outcome.

The Effect of Early Enteral Nutrition under the ERAS Model on Gastrointestinal and Immune Function Recovery in Patients Undergoing Gastric Tumor Surgery.

Patients with gastric malignant tumors usually undergo surgical treatment when indicated. Surgical intervention causes significant trauma and can lead to considerable stress responses in patients. These patients experience increased malnutrition along with reduced immune function, which ultimately leads to the occurrence of postoperative complications. Therefore, this study explored the effects of early enteral nutrition on gastrointestinal and immune function in patients undergoing gastric cancer surgery under the Enhanced Recovery After Surgery (ERAS) model, aiming to support early postoperative recovery. A retrospective analysis was conducted on the clinical data obtained from gastric tumors patients who underwent surgery in the Affiliated Hospital of Jiangsu University, between January 2019 and December 2022. Based on the gastrointestinal management approaches, the patients were divided into a control group (n = 92) and an observation group (n = 92). The control group received routine gastrointestinal management and parenteral nutrition support, while the observation group underwent early enteral nutrition support under the ERAS model. The initial postoperative flatulence, the first instance of eating, and the initial bowel movement, as well as serum nutritional indicators [albumin (Alb), prealbumin (PA), hemoglobin (Hb)], immune markers [immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA)], inflammatory markers [white blood cell (WBC), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6)] were evaluated at different time points before and after surgery. Furthermore, the incidence of postoperative complications (abdominal distension, diarrhea, and infection) and the length of post-surgery hospitalization were documented for both patient cohorts. The observation group showed shorter time to first postoperative flatus, earlier food consumption, and an advanced first bowel movement than the control group (p < 0.05). On the third day after surgery, the serum concentrations of Alb, PA, Hb, IgG, IgM, and IgA were diminished in both groups compared to their preoperative levels (p < 0.05). Moreover, on the 7th day after surgery, the serum levels of Alb, PA, Hb, IgG, IgM, and IgA increased in both groups compared to the 3rd day (p < 0.05) but remained lower than before surgery levels (p < 0.05). Additionally, the serum Alb, PA, Hb, IgG, IgM, and IgA levels were significantly higher in the observation group than in the control group on the 3rd and 7th postoperative days (p < 0.05). Three days following surgery, WBC, hs-CRP, and IL-6 levels were elevated in both groups compared to their preoperative levels (p < 0.05). On the 7th day after surgery, WBC, hs-CRP, and IL-6 levels decreased in both groups compared to the 3rd day after surgery (p < 0.05) but remained higher than preoperative levels (p < 0.05). Moreover, WBC, hs-CRP, and IL-6 levels were relatively lower in the observation group than in the control group on the 3rd and 7th postoperative days (p < 0.05). Furthermore, the observation group exhibited a decreased overall frequency of postoperative complications compared to the control group (p < 0.05), along with shorter hospitalization following the surgery (p < 0.05). Our findings indicate that early enteral nutrition under the ERAS model can better promote the recovery of gastrointestinal and immune functions in patients undergoing gastric tumor surgery while reducing postoperative complications and facilitating early discharge of patients.

Comparison of Temporalis Fascia Graft Uptake in Patients with Large Tympanic Membrane Perforation Undergoing Type 1 Tympanoplasty

Background: Managing a large tympanic membrane perforation without middle ear disease involves reconstruction of tympanic membrane through tympanoplasty. Graft uptake may be highly influenced by the choice of either an endoscopic or microscopic modality. Objective: This study aimed at comparing graft uptake rates and hearing results for patients with large tympanic membrane perforations who received Type 1 tympanoplasty using temporalis fascia grafts via endoscopic and microscopic modalities. Methods: Sixty patients presenting with large-sized tympanic membrane perforations were divided into two different groups, Group A consisting of patients who underwent endoscopic tympanoplasty and Group B consisting of patients who underwent microscopic tympanoplasty. Intraoperative damage to chorda tympani nerve was monitored and post-operative pain was measuered by neumeric pain scale on 1st and 7th post-operative days. The graft uptake after 42 days of operation was analyzed and the hearing improvement was noted by using audiometric tests. The research took place at Sir Salimullah Medical College, Dhaka, Bangladesh, between July 2022 to June 2023. Results: Graft uptake in Group B was 90% while in Group A it was 83.33%. The average postoperative hearing gain in Group A and in Group B was 9.29 dB and 10 dB respectively. There has been no statistical significance found between the two techniques regarding graft uptake and hearing outcome but significant pain score was seen on 1st POD. Conclusion: Both the endoscopic and microscopic tympanoplasty techniques yielded similar graft uptake rates and hearing improvements in patients with large tympanic membrane perforations, thus the choice of technique should depend on surgeon preference rather than the expected outcome. More studies are needed in larger cohorts for the validation of these results.

Comparison of Complications Between Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for The Treatment of Lumbar Disc Herniation

Background: Lumbar disc herniation (LDH), a common spinal condition causing lower back pain, requires surgical intervention, with common procedures being percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM). Objective: The study was aimed to compare the complications and outcomes of Percutaneous Endoscopic Lumbar Discectomy (PELD) and Open Lumbar Microdiscectomy (OLM) in treating lumbar disc herniation (LDH) at the L4/L5 level. Methods: A cross-sectional comparative analysis was conducted from January 1, 2022, to June 30, 2023, at the Department of Neurosurgery, National Institute of Neurosciences&amp; Hospital. Seventy patients with LDH were divided into two groups: Group-I (PELD, n=33) and Group-II (OLM, n=37). Baseline characteristics, motor examinations, reflexes, sensory integrity, gait assessments, and MRI findings were recorded. Primary outcomes included per-operative and post-operative complications such as dural tears, nerve root injuries, wound infections, disk space infections, cerebrospinal fluid (CSF) leaks, foot drop, and recurrence rates. Visual Analogue Scale (VAS) scores for lower back and leg pain, and Oswestry Disability Index (ODI) scores, were evaluated pre-operatively and at the 90th postoperative day follow-up. Statistical analysis was performed using the chi-square test in SPSS version 26. Results: Partial nerve root injury occurred in 3.03% of Group-I and 6.06% of Group-II. Post-operative wound infection was noted in 3.03% of Group-I, while no infections were reported in Group-II. CSF leak was observed in 2.7% of Group-II but none in Group-I. Recurrence of LDH occurred in 2.7% of Group-II and none in Group-I. Conclusion: PELD and OLM are both effective for treating LDH, with PELD showing fewer complications. J Rang Med Col. September 2024; Vol. 9, No. 2: 8-14

Clinical and Molecular Impact of Advanced Platelet-Rich Fibrin on Pain, Swelling, and Distal Periodontal Status of Mandibular Second Molars After Mandibular Third-Molar Extraction.

Background and Objectives: This study aimed to evaluate the role of A-PRF (advanced platelet-rich fibrin) in the enhancement of wound healing and protecting the periodontal health of mandibular second molars after the extraction of mandibular third molars. Additionally, the study assessed the levels of pro-inflammatory cytokines in the gingival crevicular fluid (GCF) of mandibular second molars as markers of inflammation. Materials and Methods: Twenty-five systemically healthy adult patients with bilateral removal of impacted mandibular third molars were included. Each patient received A-PRF in one extraction site, while the contralateral site served as a control. Periodontal parameters of the adjacent second molar, including probing depth (PD) and clinical attachment level (CAL), were measured in distal-vestibular (DV) and distal-lingual (DL) sites. Pain, swelling, and overall healing were subjectively evaluated. Levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) in the GCF were analyzed. Evaluations occurred at baseline and three months post-surgery. Results: A-PRF significantly improved PD (from 4.69 ± 0.61 mm to 3.85 ± 0.34 mm in DV, and from 4.71 ± 0.65 mm to 3.79 ± 0.27 mm in DL, respectively) and CAL (from 2.41 ± 0.25 mm to 1.82 ± 0.21 mm in DV, and from 2.40 ± 0.36 mm to 1.75 ± 0.19 mm in DL, respectively) of the adjacent second molar, compared to control sites, three months post-surgery. Pain and swelling scores were notably lower on the 7th postoperative day in the A-PRF group. A-PRF also reduced pro-inflammatory cytokines in GCF, significantly more than in control sites, at three months post-surgery. Conclusions: A-PRF enhances the periodontal and inflammatory status of adjacent teeth and wound healing after the extraction of mandibular third molars.

Anaesthetic Management in a Patient with Pituitary Macroadenoma: A Case Report

Pituitary tumours are the second most common intracranial tumours. The anaesthetic management of pituitary tumours requires an in-depth understanding of the principles of neuroanaesthesia and pituitary disorders. Immaculate preanaesthetic evaluation, intraoperative management and postoperative care with interdisciplinary teamwork are essential for successful outcomes in surgeries for pituitary tumours. This case report discusses a 34-year-old female patient presenting for the management of a pituitary macroadenoma, illustrating the anaesthetic challenges faced in such cases. The presence of acromegaly, along with co-morbidities such as hypertension, necessitated a detailed anaesthetic management plan. The patient underwent thorough preanaesthetic evaluation and had a transnasal trans-sphenoidal tumour excision under general anaesthesia, following standard protocols for difficult airway management. The patient was intubated using a video laryngoscope and invasive blood pressure and central venous pressure monitoring were conducted. Following surgery, the patient was transferred to the neurosurgery intensive care unit and was subsequently discharged on the 10th postoperative day

Incidence of Subdural Hygroma on Routine Early Postoperative Imaging Following Foramen Magnum Decompression for Chiari Malformation Type 1 in 156 Patients

To determine the incidence of subdural hygroma(SDH) on routine early post-operative imaging following foramen magnum decompression(FMD) with dural opening in patients with Chiari 1 malformation (CM1). Clinical and radiological data of 156 consecutive patients with CM1 who underwent FMD (2006-2023) were retrospectively analysed. Computed tomography (CT) scans done on the 7th postoperative day or earlier were reviewed for the presence of SDH (infra-and supratentorial) and ventriculomegaly. There were 96 (61.5%) males. The median age was 29.1 years. 64/156 (41 %) patients had SDH on postoperative CT done at median interval of 7 days (IQR, 5.8-7 days) after surgery. 22/64 (34.4%) patients were symptomatic for SDH, the main symptoms being holocranial headache (n=16), CSF leak (n=5) and acute respiratory distress (n=3). There was significant association between development of ventriculomegaly or worsening of preexisting ventriculomegaly and presence of SDH (p=0.004). The associated ventriculomegaly, present in 7/22 patients with symptomatic SDH, was managed with external ventricular drainage (EVD)(n=2), ventriculoperitoneal shunt (n=3) or widening of FMD and EVD (1)/ventriculo peritoneal shunt (1) (n=2). Two patients with SDH and ventriculomegaly died and 2 were moribund at 3 months after surgery. At median follow up of 12 months, the other 18 patients with symptomatic SDH had symptom resolution. SDH is a common finding in the early post-operative scans of patients undergoing FMD and dural opening for CM1. While nearly two-thirds of these patients are asymptomatic, SDH with ventriculomegaly can be associated with mortality and significant morbidity and may require emergency treatment.

Submucosal Infiltration versus Intravenous Administration of Dexamethasone in Decreasing Post-operative Inflammatory Sequelae after Third Molar Surgery - A Comparative Study

Abstract Introduction: Surgical removal of lower third molar is one of the most common surgical procedures and is quite stressful for many patients. In this study, two different routes of administration of dexamethasone 8 mg (intravenous [IV] vs. submucosally infiltrated) were used to evaluate the role of dexamethasone in reducing the post-operative inflammatory sequelae following lower third molar removal. Materials and Methods: Sixty patients who had to undergo surgical removal of mandibular third molars were randomly divided into two groups, each group consisting of 30 patients. One group of patients was administered 8 mg dexamethasone submucosally five min before the surgery. Another group of patients received 8 mg dexamethasone intravenously five min before the surgery. Facial swelling and pain were measured on the 2nd, 4th and 7th post-operative days. Results: The results of this study revealed that both the routes were effective in controlling post-operative pain and swelling. IV route of dexamethasone showed higher efficacy compared to submucosal (SM) route of dexamethasone in reducing the post-operative inflammatory sequelae in the surgical removal of impacted lower third molar teeth. Discussion: It was seen that IV dexamethasone (8 mg) and submucosal dexamethasone (8 mg) had equivalent ratings in terms of reduction of swelling and pain. Although the results of this study showed both the routes are effective in controlling post-operative swelling and pain after third molar surgery, the study concluded that certain benefits of submucosal route make the sm route to be a valuable alternative to iv dexamethasone.

OUTCOME OF HUMERUS SHAFT FRACTURES IN ADULTS TREATED BY DYNAMIC COMPRESSION PLATE IN MARDAN MEDICAL COMPLEX

Background: Humerus shaft fractures constitute approximately 3% of all fractures and are commonly managed through surgical or conservative methods depending on fracture complexity and patient condition. Dynamic compression plating (DCP) is widely regarded as a reliable surgical option, promoting union and functional recovery while minimizing complications. Despite its effectiveness, limited regional data is available to guide clinical decision-making. This study aims to evaluate the functional outcomes of DCP in the treatment of humerus shaft fractures at Mardan Medical Complex. Objective: To determine the functional outcomes of humerus shaft fractures in adults treated with dynamic compression plating. Methods: This descriptive case series was conducted at Mardan Medical Complex from June 22, 2021, to December 22, 2021. A total of 139 patients aged 18–70 years, with humerus shaft fractures presenting within 10 days of injury, were included. Patients with upper or lower humerus fractures, segmental fractures, or prior open fractures were excluded. All procedures were performed using DCP, and functional outcomes were assessed using the DASH score on the 30th postoperative day. Data on demographic characteristics, injury mechanisms, and outcomes were analyzed. Results: The mean age of the 139 patients was 32.86±13.55 years. Of these, 72.7% were male and 58.3% sustained fractures due to road traffic accidents. Functional outcomes revealed excellent results in 20.9% (n=29), good outcomes in 61.9% (n=86), fair outcomes in 15.1% (n=21), and poor outcomes in 2.2% (n=3). Middle third fractures accounted for 59% of cases, followed by distal and proximal fractures at 24.5% and 16.5%, respectively. Conclusion: Dynamic compression plating is an effective surgical technique for managing humerus shaft fractures, achieving excellent to good outcomes in the majority of cases. The findings support DCP as a preferred treatment option for optimizing functional recovery in these fractures.

Role of Oxidative Stress and Inflammation in Postoperative Complications and Quality of Life After Laryngeal Cancer Surgery.

(1) Background: Laryngeal surgery due to carcinoma leads to significant tissue disruption, cellular injury, and inflammation. This leads to increased levels of reactive oxygen species (ROS), causing oxidative damage that can influence quality of life (QOL) and recovery and complicate the postoperative course. The aim of this study was to compare how postoperative quality of life and surgical complication occurrence interacted with the biomarker levels of oxidative stress (malondialdehyde, MDA; superoxide dismutase, SOD; glutathione peroxidase 1, GPX1; and catalase, CAT) and inflammation (interleukin 1, IL-1; interleukin 6, IL-6; C-reactive protein, CRP) in patients treated with conservative and radical laryngeal surgery. (2) Methods: The study included 56 patients who underwent surgical treatment for laryngeal cancer. Blood samples were collected to analyze oxidative stress and inflammation parameters before surgery and on the first and seventh days postoperatively. Serum concentrations of MDA, SOD, GPX, CAT, IL-1, IL-6, and CRP were measured using coated enzyme-linked immunosorbent assay (ELISA) kits. EORTC QLQ-H&H43 questionnaire was used to measure the QOL of patients. (3) Results and Conclusions: T stage, pain intensity, and the extent of the surgical procedure were established as significant predictive factors for QOL in multivariate analysis. There was a significant positive correlation between surgical complication occurrence and preoperative values of GPX and MDA, but significant predictors of surgical complication occurrence on the 7th postoperative day were SOD and MDA values (p < 0.05).

Efficacy of collagen and elastin matrix in the treatment of complex lower extremity wounds.

Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.

SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS

Introduction Thalamus is a high eloquent brain region, because it contains important relay nucleus and is surrounded by vital neural and vascular structures. Cavernous malformations involving deep structures such as the basal ganglia and thalamus account for 5–10% of all cerebral cavernomas and can cause devastating neurological deficits. Surgical approach to thalamic cavernomas is associated with risks of new or worsening neurologic deficits. The benefit of surgery must be carefully weighed on an individualized basis. There are several surgical routes that can be used to approach thalamic lesions, mainly transcortical and interhemispheric approaches. A particular approach should be selected based on the location of the cavernoma in the thalamus to minimize lesion of the unaffected brain. Methods We present the case of a 43-year-old right-handed lady with right bleeding posterolateral thalamic cavernoma, admitted to the neurosurgery department of Sibiu MedLife Polisano Hospital in February 2024. The patient underwent surgery, through a transcortical trans-sulcal para-fascicular, navigation guided approach. Preoperative tractography imaging, tubular cerebral corridor retractor system and intraoperative monitoring of the cortico-spinal tract, through motor evoked potentials (transcortical, cortical and subcortical mapping) and of the spinotahamic tract through somatosensory evoked potentials were used. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day. Conclusions Thalamus is a complex structure located in a deep brain area and surgery for these region carries high risks, so the surgeon must carefully tailor these patients. The transcortical transsulcal para-fascicular approach is feasible and safe using the cerebral tubular corridor, neuronavigation and neuromonitoring. Advanced surgical technology offers the advantages of minimizing the risks of new neurological deficits.

Surgical Outcome in Retroperitoneal Sarcoma Surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) Risk-Calculators for Prediction of Severe and Overall Morbidity.

Retroperitoneal sarcoma often requires comprehensive resection, leading to severe postoperative morbidity. The lack of disease-procedure specific tools for morbidity risk and the questionable accuracy of existing tools (ACS-NSQIP and P-POSSUM) in RPS surgery drove this study to assess these calculators' accuracy. Retrospective analysis of primary RPS cases undergoing surgery at two sarcoma-referral centers was conducted. Predicted morbidity/mortality rates at 90days postsurgery, classified by Clavien-Dindo (CD) and Comprehensive Complication Index (CCI), were compared with observed data. Accuracy was assessed by Brier Score and area under the curve (AUC). Inflammatory Biomarkers Prognostic Index (IBPI) also was tested. A total of 567 patients (median age 62years; 53.6% male) with a median of four resected organs were included. 59% experienced surgical complications by 90 days postoperation, graded CD ≥ 3 in 30.5%, median CCI 20.9, with a mortality rate of 1.6% (8/567). Reoperation was required in 68 of 567 patients (12%). Thirty-day mortality was 1.1%. Severe complications occurred after 30th postoperative day in 3.5% cases. ACS-NSQIP predicted below-average complication for 65.1%, average for 16.9%, and above-average for 18% of patients. P-POSSUM predicted a 66% rate of morbidity and 4% mortality. None of the prediction tools were accurate, with Brier scores ranging 0.155-0.231 and no AUC ≥ 0.7. IBPI accuracy for predicting severe infective complication was low (AUC 0.58, Brier 0.161). The significant morbidity burden after MVR necessitates reliable evaluation, especially in frail patients. Given the limitations of ACS-NSQIP and P-POSSUM, a dedicated prediction tool for perioperative events in RPS candidates for MVR needs urgent development.

Thrombocytopenia Predicts Poor Prognosis of Liver Transplantation

Background/AimPlatelets not only participate in physiological hemostasis but also play a major role in liver ischemia-reperfusion injury, liver damage, tissue repair, and liver regeneration. A decrease in platelet count can lead to spontaneous bleeding, infection, and other complications that can seriously impact patient prognosis. Thrombocytopenia has been associated with increased complications after partial hepatectomy, although the effects of thrombocytopenia on patient outcomes remain unclear. Therefore, this study aimed to examine the impact of thrombocytopenia on short- and long-term prognosis following liver transplantation (LT). MethodsThis was a retrospective analysis comprising 234 adult liver transplant recipients and conducted from January 2019 to June 2022. Preoperative and postoperative daily platelet counts were recorded up to the 30th postoperative day (POD). We defined people with platelet counts <70 × 109/L as the low platelet group, and people with platelet counts >70 × 109/L as the high platelet group. Multivariate analysis was carried out to determine whether low perioperative platelet count was a risk factor for postoperative complications, graft failure, and patient survival. ResultsOf the 234 patients analyzed in this study, approximately half (n = 112, 47.9%) developed persistent thrombocytopenia after LT. The most substantial decrease in platelet levels occurred on POD7. The cumulative survival rates at 1, 2, and 3 years in the high platelet group were higher than those in the low platelet group, 94%, 87%, and 85%, respectively, while those of the low platelet group were 84%, 78%, and 70% (P = .0014). In addition, the high platelet group had a lower incidence of biliary complications compared with the low platelet group (8% vs 19%, P = .020). At the same time, the high platelet group had a lower incidence of posttransplant lung infection (55% vs 75%, P = .040). ConclusionsThrombocytopenia is a common complication of LT. It indicates the severity of the postoperative course and is closely associated with patient survival. In particular, patients who undergo orthotopic liver transplantation (OLT) and have a platelet count <70 × 109/L on the POD7 have significant negative prognostic implications and should be further investigated.