Deep Incision Research Articles

A comparative analysis of collagen based dressings and polysaccharide microspheres for hemostasis management in hepatic stab wounds.

This study aims to evaluate two of the most commonly used products, the collagen-based patch (Hemopatch) and the micropolysaccharide microspheres powder (Perclot), in the context of stab liver injury in pigs. The objectives of this study were to assess blood loss at various time intervals up to 24h, survival rates, and mean arterial pressure. The research involved 18 Large-White swine. The animals underwent a traumatic liver puncture through two 5cm deep blade incisions that severed two main suprahepatic veins. Hemostatic surgical treatment was conducted for 12min using two hemostatic agents. In the first 3min after injury, the Hemopatch group lost less blood than the Perclot group, with 300cc (222.5-415.0) compared to 555.0cc (480.0-632.5) (p = 0.001). However, at 13-60min post-injury, the Perclot group lost less blood than the Hemopatch group, 45.0cc (32.5-135.0) compared to 305.0cc (112.5-607.5) (p = 0.015). Lastly, the survival rate 24h after injury was higher in the Perclot group (88.8%) compared to the Hemopatch group (44.4%) (p = 0.046). Several disparities were observed between Perclot and Hemopatch. Although Hemopatch demonstrates prompt bleeding reduction in the initial 3 min, Perclot is capable of stabilizing the clot and subsequently reducing long-term bleeding, ultimately increasing the likelihood of survival. These observations support the utilization of Perclot for managing severe hepatic hemorrhage.

Fluid Mechanics of the Dead Sea

The environmental setting of the Dead Sea combines several aspects whose interplay creates flow phenomena and transport processes that cannot be observed anywhere else on Earth. As a terminal lake with a rapidly declining surface level, the Dead Sea has a salinity that is close to saturation, so that the buoyancy-driven flows common in lakes are coupled to precipitation and dissolution, and large amounts of salt are being deposited year-round. The Dead Sea is the only hypersaline lake deep enough to form a thermohaline stratification during the summer, which gives rise to descending supersaturated dissolved-salt fingers that precipitate halite particles. In contrast, during the winter the entire supersaturated, well-mixed water column produces halite. The rapid lake level decline of O(1 m/year) exposes vast areas of newly formed beach every year, which exhibit deep incisions from streams. Taken together, these phenomena provide insight into the enigmatic salt giants observed in the Earth's geological record and offer lessons regarding the stability, erosion, and protection of arid coastlines under sea level change.

Prospective study of three-dimensional-printed in vitro guide plates assisted hip arthroscopy in treatment of Cam-type femoroacetabular impingement

A prospective study was conducted to investigate the feasibility and effectiveness of three-dimensional printed in vitro guide plates assisted hip arthroscopy in the treatment of Cam-type femoroacetabular impingement (FAI). The clinical data of 25 patients with Cam-type FAI who met the selection criteria between December 2016 and September 2022 were collected. There were 13 males and 12 females with an average age of 42 years (range, 19-66 years). The disease duration ranged from 3 to 120 months, with an average of 22.2 months. The preoperative range of internal rotation-external rotation was (28.70±4.50)°, α angle was (69.04±0.99)°, visual analogue scale (VAS) score was 6.5±0.2, and modified Harris hip score (HHS) was 50.5±0.7. All patients were treated with hip arthroscopy assisted by three-dimensional printed in vitro guide plate. The occurrence of complications was observed postoperatively, α angle of the affected hip joint was measured on Dunn X-ray film, and the glenoid labrum injury was observed by MRI. The percentage of overlap between the Cam plasty area and the preoperative simulated grinding area was calculated by three-dimensional CT+reconstruction. The effectiveness was evaluated by VAS score and modified HHS score. Postoperative dorsalis pedis numbness occurred in 1 case, and the symptoms disappeared after 1 month of conventional drug treatment such as neurotrophy. Two cases of perineal skin injury occurred, and healed after symptomatic treatment. There was no male erectile dysfunction, deep incision infection, pulmonary embolism, or other serious complications occurred. The percentage of overlap between the Cam plasty area and the preoperative simulated grinding area was 81.6%-95.3%, with an average of 89.8%. All 25 patients were followed up 6-12 months, with an average of 8 months. At last follow-up, the range of internal rotation-external rotation was (40.10±2.98)°, α angle was (43.72±0.84)°, VAS score was 1.8±0.2, and the modified HHS score was 72.1±1.3, which significantly improved when compared with preoperative ones ( P<0.05). The treatment of Cam-type FAI with three-dimensional printed in vitro guide plates assisted hip arthroscopy is safe and feasible, and can achieve good effectiveness.

Approaches to Increase Early Detection and Positive Biopsy Rate of Nasal Natural Killer/T-Cell Lymphoma.

To develop methods for early detection of natural killer/T-cell lymphoma, nasal type (nasal NKTL) and to evaluate the use of apparent diffusion coefficient (ADC) measurements from diffusion-weighted imaging (DWI) for selecting biopsy sites to enhance the positive biopsy rate. The clinical data of 32 cases of nasal NKTL were retrospectively collected and analyzed. Cases were graded from 1 to 5 based on endoscopic and imaging findings. Biopsy methods included the superficial forceps method and deep incisional method. Data recorded included biopsy method, time to confirmed diagnosis, number of biopsies required, and ADC values of biopsy sites. Both endoscopic and MRI lesion severity did not affect biopsy outcomes (p = 0.8248, 0.7571). The deep incisional biopsy method had a significantly higher probability of yielding positive pathological results compared to the superficial clamping method [OR (95% CI) = 23.2143 (6.0448, 89.1513) (χ2 = 26.1089, p < 0.0001)]. The ADC value at the site with a positive biopsy result is significantly lower than at the site with a negative result (p = 0.0003). The diagnostic threshold for ADC value to predict a positive biopsy result was 0.603 × 10-3 mm2/s, with a Youden index of 0.43. Nasal NKTL has distinct characteristics distinguishing it from sinusitis and other tumors. Deep incision biopsy under general anesthesia is superior to the superficial method. The location of the positive sampling site can be guided by measuring the ADC value, and the optimal diagnostic threshold of this proposed method is 0.603 × 10-3 mm2/s. 4 Laryngoscope, 2024.

Comparison of holmium:yttrium-aluminium-garnet (YAG), thulium fiber laser, and pulsed thulium:YAG lasers on soft tissue: an ex vivo study.

To assess laser-tissue interactions through ablation, coagulation, and carbonisation characteristics in a non-perfused porcine kidney model between three pulsed lasers: holmium (Ho): yttrium-aluminium-garnet (YAG), thulium fiber laser (TFL), and pulsed thulium (p-Tm):YAG. A 150-W Ho:YAG, a 60-W TFL, and a 100-W p-Tm:YAG lasers were compared. The laser settings that can be set identically between the three lasers and be clinically relevant for prostate laser enucleation were identified and used on fresh, unfrozen porcine kidneys. Laser incisions were performed using stripped laser fibers of 365 and 550 μm, set at distances of 0 and 1 mm from the tissue surface at a constant speed of 2 mm/s. Histological analysis evaluated shape, depth, width of the incision, axial coagulation depth, and presence of carbonisation. Incision depths, widths, and coagulation zones were greater with Ho:YAG and p-Tm:YAG lasers than TFL. Although no carbonisation was found with the Ho:YAG and p-Tm:YAG lasers, it was common with TFL, especially at high frequencies. The shapes of the incisions and coagulation zones were more regular and homogeneous with the p-Tm:YAG laser and TFL than with Ho:YAG laser. Regardless of the laser used, short pulse durations resulted in deeper incisions than long pulse durations. Concerning the distance, we found that to be effective, TFL had to be used in contact with the tissue. Finally, 365-μm fibers resulted in deeper incisions, while 550-μm fibers led to wider incisions and larger coagulation zones. Histological analysis revealed greater tissue penetration with the p-Tm:YAG laser compared to the TFL, while remaining less than with Ho:YAG. Its coagulation properties seem interesting insofar as it provides homogeneous coagulation without carbonisation, while incisions remained uniform without tissue laceration. Thus, the p-Tm:YAG laser appears to be an effective alternative to Ho:YAG and TFL lasers in prostate surgery.

Sphenoderesjaponicus sp. nov. – The first deep water representative of the family Semnoderidae (Kinorhyncha, Cyclorhagida) in the sea of Japan

A new species of semnoderid kinorhynchs, Sphenoderes japonicus sp. nov. collected from oxidized brown silt on the steep slope of the deepest depression in the Sea of Japan, Northwestern Pacific, is described using light and scanning electron microscopy. This new representative of the family Semnoderidae is characterized by the structure of the first trunk segment consisting of externally closed cuticular ring with indistinct intracuticular tergosternal junctions. Cuticular ring of the first trunk segment is with deep and narrow middorsal incision and much broader midventral incision filled by large midventral placid. Acicular lateroventral spines on trunk segments 3–9. Lateroventral accessory spines are minute, only on trunk segment 5. Trunk segment 10 with acicular spines in laterodorsal position in female and in midlateral position in male. S. japonicus sp. nov. constitutes the first bathial species of this family and the first species of Semnoderidae in the Sea of Japan.

A Prospective Randomized Controlled Study of Stratafix versus Standard-of-Care for Deep Tissue Closure in Orthopedic Surgery.

Orthopedic deep surgical incisions require the approximation of 1 or multiple tissue layers. This prospective randomized controlled study aimed to assess the usefulness and effectiveness of a barbed suture technique (Stratafix symmetric PDS plus) versus the conventional interrupted knotted suture technique for deep tissue closure in orthopedic surgery by comparing deep fascia suture time, relative cost, and wound-related complications. A total of 254 patients with deep surgical incisions who underwent orthopedic surgery between October 1, 2020, and June 30, 2021, were recruited. Their general characteristics (age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status score, total operation time, and length of deep incision) and factors related to deep incision wounds (suture type and number, wound closure time, and operation site outcomes) were collected. The general characteristics did not differ between the Stratafix and conventional groups. There were no between-group differences observed in total operation time or total anesthesia time. The wound suture times differed significantly. In the conventional group, the suture time per unit length was lower in the group with the length of deep incision under 20 cm but did not differ significantly for each wound size. In the Stratafix group, the suture time per unit length was lower in the group under 15 cm, with the shortest time observed for 10-14.9 cm, followed by 5.0-9.9 cm and the group under 5 cm. The conventional group developed 4 cases of superficial wound infection or surgical wound necrosis. One case of protruded suture tap occurred in the Stratafix group. The average suture time per unit length increased for lengths under 5 cm as barbed sutures required more time from the start of the first suture to finish of the last suture. There was no significant benefit for very short suture length. One barbed suture material allows a suture of approximately 10-12 cm; sutures beyond that require more time because the surgeon has to start again. The Stratafix group used less suture material than the conventional group.

A clinical application for arterial coupling and histomorphometric comparison of internal mammary and thoracodorsal arteries for safe use.

In breast reconstruction, arterial coupling has been reported to be more favorable in the thoracodorsal artery (TDA) than the internal mammary artery (IMA). This technique may help overcome anastomosis in a small, deep space. Understanding the arteries' mechanical properties is crucial for breast reconstruction's safety and success. Abdominal-based free flap breast reconstructions performed by a single surgeon between 2020 and 2022 were retrospectively analyzed. The patients were classified by microanastomosis technique (handsewn and coupler device) to compare the rate of vascular revision. Histomorphometric analysis of arterial coupling in TDA and IMA was performed in 10 fresh cadavers for comparing wall thickness and composition, including densities of elastic fiber, smooth muscle, and collagen. A total of 309 patients (339 reconstructed breasts) were included. There were 29 patients in the TDA handsewn group (A), 38 patients in the TDA coupler group (B), and 242 patients in the IMA handsewn group (C). The rates of arterial revision in groups A, B, and C were 0.00% (95%CI: 0.00%-11.03%), 2.5% (95%CI: 0.44%-12.88%), and 1.49% (95%CI: 0.58%-3.77%), respectively, with no statistically significant differences (p-value = .694). Histologically, the thickness of the tunica media and adventitia between IMA and TDA showed no significant difference. The density of elastic fiber was significantly higher in IMA (16.70%) than in TDA (0.79%) (p-value <.001). The histologic characteristics of TDA are more favorable for arterial coupling than those of IMA. Arterial coupling is a safe option in situations where TDA anastomosis must be performed through a narrow and deep incision.

Evolution of a late Quaternary succession by interpretation of high‐resolution seismic and bathymetric data, Adriatic Sea

AbstractThis paper presents the results of the interpretation of a set of high‐resolution seismic lines integrated with multibeam echosounder data acquired in a coastal area in the Northern Adriatic Sea. The aim of the study was to reconstruct the stratigraphic evolution of a late Quaternary sedimentary succession offshore the town of Bibione, North‐Eastern Italy, by recognising the key unconformities, identifying the main depositional units, dating them and reconstructing the depositional environments in relation to relative sea‐level variations. Specifically, four sedimentary units, separated by erosional unconformities associated with the development of deep channels, were identified and dated based on literature information. By interpreting the seismic data, sedimentary dynamics were reconstructed and palaeoenvironments identified. The lower unit corresponds to a paludal environment, showing abundant gas seeps and accumulations (bright spots); the two intermediate units correspond to fluvial deposits, filling the deep incisions that characterise the bounding surfaces. Finally, the shallowest unit, bounded by a wave‐ravinement surface incised by tidal currents, corresponds to the Holocenic progradation of the coastal wedge. In addition, several vertical gas chimneys were identified, ranging in width from a few metres to 20–30 m. These were present in all units, often reaching the sea floor. Finally, elongated mounds, about 300 m wide, at the sea floor were recognised. The bathymetric and seismic characteristics of these elongated bodies and their relationship to adjacent sedimentary bodies suggest that they are probably methane‐derived carbonate formations known as ‘Trezze’ or ‘Tegnùe’. These names recall the fact that the trawls of the local fishermen were often hindered (‘tegnù’ in the Venetian language) or even cut off by these formations.

The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty.

Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery.

Stacking pattern transition caused by submarine channel inception and internal levée development

ABSTRACTThe shift from highly amalgamated and laterally offset to aggradational and vertically stacked submarine channels is a pattern that has been widely recognized in seismic reflection datasets as well as in outcropping successions worldwide. However, the sedimentary and stratigraphic details of such an important part of channel evolution and its implications have not been discussed extensively. That gap is addressed here by characterizing a previously undocumented, seismic‐scale outcrop of the Tres Pasos Formation (Magallanes Basin, Chile) that records the transition from a laterally offset/low‐aggradational channel complex to a vertically stacked aggradational complex associated with the development of an internal levée that enhanced channel aggradation. The boundary between the two complexes is defined by a composite erosional surface (up to ca 35 m relief) with two adjacent element‐scale channelized incisions with contrasting sedimentary infills that provide unprecedented insight into this key phase of submarine channel evolution. Observations indicate that, in between these two depositional architecture styles, there is a significant phase of deep incision and bypass. The relief achieved via this deep incision of one or multiple simultaneously active conduits is interpreted to be necessary to set up the conditions for flow stripping and, subsequently, overbank deposition. Finally, the siltstone‐rich intra‐channel lithofacies association observed directly overlying part of the incision is interpreted to represent the stratigraphic expression of the earliest deposits of an active submarine channel preserved due to the abrupt abandonment of this pathway and the development of an adjacent conduit, which resulted in the former being covered with fine‐grained overbank deposits.

(214) MULTIPLE GRID INCISION OF TUNICA ALBUGINEA AND SEALING WITH COLLAGEN FLEECE FOR IPP, A PILOT STUDY

Abstract Introduction Recently, there have been reports on partial plaque excision and grafting with collagen fleece technique for the treatment of Peyronie’s disease. Previously, the authors reported the modification of this technique as multiple grid incisions of Peyronie’s plaque due to lack of hitological evidence of new tunical regeneration from the collagen fleece graft. Objective In this pilot study, we assessed the feasibility of this technique to insert IPP in patients of severe corporal fibrosis from previous failed IPP or Peyronie’s disease with severe deformity. Methods From Aug 2018, inflatable IPP (AMS700) was inserted in a total of 9 patients, 4 patients of failed IPP and 5 patients of Peyronie’s disease with severe deformity, respectively. After dissection of the neurovascular bundle or urethra according to the location of plaque or deformity, surgical technique was composed 3 major steps; 1) multiple deep longitudinal tunical incisions over Hegar dilator to achieve enough tunical diameter for insertion of sylinder into the corpus cavernosum and correct bottle neck deformity, 2) multiple transverse incision of tunica to correct penile curvature and gain enough length of corporal body and 3) sealing with collagen fleece (TachoSil®) without suturing. Prospectively, we assessed the stretched penile length (SPL), totally straightness, erectile function were evaluated at 3, 6 and 12 months. Results Mean patient age was 61.7 years (range: 56–67). In 5 patients of Peyronie’s disease, mean curvature was 53.5 (40-80) degree and all with hinge and hourglass deformity. Inflatable IPP(AMS 700CX) was inserted in all 5 patients and achieved total straightness after mean operative time of 150 min.. Glans necrosis was occurred in two patients and skin necrosis in 3 but resolved with cell therapy after 3 months. All 5 patients satisfied in GAQ at 1 year. In 4 patients of previous failed IPP, 2 were prothesis infection and prothesis protrusion in 2. Two patients were satisfied with a little short 15 cm sylinder insertion and 2 patients still dissatisfied with short length of penis. Conclusions In patients of failed IPP with resultant severe corporal fibrosis or Peyronie’s disease with severe deformity, multiple longitudinal incision to achieve enough diameter and transverse incision to gain the coporal length enable successful insertion of IPP. Postopeartive skin necrosis or glans necrosis were troublesome in patients of diabetes or compressive dressing. Disclosure No.

Buccal Fat Advancement-Transposition Flap for Reconstruction of Midface Volume Defects.

Background: The buccal fat pad (BFP) has previously been utilized for repair of various defects of the head and neck. Objectives: We explore the utility of a pedicled buccal fat advancement-transposition (BFAT) flap in various forms of midface reconstruction through a variety of surgical approaches and characterize its volume and axial reach in human anatomic specimens. Methods: Ten adult full-head human anatomic specimens were dissected, and a single surgical case demonstrating the use of a BFAT flap is described. Results: Nasolabial, subciliary, and deep plane facelift incisions all provided access to the BFP for use as a BFAT flap. The mean volume of mobilizable fat contained within a BFAT flap accessible through external incision was 7.1 cm3. Once fully mobilized, the externalized BFAT flap had a mean axial reach of 6.9 cm without tension. We also present a case illustrating the successful use of a BFAT flap for volumization of a large midface defect secondary to Mohs micrographic surgical resection of a cutaneous malignancy. Discussion: The BFAT flap, which exhibited substantial volume and reach in this study, can be harvested through multiple dissection windows or pre-existing defects and be used to reconstruct a variety of midface defects.

The effect of weathering in runoff-to-groundwater partitioning in the Island of Hawai'i: Perspectives for landscape evolution

We investigated how runoff-to-groundwater partitioning changes as a function of substrate age and degree of regolith development in the Island of Hawai'i, by modeling watershed-scale hydrodynamic properties for a series of volcanic catchments of different substrate age developed under different climates. In the younger catchments, rainfall infiltrates directly into the groundwater system and surface runoff is minimal, consisting of ephemeral streams flowing on the scale of hours to days. The older catchments show increasing surface runoff, with deeper incision and perennial discharge. We hypothesize that watershed-scale hydrodynamic properties change as a function of their weathering history—the convolution of time and climate: as surfaces age and become increasingly weathered, hydraulic conductivity is reduced, leading to increased runoff-to-recharge ratios. To test this relationship, we calculated both saturated hydraulic conductivity (k) and aquifer thickness (D) using recession flow analysis. We show that the average k in the younger catchments can be between 3 to 6 orders of magnitude larger than in older catchments, whereas modeled D increases with age. Ephemeral streams with zero baseflow at daily timescales cannot be evaluated using the same method. Instead, we calculated the recession constant for two contiguous catchments developed on young ash or lava deposits of different ages. Increasing bedrock age results in slower recession response in these ephemeral streams, which is consistent with decreasing hydraulic conductivity. Our results highlight the role of the weathering history in determining the evolution of watershed-scale hydrologic properties in volcanic catchments.

(097) 3 Year Follow Up After Modified Grid Incision and Sealing with Collagen Fleece for Treatment of Peyronie’s Disease

Abstract Introduction Previously, we introduced a less invasive modified technique by multiple grid incisions of Peyronie’s plaque. Objective To assess the efficacy of technique in 32 patients with 3 year follow-up. Methods From 2018, 32 patients with stable Peyronie’s disease were included with 3 major steps of surgery; 1) dissection of neurovascular bundle/urethra according to plaque location, 2) multiple deep grid incisions of plaque for complete correction of curvature/deformity, 3) sealing with TachoSil®. Prospectively, the stretched penile length (SPL), totally straightness, penile sono, erectile function at preoperative, and 6, 12, 24, 36 months postoperatively under approval of Institutional Review Board. Results Mean age was 59.2 years (46–72). Mean curvature was 53.5 (40–80) degree, 8 with hinge and 7 with hourglass deformity. IPP was inserted in 4 and 1 at postoperative 30 months for poor erectile function. Mean follow-up was 35.4 months (12–57). Daily massage softened the hard thickening of penis gradually from 3 months until 3 year. On follow-up sonography, subcutaneous thickening gradually decreased to near normal at 1–3 year and tunical breakage by grid incision reunited at postoperative 10–12 months. 2 patients immediately recurred dorsal curvature but most patients achieved totally straightness. Most patients gained preoperative length after 1.6 year. 96% of patients satisfied in GAQ at 2 year. Minor skin problem was occurred in two of IPP. Subcutaneous bulging hematoma was occurred in 3 patients but subsided in two within 3 months. One patients need revision surgery. In postoperative erectile function of 23 patients without IPP, spontaneous hard erection was recovered in 5 and the rest are satisfied with PED5 inhibitors. Conclusions Our prospective progress reports with technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of tunica albuginea but need long term follow up for 3 years at best. Disclosure No.

Two new species of Hesperopenna Medvedev & Dang, 1981 (Coleoptera, Chrysomelidae, Galerucinae) from Singapore.

Two new species of Hesperopenna Medvedev & Dang, 1981 are described from Singapore: H.temaseksp. nov. and H.bakerisp. nov. The specimens of both new species were collected by Charles Fuller Baker and found in the unidentified Galerucinae material deposited in the National Museum of Natural History, Smithsonian Institution, Washington, DC. Hesperopennatemaseksp. nov. is diagnosed by the black extreme elytral suture in the basal third, antennae longer than the body, the structure of the penis, and the last abdominal ventrite with two deep U-shaped incisions in females. Hesperopennabakerisp. nov. is diagnosed by the black tibia and first two tarsomeres, and the structure of the penis.

Investigating the efficacy of vacuum sealing drainage versus traditional negative pressure drainage in treating deep incision infections following posterior cervical internal fixation—a retrospective cohort study

BackgroundAssessing the efficacy and safety of Vacuum Sealing Drainage (VSD) in treating deep incision infections (DII) following posterior cervical internal fixation.MethodsWe retrospectively studied the clinical effects of VSD and Traditional Negative Pressure Drainage (TND) on 12 patients with deep incision infection after posterior cervical fixation surgery who were treated in our department from 2012 to 2020. A comparison of patient-related factors (age, gender, BMI, comorbidities, initial internal fixation surgery segment, preoperative laboratory inflammation indicators) and surgical-related factors (postoperative duration of fever, positive rate of drainage fluid bacterial culture, Visual Analogue Scale (VAS) score at 3 days after surgery, laboratory indicators at 3 days after surgery, debridement frequency and drainage time, hospital stay, internal fixation retention rate, and infection recurrence rate) between the VSD group and the TND group was conducted using independent sample t tests to draw experimental conclusions.ResultsThis study included 12 patients, with six cases of VSD (5 males and 1 female) and six cases of TND (4 males and 2 females). The VSD group had significantly lower postoperative fever time (1.50 ± 0.46 days vs. 4.28 ± 0.97 days, P < 0.05), a higher positive rate of bacterial cultures in drainage fluid (5/6 vs. 2/6, P < 0.05), lower 3 day VAS scores (3.13 ± 0.83 vs. 3.44 ± 0.88, P < 0.05), lower 3 day CRP levels (66.89 ± 23.65 mg/L vs. 57.11 ± 18.18 mg/L, P < 0.05), a shorter total drainage time (14.50 ± 2.98 days vs. 22.56 ± 3.01 days, P < 0.05), and a higher total drainage flow rate (395.63 ± 60.97 ml vs. 155.56 ± 32.54 ml, P < 0.05) than the TND group (the total drainage volume throughout the entire treatment process). In addition, the frequency of debridement (2.67 ± 0.52 times vs. 3.17 ± 0.41 times, P < 0.05) and average hospital stay (23.13 ± 3.27 days vs. 34.33 ± 6.86 days, P < 0.05) were significantly lower in the VSD group, although both groups retained internal fixation.ConclusionsVSD is a secure and effective treatment for deep incision infections that results from cervical posterior internal fixation surgery.

Surgical Site Infection in the General Surgery Department at the Fousseyni Daou Hospital in Kayes

Objectives: To determine frequency, analyze risk factors, identify responsible germs and antibiotic susceptibility, and assess the cost of infection. Patients and Method: We conducted a prospective study (August 1, 2022 to February 2023) for a period of 6 months. During our series, we received 250 patients who had been operated on and hospitalized in the general surgery department. The diagnosis of surgical site infection was based on criteria set forth by the Atlanta CDC. Data collection was carried out by interviewing, consulting records and anaesthesia sheets. Surgical wound monitoring was done up to the 30th postoperative day. A sample was taken for each infection. The word processor and tables were made on Microsoft Word 2019. Data were captured and analyzed on SPSS software (version 25). Results: We collected a total of 250 patients in our study. 31 developed an infection of the surgical site, a frequency of 12.4%. There were 31 patients, including 23 men and 8 women, with a mean age of 34 years, with a standard deviation of 20.75. The most common type of infection was superficial incision infection with 70.9% followed by deep incision infection with 29.1%. Risk factors for Surgical Site Infection Were: haemoglobin level; the nature of the surgery; ALTEMEIR contamination class 3 and 4; NNISS index 1 and 2; the type of intervention with probability tests P&lt;0.05. The analysis of the 31 samples resulted in 31 positive cultures, i.e. a bacteriological yield of 100%. Echerichia coli was the most isolated germ with 25.8%, followed by Enterobacter cloacae 19.3% and Enterococcus 19.3%. The Treatment was: Carrying out local care based on antiseptics (dakin; Betadine; hydrogen peroxide) and general (adapt to susceptibility testing). The consequence of surgical site infection was the prolongation of the hospital stay by an average of 19 days for infected patients; with an estimated additional cost of 294712 and 0% mortality.

Topical Losartan Inhibition of Myofibroblast Generation in Rabbit Corneas With Acute Incisions.

The purpose of this study was to study whether deep central corneal incisions close during topical losartan treatment and the effect of topical losartan on myofibroblast generation after incisions in rabbit corneas. Rabbits (12) had a 0.35-mm deep radial incision from the center of the cornea into the limbus in 1 eye that was approximated with a single 10-0 nylon suture 1 mm inside the limbus. The incision was treated with 50 μL of topical 0.8 mg/mL losartan or 50 μL of balanced salt solution vehicle 6 times per day for 1 month. Standardized slitlamp photographs of the central incisions were analyzed for opacity with ImageJ before euthanasia. Triplex IHC was performed on cryofixed corneas for myofibroblast marker alpha-smooth muscle actin, mesenchymal cell marker vimentin, and basement membrane marker laminin alpha-5. Stromal α-SMA-positive myofibroblasts surrounding the incisions were quantitated with ImageJ. Topical losartan compared with vehicle did not affect closure of the radial incisions or the opacity that developed surrounding the incisions at 1 month after injury. Topical losartan compared with vehicle did significantly decrease the average density of stromal myofibroblasts surrounding the incisions. Topical losartan, a known inhibitor of transforming growth factor beta signaling, did not affect closure of deep corneal incisions. Losartan decreased myofibroblast generation surrounding nearly full-thickness radial corneal incisions compared with vehicle. The opacity at the incisions was not significantly affected by losartan-likely because corneal fibroblasts that develop in the stroma adjacent to the incisions were not changed by the losartan compared with the vehicle.

Postoperative Progress of Deep Grid Incision and Sealing with Collagen Fleece for Treatment of Peyronie's Disease: Prospective Observational Study for 3 Years.

Despite recent popularity, partial plaque excision and sealing with TachoSil has concern about tunica regeneration from graft and lack of long-term results. Previously, we introduced multiple deep grid incisions of Peyronie's plaque to minimize tunical defect with consequent veno-occlusal erectile dysfunction. To assess the efficacy of modified grid incision of plaque and sealing with collagen fleece in postoperative progress of 34 patients for 3 years. From Aug 2018, 34 patients with stable Peyronie's disease (PD) underwent surgery involving three major steps: 1) dissection of the neurovascular bundle or urethra according to plaque location, 2) multiple deep grid incisions of plaque for complete curvature correction, and 3) sealing with collagen fleece without suture. We assessed the stretched penile length, totally straightness, penile sonography, erectile function preoperatively and 3, 6, 12 months and annually postoperatively. This study was approved by the Institutional Review Board. Mean age was 59.4 years (29-72 years). Mean curvature was 53.5 degree (35-100 degree), with hinge and hourglass deformity in 12 and 8 patients, respectively. Five patients required inflatable penile prosthesis (IPP) insertion, with one more at 30 months. The mean follow-up was 42.3 months. Penile rehabilitation, including daily massage, reduced subcutaneous thickening by 12 months postoperatively. All patients initially achieved complete straightness, with two experiencing recurrent curvature. Four patients had subcutaneous hematomas, subsiding in two. Minor skin issues occurred in three IPP patients. Postoperative erectile function was satisfactory in 85.0% of patients. Most regained preoperative length by 1.6 years. Global Assessment Questionniare satisfaction increased from 69.0% at 1 year to 90.0% until 3 years. The modified grid incision with collagen fleece sealing effectively treats PD without causing tunica albuginea defects. Long-term follow-up is essential for monitoring erectile function and penile length recovery, ensuring successful clinical outcomes.