Wound Infection Complications Research Articles

Effect of probiotics and synbiotics on complications of wound infection after colorectal surgery: A meta-analysis.

Wound infection is a serious complication that impacts the prognosis of patients after colorectal surgery (CS). Probiotics and synbiotics (Pro and Syn) are live bacteria that produce bacteriostatic agents in the intestinal system and have a positive effect on postoperative wound infections. The purpose of this study was to evaluate the effect of Pro and Syn on complications of wound infection after CS. In November 2023, we searched relevant clinical trial reports from Pubmed, Cochrane Library, and Embase databases and screened the retrieved reports, extracted data, and finally analysed the data by using RevMan 5.3. A total of 12 studies with 1567 patients were included in the study. Pro and Syn significantly reduced total infection (OR, 0.44; 95% CI, 0.35, 0.56; p < 0.00001), surgical incision site infection (SSI) (OR, 0.61; 95% CI, 0.45, 0.81; p = 0.002), pneumonia (OR, 0.43; 95% CI, 0.25, 0.72; p = 0.001), urinary tract infection (OR, 0.28; 95% CI, 0.14, 0.56; p = 0.0003), and Pro and Syn did not reduce anastomotic leakage after colorectal surgery (OR, 0.84; 95% CI, 0.50, 1.41; p = 0.51). Pro and Syn can reduce postoperative wound infections in patients with colorectal cancer, which benefits patients' postoperative recovery.

Multiple complications of wound infection of mixed etiology: clinical case

Purpose: to demonstrate a case of mixed purulent wound infection of the leg with the sequential development of multiple complications — phlegmon, staphylococcal infection with scarlet-like syndrome and the skin-articular form of Henoch-Schönlein hemorrhagic vasculitis in a 12-year-old child. Results. A severe, complicated form of purulent lesions of the skin and subcutaneous tissue is described — phlegmon of the lower leg, which arose as a result of infection of previously damaged tissues by the main causative agents of mixed wound infection — S. aureus and S. pyogenes in the IV degree of contamination. On the 7th day of the disease, the manifestation of an immune complex complication was noted — the skin-articular form of Henoch-Schönlein hemorrhagic vasculitis and symptoms of staphylococcal infection with scarlet-like syndrome, which required a differential diagnosis with wound (extrabucal) scarlet fever. Conclusion. The difficulties of differential diagnosis are shown. The delayed appearance of the rash on the 7th day of illness, pronounced hyperemia of the skin with a cyanotic tint around the wound, the formation of a large affected area, the appearance of peeling of the skin earlier than with scarlet fever — already against the background of a fading rash, allowed us to think about a staphylococcal infection with scarlet fever-like syndrome.

Infection with klebsiella and pseudomonas in mine-blast wounds: frequency of their isolation at the third stage of evacuation; spectrum of their resistance; sensitivity to antimicrobial drugs; general rules of military medical care

Introduction. During the war that has been going on in Ukraine for two years, the number of patients with mine-blast injuries has increased dramatically. The issue of wound colonization by resistant microorganisms and modification of their species spectrum, which increases during the evacuation of victims to various medical facilities, is of great importance. At the third stage of wounded military personnel evacuation 87.7 % of wounds were occupied by gram-negative bacteria in the form of monoculture, including strains of Pseudomonas aeruginosa and Klebsiella pneumoniae with multidrug resistance, which have a high potential for adaptation in hospital conditions. The aim of the study. To investigate the frequency of infection with Klebsiella and Pseudomonas of mine-blast wounds at the third stage of evacuation, to determine the spectrum of their resistance, sensitivity to antimicrobial drugs, and to present general recommendations for military medical care. Materials and methods. The material from purulent wounds was taken from victims with mine-blast injuries who were admitted for inpatient treatment to the surgical department. The sampling was carried out with sterile swabs with transport nutrient medium. The material was inoculated on blood agar, Endo medium, CHROMID® P. Aeruginosa Agar, MPA and incubated at 37°C for 24 hours. Biochemical identification was performed using the Enterotest 24 and Nefermtest 24 test systems (Lachema, Czech Republic). Antimicrobial susceptibility testing was performed using the Kirby-Bauer method and the determination of the minimum inhibitory concentration (MIC) using broth microdilutions according to the recommendations of the European Committee for the Antimicrobial Susceptibility Testing (EUCAST 2023). Healthcare-associated infections (HCAI) among the wounded servicemen were diagnosed according to the updated MoH Order No. 1447. Results. K. pneumoniae and P. aeruginosa were isolated from the wounds of 38 examined mine-blast injured patients. Out of these 17 (44.7 %) patients had P. aeruginosa; in 9 patients both pathogens were in association; in 2 patients P. aeruginosa was isolated in pure culture; in the remaining cases P. aeruginosa was in association with other microorganisms. Quantitatively, the bacteria were isolated in the range of 106-109 colony forming units (CFU/ml) of pathogen in the patient’s wound contents. In wounded servicemen, infectious wound complications appeared later than the 3-rd day of hospital stay, so they were classified as HCAI. 33.3 % and 22.2 % of K. pneumoniae isolates demonstrated susceptibility to amikacin and imipenem, respectively. Moderate susceptibility of P. aeruginosa to amikacin was detected in 29.4 % of isolates, and to ticarcillin-clavulanate – in 23.5 %. 41.2 % of P. aeruginosa isolates demonstrated sensitivity to piperacillin-tazobactam, 23.5 % – to imipenem, and 11.8 % – to ceftazidime. No significant difference was detected between the susceptibility of Pseudomonas and Klebsiella strains to imipenem (p more than 0.05). It was recorded absolute susceptibility of K. pneumoniae and P. aeruginosa strains to colistin. In total 92.3 % of P. aeruginosa and 90.7 % of Klebsiella isolates were represented by multidrug-resistant strains. Timely and thorough primary surgical treatment of the wound and correct antimicrobial treatment reduce the risk of wound infection. Conclusions. K. pneumoniae and P. aeruginosa were isolated from 44.7 % of wounded servicemen with mine-blast trauma at the third stage of evacuation. There was an increase in the frequency of multidrug-resistant strains of K. pneumoniae (90.7 %) and P. aeruginosa (92.3 %). The isolated strains of K. pneumoniae and P. aeruginosa that induced healthcare-associated infections were hospital-acquired. All isolates were susceptible to colistin. High-quality treatment of wound requires complete elimination of microorganisms prior to further rehabilitation stages.

Early Outcomes after Minimally Invasive Percutaneous Calcaneal Osteotomy in the Treatment of Cavovarus and Planovalgus Foot Deformities

Category: Hindfoot; Other Introduction/Purpose: A calcaneal osteotomy is often included as part of the treatment in planovalgus and cavovarus foot deformities. Often this is done through an open approach where complications of wound infection and sural nerve injury are common. More recently, this strategy has been modified using minimally invasive techniques. A percutaneous approach, in comparison to the standard open calcaneal osteotomy, allows for reduced postoperative complication and decreased pain compared to an open procedure. This retrospective chart review aims to evaluate the postoperative outcomes of patients undergoing calcaneal osteotomy via a minimally invasive percutaneous approach in foot reconstructive surgery to assess early functional outcomes, complication rate and revision rates. Methods: One fellowship-trained foot and ankle orthopaedic surgeon at one academic institution performed minimally invasive calcaneal osteotomy on 20 patients. All cases were completed between March 2021 and March 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Results: Participants included 15 females and 5 males, 4 of whom were smokers. Average age was 42.2 years. Average BMI was 32.3, and average follow up was 130.4 days. Complications included 1/20 patients had a postoperative wound breakdown of the screw site requiring incision and debridement with closure and 2/20 cases of sural neuritis. One resolved 6 months after treatment and the other was present but became less symptomatic. All participants achieved union, and there were no revisions. All shifts corrected hindfoot deformity either via medializing or lateralizing osteotomy. Average preoperative PROMIS scores in the domains of physical function, pain interference, and mobility were 36.8 (28.6-46), 67.1 (54.3-78), and 34.6 (25-40), respectively. Average postoperative PROMIS scores were 35.7 (21-76), 62.3 (39-76), and 33.4 (16-75), respectively. Conclusion: Minimally invasive calcaneal osteotomy appears to be an efficacious and safe treatment option for the correction of cavovarus and planovalgus hindfoot deformities with the ability to obtain appropriate hindfoot correction with low complication rates and high union rates. Early outcome measures show a favorable pain interference PROMIS score as well as a trend in improvements in PROMIS physical function scores. Longer term data will need to be done to assess long term functional outcome and revision rates.

Advances in the treatment of combat trauma to the extremities: photodynamic therapy and methods of plastic wound closure

Objective. To evaluate our own ten–year experience in the use of photodynamic therapy and plastic wound closure methods in the treatment of combat trauma victims using various photosensitizers and light sources, as well as tissue therapy.&#x0D; Materials and methods. In the Department of Acute Diseases of the Major Vessels of the Zaitsev Institute of General and Emergency Surgery, 36 patients with mine–blast and shrapnel wounds with damage to the major vessels underwent staged treatment of infectious wound complications using negative pressure wound therapy, photo– and photodynamic therapy, followed by wound closure with a fibroblast matrix. Bacterial contamination with the identification of strains, the timing of pathogen eradication in the wound, and the duration of wound healing were assessed.&#x0D; Results. As a local treatment, negative pressure wound therapy was initially used in a constant vacuum mode of –75 to –115 mm Hg for 4 to 5 days. In case of reduction/disappearance of soft tissue edema, the wounds after fasciotomy were sutured, and dermotension was used in 5 patients. After photosensitisation, the wound was irradiated with Korobov photonic matrices "Barva–Flex" with a wavelength of 660 nm (red light). During the staged treatment of wounds, complete eradication of pathogens in the wound was recorded on the 5th day, and complete wound healing was recorded within 17 days.&#x0D; Conclusions. Comprehensive treatment of infectious wound complications in victims with combat trauma using negative pressure wound therapy and photo– and photodynamic therapy, especially in the context of the formation of infectious pathogens resistance, led to better wound healing in a short time.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignant tumors in children: Initial experience in a single institution.

Peritoneal malignant tumors in children are rare but commonly associated with disease progression and poor outcome. The successful treatment experience of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in adult peritoneal carcinoma has been applied to pediatric peritoneal malignancy in recent years. However, patients with desmoplastic small round cell tumor (DSRCT) accounted for the majority of patients treated with CRS and HIPEC in previous studies. The role of CRS and HIPEC remains controversial due to the rarity of the disease and the limited sample size of studies. Additionally, the cases using CRS and HIPEC except DSRCT were mainly small case reports with unclear outcomes. We present our experience in the treatment of pediatric peritoneal malignancies using CRS and HIPEC, with more emphasis on the safety, feasibility, and short-term outcome. A retrospective query from December 2019 to February 2022 identified 19 children with peritoneal malignancies who underwent CRS and HIPEC in our institution. Clinical characteristics, therapies, and outcomes were summarized and analyzed. The median age of the patients was 6.4 years (range, 0.7-13.9 years). The histologic types included rhabdomyosarcoma (7), Wilms tumor (2), clear cell sarcoma of the kidney (2), undifferentiated sarcoma (2), immature teratoma (1), peritoneal serous carcinoma (1), malignant rhabdoid of the kidney (1), malignant germ cell tumor (1), neuroblastoma (1), and epithelioid inflammatory myofibroblast sarcoma (1). Seven patients underwent initial operation, and 12 patients received reoperation for tumor recurrence. The median peritoneal carcinomatosis index was 5 (range, 2-21). There were no perioperative deaths or life-threatening complications of CRS and HIPEC. Two patients had grade 3 complications of wound infection and wound dehiscence. With a median follow-up time of 14 months (range, 1.5-31 months), 14 patients were alive, and 5 died of tumor recurrence. Of the 14 patients who were alive, 2 relapsed after CRS and HIPEC and then received radiotherapy and molecular-targeted therapy or chemotherapy. CRS and HIPEC are safe and feasible in children, without increasing serious complications in the peri- and postoperative periods. The complication is acceptable. The short-term outcome shows possible effectiveness in pediatric peritoneal malignant tumors. The long-term effectiveness needs to be verified by additional cases and long-term follow-ups.

Endoscopic Management of Postoperative Esophageal and Upper GI Defects-A Narrative Review.

Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.

Advantages of using a nanomodified mesh with an antiseptic in the surgical treatment of abdominal hernia

Surgical treatment of open operations for abdominal hernias (AH) using classic techniques of allogeneoplasty (sublay, onlay) is often accompanied by an increase in intra-abdominal pressure (IBP) and a decrease in the volume of the abdominal cavity, which in the postoperative period leads to abdominal compartment syndrome (ACS) In 2 ,4 - 3.6% of cases and mortality in 1.2 - 3.4% of observations. This requires a special method of closing a large defect of the abdominal wall, which would not increase ICP. The use of improved techniques contributes to the creation of the optimal volume of the abdominal cavity and improves the results of treatment, in particular, the frequency of ACS decreases. But it should be noted that the use of combined operations with a classic polypropylene mesh leads to a high frequency of complications from the postoperative wound, such as seroma (30.8 - 60.4%), suppuration of the postoperative wound (4.8 - 6.4%), ligature fistula (1.2 - 3.0%), meshoma (0.06 - 1.60%).&#x0D; Aim – to improve the results of surgical treatment of abdominal hernias (AG) when using a nanomodified polypropylene mesh with an antiseptic.&#x0D; Materials and methods. An analysis of surgical treatment of 400 patients with GJ was carried out. Depending on the type of mesh implant used during surgical treatment, patients were divided into two groups. 200 (50%) patients of group I underwent surgery using a nanomodified polypropylene mesh with an antiseptic, in group II, 200 (50%) patients underwent surgery using a classic polypropylene mesh.&#x0D; Results and discussion. Statistically significantly better results were obtained in patients of group I compared to group II. Thanks to the fact that in patients of group I, a nanomodified polypropylene mesh implant with an antiseptic was used, it was possible to achieve a reduction in the frequency of seroma by 4.2 times, suppuration of the postoperative wound by 8 times, inflammatory infiltrate by 10 times, and the occurrence of ligature fistulas of the anterior abdominal wall by 12.5 times, meshomas in 7.5 times. The long-term results of surgical treatment of AG also confirm the advantages of operations for abdominal hernias using nanomodified polypropylene mesh with an antiseptic compared to the use of classic polypropylene mesh, which is associated with a decrease in the frequency of wound infectious complications, migration and shrinkage of the mesh and prevents recurrence of AG. The duration of inpatient treatment in group I was (7.0±1.0) days, in group II – (12.0±2.2) days.&#x0D; Conclusion. Surgical treatment of abdominal hernias using a nanomodified polypropylene mesh with an antiseptic is more effective compared to the use of a classic polypropylene mesh, as evidenced by a decrease in the frequency of seroma from (30.5±1.2) to (7.3±0.5)%, suppuration postoperative wound - from (9.8±0.5) to (1.2±0.2)%, inflammatory infiltrate - from (12.2±0.6) to (1.2±0.2)%, ligature fistulae of the anterior abdominal wall - from (6.5±0.5) to (0.5±0.1)%, meshomas - from (3.9±0.3) to (0.5±0.1) %, chronic postoperative pain - from (8.0±0.6) to (1.3±0.2)%, hernia recurrence - from (9.3±0.6) to (1.3±0.2 )%.

The Use of Five-Strand Hamstring Autograft to Increase the Graft Size in Anterior Cruciate Ligament Reconstruction—A Prospective Cohort Study With Satisfactory Early Clinical Results

To report on the outcomes of using 5-strand hamstring autograft to increase the graft size for anterior cruciate ligament (ACL) reconstruction and to determine whether the clinical results are comparable to using conventional 4-strand graft. A prospective cohort study of patients with arthroscopic-assisted single-bundle ACL reconstruction using hamstring autograft from January 2019 to June2021.The patients were prospectively recruited to undergo ACL reconstruction with either 5-strand hamstring graft (group A) or 4-strand hamstring graft (group B). In total, 45 patients were included into the study. The mean diameter of the final graft was 8.9 ± 0.6 cm in the 5-strand group and 7.5 ± 0.8 cm in the 4-strand group (P < .001). Four-strand graft diameter measurements were taken intraoperatively in the 5-strand group before preparation of the 5-strand graft. The mean graft diameter of the 4-strand grafts was similar in both groups: 7.3 ± 0.3 mm in group A and 7.5 ± 0.8 mm in group B (P= .72). There was no statistically significant difference between the 2 groups of patients in terms of the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms, KOOS Pain, KOOS Activities of Daily Living, KOOS Sports and KOOS Quality of Life scores. There were no postoperative complications of wound infection in both groups of patients. There was one case of graft rupture (4.8%) in the 4-strand group, which required revision reconstruction with patellar tendon graft 9 months postoperatively. There was no case of graft rupture in the 5-strand group (P= .29). The 5-strand hamstring graft technique provides a graft with significantly larger graft diameter than the quadrupled graft technique, with satisfactory short- to medium-term outcomes. The 5-strand graft is therefore a useful technique to increase the graft size when faced with the problem of small hamstring graft. Level II, prospective cohort study.

Safety and Efficacy of Monopolar Cautery in Dissection of Mesoappendix in Laparoscopic Appendectomy in Western Nepal, a Multicentered Cross-Sectional Retrospective Study

Introduction: Different instruments are being used for appendiceal mesentery dissection in laparoscopic appendectomy. The effectiveness and versatility of monopolar cautery for the same makes it a commonly used option. This study aims to observe the safety and efficacy of monopolar cautery in laparoscopic appendectomy for the dissection of mesoappendix.&#x0D; Methods: 424 cases who underwent laparoscopic appendectomy from November 2018 to April 2020 using monopolar cautery for mesoappendix dissection were included in this multi-centered cross-sectional retrospective study. The operating time, intra and post-operative complications and length of hospital stay were evaluated. Measures of central tendency were performed for data analysis. &#x0D; Results: Acute appendicitis was the common indication (96.7%) for the laparoscopic surgery, with 99.1% success rate with a male to female ratio of 1.17:1 and mean age of 21.48+14.80 years. The median operating time and length of hospital stay were 30 mins (range: 15–130 mins) and 3 days (range: 1-15 days), respectively. Moderate intra-operative bleeding was noted in 0.5%. Post-operative complications of wound infection (3.4%) and prolonged ileus (1.7%) were noted.&#x0D; Conclusion: Use of monopolar cautery for dissection of mesoappendix in laparoscopic appendectomy is still safe and efficient even with the advent of newer and more expensive instruments in the present world.

Treatment of femoral head replacement in elderly patients with femoral neck fracture complicated with uremia

To investigate the treatment method and effect of artificial femoral head replacement for elderly patients with femoral neck fracture complicated with uremia. From January 2016 to December 2020, 21 elderly patients with femoral neck fracture complicated with uremia were treated with artificial femoral head replacement. There were 3 males and 18 females, aged 65 to 83 years old with an average of (77.2±1.9) years. All patients were complicated with uremia and required long-term maintenance of hemodialysis. The age of dialysis was 2 to 11 years with an average of (6.3±1.6) years, 2 to 3 times per week. The time from injury to admission to operation was 3 to 7 days with an average of (4.0±2.1) days. The anemia and hypoproteinemia of the patients were corrected preoperatively, and the serum potassium and creatinine indexes of the patients were adjusted by hemodialysis. All the incisions were healed in the first stage, and there were no complications of wound infection, prosthesis loosening, dislocation and deep vein thrombosis. All patients resumed routine hemodialysis in time to maintain the stability of serum creatinine and potassium levels. All 21 patients were followed up for 5 to 23 months with an average of (16.8±2.6) months. Harris scores changed from (24.8±2.5) scores preoperatively to (87.2±3.1) scores postoperatively. Elderly patients with femoral neck fracture combined with uremia underwent artificial femoral head replacement surgery, as long as the perioperative treatment is appropriate, with active postoperative rehabilitation treatment, can obtain a good clinical effect.

Individualized Risk Prediction Tool for Serious Wound Complications After Mastectomy With and Without Immediate Reconstruction.

A greater proportion of patients with surgical risk factors are undergoing immediate breast reconstruction after mastectomy, resulting in the need for better risk prediction to inform decisions about the procedure. The objective of this study was to leverage clinical data to restructure a previously developed risk model to predict serious infectious and noninfectious wound complications after mastectomy alone and mastectomy plus immediate reconstruction for use during a surgical consultation. The study established a cohort of women age 21 years or older treated with mastectomy from 1 July 2010 to 31 December 2015 using electronic health records from two hospitals. Serious infectious and non-infectious wound complications, defined as surgical-site infection, dehiscence, tissue necrosis, fat necrosis requiring hospitalization, or surgical treatment, were identified within 180 days after surgery. Risk factors for serious wound complications were determined using modified Poisson regression, with discrimination and calibration measures. Bootstrap validation was performed to correct for overfitting. Among 2159 mastectomy procedures, 1410 (65.3%) included immediate implant or flap reconstruction. Serious wound complications were identified after 237 (16.8%) mastectomy-plus-reconstruction and 30 (4.0%) mastectomy-only procedures. Independent risk factors for serious wound complications included immediate reconstruction, bilateral mastectomy, higher body mass index, depression, and smoking. The optimism-corrected C statistic of the risk prediction model was 0.735. Immediate reconstruction, bilateral mastectomy, obesity, depression, and smoking were significant risk factors for serious wound complications in this population of women undergoing mastectomy. Our risk prediction model can be used to counsel women before surgery concerning their individual risk of serious wound complications after mastectomy.

Підходи до хірургічного лікування глибоких опіків кисті, обтяжених синдромом субфасціальної гіпертензії

The problem of treatment of subfascial hypertension syndrome in burn injury of the hand remains relevant due to lack of vigilance about its possible development. Purpose - to improve the results of treatment of deep burns of the hand by using the tactics of early surgery. Materials and methods. The clinical material consisted of 195 patients with burn lesions of the hand. The main group consisted of 83 victims, who used the tactics of active early surgery, followed by recovery and reconstruction. The comparison group consisted of 112 patients - in the treatment of which the tactics of gradual necrectomies were used after the formation of demarcation lines with the subsequent healing of wounds with the use of ointment dressings. Results. The data obtained showed that timely diagnosis, which consisted of the right treatment tactics, reduced the number of amputations and prevented the disability of victims with burns. This was achieved through timely and technically correct method of performing open decompression fasciotomies, which managed to reduce the subfascial pressure in each affected case, which prevented critical ischemia of muscle fibers and the development of Folkman’s contracture. It is extremely important to perform open fasciotomies in the syndrome of subfascial hypertension, because only in this way a complete decompression of tissues was achieved, and a timely verified diagnosis ensured a good treatment result. Early active surgical tactics for deep burns became a priority, compared to industry standards, which was expressed in an increase in the number of early surgical interventions (54.2% vs 23.2%; p&lt;0.02), which reduced the proportion of wound infectious complications (4.8% vs 18.2; p&lt;0.01), reduce the number of cicatricial contractures (14.5% vs 50.9%; р&lt;0.02). Conclusions. Timely diagnosis of subfascial hypertension of the hand, active early surgical tactics, the proposed technique of decompression fasciotomies significantly improved the results of treatment, which manifested itself in the restoration of motor function of the hand. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: burns, hand’s burns, subfascial hypertension syndrome, open decompression fasciotomies, wounds.

Phage therapy in the treatment of combat trauma

The high resistance of the bacterial flora to existing antibacterial drugs makes it necessary to look for new approaches in the tactics of treating infectious wound complications. Phage therapy is one of the alternative ways to solve this problem. Foreign military medical organizations, together with private pharmaceutical companies, with the financial support of states, are actively developing all kinds of ways to use bacteriophages in various areas of combating bacterial infectious agents. The article outlines main research programs aimed at studying the possibilities of phage therapy in combat and burn injuries, which are being developed in Western Europe (France, Poland, Belgium, Austria, Switzerland), the USA, China, and Israel.

Transradial versus Transfemoral Approaches in Diagnostic and Therapeutic Neuroendovascular Interventions: A Meta-Analysis of Current Literature

The adoption of the transradial approach (TRA) has been increasing in popularity as a primary method to conduct both diagnostic and therapeutic interventions. As this technique gains broader acceptance and use within the neuroendovascular community, comparing its complication profile with a better-established alternative technique, the transfemoral approach (TFA), becomes more important. This study aimed to evaluate the safety of TRA compared with TFA in patients undergoing diagnostic, therapeutic, and combined neuroendovascular procedures. A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed and other databases was conducted for studies from all available dates. To compare TRA and TFA, we performed an indirect meta-analysis between studies that mentioned the complications of the procedures. Our search yielded 532 studies, of which 108 met full inclusion criteria. A total of 54,083 patients (9137 undergoing TRA and 44,946 undergoing TFA) were included. Access site complication rate was lower in TRA (1.62%) compared with TFA (3.31%) (P < 0.01). Neurological complication rate was lower in TRA (1.64%) compared with TFA (3.82%) (P= 0.02 and P < 0.01, respectively). Vascular spasm rate was higher in TRA (3.65%) compared with TFA (0.88%) (P < 0.01). Wound infection complication rate was higher in TRA (0.32%) compared with TFA (0.2%) (P < 0.01). Patients undergoing TFA are significantly more likely to experience access site complications and neurological complications compared with patients undergoing TRA. Patients undergoing TRA are more likely to experience complications such as wound infections and vascular spasm.

The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes.

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

Radiation Therapy in Primary Soft Tissue Sarcoma of the Superficial Trunk.

Despite anatomical differences, truncal soft tissue sarcomas (STS) often are grouped with extremity sarcomas. We evaluated the clinical outcome of patients with truncal STS who underwent gross total resection (GTR) and radiation therapy (RT), with special emphasis on those treated with intensity modulated radiation therapy (IMRT). From January 1, 2001 to December 31, 2018, 64 patients received GTR and RT, where 48 patients were male, 35 patients were aged ≤ 60 years, and 48 patients had tumors ≤ 10 cm. Sixty-two tumors were high grade, 36 were in the chest wall, 7 in the abdominal wall, and 21 were paraspinal. During surgery, 7 received mesh reconstruction, and 6 received flap closure. R0 resection was achieved in 53 patients. Thirteen patients received chemotherapy. With a median follow-up of 57 months, the 5-year actuarial local control (LC) was 71%. In the IMRT subset (50/64, 78%), the 5-year LC for the chest/abdominal wall was 84%, and 69% for the paraspinal subsite. Grade 2+ radiation dermatitis was seen in 21 of 64 (33%) patients, 5 of 64 (8%) developed noninfectious wound complications, 5 of 64 (8%) developed infectious wound complications, and 1 of 64 (2%) developed grade 2 chest wall pain. No additional grade 2+ late toxicity was observed. Based on this study, achieving LC in truncal STS treated with GTR and RT remains challenging even with IMRT (5-year LC: 78%). While the use of IMRT was more promising for tumors of the chest/abdominal wall with 5-year LC of 84%, it was 69% for those located in the paraspinal subsite, indicating a need for further improvement.

Influence of the combined method of air-plasma flows and NO-therapy on the blood system parameters in treatment of infectious wound complications in cardiac surgery

Nitric oxide (NO) is a universal biological mediator that has a multifaceted effect on physiological and pathological processes in various organs and systems of the body. It is known that NO-therapy is a powerful stimulator of a positive effect on the course of the wound process, especially in complicated wounds.Objective: to evaluate the use of the combined effect of NO-containing air-plasma flows on the parameters of the blood system in the treatment of infectious wound complications in cardiac surgery patients.Materials and methods. A total of 60 patients were included in the study: 31 (52%) men and 29 (48%) women aged 29 to 79 years (mean 63.67 ± 7.6 years). All patients were divided into two groups: Group I – 30 patients who received treatment for sternomediastinitis using a combined exposure to air-plasma flow and exogenous nitric oxide; Group II – 30 patients who were treated for sternomediastinitis according to the clinical guidelines for the surgical treatment of patients with postoperative mediastinitis and osteomyelitis of the sternum and ribs.Results. The use of the combined effect of NO-containing air-plasma flows for the treatment of sternomediastinitis is accompanied by a decrease in the level of acute phase proteins already by 3 days, normalization of leukocytes and neutrophils by 10 days after the start of therapy, and prevents hyperaggregation and spontaneous aggregation of platelets.Conclusion. The use of the combined method of low-temperature plasma and exogenous nitrogen monoxide in the local treatment of infectious wound complications after cardiac surgery is justified and effective. No reliable confirmation of the cytotoxic effect of exogenous nitric oxide in the applied dosage on the elements of red blood was found in this study

A multicenter, prospective randomized trial of negative pressure wound therapy for infrainguinal revascularization with a groin incision

BackgroundWound complications after open infrainguinal revascularization are a frequent cause of patient morbidity, resulting in increased healthcare costs. The purpose of the present study was to assess the effects of closed incision negative pressure therapy (ciNPT) on groin wound complications after infrainguinal bypass and femoral endarterectomy. MethodsA total of 242 patients who had undergone infrainguinal bypass (n = 124) or femoral endarterectomy (n = 118) at five academic medical centers in New England from April 2015 to August 2019 were randomized to ciNPT (PREVENA; 3M KCI, St Paul, Minn; n = 118) or standard gauze (n = 124). The primary outcome measure was a composite endpoint of groin wound complications, including surgical site infections (SSIs), major noninfectious wound complications, or graft infections within 30 days after surgery. The secondary outcome measures included 30-day SSIs, 30-day noninfectious wound complications, readmission for wound complications, significant adverse events, and health-related quality of life using the EuroQoL 5D-3L survey. ResultsThe ciNPT and control groups had similar demographics (age, 67 vs 67 years, P = .98; male gender, 71% vs 70%, P = .86; white race, 93% vs 93%, P = .97), comorbidities (previous or current smoking, 93% vs 94%, P = .46; diabetes, 41% vs 48%, P = .20; renal insufficiency, 4% vs 7%, P = .31), and operative characteristics, including procedure type, autogenous conduit, and operative time. No differences were found in the primary composite outcome at 30 days between the two groups (ciNPT vs control: 31% vs 28%; P = .55). The incidence of SSI at 30 days was similar between the two groups (ciNPT vs control: 11% vs 12%; P = .58). Infectious (13.9% vs 12.6%; P = .77) and noninfectious (20.9% vs 17.6%; P = .53) wound complications at 30 days were also similar for the ciNPT and control groups. Wound complications requiring readmission also similar between the two groups (ciNPT vs control: 9% vs 7%; P = .54). The significant adverse event rates were not different between the two groups (ciNPT vs control: 13% vs 16%; P = .53). The mean length of the initial hospitalization was the same for the ciNPT and control groups (5.2 vs 5.7 days; P = .63). The overall health-related quality of life was similar at baseline and at 14 and 30 days postoperatively for the two groups. Although not powered for stratification, we found no differences among the subgroups in gender, obesity, diabetes, smoking, claudication, chronic limb threatening ischemia, bypass, or endarterectomy. On multivariable analysis, no differences were found in wound complications at 30 days for the ciNPT vs gauze groups (odds ratio, 1.4; 95% confidence interval, 0.8-2.6; P = .234). ConclusionsIn contrast to other randomized studies, our multicenter trial of infrainguinal revascularization found no differences in the 30-day groin wound complications for patients treated with ciNPT vs standard gauze dressings. However, the SSI rate was lower in the control group than reported in other studies, suggesting other practice patterns and processes of care might have reduced the rate of groin infections. Further study might identify the subsets of high-risk patients that could benefit from ciNPT.

1113 The impact of BMI on postpartum infectious morbidities and wound complications: a study of extremes

Increased risk of postpartum(PP) infection among women with elevated BMI is well described. However, the specifics of these risks are less well understood among BMI categories above 40. The objective of this study was to evaluate the impact of extreme obesity on infectious morbidity and wound complications during the PP period. Secondary analysis of women in the MFMU Cesarean Registry who underwent cesarean delivery and had BMI>40 kg/m2. Primary outcome was any PP infectious morbidity including endometritis and wound infection. Secondary outcomes included wound complication infection prior to delivery discharge, readmission for wound complication, and wound infection. Bivariate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2). Regression modeling used to estimate odds of outcomes. Of 8503 women included, 7020(82.6%) with BMI 40-49.9kg/m2, 1240(14.6%) BMI 50-59.9kg/m2, 211(2.5%) BMI 60-69.9kg/m2, and 32(0.004%) BMI>70kg/m2. Rates of diabetes, Black race, Medicaid, preeclampsia, labor duration and use of general anesthesia all increased with increasing BMI (Table 1). Rates of PP infectious complications increased with BMI category, though this was driven by wound infection (Table 2). Inpatient wound complications did not differ, but readmission wound complications did increase with BMI (Table 2). After adjusting for confounders, compared to women with BMI40-49.9, adjusted odds of wound infection increased with BMI (aOR 2.27 for BMI 50-60, aOR 3.65 for BMI 60-70, aOR 38.6 for BMI>70, Table 2). Adjusted odds of readmission for wound complications also increased with increasing BMI (Table 2). Women with BMI 50-70 are at an increased risk of wound infections and complications compared to women with BMI 40-49.9. These data provide increased guidance for counseling women with extremely elevated BMI as well as highlight the importance of postpartum wound prevention bundles.View Large Image Figure ViewerDownload Hi-res image Download (PPT)