Compression Dressings Research Articles

P93 THE POWER OF GROUP WORK IS THE STRENGTH OF A SUCCESS: TAVI!

Abstract TAVI (Transcatheter Aortic Valve Implantation) is a procedure performed by a multidisciplinary team, preferably in a hybrid room where both interventional and cardiac surgery procedures are performed. This procedure is a splendid example of team work, where all the figures involved (hemodynamist, cardiac surgeon, anesthetist, sonographer and nurses) collaborate, each with a specific role, in the safe execution of the implantation of the transcatheter aortic valve in patients with high operative risk. Specifically, during the TAVI there are 4 nurses with very specific roles: CIRCULATING NURSE: • He/she welcomes the patient in pre–operating room (identification, checklist) • He/she transfers the patient to the hybrid room (positioning, etc.) • He/she supports the scrub nurse (materials, Pacemaker management) • He/she performs TIME–OUT and SIGN–OUTANESTHESIA NURSE: • He/she takes care of positioning all the monitoring instruments (ECG plates, defibrillator, etc. ..), finds all the venous accesses and supports the anesthetist (ventilation, intubation if necessary, EGA, ACT, etc …)SCRUB NURSE: • He/she collaborates with the hemodynamist in the execution of the procedure and in the management of sterile materials.CRIMPER NURSE: • He/she is responsible for the correct preparation of the valve and the material required for its assembly. This “new” competence of the nurse sees him engaged in the following activities: 1. preparation of the overbed table 2. preparation of catheters, introducers and any catheters for pre–dilatation (valvuloplasty) 3. preparation of valve delivery and positioning systems 4. valve washing 5. assembly and “crimping” of the valve At the end of the procedure, the nurses carry out the compressive dressing of the arterial and venous accesses, monitor and verify the correct arterial haemostasis by promptly intervening on any vascular complications (haemorrhages, pseudoaneurysms). Since October 2017, our Center has carried out numerous procedures with intra–operative and post–operative results comparable to national data, thanks to the efforts and commitment of our Heart Team. TAVI turns out to be an excellent example of teamwork, where success is given by the synergy between the various professional figures that are essential to each other.

Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boys

Circumcision is the most commonly performed surgical procedure in the world, with one-third of males circumcised globally. Post-neonatal, prepubescent sutured circumcision demonstrates complication rates ranging from 1.7% to 9.1%. We have previously reported that 2-octyl cyanoacrylate (2-OCA, Dermabond, Ethicon) primary circumcision (PC) and circumcision revision (CR) in prepubescent children demonstrated superior cosmesis, shorter operating room (OR) times and cost savings. The aim of our study is to evaluate complication and reoperation rates with a scalpel-free and suture-less technique for primary circumcision (PC) and circumcision revision (CR) using 2-OCA. Following IRB approval, we conducted a retrospective review of all boys at our institution who underwent PC or CR using 2-OCA and monopolar diathermy between January 2014 and January 2021. All procedures were performed by a single surgeon. The technique is outlined in the figure below. No aligning sutures or instruments were used in this process. Patients that required sutures or compressive dressings based on age or associated anomalies were excluded from analysis. We obtained all returns to our system within 30 days of the procedure and returns to the OR during the study period using the REDCap database. Of 1107 procedures performed during the study period, 634 procedures (479PC and 155 CR) met inclusion criteria. Median age was 12 months (range 3 months-10.4 years) with minimum follow up of 1 year. There were 3 patients (0.47%) that returned to system within 30 days for surgical site bleeding, and one patient (0.15%) required surgical intervention within 30 days. Nine patients required reoperation after 30 days, five (0.8%) for iatrogenic phimosis, 3 (0.5%) for redundant prepuce and 1 for keloid formation. We observed an overall complication rate of 1.3% (6/634) and reoperation rate of 1.6% (10/634). Since FDA approval in 1998, 2-OCA has been widely adopted as a replacement for sutures in tension-free wounds. However, it has yet to gain widespread use for circumcision given concerns for wound dehiscence and surgical site bleeding. This study demonstrates that a scalpel-free and suture-less technique demonstrates complication and reoperation rates are lower than reported circumcision using scalpel and sutures. Limitations include retrospective design, single surgeon experience, and REDCAP database only identifying patients with complications that required a return to system. Our technique for suture-less circumcision using 2-OCA offers superior cosmesis, shorter OR times, cost savings, and a lower complication rate (1.3%) compared to sutured circumcision (>1.7%) reported in post-neonatal prepubescent boys.

CT Cavernosography Technique

ABSTRACT Introduction Penile anatomy is complex and variable, and not readily assessed with standard ultrasound techniques. Herein we describe the technique and performance of CT cavernosography for the evaluation of penile anatomy in complex cases of Peyronie's disease and erectile dysfunction. Objective To describe the procedural steps of CT cavernosography, along with a case report of its use. Methods An injection of vasoactive medication is given intracavernosally. A 1cc injection of subcutaneous 1% lidocaine is administered for local analgesia. A 20 gauge angiocatheter is inserted into the corpus cavernosum. 5cc of contrast media is injected via the cannula while the intracavernosal injection takes effect. After 5 minutes, a volume of contrast is injected via the angiocatheter such as to induce a maximal rigidity erection. A CT scan is then obtained. Finally, 2000mcg of phenylephrine is injected via the cannula, and the catheter is removed. A compressive dressing is applied. Images are available for review with the patient within 15 to 20 minutes. Results The procedure is well tolerated and provides valuable insight for both the patient and physician with regards to future treatments for Peyronie's disease and erectile dysfunction. Conclusions CT cavernosography can be performed easily and readily by the urologist for complex patients who desire further investigation of their condition, or to delineate further anatomic detail prior to undertaking a surgical procedure. Disclosure No

Primary lymphedema of the left lower limb in a new-born boy: a case report

A 7-day-old boy was admitted with a history of swelling involving his left lower limb since birth. He was born normally to a Gravida 1, Para-0, to a 22-years-old mother. Antenatal history was nothing significant. His clinical examination revealed left lower limb swelling and was suggestive of primary lymphedema. It involved from the ankle area up to the groin of the left side of the limb. His right lower limb and both upper limbs were normal. His other systemic examination was also normal. He was treated with aseptic needle aspiration of the lymphatic fluid, and a compression dressing was applied. He suddenly died of an unknown reason while sleeping at around 4.00 AM on the third post aspiration day.

A Description of Novel Uses of Hip Protectors in an Elderly Hip Fracture Population: A Technical Report.

Hip fractures are a significant cause of morbidity and mortality in the elderly population. The number of hip fractures is set to increase significantly by 2050 as the global population ages. The costs associated with hip fracture patients are significant due to prolonged hospitalisation and rehabilitation.Hip protectors have been advocated as a strategy to reduce the risk of hip fractures in a high-risk population. Evidence suggests that hip protectors are a cost-effective method for reducing the risk of hip fractures. There have, however, been issues with adherence with wearing hip protectors amongst patients and healthcare staff.Despite prevention strategies, many patients continue to present with hip fractures. Many of these patients have cognitive impairment or experience peri-operative delirium. This can cause issues with patients' interference with the operative wound and presents a significant burden to the healthcare team with the need for increased wound monitoring and care in the post-operative period. Applying a well-fitted hip protector provides a substantial additional barrier to protect the surgical wound. Hip fracture surgical wounds can be difficult to manage in these patients and our standard post-operative protocol is to apply compression dressings in this group of patients. We have found that a well-fitted hip protector can provide adequate compression to the surgical site.We describe a brief technical report on a novel use of hip protectors in providing wound security in the agitated patient post-operatively as well as a method of providing compression to the surgical wound site.

Sialocele of Submandibular Gland, an Unreported Complication of Bilateral Sagittal Split Osteotomy

Bilateral sagittal split osteotomy is a routine procedure with predictable and well-known complications. The authors report a thitherto unreported complication of bilateral sagittal split osteotomy presenting as a postoperative sialocele of submandibular salivary gland tissue in the floor of the mouth. The sialocele was probably caused by overinstrumentation and injury to sublingual salivary tissues or Wharton's duct during bicortical drilling or screw fixation. This iatrogenic sialocele was managed conservatively with multiple aspiration and compression dressings. Although rare and unreported so far this complication may be included in the preoperative consent process.

Improving Venous Ulcer Outcomes

Venous leg ulcers (VLUs) are caused by compromised flow of venous and lymphatic fluids from the lower leg toward the central circulatory system. They are one of the most common types of chronic wounds, affecting 3% to 5% of those 65 years of age and older.¹ Most VLUs heal within 12 weeks with sustained lower leg compression sufficient to reduce the edema associated with venous insufficiency.² Diagnosing and improving a patient's venous insufficiency and addressing concomitant arterial disease are key elements of VLU management.³ Surgical correction has been effective for superficial venous insufficiency.⁴ Various topical,⁵ physical,⁶ or systemic⁷ interventions have been studied as adjuncts to compression in efforts to further improve VLU outcomes, with mixed results. This month's Evidence Corner summarizes recent randomized clinical trials (RCTs) documenting healing effects of topical gauze dressings impregnated with hyaluronic acid (HA) or placebo cream⁸ as an adjunct to patient-appropriate compression or low-level laser radiation as an adjunct to clinically prescribed elastic compression, diet, leg elevation, exercise, and moisture-retentive, absorbent, or microbicidal dressings.⁸.

Otoplastic Surgery for Calcified Auricular Deformity

Auricular hematoma is one of the most common problems among people who have got repetitive blunt trauma to the external ear. Prompt managements are drainage of hematoma and following prevention of re-accumulation (e.g. compression dressing). If the treatment is not successful, many complications can occur, including perichondritis, infection and necrosis. Especially long-lasting loss of blood supply to the ear cartilage and formation of neocartilage from disrupted perichondrium can result in cauliflower ear deformity. There were some studies trying to classify and to treat the cauliflower ear by the degree of deformities. And excision of deformed cartilage with reshaping of the auricle has been reported several times. In this article, we would like to introduce a successful drilling technique of otoplasty as a useful treatment option.

Management of Chronic Wounds

Chronic wounds are challenging for both the practitioner and the patient. These wounds often cause pain and lead to unemployment, social activity disruption, and quality of life issues for the patient. As the world population advances in age and increases in body mass index, there has been an increase in diabetes and venous insufficiency, ultimately resulting in a rise in the number of patients with chronic wounds. This review covers disease definition, wound-healing necessities, treatment options for management of chronic wounds, special wound care considerations, and investigational therapies. Figures show distribution of chronic wound etiologies, vacuum-assisted closure treatment of chronic wounds, chronic arterial ulcer of the medial foot, a step-wise application of a multilayer compression dressing, and four stages of pressure ulcers. Tables list known causes of tissue hypoxia, types of débridement, common dressings used in chronic wounds, and stages of a pressure ulcer. This review contains 5 highly rendered figures, 4 tables, and 99 references

Management of Chronic Wounds

Chronic wounds are challenging for both the practitioner and the patient. These wounds often cause pain and lead to unemployment, social activity disruption, and quality of life issues for the patient. As the world population advances in age and increases in body mass index, there has been an increase in diabetes and venous insufficiency, ultimately resulting in a rise in the number of patients with chronic wounds. This review covers disease definition, wound-healing necessities, treatment options for management of chronic wounds, special wound care considerations, and investigational therapies. Figures show distribution of chronic wound etiologies, vacuum-assisted closure treatment of chronic wounds, chronic arterial ulcer of the medial foot, a step-wise application of a multilayer compression dressing, and four stages of pressure ulcers. Tables list known causes of tissue hypoxia, types of débridement, common dressings used in chronic wounds, and stages of a pressure ulcer. This review contains 5 highly rendered figures, 4 tables, and 99 references

Unna Boot With Keystone Advancement Flap Leads to Excellent Outcomes for Lower Extremity Reconstruction.

The reconstruction of lower extremity defects can be technically challenging. The keystone island perforator flap is a workhorse reconstructive option for difficult-to-repair regions, including the lower limb. The goal of this study is to evaluate outcomes using the keystone flap in combination with the zinc oxide compression dressing (Unna boot) for repair of lower extremity defects. We retrospectively evaluated 96 patients who underwent resection of malignancies or atypical neoplasms on the lower legs. A total of 114 defects were repaired with the keystone flap in combination with the Unna boot. Post-operative outcomes were assessed. The combination of the keystone flap with postoperative Unna boot application led to excellent outcomes. There was no association between complication rates and patient co-morbidities. The combination of the keystone flap with the Unna boot is a safe and efficacious approach for reconstruction of lower extremity defects. J Drugs Dermatol. 2021;20(12):1308-1312. doi:10.36849/JDD.5915.

Merocel compression dressing: a novel modified surgical technique for treating auricular pseudocyst.

Auricular pseudocyst (AP) is a benign, noninflammatory swelling to the ear, located on either the front or side surface. Deroofing surgery with variable compression methods is considered the most effective method. However, post-operative wound pain is the main drawback following compression. We are introducing a novel painless surgical procedure which involves deroofing technique followed by Merocel® compression dressing. From 2015 to 2020, thirty-one patients with AP received this new surgical compression method in our university-affiliated tertiary hospital. Retrospective chart review and the analysis of the results were conducted. All patients had unilateral lesions, with left side lesions (58.1%) predominant. The concha cymba (38.7%) and concha cavum (35.8%) were the most common sites. Previous aspiration or drainage had been performed for the cysts in eight patients (25.8%). Only one patient had the recurrence after post-operative 3months and received the revised surgery without following recurrence and discomfort. Among all patients, 29 (93.5%) patients claimed minimal pain around 0 or 1 in numeric rating scale of pain score. Three patients had mild ecchymosis but recovered after conservative treatment. One patient had mild auricular deformity after surgery due to pre-treatment partial cartilage necrosis. All patients had follow-up for at least 6months. This novel Merocel® compression dressing technique to treat AP after deroofing is an effective procedure. Minimal pain, simple to do and easily acquired materials were the advantages of this novel procedure.

TRAUMATIC MACROGLOSSIA: A CASE REPORT

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Self-inflicted traumatic macroglossia is extremely rare and only reported in a handful of case reports. We re-port an interesting case in a 37-years-old female. CASE PRESENTATION: A 37-years-old female was admitted to ICU for intracranial hemorrhage. Hospital stay was complicated by acute respiratory failure requiring urgent intubation. On day 3 of admission, patient developed acute tongue swelling. Physical exam was remarkable for markedly enlarged tongue measuring 'length 10cm, width 9.5cm, and circumference 23 cm. An initial diagnosis of angioedema was made and the patient received multiple dos-es of steroids, antihistamine and even icatibant trial with minimal improvement. C1 esterase inhibitor, C1 es-terase antigen, C3, C4 and tryptase level were all unremarkable. Factor XII was also normal. Paraneoplastic workup including CT neck/chest/abdomen/pelvis and lumbar puncture were unremarkable. Tongue biopsy re-vealed edematous benign squamous mucosa negative for vasculitis. During her hospital course, she was wit-nessed actively biting her tongue -despite using a bite blocker- while she was awake for which she underwent tooth extraction (teeth #23–25) and had a jaw spreader placed. DISCUSSION: Traumatic macroglossia has been reported in literature following oral cavity surgeries, trauma in anticoagulated patients and tongue biting in epileptics etc. Self-inflicted traumatic macroglossia is rare but can be potentially life-threatening if airway is not secured promptly. Our patient was intubated before she developed tongue swelling. We initially treated her for angioedema given sudden onset but persistent tongue swelling for more than 30 days despite receiving multiple medications made the diagnosis of angioedema unlikely. Factor XII genetic analysis is used to identify patients with hereditary angioedema with normal C1 Inhibitor. Both C1 inhibitor and Factor XII were normal in our patient. A detailed review of medications causing tongue swelling as possible side effect was also done and possible culprits were discontinued. The patient underwent extensive imaging studies that ruled out SVC syndrome or other vascular/lymphatic obstruction as a potential cause. A diagnosis of self-inflicted traumatic mac-roglossia was made after witnessing the patient bite her tongue repeatedly in light of negative workup for other etiologies Tongue swelling was managed with tooth extractions, jaw spreaders, compressive dressing and lin-gual massage. Surgery was discussed with family but they opted for conservative management. CONCLUSIONS: This case report brings into light an interesting case of self-inflicted traumatic macroglossia as well as clinical challenges in its diagnosis and management. REFERENCE #1: A. J. Hotaling and J. S. Reilly, "The diagnosis and treatment of macroglossia in children," Ear, Nose, & Throat Journal, vol. 65, no. 10, pp. 444–448, 1986 REFERENCE #2: J. E. Vogel, J. B. Mulliken, and L. B. Kaban, "Macroglossia," Plastic and Reconstructive Surgery, vol. 78, no. 6, pp. 715–723, 1986 REFERENCE #3: B. W. Neville, D. D. Damm, A. Allen, and A. Chi, Oral and Maxillofacial Pathology, Elsevier Health Sciences, Amsterdam, Netherlands, 2015 DISCLOSURES: No relevant relationships by Sarah Elsayed, source=Web Response No relevant relationships by Ahmed Gohar, source=Web Response no disclosure on file for Zinobia Khan; No relevant relationships by Sudhir Krishnan, source=Web Response No relevant relationships by Mani Latifi, source=Web Response No relevant relationships by Mariam Saeed, source=Web Response

CHIVA method for the treatment of chronic venous insufficiency.

CHIVA method for the treatment of chronic venous insufficiency.

Use of a Negative-Pressure Wound Dressing to Prevent Surgical Site Complications after Revision Knee Arthroplasty—A Randomized Controlled Trial

The aim of this study was to determine if a negative pressure wound therapy (NPWT) system can facilitate wound healing and withstand mechanical stress owing to the high range of motion of the knee joint in total knee arthroplasty. The benefits of NPWT include aiding wound granulation and a reduction in wound edema and secretion; our goal is to investigate its benefits in primary wound closure. Within an eight-day duration of treatment, we compared standard wound dressing (gauze and compression) with the disposable NPWT system (PICO)TM. A total of 79 patients were recruited in a controlled, randomized, prospective, single-institution clinical trial. A total of 40 patients were allocated to the study group and 39 to the control group. In terms of blood loss and infection parameters, there was no significant difference between both groups. In the NPWT group, we determined a significant reduction in wound edema but none in wound secretion. While the NPWT dressings survived the mechanical effects of movement during postoperative physiotherapy, conventional compressive dressings were often renewed. Even though the risk factors that could lead to delayed wound healing were reduced in the test group, we could not identify any significant difference pertaining to delayed wound healing that required surgical treatment.

MP04-11 LAPAROSCOPY ASSISTED PERITONEAL PULL-THROUGH VAGINOPLASTY IN TRANSGENDER WOMEN, AN OLD TECHNIQUE IN MODERN TIME

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-11 LAPAROSCOPY ASSISTED PERITONEAL PULL-THROUGH VAGINOPLASTY IN TRANSGENDER WOMEN, AN OLD TECHNIQUE IN MODERN TIME Marta Bizic, Borko Stojanovic, Marko Bencic, Slavko Matic, and Miroslav Djordjevic Marta BizicMarta Bizic More articles by this author , Borko StojanovicBorko Stojanovic More articles by this author , Marko BencicMarko Bencic More articles by this author , Slavko MaticSlavko Matic More articles by this author , and Miroslav DjordjevicMiroslav Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold standard in genital gender affirming surgeries (GGAS) is penile inversion vaginoplasty. In cases in whom penile skin is lacking. Either because of medication with puberty blockers or radical circumcision, or inadequate penile skin length, different options for neovaginal reconstruction must be offered to the patients. We asses laparoscopy assisted peritoneal pull-through vaginoplasty in combination with penile skin flaps for transgender women. METHODS: During two years period (March 2018-June 2020), we performed 47 primary laparoscopy assisted peritoneal pull-through vaginoplasties in transgender women. The surgery consisted of complete penectomy to the pubic bones in all patients, bilateral orchiectomy in 42 patients (5 patients had bilateral orchiectomy, prior the GGAS), clitoroplasty, urethroplasty, vulvoplasty and vaginoplasty using peritoneal flaps in combination with inverted penile skin flap. In two patients in whom lichen sclerosis was suspected removal of the affected skin was performed before creation of the neovagina. Two peritoneal flaps were dissected from the posterior aspect of the bladder and anterior aspect of the rectum in about 5cm in width and about 7cm in length and anastomosed with interrupted sutures with asymmetrically fashioned penile skin flap in order to prevent neovaginal stenosis. Vaginal packing is placed for the period of 5 days postoperatively, together with two drains. Urinary catheter is placed for urine derivation for 2 weeks. Compressive dressing is applied. RESULTS: Follow-up ranged from 6 to 23 months (mean 13 months). All patients were instructed to perform regular dilation of their neovagina for the first 12 months postoperatively by a pelvic floor physiotherapist. Even though peritoneum was found to produce some lubrication, patients were advised to use the lubricant during the sexual intercourse. Complications occurred in 5 of our patients: 3 had prolonged hematoma of the labia majora, one had neovaginal introitus dehiscence and one had superficial necrosis of the left labia majora. None of the complications required additional surgeries. The depth of the neovagina at the control check-up in 6 months after surgery was 14.7±0.5cm, while width was about 3.4±0.4cm. Majority of patients (≈96%) were satisfied with the new genitals, sensitivity, lubrication and possibility of engaging in sexual intercourse according to self-reports. One patient required reduction of the size of her clitoris because of hypersensitivity and the other one requested laser treatment of the incisional scars. CONCLUSIONS: Albeit known for quite a long time in vaginal reconstruction for cis-women languishing over vaginal agenesis and different states of vaginal absence, peritoneal pull-through vaginoplasty offers promising outcomes in transgender women GGAS that will give self-lubricating neovagina, with insignificant scarring and complications and high degree of patient's satisfaction. Source of Funding: / © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e71-e71 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marta Bizic More articles by this author Borko Stojanovic More articles by this author Marko Bencic More articles by this author Slavko Matic More articles by this author Miroslav Djordjevic More articles by this author Expand All Advertisement Loading ...

Methods for Minimizing Bleeding in Facelift Surgery: An Evidence-based Review.

Introduction:Bleeding and hematoma remain leading causes of postoperative complications and unsatisfactory patient outcomes in facelift surgery. Several methods have been implemented, and continue to be developed, to minimize bleeding in facelift surgery. These methods include perioperative blood pressure management, compression dressings, drains, tissue sealants, wetting solution infiltrate, and tranexamic acid.Methods:An evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database according to PRISMA guidelines. Included studies were evaluated for the effects of implemented methods on bleeding outcomes in facelift surgery. Recommendations for each method evaluated were determined based on the amount, level, and heterogeneity of included studies.Results:Thirty-six studies were included in the evidence-based review. Effective strategies to reduce the time to hemostasis, postoperative drainage volume, and hematoma rate included perioperative blood pressure management, tissue sealants, and tranexamic acid. While the use of drains or wetting solution infiltrate did not demonstrate to significantly influence bleeding outcome measures, these methods may provide other advantages to facelift surgery. Compression dressings have not demonstrated a significant effect on facelift outcome measures.Conclusions:Perioperative medical management of blood pressure, tissue sealants, and tranexamic acid are most effective in facilitating hemostasis and preventing postoperative hematoma in facelift surgery.

The CADI-study: Compression after device implantation - To examine the effect of a compressive dressing after device implantation or replacement focusing on the patient"s bleeding, hematomas and pain

Abstract Funding Acknowledgements University Hospital Rigshospitalet, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Denmark Background Bleeding and pocket hematomas are a known complication in pacemaker or implantable cardioverter defibrillator (ICD) implantations. Hematomas are associated with increased risk of infection and pain. Purpose To investigate whether a compressive dressing applied for three hours can prevent bleeding, pocket hematomas and pain. Method The study was a pseudo-randomized intervention study including patients scheduled for implantation or box change of a pacemaker or an ICD. In alternating months patients either received a compressive dressing (intervention group) or not (control group). Patients were excluded by the implanting physician if there was a clinical indication for a compressive dressing due to seeping bleeding. Patients were followed at the catheterization lab, for three hours at the ward and until the first outpatient control visit (1-3 months). The outcomes were: Bleeding, pocket hematomas and pain. The bleedings were graded as active bleeding or seeping bleeding or hematomas. Hematomas were measured by degree 1 to 3 (3 largest) and size (in cm). Pain was rated by the patient by numerical rank scale (NRS) from 0 to 10 (10 worst). Descriptive statistics were used. Results A total of 191 patients were included, 95 patients in the intervention group. After inclusion 24 patients of the 96 patients in the control group were excluded by the implanting physician on clinical indication for a compressive dressing. Before the intervention there were significantly more patients with bleeding (graded as: Seeping bleeding) in the intervention group (n = 25, (26.9%)) compared to the control group (n = 4, (5.6%), p <0.001). No patients had developed pocket hematomas at the end of the procedure. Furthermore, the pain score was low in both groups (Total n = 19, NRS score ≤ 2.5). Over the next three hours in the ward, there was no significant difference in the bleeding (graded as: Seeping bleeding) in the groups (intervention: n = 8 vs. control: n = 3, p = 0.55). Two patients in each group had developed a pocket hematoma after three hours (p = 0.36) and the intervention group experienced more pain (intervention: 1.7 (±2.4) vs. control: 1.1(±1.7), p= 0.02). At the outpatient control 1-3 months after implantation, there was no significant difference between the groups related to bleeding, pocket hematomas and pain. Conclusion Compressive dressing did not significantly reduce bleeding or the number of pocket hematomas after pacemaker or ICD implantation. In addition patients reported a slight increase in pain scores related to the compressive dressing. The results question routine compression after procedure, but should be validated in larger studies.

Mini open non vascularized fibula graft harvesting technique without any specialized instrumentation: A case report

Fibula graft harvesting is a common procedure in orthopedic practice. The common approach to the shaft of fibula is through long incision made over the fibula. This was fraught with complications including common peroneal nerve injuries, pain and significant graft site morbidity to patients. Techniques then came to describe harvesting fibula through minimal incisions. However these needed specialized circular harvesters and hence was difficult to perform in hospitals catering to poor socioeconomic strata. We have devised minimally invasive technique of fibula harvesting using a long 4.5 system narrow DCP (Dynamic compression plate) used as soft tissue stripper and have combined the procedure with mini open fasciotomy and compression dressing. Our patient did not have any postoperative common peroneal, superficial peroneal or deep peroneal nerve injury. Postoperative graft site pain was minimal.

Management of Chyle Leak After Head and Neck Surgery; Our Meritorious Experience in 52 Cases and Review of Literature.

Iatrogenic chyle leak is commonly seen when dissection happens very low in neck. Management of chyle leak is conservative with compression dressing, fat restricted diet, somatostatin analogues. Surgery is required in extreme cases with failure of conservative treatment. This is a retrospective observational study carried out from a prospectively maintained database. A total of 6482 head and neck surgeries with neck dissections were carried out between January 2015 till July 2020 at our tertiary cancer center. Out of which there were 52 cases of chyle leak reported post neck dissection. All details regarding age, sex, primary tumor location, surgery performed, level of nodal dissection performed, details related to chyle leak from beginning day and its progression and management offered. The median age in the study group was 42years (24-70years). Chyle leak was most commonly seen on left side (88.5%). Low output leaks(n = 43) resolved within a median period of 9days (5-13days) period of conservative management. High output leak (n = 9) had leak resolution within a median period of 12days (7-19days). Patients who had received preoperative radiotherapy and who had extra nodal extension in lymph nodes had significantly higher incidence of high output leaks. Chyle leak is a rare but serious complication in head and neck surgery. Timely identification and management is crucial. Conservative management is mainstay. Surgical management is instituted in cases of failure of conservative management.