Cases Of Postoperative Wound Infection Research Articles

Early and mid-term outcomes of minimally invasive mitral valve surgery in high operative risk patients at University Medical Center, Ho Chi Minh City

Introduction: Minimally invasive mitral valve surgery (MIMVS) has seen significant advancement in the past decades, offering numerous benefits to patients. However, there remain cohorts of patients with mitral valve pathologies, deemed at higher surgical risk, who may face rejection for MIMVS due to concerns regarding potential postoperative complications associated with this approach. Objective: To assess early and midterm outcomes of MIMVS in higher-operative-risk patients at the University Medical Center of Ho Chi Minh City. Methods: A retrospective descriptive study of the patients meeting our high operative risk criteria, who underwent mitral valve surgery at the University Medical Center of Ho Chi Minh City from January 2017 to March 2023. Results: A total of 68 eligible cases were included in our study. The male-to-female ratio was 0.6:1. Among these cases, 21 patients underwent valve repair and 47 others underwent mitral valve replacement. 30.9% of cases presented with NYHA class III or above heart failure. The mean cardiopulmonary circulation time and aortic cross-clamp time were 157.4 ± 38.8 minutes and 102.7 ± 26.3 minutes, respectively. Three cases experienced minimally invasive surgery related complications, including one case of limb ischemia requiring fasciotomy, one case of femoral wound seroma, and one case of postoperative wound infection necessitating debridement. No instances of conversion to sternotomy or in-hospital mortality were observed. The mean ICU stay and postoperative length of stay at ward were 4.6 ± 3.5 days and 10.8 ± 5.9 days, respectively. Patients showed rapid recovery during the postoperative period. During ICU care, one patient suffered a non-disabling cerebrovascular accident, one case required continuous renal replacement therapy, three cases necessitated intra-aortic balloon pump placement, and three cases required reoperation due to hemorrhagic pleural effusion. During follow-up period, three patients died within 6 months, and another patient died after their surgery one year. Other patients had favorable outcomes at the time of discharge and at subsequent follow-up. Conclusion: Minimally invasive mitral valve surgeries highlight the feasibility and safety of minimally mitral valve surgery in higher-operative-risk patients.

Utilizing the chest tube insertion site as the site of initial trocar insertion with an optical-access trocar in video-assisted thoracoscopic surgery for spontaneous pneumothorax.

BackgroundIn video-assisted thoracoscopic surgery for spontaneous pneumothorax, the initial trocar can be inserted into the pleurocutaneous fistula formed during preoperative chest drain placement. The use of an optical-access trocar to replace the initial trocar and chest tube may have a greater success rate than blind trocar insertion. Therefore, the present study aimed to evaluate the safety and feasibility of the use of an optical-access trocar to replace the initial trocar and chest tube during surgery for spontaneous pneumothorax.MethodsThe present study included 28 patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax following preoperative chest drain placement between April, 2017 and December, 2019. At the start of surgery, the chest drain was removed and the initial trocar was inserted into the pleural cavity. An optical-access trocar with an inner diameter of 5 mm was used as the initial trocar. To use a 0-degree endoscope for the optical-access trocar, this procedure requires the preparation of both, a 0-degree endoscope and a 30-degree endoscope. To evaluate the safety of the optical view method, the lungs and chest wall adjacent to the initial trocar insertion site were observed from the second trocar.ResultsThe initial trocar could be inserted through the chest tube insertion site in 26 out of 28 cases (92.9%). No instances of lung injury or pulsatile bleeding around the initial trocar were observed. No cases of postoperative wound infection or wound dehiscence were observed.ConclusionsThe use an optical-access trocar as the initial trocar when replacing a preoperatively placed chest tube is safe and feasible during video-assisted thoracoscopic surgery for spontaneous pneumothorax.

A prospective comparative study of surgical release of carpal tunnel syndrome with and without flexor tenosynovectomy

Background: Carpal tunnel syndrome (CTS) is a common condition causing hand pain and numbness. The rationale of tenosynovectomy is to remove the flexor tenosynovium that is contributing to increased volume within the carpal canal, thus removal of this tenosynovium should give more space for the median nerve and there by relief from symptoms. Aims and Objectives: The main objective of our study was to assess the role of routine flexor tenosynovectomy in the treatment of CTS. Materials and Methods: Eighty-six hands with CTS were randomized into two groups, either to carpal tunnel release with or without flexor tenosynovectomy. All patients were requested to fill up the self-administered questionnaire for the assessment of symptom severity and functional status, examined for 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score preoperatively, 2 weeks, 1 month, and 6 months follow-up. Results: After the surgical release, both groups improved significantly with respect to symptom severity and functional status, 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score but there was no significant difference between the two groups. There were two cases of post-operative wound infection and one case of mild reflex sympathetic dystrophy. Conclusion: We conclude that routine flexor tenosynovectomy during surgical release of carpal tunnel in patients with CTS does not provide any added benefit nor does it increase any morbidity.

Comparison of 21 Days Versus 10 Days Bladder Catheterization after Hypospadias Repair

Objectives: To compare 21 days versus 10 days bladder catheterization after hypospadias repair. Methods: After approval from ethical committee, Randomised controlled trial performed, in which 196 male patients were enrolled in the study that was conducted at department of pediatric surgery, Children hospital, Lahore. All patients underwent Snodgrass procedure. Group-1 patients were considered for 10 days bladder catheterization for hypospadias repair and group-2 patients were catheterized for 21 days. Complications were documented on follow-up visits in group 1 at 1 week (17 days), 3 weeks (34 days), and 6 weeks (51 days) after catheter removal. In group 2 at 1 week (day 28th), 3 weeks (day 42nd), 6 weeks (day 63rd) after catheter removal. Results: The mean age in group-1 and group-2 was 7.25 ± 3.22 years and 6.29±3.02 years. There were significantly less cases of urethrocutaneous fistula in group 2 when compared to group 1. Urethro-cutaneous fistulas (UCF) developed in 13(13.26%) ,11(11.22%) and 10 (10.2%) cases at 1, 3, and 6 weeks post catheter removal follow up in group 1. While in group 2 UCF developed in 4 (4.08%), 3(3.1%) and 2(2.04%) at 1, 3, and 6 weeks follow up. There were 5(5.2%) and 4(4.1%) cases of post-operative wound infection in groups 1 and 2 respectively (p-value = 0.500). Wound dehiscence was seen in 1 (1.02%) case in group 1 and was not seen in group 2(p value =0.500). glans dehiscence was not seen in group 1 while 1 (1.02%) case seen in group 2 (p value 0.500). Conclusion: We conclude that 21 days catheterization after hypospadias repair gives better outcome and fewer complications when compared to 10 days catheterization. Keywords: Bladder catheterization; Hypospadias repair; Fistula formation. How to cite: Abdullah M., Saleem M., Zafar M.G., Sattar M.F., Hasnain I, Wasti R.A. Comparison of 21 Days Versus 10 Days Bladder Catheterization for Hypospadias Repair. Esculapio 2021;17(02):187-190.

Cervical decompressive laminectomy and lateral mass screw-rod arthrodesis: surgical experience and analytical review of 4120 consecutive screws

Background Cervical decompressive laminectomy with lateral mass arthrodesis is a common neurosurgical procedure used to address a variety of cervical spine pathologies. Purpose This study aimed to determine the safety and efficacy of this neurosurgical procedure using the Anderson–Sekhon technique for screw trajectory. Methods The study retrospectively reviewed all clinical and radiological indicators for patients who underwent lateral mass arthrodesis between December 2005 and December 2017. All patients underwent polyaxial screw-rod implants using the Anderson–Sekhon technique for screw trajectory. It additionally reported all intra- and post-operative complications, along with short- and long-term outcomes for these patients. The follow-up period ranged from 2 months to 10 years. Results The study evaluated 695 patients who received a total of 4120 lateral mass screws. This is considered the largest reported case series up to date. No patients had neuro-vascular injuries. The main complications included 51 (7.3%) cases of screw malposition, as when the screw had breached either of foramen transversarium, neural foramen, or the facet joint; 39 (5.6%) cases of lateral mass breakdown; 29 (4.2%) cases of C5 root pain which has subsided overtime; 22 (3.2%) of incidental durotomy; and 18 (2.6%) cases of postoperative wound infection. There were only 3 cases of screw pullout leading to a stability rate of 99.5%. Most cases demonstrated very good to excellent outcomes on both short- and long-term follow-up. Conclusions Cervical decompressive laminectomy with lateral mass arthrodesis is a safe and effective technique for the management of different cervical spine pathologies, which results in favourable short- and long-term outcomes.

Pengaruh Pemberian Antibiotik Profilaksis Sefazolin, Seftriakson dan Antibiotik Seftriakson Sebelum dan Sesudah Operasi Terhadap Infeksi Luka Pasca Operasi

Objective : To determine the effect of giving prophylactic antibiotic ceftriaxone and cefazolin and giving ceftriaxone before and after surgery to the risk of postoperative wound infection in postoperative patients. Method : This study was an experimental study with a post test control group design that looked at the differences in the effect of administration of ceftriaxone, cefazolin, and ceftriaxone before and after surgery on the risk of postoperative wound infection. The population in this study were patients planned for surgery in the Obstetric and Gynelologic Departement of Dr. M. Djamil General Hopital, Padang. The number of samples used by 30 people with a group of 10 people each group. The study began in August until the number of samples was fulfilled. Univariate analysis was used to see the frequency, percentage, mean, and standard deviation. Bivariate analysis using Chi-square test with 95% CI (α <0.05) was used to see differences in the effect of the three antibiotic procedures. Results : There were no cases of postoperative wound infection based on the three procedures used. There was no difference in the effect of prophylactic antibiotics in postoperative infections. Conclusion: There was no difference in the effect of the three procedures for prophylactic antibiotics in postoperative infections. Keywords: Prophylactic Antibiotics, Surgical Wound Infections, Cefazolin, Ceftriaxone, Superficial incisional SSI

Pengaruh Pemberian Antibiotik Profilaksis Sefazolin, Seftriakson dan Antibiotik Seftriakson Sebelum dan Sesudah Operasi Terhadap Infeksi Luka Pasca Operasi

Objective : To determine the effect of giving prophylactic antibiotic ceftriaxone and cefazolin and giving ceftriaxone before and after surgery to the risk of postoperative wound infection in postoperative patients.Method: This study was an experimental study with a post test control group design that looked at the differences in the effect of administration of ceftriaxone, cefazolin, and ceftriaxone before and after surgery on the risk of postoperative wound infection. The population in this study were patients planned for surgery in the Obstetric and Gynelologic Departement of Dr. M. Djamil General Hopital, Padang. The number of samples used by 30 people with a group of 10 people each group. The study began in August until the number of samples was fulfilled. Univariate analysis was used to see the frequency, percentage, mean, and standard deviation. Bivariate analysis using Chi-square test with 95% CI (α <0.05) was used to see differences in the effect of the three antibiotic procedures.Results: There were no cases of postoperative wound infection based on the three procedures used. There was no difference in the effect of prophylactic antibiotics in postoperative infections. Conclusion: There was no difference in the effect of the three procedures for prophylactic antibiotics in postoperative infections.Keywords: Prophylactic Antibiotics, Surgical Wound Infections, Cefazolin, Ceftriaxone, Superficial incisional SSI

Pre- and Postoperative Evaluation of Operated Myoma Uteri Patients: a 5-Year Tertiary Care Experience

Introduction: This study aims to evaluate the pre- and postoperative outcomes of myomas operated in a tertiary clinic.
 Method: We retrospectively evaluated data from a total of 378 cases operated for myomas between January 2014 and December 2018 in the Dicle University Medical Faculty Obstetrics and Gynecology Clinic. 
 Results: There were 169 cases of abdominal myomectomy (44.7%), 156 cases of total abdominal hysterectomy (41.3%), 15 cases of laparoscopic myomectomy (4%), 13 cases of total laparoscopic hysterectomy (3.4%), 12 cases of myomectomy during cesarean delivery (3.2%), 9 cases of hysteroscopic myomectomy (2.4%), and 4 cases of vaginal myomectomy (1.1%). Pathology results revealed 341 cases of leiomyoma (88.2%), 32 cases of concomitant leiomyoma and adenomyosis (8.4%), and 13 cases of STUMP (3.3%). There were 5 cases of intraoperative bowel injury, 1 case of bladder injury, and 1 case of postoperative wound infection.
 Conclusion: Myomas can be surgically treated with satisfactory outcomes and low complication rates. The preferred surgical treatment will majorly depend on the patient's fertility expectations.

ANÁLISE DA FREQUÊNCIA DE INFECÇÃO DE FERIDA OPERATÓRIA DE ACORDO COM O TIPO DE ASSEPSIA E ANTISSEPSIA NO PRÉ-OPERATÓRIO

Estudos sugerem que não há necessidade do uso de escovas para degermação pré-operatória das mãos, preconizando apenas o uso de antissépticos. A escovação parece aumentar as lesões nas mãos e disseminar bactérias; enquanto a utilização de antissépticos reduz o tempo de degermação e o uso de escovas. Objetivo: realizar uma análise comparativo entre a escovação tradicional pré-cirurgica das mãos com antissépticos e a degermação pré-cirurgica com a lavagem das mãos utilizando o antisséptico polivinilpirrolidona-iodo (PVP-I) ou clorexidine. Métodos: Para alcançar esses objetivos foi realizado um Estudo Documental e Exploratório de 200 cirurgias ginecológicas e de mastologia realizadas no Hospital Escola Alvaro Alvim, Campos dos Goytacazes, RJ. Os dados de interesse para o estudo foram obtidos a partir da coleta de dados de registro de cirurgias do centro cirúrgico e respectivo prontuário de acordo com a ficha clinica elaborada para a coleta das informações. As 200 cirurgias foram divididas em dois grupos sendo 100 delas realizadas por equipes que utilizaram a escovação das mãos (grupo A) e as outras 100 cirurgias à equipe apenas lavou as mãos com os antissépticos (grupo B) citados acima. Resultados: Foram observados quatro casos de infecção da ferida pós-operatória, dois no grupa A e dois no grupo B. A análise dos resultados do presente estudo mostra que os dois métodos aplicados de assepsia pré-cirúrgica, com e sem utilização de escovas, apresentaram eficiência e eficácia semelhantes, uma vez que não houve diferença estatística significante entre as taxas de infecção da ferida operatória.

Floppy eyelid syndrome "plasty" procedure: Employment of a periosteal transposition flap for surgery of floppy eyelid syndrome.

Floppy eyelid syndrome "plasty" (FESplasty) is a surgical technique that addresses underlying superior tarsal plate and lateral canthal instability in floppy eyelid syndrome (FES) and aims to restore normal anatomical and physiological function to the upper eyelid. To describe the use of FESplasty in the surgical management of FES, and to report outcomes in an initial patient cohort. Retrospective study. Seven patients (nine eyelids) with FES undergoing FESplasty. A single surgeon (G.W.) performed all procedures. FESplasty utilizes a periosteal flap based at the inferolateral orbital rim, and applied to the anterior surface of the upper tarsal plate. It is combined with a titrated shortening procedure of the upper eyelid. Patient demographics, comorbidities and ocular symptoms and signs were recorded preoperatively. Pre- and postoperative upper eyelid distractibility were graded and documented. Postoperative improvement in upper eyelid distractibility and symptomatology, operative complications and FES recurrence. FES symptoms and upper eyelid laxity improved at last follow-up (average 24 weeks) in all patients, with no FES recurrences after a maximum follow-up of 36 weeks. One patient, in whom FESplasty exacerbated his pre-existing aponeurotic ptosis, required definitive ptosis surgery subsequently. There was one case of postoperative wound infection. Obstructive sleep apnoea was present in four of the seven patients. The remaining three patients were awaiting assessment. FESplasty is likely to confer long-term effective stabilization of the lateral canthal tendon, lateral commissure and superior tarsal plate. Anatomical and functional results appeared to have been successfully achieved.

Should pre-manipulation radiographs be obtained in ankle fracture-dislocations?

BackgroundShould pre-manipulation radiographs be obtained in ankle fracture-dislocations? This question remains controversial. The twelfth British Orthopaedic Association Standard for Trauma (BOAST-12) published in August 2016 states that ‘Reduction and splinting should be performed urgently for clinically deformed ankles. Radiographs should be obtained before reduction unless this will cause an unacceptable delay’.2 We quantify the delay caused by obtaining a pre-manipulation radiograph, and additionally determine whether a pre-manipulation radiograph influences the adequacy of initial reduction. MethodRadiographs of consecutive adult ankle fractures that underwent open reduction and internal fixation (ORIF) in a major trauma unit over a 12 months period were reviewed. Patients were divided into three groups. Group A -– pre-manipulation but post radiograph frankly displaced ankle fractures not in a cast. Group B – post manipulation ankle fractures in a cast without prior radiograph, and group C –– minimally displaced ankle fractures not in a cast. Data was collected on age, gender, fracture pattern, time and mode of arrival to the ED. Further analysis was undertaken on groups A & B. Delay to, and adequacy of, reduction were recorded. Quality of surgical reduction and fixation was assessed. Cases of post-operative wound infection were identified and analysed. Mid-term patient reported outcome measures (PROMS) at a minimum of 21 months after surgery were recorded. ResultsThere were 62 patients in group A and 51 in group B. Obtaining a radiograph prior to manipulation resulted in a mean delay of 71 minutes from time of arrival to a radiograph being taken that confirmed a reduced ankle mortice. Taking a pre-manipulation radiograph did not increase the chances of a successful reduction at the first attempt. There was a trend towards better PROMS in patients who underwent early reduction in the ED. ConclusionThe time taken to achieve a reduced ankle mortise was significantly longer for patients who had a radiograph before manipulation with the potential for exacerbating soft tissue trauma. A pre-plaster radiograph made no difference to the chances of a successful initial attempt at fracture manipulation. Level of evidenceLevel 3: Retrospective Comparative Study.

Intermediated-term Results of Salvage Procedure using Tibiocalcaneal Fusion and Strut-fibular Graft for Ankle Arthropathy with Severe Bone Defect

Category: Ankle Arthritis, Diabetes Introduction/Purpose: Severe bone defect around the ankle joint is a challenging problem in salvage operation. It has been considered as one of major factors leading to the failed fusion, because it can be difficult to make the rigid internal fixation and the compact bone filling. This retrospective study was performed to evaluate the clinical outcomes of the tibiocalcaneal fusion combined with strut-fibular graft as a salvage procedure for end-stage ankle arthropathy with severe bone defect. Methods: Twenty-eight patients were followed for more than 3 years after tibiocalcaneal fusion using the locking compression intramedullary(IM) nail and strut-fibular graft. The mean age was 57.6 years, and the mean follow-up period was 4.2 years. The clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society(AOFAS) scores, Foot and Ankle Ability Measure(FAAM) score. The subjective satisfaction score, postoperative complications, and the reoperation rate were evaluated. As the radiographic evaluation, the period to fusion, the degree of shortening compared with contralateral limb, and the degenerative change on adjacent joints were analysed. Results: AOFAS score significantly improved from preoperative average 28.8 points to 80.4 points at final follow-up (p<0.001). FAAM score had significantly improved from preoperative average 33.5 points (daily activity), 15.4 points (sports activity) to 79.8 points, 68.4 points at final follow-up (p<0.001). The period to fusion were average 18.2 weeks (tibia-fibular graft) and 19.5 weeks (calcaneus-fibular graft), respectively. 26 patients (92.8%) except for 2 patients achieved complete fusion. The degree of limb shortening was maintained from preoperative average 12.8 mm to 14.5 mm at final follow-up (p=0.236). There were 3 cases of postoperative wound infection, 3 cases of superficial peroneal nerve injury, 4 cases of metal irritation, 3 cases of degenerative changes on adjacent joint, and 2 cases of reoperation following the failed fusion. Conclusion: Tibiocalcaneal fusion using the locking compression IM nail and strut-fibular graft appear to be an effective salvage procedure for end-stage ankle arthropathy with severe bone defect. Although longer operation time and more postoperative complications have happened as compared to the cancellous bone graft alone, this surgical technique can contribute to the pain relief and improvement of gait ability through a satisfactory fusion rate and minimization of limb shortening.

Laparoscopic cysto-gastrostomy for management of pancreatic pseudocyst. Single center experience in upper Egypt

Background: One of the most common lumps of the pancreas is the pancreatic pseudocyst, with an estimated incidence of 70-80%. There are two main options for treatment pancreatic pseudocyst if it persists beyond six weeks and not respond to conservative treatment, surgical (laparoscopic and conventional open surgery) and non-surgical treatment (endoscopic and percutaneous drainage through ultrasonography or computed tomography guide). The objective of this study was to evaluate the outcome of laparoscopic pancreatic cystogastrostomy for pancreatic pseudocyst as regard operative and postoperative results in Sohag university Hospitals.Methods: This was a prospective observational single center study at the General surgery department Sohag University Hospitals, Egypt. The study populations were patients suffering from pancreatic pseudocyst attend to the outpatient clinic from March 2014 to March 2017. All patients were evaluated by history taking, physical examination, laboratory investigation and imaging evaluation by abdominal ultrasonography and contrast enhanced computed tomography of the abdomen.Results: Between March 2014 and March 2017, 14 patients with pancreatic pseudocyst had fulfilled our inclusion criteria and included in this study. 8 patients were female and 6 patients were male. 12 patients had previous history of acute biliary pancreatitis at least 6 months before the operation. 2 patient had undetermined pancreatitis. The mean age of the patient was 45.5±1.8 years and the mean operative time was 153±29 minutes the mean time to start oral fluid was 29±2 hours. 12 of the patient shad a laparoscopic cholecystectomy as all of them had acute biliary pancreatitis all operations were completed laparoscopically no conversion to open surgery was done.no mortality detected in our study .no intraoperative complications only one case had postoperative bleeding that respond to conservative therapy, one case of postoperative wound infection responds to antibiotic therapy. All cysts were resolved completely success rate (100%). The mean hospital stay was 4.35±0.28 days. The mean follows up time was 10.5±0.875 months.Conclusions: Laparoscopic cysogastrotomy is as safe, effective procedure for management of the pancreatic pseudocyst in the hand of expert well trained laparoscopic with enough equipment.

Mycoplasma hominis infection following neurosurgical intervention in a patient with spinal cord compression

Introduction: Mycoplasma hominis is a rare but recognized cause of post-operative wound infection. There are very few cases reported in the literature of M. hominis infection following neurosurgery. Case presentation: A 30-year-old woman with a history of chronic low back pain and symptoms consistent with sciatica underwent a microdiscectomy and anterior lumbar inter-body fusion for cord compression. Following surgery she developed an abscess overlying the lumbar surgical wound. Initial microbiological samples were negative on routine culture and the abscess recurred following surgical washout. Culture of a second specimen taken 1 month following the initial surgery revealed small colourless colonies that were not able to be seen on Gram stain. Molecular testing with 16S rRNA gene analysis confirmed M. hominis infection and the patient was treated with long-term oral moxifloxacin. Conclusion: Infection with M. hominis should be considered in culture-negative cases of post-operative wound infection where routine antibiotics fail. Diagnosis of Mycoplasma can be delayed due to the fastidious nature of the organism and may require molecular techniques. Initiation of appropriate antimicrobial treatment is often associated with a good clinical outcome.

Barbed Suture Is Associated With Increased Risk of Wound Infection After Unicompartmental Knee Arthroplasty

BackgroundLiterature addressing the risks of barbed suture in arthroplasty remains limited. No study to our knowledge has compared rates of wound infection between barbed and conventional suture after unicompartmental knee arthroplasty (UKA). We hypothesized that barbed suture would be associated with an increased risk of wound infection in patients undergoing UKA. MethodsElectronic records were retrieved for 1040 UKA procedures. Odds ratios with postoperative wound infection as the outcome and barbed suture as the exposure were calculated. Binary logistic regression corrected for age, gender, body mass index, operative time, and risk factors (smoking, diabetes, renal insufficiency, and immunosuppression). Barbed suture consisted of Quill #2 polydioxanone (or #0 Vicryl) for deep closure and Quill 2-0 Monoderm for subcuticular closure. Conventional suture consisted of #0 Vicryl for deep closure and subcuticular 2-0 Monocryl or staples for skin closure. ResultsA total of 839 procedures were included. Barbed suture was used in 333 surgeries, and conventional suture was used in 506. Eight cases of postoperative wound infection were identified. All infections occurred in the barbed suture cohort. Regression analysis revealed an association between subcuticular barbed suture and postoperative wound infection (odds ratio = 22.818, confidence interval = 2.69-2923.91; P = .0074). ConclusionsThe findings indicate that the use of barbed suture in subcuticular layer closure is associated with an increased risk of wound infection. This may be exacerbated by early intensive mobilization, commonly undertaken after UKA to permit rapid functional return. We recommend against the use of barbed suture for subcuticular layer closure in UKA.

Application of traditional indexes and adverse events in the ophthalmologic perioperative medical quality evaluation during 2010-2012.

To evaluate the medical quality of ophthalmologic perioperative period during 2010-2012 in our hospital. The relevant data of perioperative period were collected in our hospital during 2010-2012, and the medical quality of perioperative period was evaluated by using the traditional evaluation indexes and adverse events. Whereby, the traditional indicators include vision changes, improving of intraocular pressure, diagnostic accordance rate before and after operation, cure improvement rate, successful rescue rate, and incidence of surgical complications, etc. Adverse events are associated with ophthalmologic perioperative events including pressure sores, postoperative wound infection, drug adverse events, and equipment related adverse events. There were 1483, 1662 and 1931 ophthalmic operations in our hospital in the year 2010, 2011 and 2012, respectively. From traditional index analysis, the proportions of vision improvement for each year were 96.43%, 96.76% and 97.32%, respectively; the rates of intraocular pressure improvement were 87.50%, 85.72% and 90.17%, respectively (P <0.05); the diagnostic accordance rates before and after operation were 99.86%, 99.94% and 99.90%, respectively; cure improvement rates were 99.73%, 99.93% and 99.84%, respectively; the successful rescue rates were 82.98%, 81.46% and 76.66%, respectively; the complications incidence rates were 18.44%, 17.52% and 17.97%, respectively. The negative factor analysis results showed that: among all the patients of ophthalmic surgeries in our hospital during 2010 and 2012, only one case of postoperative wound infection was found in 2011, and also only one case of tumbling in 2010. The adverse drug events for each year were 1 case (0.07%), 2 cases (0.12%), and 4 cases (0.21%), respectively; the medical device adverse events for each year were 3 cases (0.20%), 5 cases (0.30%), and 6 cases (0.31%), respectively. Noticeably, only one case with postoperative infection of endophthalmitis was found in 2011. Moreover, no pulmonary infection or pulmonary embolism occurred during the three years. The perioperative adverse event rates for each year were 0.34% (5/1483), 0.48% (8/1662) and 0.52% (10/1931), respectively. Though incidence was rising during the three years period, no statistical significance was observed (P>0.05). It is the same case with drugs and medical devices adverse events (P >0.05). Traditional indicators reflect an excellent operation of the perioperative ophthalmologic quality, whereas adverse events analysis indicates some underlying problems. Compared with the traditional indexes for medical quality evaluation, the index of adverse events is more reasonable and easier to make an objective evaluation for medical quality of ophthalmologic perioperation, facilitating further refine analysis. Reasonable application of the adverse events indicators helps hospital to make the detailed quality control measures.

English

OBJECTIVES: The objectives of this study were to study the total cost and operative time required for suture and staple Repairs, to study the effect on wound healing and infection rate with the use of Sutures and staples, to study the cosmetic results of these two techniques and to study the degree of patient's acceptance with the two techniques. MATERIALS AND METHODS: Source of Data: The study was conducted on 100 patients who undergoing elective surgery from January 2010 to March 2014 in BLDE UNIVERSITY, Shri B M Patil medical college Bijapur. The patients were randomly selected to receive either suture or staple repair. METHOD OF COLLECTION OF DATA: DURING OPERATION- from operating surgeon. Post operatively: from patient's input. Supply of Suture and Staples: from pharmacy. FOLLOW UP OF PATIENTS: Patients came for follow up to out- patient Department After discharge. INCLUSION CRITERIA: Patients undergoing elective abdominal surgery, with clean wound. EXCLUSION CRITERIA: Patients having lacerated wounds with skin loss. RESULT: The study groups included 100 patients who underwent wound closure by staplers and 100 patients who underwent the silk suturing. The youngest patient was aged 2 year and the oldest was 75 years old. The commonest region of the surgical wounds in this study was inguinal, 20 in staplers and 20 in suture group. The time taken for wound closure using staplers showed statistically significant difference over silk suture closure. It took the stapler four times less duration to perform wound closure. The appearance of the scar among the staple groups was good in 90% of those who returned for follow up at one month, 10% had average scar. The average cost of using staple was higher than silk suture. Patient acceptance was better in the staple group with less pain during removal as compared to suture group. There were four complications in the staple group in the form of wound infection and ten cases of postoperative wound infection in the suture group. Average VAS of patients in staple group at the end of one month was 71.88 (±5.50) while the average for suture group was 64.44(±6.17). P value calculated using Student's Unpaired 'T' test. P value was <0.0001 which was highly significant.

Treatment of unstable pelvic ring injuries with vertebropelvic transpedicular fixation

In the period from 2011 to 2013 in Botkin City Hospital 17 patients with unstable injuries of pelvic ring and lumbosacral junction were operated using the method of transpedicular vertebropelvic fixation. In the preoperative period a comprehensive instrumental examination, including X-rays and CT was performed in all patients. In 11 (64.7 %) patients neurological complications were detected, of which 4 (23.5%) - cauda equina syndrome (patients with transverse fractures of the sacrum). The follow- up of patients was 1.5 years In all cases the X-ray pattern after surgical treatment was regarded as satisfactory. During the observation period the necessary to remove the fixation devices didn’t appear. The regression rate of neurological symptoms in the postoperative period depend on the severity of the initial injury and the intensity of symptoms. In the group of patients with transverse fractures of the sacrum disorders of pelvic organs remained, caused by primary severe damage in the sacral canal zone. In the other groups there was a gradual regression of motor and sensory disorders in the year after surgery. The complications in the early postoperative period: 2 (11.8 %) cases of delayed healing of surgical wounds in the sacral region (secondary healing) and one (5.9%) case of postoperative wound infection that requested the secondary surgical treatment, rehabilitation and installation of the suction-irrigation system. The method of transpedicular vertebropelvic fixation is effective in the treatment of unstable pelvic injuries if braking-down of gemipelvis is necessary and also in the combined damage of low-lumbar spine.

Clinical Significance of β-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study

ObjectivesMastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of β-tricalcium phosphate and polyphosphate (β-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies.MethodsTwenty patients with chronic otitis media underwent mastoid obliteration using β-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, β-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with β-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery.ResultsIn the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups.ConclusionAlthough β-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.

Can the duration of vomiting predict postoperative outcomes in hypertrophic pyloric stenosis?

BACKGROUND AND OBJECTIVES:Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction (GOO) in infants. Prolonged GOO is believed to result in acid and electrolyte disturbances, gastric atony, and delayed postoperative recovery. We studied the impact of prolonged vomiting as an indicator of GOO symptoms on the post-operative outcomes in HPS.DESIGN AND SETTING:A retrospective chart review of all patients who underwent pyloromyotomy at a tertiary care center between February 1997 and February 2009.PATIENTS AND METHODS:The duration of pre-operative vomiting was correlated with presenting electrolytes and acid-base balances, postoperative time to full feed, postoperative morbidity and duration of hospitalization.RESULTS:Forty-seven patients were identified. At presentation, the median (range) for duration of symptoms was 14 (3-60) days, and surgeries were performed at 2 (0-6) days after admission. Apart from one case of postoperative wound infection, all patients had an unremarkable recovery. The unusually prolonged duration of vomiting in our cohort did not correlate with the mean (SD) preoperative chloride level of 93.9 (8.8) mEq/L, mean (SD) pH level of 7.5 (0.9), mean postoperative time to full feeding of 31 (15.1) hours, or mean duration of hospitalization of 5.1 (2.2) days.CONCLUSION:Duration of vomiting in HPS at presentation does not seem to have a significant impact on the postoperative outcomes.