Compression Dressings Research Articles

Combined local flap placement and negative-pressure wound therapy for the management of critical peritracheostomal pharyngocutaneous fistula

ObjectivePeritracheostomal pharyngocutaneous fistula (PCF), a direct connection between the PCF and tracheal stoma due to a skin defect, is among the most problematic complications after total laryngectomy or pharyngolaryngectomy. Peritracheostomal PCFs can cause lethal complications, including severe pneumonia or carotid blowout, secondary to salivary leakage directly into the tracheal stoma, and their management is challenging without early invasive surgical closure. We aimed to evaluate the utility of our novel and minimally invasive combined local skin flap placement and negative-pressure wound therapy (NPWT) method for the management and conservative closure of peritracheostomal PCFs. MethodsWe retrospectively enrolled patients who developed a peritracheostomal PCF from July 2015 to September 2021 at our institution and affiliated hospitals. Postoperative PCFs were all initially managed with appropriate wound bed preparation. Subsequently, a small local flap of healthy, lower neck skin was elevated and transferred anterior to the PCF to replace the peritracheostomal skin defect. The flap served to provide a sufficient surface for film dressing attachment and facilitated airtight sealing during NPWT. We initiated NPWT after confirming the local skin flap was firmly sutured to the tracheal mucosa. A flexible hydrocolloid dressing was applied to the peritracheostomal skin flap, and a film dressing was placed on the flexible hydrocolloid dressing and surrounding cervical skin. We inserted the NPWT foam shallowly into the fistula tract and applied negative pressure (73.5–125 mmHg). NPWT was continued until the PCF was closed or became so small that salivary leakage was minimal and could be managed by conventional compression dressings. ResultsWe enrolled six patients [male, n = 6; mean age, 66.5 years (range, 57–80 years)]. NPWT was applied for an average of 18.2 days (range, 2–28 days). During NPWT, air leakage occurred once (2 cases), only a few times (2 cases), or not at all (2 cases). In all patients, complete fistula closure was achieved in an average of 28.2 days (range, 15–55 days) after the start of NPWT, and no patient required further surgical intervention. There were no lethal complications (e.g., severe pneumonia) during treatment. ConclusionOur method of combined local flap placement and NPWT enabled effective management of salivary aspiration and accelerated wound healing, which allowed conservative fistula closure in all patients. We believe combined local flap placement and NPWT should be considered a first-line treatment for intractable peritracheostomal PCF.

Healing with Systematic Wound Management after Minimally Invasive Treatment of Axillary Osmidrosis.

Axillary osmidrosis (AO), the condition of armpit smell, can be treated with minimally invasive techniques. However, patients may experience wound complications and a relatively long recovery period after operation. In this case series, the researchers investigated the effectiveness of systematic wound management for wound healing after minimally invasive treatment of AO.From January 2016 to December 2021, 64 patients with AO underwent systematic wound management after minimally invasive treatment. Systematic wound management included three consecutive steps of wound irrigation with 0.9% sodium chloride, suction drainage, and compression dressing. The researchers retrospectively evaluated wound healing results and recorded complications. Of the patients, 60 (93.8%) had good primary wound healing results, 1 (1.5%) developed a hematoma, and 3 (4.7%) had partial epidermis necrosis. The hematoma was easily evacuated, and the partial epidermis necrosis recovered spontaneously without obvious scarring. No other adverse effects were observed.The results of this case series indicate that systematic wound management is reliable and practical and provides good wound healing results after minimally invasive treatment of AO.

Role of tourniquet release timing on blood loss and functional outcomes in total knee arthroplasty: Insights from a low- and middle-income country.

To identify the effect of releasing a tourniquet before versus after wound closure in total knee arthroplasty (TKA) on blood loss, functional outcomeand postoperative complications. A prospective cohort study was conducted including 53 patients from May 2023 to September 2023. All patients underwent unilateral TKA and were divided into two groups based on surgeon preference of deflating tourniquet, Group A consisted of patients in whom the tourniquet was deflated before wound closure for haemostasis and Group B consisted of patients in which tourniquet was deflated after wound closure and compressive dressing. Blood loss was evaluated via intraoperative blood loss (the number of soaked sponges/gauzes, blood in a suction bottle, total output in a suction bottle-irrigation used)and on-field blood lossand calculated blood loss (Using Gross and Meunier's formula). The Functional outcome was evaluated using Knee injury and osteoarthritis score-42 questions. Early postoperative complications and differences in the requirement of blood transfusions were also assessed. There was a significant difference in intraoperative blood loss between the two groups. The median intraoperative blood loss was 135 mL(interquartile range [IQR]: 90-149) in Group A and 56.2 mL (IQR: 45-68) in Group B (p value: 0.001). However, no difference was found between the groups in calculated blood loss using Gross and Meunier's formula. The median calculated blood loss was 439 mL (IQR: 450-813) in Group A and 508 mL (IQR:226-671) in group B (pvalue: 0.981). There was no significant difference between the groups in blood transfusion requirements or functional outcomes. Based on our results, we conclude that the intraoperative blood loss in TKA is significantly different between the groups but only represents a fraction of true blood loss (23%). The timing of releasing the tourniquet does not affect functional outcomes, blood transfusionand postoperative morbidity; hence, any time can be opted as per surgeon preference. Level II,prospective comparative study.

A case series of forearm compartment syndrome complicating transradial cardiac catheterization

BackgroundAcute compartment syndrome following a transradial coronary approach is rare. However, as the incidence of coronary arterial disease increases due to lifestyle factors and multiple comorbidities, transradial coronary angiography has become more common for diagnostic and therapeutic purposes in cardiovascular centers. Despite its rarity, we encountered two cases of acute compartment syndrome within a 1-week interval in the cardiology unit of a tertiary hospital.Case presentationThe first case involved a 75-year-old woman diagnosed with non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram was performed via an uncomplicated right radial artery puncture. Following the procedure, the patient experienced significant swelling in the right forearm. An emergency fasciotomy release of the right forearm was conducted, revealing a gushing hematoma upon entering the flexor compartment. Fortunately, the wound healed well two months postoperatively with no functional deficits. In the second case, an 80-year-old man presented with severe angina pectoris upon exertion and was diagnosed with NSTEMI. The following day, he developed compartment syndrome in the left forearm, necessitating an emergency fasciotomy. Intraoperative examination revealed muscle bulging within the forearm compartments accompanied by extensive hematoma. Postoperatively, a deranged coagulation profile caused oozing from the wound. However, since there was no arterial bleeding, a compression dressing was applied. This led to a gradual drop in hemoglobin levels and worsened his heart condition. Despite resuscitative efforts and attempts to correct the coagulopathy, the patient experienced cardiorespiratory arrest and succumbed to ischemic heart disease in failure.ConclusionClinicians must remain vigilant in identifying this potentially limb-threatening condition. Patients with pre-existing anticoagulant therapy and underlying atherosclerotic disease are at a higher risk of bleeding complications. Implementing effective hemostasis techniques and promptly managing swelling can help prevent the occurrence of compartment syndrome. Timely assessment and maintaining a high level of clinical suspicion are paramount. If necessary, early consideration of decompressive fasciotomy is essential to avert catastrophic outcomes.

The efficacy of compression dressings to reduce haematoma post cardiac implantable electronic devices - a systematic review and meta-analysis

Abstract Background Pocket haematomas are one of the most common complications post cardiovascular implantable electronic device (CIED) implantation. Objective We explored the use of mechanical compression devices compared to the conventional dressings post CIED implantation, to reduce the incidence of pocket haematomas. Secondary outcomes were pain scores and wound scar or healing. Methods Five electronic databases were systematically searched from their inception to 1st November 2023, identifying all studies which explored compression dressings post CIED implantation. Data were independently extracted by investigators according to predefined clinical endpoints. We used a Random-effects model for data analysis based on event rates (ER) and 95% confidence interval (CI). Results Six studies (786 patients) were included in the meta-analysis, with 373 in the compression arm and 385 patients in the control groups across the studies. There was a total incidence of 82 haematomas, of which 24.4% were in the mechanical compression group and 75.6% in the conventional dressings group (RR 0.36, 95% CI 0.23- 0.57). One study suggested improved wound healing with the compression dressing arm (Manchester Scar Scale 9.5 at 2 weeks for the control group and 7.5 for the compression dressings group). Two studies suggested increased pain scores (using a visual analogue scale) shortly after dressing application. One study suggested improved comfort scores in the compression group compared to the control at 48 hours and 7 days. Conclusion This systematic review and meta-analysis suggests for patients post CIED implantation, the use of novel mechanical compression dressings, when compared to conventional dressings, reduces the risk of pocket haematoma.Forest plot

Effect of Compression Dressing After Upper Eyelid Blepharoplasty on Edema, Ecchymosis, Pain, and Ocular Surface Irritation.

To investigate the effect of a compression dressing (CD) on edema, ecchymosis, aesthetic outcome, pain, and ocular surface irritation after upper eyelid blepharoplasty. We conducted a case-control study. Bilateral blepharoplasty was performed on both upper eyelids at the same time in patients with dermatochalasis. One side was randomized for CD. Edema and ecchymosis were scored at a 4-point rating scale by a blinded observer 1 day (D1), 1 week (D7), and 8 weeks (D56) after surgery; the same for scar formation regarding redness and bulging at D7 and D56. Aesthetic outcome was evaluated by the patient and blinded observer using the global aesthetic improvement score at D1, D7, and D56. Postoperative pain was scored by the patients using a visual analogue scale (0 to 10) at D1. At D1 patients had to state which side they felt more comfortable. Edema, scar formation and aesthetic outcome evaluated by the patient and blinded observer did not differ between the 2 sides on any of the survey days ( p > 0.05). The median degree of ecchymosis was slightly higher on the lids without CD at D1 (1 [0-2] vs. 1.5 [0-2]; p = 0.495) and D7 (0 [0-2] vs. 0.5 [0-2]; p = 0.183), but not statistically significant. Postoperative pain was similar regardless to the use of CD ( p = 0.925). The majority (55%) found the side without CD more comfortable. There was no case of corneal erosion and corneal staining was similar in both groups ( p > 0.05). Using a CD after blepharoplasty shows no advantages regarding postoperative edema, ecchymosis, scar formation, or aesthetic results in the early postoperative period. As most patients preferred the noncovered side, CD can be omitted after blepharoplasty without inferiority for the postoperative results. NCT06111170.

Elastic Compression Dressing after Total Hip Replacement Slightly Reduces Leg Swelling: A Randomized Controlled Trial.

Background: Even minor adverse reactions after total hip replacement (THR), including lymphedema, postoperative leg swelling, and blood loss, compromise patient comfort in times of minimally invasive fast-track surgery. Compression dressings are commonly used in surgical practice to reduce swelling or blood loss. However, the use of spica hip compression dressings after primary THR is controversial, and prospective studies are lacking. Methods: We conducted a prospective, single-center, two-arm, randomized controlled trial (RCT) of patients undergoing THR for primary osteoarthritis. A total of 324 patients were enrolled; 18 patients were excluded, and 306 patients were finally analyzed. Leg swelling as primary endpoint was measured pre- and postoperatively with a rotating 3D infrared body scanner. Secondary endpoints were transfusion rate and blood loss, estimated by Nadler and Gross formulas. Results: Postoperative leg swelling was lower in the compression group (241 ± 234 mL vs. 307 ± 287 mL; p = 0.01), even after adjustment for surgery time and Body-Mass-Index (BMI) (p = 0.04). Estimated blood loss was also lower in the compression group on the first (428 ± 188 mL vs. 462 ± 178 mL; p = 0.05) and third (556 ± 247 mL vs. 607 ± 251 mL; p = 0.04) postoperative days and leveled off on the fifth postoperative day, but lost significance after adjustment for BMI and surgery time. Neither group received a transfusion. Conclusions: Compression dressing after THR in the context of minimally invasive surgery slightly reduces leg swelling, but has no effect on blood loss or blood transfusion rate. So, this method could not generally be recommended in primary hip replacement.

Evaluation of the Safety and Efficacy of Coronary Intervention through the Brachial Artery Compared to the Radial Artery in Elderly Patients with Different Extubation Times

Introduction: Percutaneous coronary intervention (PCI) is an important treatment for acute coronary syndrome. The main puncture paths of PCI include radial artery, brachial artery, and femoral artery. The aim of this study was to investigate the safety and efficacy of transbrachial intervention in elderly patients. Methods: According to intraoperative and postoperative nursing records, a retrospective analysis was performed for 70 elderly patients who underwent coronary intervention were divided into brachial artery A group (33 cases) and brachial artery B group (37 cases) according to immediate postoperative extubation compression dressing and 6 hours postoperative extubation compression dressing, and matched elderly patients who had successful transradial artery puncture in the same period as radial artery group (35 cases). The success rate of puncture and catheterization, arterial puncture time, total operation time, length of hospital stay, patient comfort score, incidence of arterial spasm and occlusion, subcutaneous ecchymosis and hematoma, epidermal blister occurrence, vagal reflex, pseudoaneurysm development, arteriovenous fistula formation, nerve damage risk assessment and osteofascial compartment syndrome were compared. Results: Compared with the radial artery group, the brachial artery group (group A and group B) had a higher success rate of puncture and catheterization (97.0% vs. 97.3% vs. 80.0%, p = 0.013), shorter arterial puncture time (2.45 ± 0.38 vs. 2.40 ± 0.35 vs. 3.40 ± 0.37, p = 0.000), and lower incidence of arterial spasm (0.0% vs. 0.0% vs. 34.3%, p = 0.000), arterial occlusion (0.0% vs. 0.0% vs. 14.3%, p = 0.005) and puncture site bleeding (12.1% vs. 5.6% vs. 40.0%, p = 0.001). The incidence of epidermal blister was higher in brachial artery A group than in brachial artery B group (24.2% vs. 2.7%, p = 0.003) or radial artery group (24.2% vs. 0%, p = 0.001), and the incidence of epidermal blister in brachial artery B group and radial artery group was not much different. There was no difference between the three groups in total operation time, length of hospital stay, comfort score, subcutaneous ecchymosis and hematoma, vagal reflex, pseudoaneurysm, arteriovenous fistula, nerve damage and osteofascial compartment syndrome. Conclusion: In elderly patients, coronary intervention through brachial artery is not inferior to radial artery.

Avaliação dos efeitos do curativo compressivo após procedimentos intervencionistas por via radial

Background External compressive devices after radial puncture for cardiac catheterization and percutaneous coronary intervention aim at hemostasis, patient comfort, and safety. The objective of the study was to evaluate patients undergoing invasive coronary procedures by radial approach, in which a low-cost compressive dressing developed at the service was used, assessing its safety and the occurrence of complications. Methods Patients undergoing coronary angiography and percutaneous coronary intervention, evaluated at the time of removal of compressive dressing and after 7 days, by means of a questionnaire addressing comorbidities, clinical picture, procedure and compression time, physical assessment of hematoma and pain, and a vascular Doppler ultrasound to evaluate radial artery occlusion. Results A total of 144 patients were evaluated, 138 of whom were followed up within 7 days. Events did not differ among diagnostic and therapeutic procedures. In the immediate evaluation after removal of dressing, an incidence of 4.2% of radial artery occlusion was observed, with pain reported by 23.6% of patients, graded at 2.9±1.7 points in the Visual Analogue Scale (intensity of zero to ten), and no major bleeding. Hematoma occurred in one patient (0.9%), classified as type III according to the EASY criteria. In the 7-day evaluation, the incidence of radial artery occlusion was 2.2%, pain was reported in 11.1% of sample (intensity 1.8±0.8), and hematoma was evident in 3.5%. Conclusion The compressive dressing proved to be a safe procedure, with a low rate of complications and a low rate of local pain in patients undergoing invasive coronary procedures via radial approach.

(102) A Preliminary Analysis of Outcomes and Complication Rates for Patients Undergoing Inflatable Penile Prosthesis Implantation Following Intracavernosal Injection Therapy With or Without Concurrent Anticoagulation

Abstract Introduction Medications, namely antiplatelets (AP) and anticoagulation (AC), are effective at avoiding fatal vascular complications and prolonging the lives of our patients. As such, more and more men seeking treatment for erectile dysfunction (ED) also take blood thinners. This is an interaction we must better understand to provide safe, individualized care to our patients and minimize peri-operative morbidity. Currently, there is no published information on whether differences exist in the escalation of treatment for patients with erectile dysfunction and on AC. A previous study has demonstrated no statistically significant difference in complications between AC and non-AC groups while on ICI, despite there being a higher rate of absolute bleeding events for AC patients. Objective To compare outcomes and complication rates in patients undergoing IPP implantation following ICI therapy with or without concurrent anticoagulation. Methods A retrospective observational study was undertaken. Electronic patient records from January to September 2021 were reviewed. Included patients were those who had either currently or previously utilized ICI therapy for ED treatment. ICI therapy surveys and Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire were obtained. 85 patients met the inclusion criteria; 43 concurrently using AC during ICI therapy and 42 with no AC use. Patients who were unable to completely stop their AC medications a week before surgery due to cardiovascular concerns or recommendations, underwent bridging with a shorter half life and reversible AC. Extra measures taken during the IPP for such patients, including meticulous hemostasis, compression dressing and drain insertion. Additional data regarding IPP implantation as well as any complications or infections experienced following IPP surgery which were compared between the AC and no AC groups. Results Patient demographics, IPP implantation information and subsequent complication rates are listed below in Table 1. There was no statistically significant difference in the rate of patients who underwent IPP placement between the AC and no AC cohorts. Moreover, there was also no statistically significant difference in median time from date of initial ICI usage to time of IPP placement as well as median time from IPP placement to last follow-up. Among the 12 total patients who underwent IPP placement, none experienced any complications, including infection, mechanical failure, device removal or revision at any time point up to last follow-up (longest was 18 months). No statistically significant differences in EDITS score between both groups was observed. Conclusions These preliminary findings, while requiring large-scale follow up, show that there is no statistically significant difference in rate of patients opting for IPP surgery following initiation of ICI therapy regardless of concomitant AC usage as well as the rate of complications following IPP implantation. Lastly, there is no drawbacks in performing such procedure in this specific cohort of patients, provided that all necessary measures are taken into consideration to minimize bleeding complications. Disclosure No.

A Pilot Study Testing the Novel Use of a Snake Bite Compression Device for Field Hemostasis and Wound Repair in an Animal Model.

A commercially available snake bite device was pilot tested for novel use as a method of hemostasis and wound repair at a noncompressible site in a live swine model. The device is light, is plastic, uses a hook-and-loop strap attachment, and is easily deployed. The device could offer a method for the field repair of an actively bleeding laceration at a noncompressible site in an austere environment. This was an interventional, prospective, controlled study in a large animal model. The study was approved by the Rhode Island Hospital Institutional Review Board (IRB) and the Animal Welfare Committee/Institutional Animal Care and Use Committee and the Lifespan Research Conflict of Interest Committee. Each animal acted as its own control. Blood loss was measured and compared between repairs of standardized incisions with and without the device's application. The lacerations were sutured closed. Two proceduralists alternated tasks of wound repair versus blood collection. Blood loss was measured by using gauze sponges to capture the blood during a 30-second free-bleeding period and during the repair itself. Using a one sample t-test (the expected difference in blood loss between the two incision repair methods = 0 if the null hypothesis were true), we calculated the mean difference in the deltas between the repair methods. The mean delta difference was 3.1 g (SE ± 0.97). The t-test demonstrated that there was a significantly greater blood loss during the standard repair method, t(9) = 3.11, P < 0.01 than during the repair with the device in place (see Fig.2). A statistical power analysis conducted showed that with a sample size of 10 animals, there was sufficient statistical power to detect this significant effect (β = 0.82, α < 0.05, one-tailed). There was statistically significantly less blood loss during the repairs with the device's application. This feasibility experiment demonstrates that a commercially available snakebite device may be useful for hemostasis during laceration repair at anatomic sites not amenable to application of tourniquets or compressive dressings. Strengths of the study include the prospective controlled design, including the use of each animal as its own control; alternating proceduralists to account for any variability in suturing efficiency; and the statistical significance of the results despite the small number of subjects. One weakness is that the time required for each repair was not measured. The device's portability and reusability suggest applicability in austere medical environments. Future studies could include timing the repairs, using a skin stapler or wound adhesive instead of sutures, applying a hemostatic agent before the repair, and sequentially applying the device to wounds longer than the device.

A case series of successfully managing exomphalos major with awake graduated compression dressing and early enteral feeding.

Exomphalos anomaly is defined as the herniation of abdominal viscera into the base of the umbilical cord, with only a membranous sac covering these contents. It has an incidence of approximately 1 in 4000-6000 births. Management of exomphalos major (EM) remains controversial and limited, with very few studies to guide decision-making. This is a case series of four neonates with EM treated at a tertiary paediatric referral centre between 2018 and 2021 with a gradual compression dressing technique. Four neonates were diagnosed with EM. The average gestational age was 38 + 5 (range 38 + 2 - 39 + 2), and the average birth weight was 3.1kg (range 2.56 - 3.49kg). The defect size ranged between 5 and 7cm. All patients were commenced on gradual compression dressing between days 1 and 3 of life. Dressings were applied at the bedside in the general neonatal ward. The average time taken to reach full feeds was 1week; only one patient required parenteral nutrition. Three underwent surgical repair at two and 16weeks of age; one had delayed repair at the age of 1year because of the COVID-19 pandemic. None required patch repair. None required prolonged ventilation after repair. This case series describes a successful compression dressing technique that reduces sac content without the need for general anaesthetic or respiratory compromise, whereby simultaneous enteral feeding is tolerated.

(390) A Preliminary Analysis of Outcomes and Complication Rates for Patients Undergoing Inflatable Penile Prosthesis Implantation following Intracavernosal Injection Therapy With or Without Concurrent Anticoagulation

Abstract Introduction Medications, namely antiplatelets (AP) and anticoagulation (AC), are effective at avoiding fatal vascular complications and prolonging the lives of our patients. As such, more and more men seeking treatment for erectile dysfunction (ED) also take blood thinners. This is an interaction we must better understand to provide safe, individualized care to our patients and minimize peri-operative morbidity. Currently, there is no published information on whether differences exist in the escalation of treatment for patients with erectile dysfunction and on AC. A previous study has demonstrated no statistically significant difference in complications between AC and non-AC groups while on ICI, despite there being a higher rate of absolute bleeding events for AC patients. Objective To compare outcomes and complication rates in patients undergoing IPP implantation following ICI therapy with or without concurrent anticoagulation. Methods A retrospective observational study was undertaken. Electronic patient records from January to September 2021 were reviewed. Included patients were those who had either currently or previously utilized ICI therapy for ED treatment. ICI therapy surveys and Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire were obtained. 85 patients met the inclusion criteria; 43 concurrently using AC during ICI therapy and 42 with no AC use. Patients who were unable to completely stop their AC medications a week before surgery due to cardiovascular concerns or recommendations, underwent bridging with a shorter half life and reversible AC. Extra measures taken during the IPP for such patients, including meticulous hemostasis, compression dressing and drain insertion. Additional data regarding IPP implantation as well as any complications or infections experienced following IPP surgery which were compared between the AC and no AC groups. Results Patient demographics, IPP implantation information and subsequent complication rates are listed below in Table 1. There was no statistically significant difference in the rate of patients who underwent IPP placement between the AC and no AC cohorts. Moreover, there was also no statistically significant difference in median time from date of initial ICI usage to time of IPP placement as well as median time from IPP placement to last follow-up. Among the 12 total patients who underwent IPP placement, none experienced any complications, including infection, mechanical failure, device removal or revision at any time point up to last follow-up (longest was 18 months). No statistically significant differences in EDITS score between both groups was observed. Conclusions These preliminary findings, while requiring large-scale follow up, show that there is no statistically significant difference in rate of patients opting for IPP surgery following initiation of ICI therapy regardless of concomitant AC usage as well as the rate of complications following IPP implantation. Lastly, there is no drawbacks in performing such procedure in this specific cohort of patients, provided that all necessary measures are taken into consideration to minimize bleeding complications. Disclosure No.

Usefulness of Endoluminal Vacuum-Assisted Closure Therapy for Pharyngocutaneous Fistula

Pharyngocutaneous fistula (PCF) is a communication created between the pharynx and skin of the neck associated with flap reconstruction or primary closure of a pharyngeal defect. In patients who underwent laryngectomy and pharyngectomy, salivary accumulation in the deep neck space through the pharyngeal dehiscence can cause life-threatening complications, among which is carotid artery blow-out. Broad-spectrum antibiotics, compressive dressing, and artificial nutrition are usually applied first. Many closing methods have been studied, both surgically (direct repair or using flaps) and non-surgically (negative pressure therapy, hyperbaric oxygen therapy, or botulinum toxin injection). The use of a vacuum-assisted closure system placed endoluminally or externally has been recently reported to treat any leaks in the upper gastrointestinal tract. Here, we report a successfully-treated PCF using the endoluminal vacuum-assisted closure system.

Compression Dressing versus Noncompressive Transparent Eye Shield after Ptosis Surgery.

We aimed to investigate the effect of compression dressing on edema, ecchymosis, pain, and ocular surface irritation after ptosis surgery. After ptosis correction [anterior levator reinsertion (and resection) (ALR), if necessary additional blepharoplasty], the eye was randomized for compression dressing or transparent eye shield. Edema and ecchymosis were scored on a four-point rating scale by a blinded observer 1 day (D1), 1 week (D7), and 8 weeks (D56) after surgery; the same was done for scar formation regarding redness and bulging at D7 and D56. Aesthetic outcome was ranked by patient and blinded observer using the Global Aesthetic Improvement Score at D1, D7, and D56. Postoperative pain was scored using a visual analogue scale (0 to 10) at D1. Impairment after surgery by dressing or eye shield was evaluated at D1. Ecchymosis, edema, scar formation, and aesthetic outcome ranked by the patient and blinded observer did not differ between the groups with compression dressing and eye shield at any day of follow-up (P > 0.05). Postoperative pain and impairment were the same in both groups (P > 0.05). One case of corneal erosion occurred in the group with compression dressing at D1 (P = 0.342). At D7, corneal staining was increased in the group without compression dressing (P = 0.930). Compression dressing after ALR does not reduce ecchymosis, edema, or postoperative pain and has no effect on early scar formation or aesthetic results. To prevent corneal erosion caused by the dressing, it can be omitted after ALR without inferiority for the early postoperative results.

Postoperative care in hypospadias. Common practices and evidence available.

There are many alternatives available regarding postoperative care in hypospadias surgery. The objective of this study was to assess the current care situation in our environment and to review the evidence available for pediatric surgeons who conduct this procedure. A survey regarding the main aspects of hypospadias postoperative care was created and distributed to pediatric surgeons. In addition, the evidence currently published in this field was reviewed. A total of 46 replies were achieved. 100% of the surgeons leave in place a probe or stent, and more than 80% remove it after 5 or 7 days. 87.8% of the respondents use a double diaper, but only 65.2% discharge patients early in the postoperative period. 60.9% prescribe antibiotic prophylaxis for as long as the probe remains in place, and 34.8% use full-dose antibiotic therapy. There was a general consensus regarding urethroplasty guiding and the use of compression dressings among the pediatric surgeons surveyed. However, more discrepancies were found in the use of antibiotic therapy and early discharge. The currently available evidence and international practice suggest using a probe with double diaper and early discharge, with postoperative antibiotics being limited. In the absence of clear evidence for a specific care type, the patient's experience could be used to choose the best postoperative protocol on an individual basis.

Splint versus no splint after ankle fracture fixation; Results from the multi-centre post-operative ankle splint trial (PAST)

BackgroundThere is considerable variation in the rehabilitation of ankle fractures. Ankle fractures treated surgically are often immobilized or splinted in the early post-operative period, despite the lack of robust evidence supporting this intervention. Thus, this randomized controlled trial aims to investigate the anecdote that splinting reduces pain and oedema. MethodsA prospective multi-centre randomized controlled trial was performed in three trauma centres. Eligible patients were over 18 years of age that have sustained an isolated unilateral ankle fracture requiring surgical intervention. Patients were randomized to two groups receiving either; a plaster of Paris posterior back-slab or compressive bandage dressing. The post-operative rehabilitation protocol was standardized across both groups. Baseline demographics and fracture characteristics and classifications were analysed. Primary outcomes included; oedema measured by the figure-of-eight-20 technique and pain at multiple time points. Secondary outcomes included; the American Orthopaedic Foot and Ankle Society (AOFAS) score, satisfaction, unplanned emergency room (ER) visits and complications. ResultsA total of 104 comparable participants were included; 54 in the non-splint group and 50 in the splint group. There was no significance difference in ankle oedema, ankle oedema compared to contralateral ankle and pain scores between the two groups (P = 0.56, P = 0.25, P = 0.39 respectively). Patient satisfaction was higher in the early postoperative period in the non-splint group (P = 0.016). The AOFAS score was not significantly different across any time point (P = 0.534). In the splint group, there was a 46% rate of splint-related complaints and complications. Unplanned ER visits occurred in 46% of the splint group and 7.4% of the non-splint group (P < 0.001). There were 2 wound infections, 1 non-union and 1 deep vein thrombosis in the splint group. There was 1 wound infection and 1 deep vein thrombosis in the no-splint group (P = 0.481) ConclusionThe routine use of a splint does not add any perceivable benefit to the postoperative course of an ankle fracture fixation, particularly in the reduction of oedema and postoperative pain. Another key finding is that the absence of a splint does not appear to result in higher complication rates, instead leads to higher unplanned ER visits and lower early satisfaction rates.

Fixation of the Compressive Dressing for Nipple-areola Complex Graft during Double Incision Chest Contouring Surgery for Assigned-female-at-birth Persons with Diagnosis of Gender Dysphoria: Sutures or Staples?

When transplanting skin grafts, a compressive dressing is usually used to hold the skin graft in place. Dressing fixation can be achieved with either sutures or staples. The purpose of this study was to compare sutures and staples as a method of fixation for the compressive dressings of the nipple-areola complex (NAC) grafts, during double incision chest contouring surgery in assigned-female-at-birth persons with diagnosis of gender dysphoria. The two methods of fixation were compared according to pain at removal, time consumption, difficulty of removal, costs, and sustainability. Forty patients were randomized to dressing fixation with either sutures or staples. Timing for dressing fixation during surgery and removing the dressing was measured. Pain during removal was measured using vNRS-11. Difficulty of removal was measured with VAS-100. Costs of materials were compared. All NAC grafts survived, and no complications such as infection or bleeding occurred. Staples were significantly more painful to remove when compared to sutures [mean vNRS-11 2.98 (SD ± 2.43) versus 1.25 (SD ± 0.92), P < 0.001]. Fixation with staples was faster than fixation with sutures (5.3 versus 94.6 s). No difference in removal time was found. Nurses found staples easier to remove. Sutures were slightly less costly (18 SEK) compared to staples (30 SEK). Finally, sutures produce less material waste. Being that all other outcomes are similar or insignificant, the less-pain experienced at removal of sutures makes this the preferable method for fixation of the compressive dressing for NAC grafts during double incision chest contouring surgery.

A "Tie-Over" Hemostatic Approach in Emergency Department: An Alternative Option for Recurrent Episodes of Postoperative Intraoral Hemorrhage.

This case series aimed to describe a hemostatic technique that has been applied in patients admitted to emergency department (ED) of a tertiary hospital due to recurrent episodes of intraoral hemorrhage (IOH) after various dentoalveolar operations. The "tie-over" approach involved the intraoral use of Xeroform® gauze (as compressive bolster dressing) and the oral rinsingwitha liquid mixture of hemostatic agents. Between February 1, 2014, and July 31, 2017, we retrospectively reviewed the medical data and records of patients in ED who chiefly complained about IOH. The inclusion criteria were cases secondary to dentoalveolar surgeries that have been exclusively treated by tie-over bolster approach. Data such as frequency and severity of hemorrhage episodes, pain, and discomfort were assessed pre- and postoperatively. The presented technique was applied in 23 patients, but 20 of them complied with follow-up evaluation. The mean age of those patients was 60.57years (15-82years) with a mean follow-up time of 5.05days. Eighteen patients were taking antithrombotic medications, either per os (oral antiplatelets and anticoagulants-OAA group) or subcutaneously (heparin group). One patient from OAA group and 2 from heparin group experienced in total 4 bleeding events postoperatively. Three of those events were recorded as minimal (oozing) and did not last over 20min. All the patients declared satisfaction about the non-bleeding oral status. In addition to its compelling outcomes, we advocate that this approach conferred physiological benefits on patients who visited ED with symptoms of anxiety and malaise, secondary to multiple, lasting, or uncontrolled episodes of IOH related to extensive surgical trauma. The presence of the gauze intraorally was short-term and created minimal discomfort.

The cover of an ear thermometer probe as a split-thickness skin graft mold in external auditory canal reconstruction.

Maintaining the patency of the external auditory canal (EAC) during reconstruction is important because of its physiological role in hearing and immunological protective functions. The curved shape of the EAC presents a challenge when performing a skin graft. One of the key points for a successful skin graft is to ensure compression on the wound bed, and many novel methods, including prefabricated ear molds, have been reported for this purpose. In this study, we present a case of a skin graft performed to reconstruct a skin defect following excision of actinic keratosis in the EAC, using the cover of an ear thermometer probe as a mold for the graft to match the curvature of the EAC. This is an economical and practical method for secure compression dressing of a skin graft in the EAC.