Wound Dehiscence Research Articles

Reconstruction for extensive sacrococcygeal defects in complex tumor patients with personalized customized gluteus maximus myocutaneous flaps

AimTo evaluate the clinical effects of personalized customized gluteus maximus myocutaneous flaps (GMMF) for reconstruction of extensive sacrococcygeal soft tissue defects in complex tumor patients. MethodsA retrospective chart review was conducted on 8 patients who underwent personalized customized GMMF reconstruction for large sacrococcygeal defect from December 2021 to August 2023. The personalized customized GMMF were designed based on the variations of tissue defect in location, shape and volume of different dead spaces. The principle of the personalized GMMF is to ensure that the rotation point of the flap can reach the farthest end of the defect. Patient demographics, operative characteristics, and perioperative risk factors were analyzed. Clinical outcomes were assessed, focusing on complications such as flap necrosis, wound dehiscence, infection, seroma, and hematoma. ResultsSix patients with rectal cancer and two with sacral tumors underwent personalized customized GMMF reconstruction for extensive sacrococcygeal defects. The average volume of the wound cavity was 104 mL, with a mean vertical depth was 10.8 cm. Six patients had low serum albumin (<35 g/L). After a mean follow-up of 15.5 months, no major complications occurred, except for one seroma that resolved within 2 weeks. ConclusionThe personalized customized GMMF described in this study is an effective method for reconstructing large sacrococcygeal wounds with significant depth in complex tumor patients. It allows for greater rotation of the muscle flap into the sacrococcygeal wound defect and provides adequate blood supply by utilizing the bulk of muscle tissue to obliterate dead space.

Wound closure techniques for spinoplastic surgery: a review of the literature.

The approach to skin closure in spinal surgery is dependent on surgeon preference and experience. Wound complications, including dehiscence and surgical site infection (SSI), are common following spine surgery. The authors reviewed various wound closure techniques employed in spinal surgery. A systematic review was conducted to identify articles comparing wound closure techniques after posterior spinal surgery. Articles that employed experimental or observational cohort study designs and reported rates of SSI, dehiscence, or scarring following spinal surgery were included. Eight studies examining closure techniques of the skin were identified: five retrospective cohort studies and three randomized-controlled trials. No differences in the incidence of SSI were reported based on suture technique, although staples were associated with higher SSI rates in single level spinal fusion, and barbed suture resulted in decreased wound complications. The use of intracutaneous sutures was associated with a higher incidence of wound dehiscence when compared to tension-relieving far-near near-far suture (FNS) and far-near near-far interrupted point (FNP) sutures. However, the latter two also resulted in the highest rates of delayed wound healing (i.e., time to fully heal). Modified Allgöwer-Donati suture (MADS) resulted in smaller scar area when compared to vertical mattress suture. Significant differences exist in wound healing when comparing suture techniques in spinal surgery. Surgical staples allow for faster closing time, but are also associated with higher wound complications. Intracutaneous sutures appear to have higher rates of dehiscence compared to vertical mattress suture but display faster wound healing. Future studies are necessary to elucidate contributory factors, including local ischemia and changes in tensile forces. Level IV.

Preoperative Hypoalbuminemia Predicts 30-day Complications in Head and Neck Microvascular Surgery.

Hypoalbuminemia, a marker for poor nutritional status, has been associated with postoperative complications, including head and neck cancer surgery. This study investigates the impact of hypoalbuminemia on head and neck microvascular free tissue transfer reconstruction. This retrospective cohort study queried the 2005-2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available preoperative albumin, BMI, and age were included. Hypoalbuminemia was defined as a preoperative albumin <3.5 g/dL. Univariate and multivariable logistic regression were performed. A total of 3,886 cases met the inclusion criteria, of which 835 (21.5%) had hypoalbuminemia. The hypoalbuminemia cohort was older, had lower BMI, had higher ASA classification, and had worse functional health status. Adjusted multivariable logistic regression showed that hypoalbuminemia was associated with unplanned return to the operating room within 30 days (OR: 1.36, p < 0.01), unplanned reoperation (OR: 1.36, p < 0.01), any complication (OR: 1.77, p < 0.01), surgical complications (OR: 1.94, p < 0.01), and medical complications (OR: 1.34, p = 0.01). Hypoalbuminemia was correlated with a longer hospital stay, superficial surgical site infection, wound dehiscence, transfusion, deep vein thrombosis, and acute renal failure. Hypoalbuminemia is a risk factor for postoperative complications after microvascular free tissue transfer for head and neck reconstruction. This study suggests that preoperative optimization of hypoalbuminemia may be beneficial for these patients. 3 Laryngoscope, 2024.

Early enteral nutrition (EEN) following intestinal anastomosis in pediatric patients – what’s new?

Abstract Introduction Abdominal surgery in children may disrupt normal gut function, necessitating prolonged fasting, which can lead to complications such as dehydration and nutritional deficits. Early enteral nutrition (EEN) after surgical procedures can enhance wound healing, prevent malnutrition, and expedite recovery. Although concerns exist regarding the risk of complications associated with EEN, current evidence suggests that it is not linked to increased perioperative complications. Content This scoping review provides an overview of the role of EEN in pediatric abdominal surgery, exploring its benefits and risks within the context of recent literature from 2021 to 2024. A systematic literature search was conducted using the PubMed database in April 2024 and the identified studies were compared. The search revealed 586 results, wherefrom eight studies (three systematic reviews and five clinical studies) fulfilled the inclusion criteria. Five studies were added since 2021. Overall, EEN may reduce the length of hospital stay, time to full oral intake, and return of bowel function. It does not seem to increase the rate of anastomotic leakage. EEN is associated with lower rates of surgical site infections and wound dehiscence as well as fewer septic complications. One study showed an increase in nausea/vomiting and abdominal distension in the EEN group, which did not lead to further complications. Summary and Outlook Current evidence suggests that EEN after abdominal surgery in pediatric patients is not associated with a higher rate of complications. In fact, EEN seems to be beneficial and lead to improved patient outcomes and shorter hospital stays. Emphasis on patient and parent comfort, individualized feeding initiation based on clinical factors, and standardized postoperative feeding protocols are recommended to optimize outcomes in pediatric abdominal surgery.

Initial case series experience with robotic-assisted transanal minimally invasive surgery performed with da Vinci single-port system for the excision of rectal cancer.

Transanal minimally invasive surgery (TAMIS) is widely used for rectal lesion excision. Robot-assisted TA TAMIS (R-TAMIS) may improve surgical ergonomics. The introduction of the da Vinci Single-Port (SP) robot, designed for endoluminal surgery, has brought new possibilities. Our primary objective herein was to assess the technical and oncological feasibility and efficacy of Single-port robotic TAMIS (SPR-TAMIS) in rectal cancer excision. The secondary objective was to analyze the perioperative outcomes. We included 14 consecutive patients with rectal cancer who underwent SPR-TAMIS between April 2021 and February 2023. Patient data, surgical details, and clinical outcome data were collected to assess the safety and feasibility of SPR-TAMIS. The median participant age was 72years, and full-thickness excision was performed without specimen fragmentation in all cases. The median tumor diameter was 2.7cm, positioned between 10cm proximally and 7cm distally from the anal verge. Negative margins were achieved in 93% of cases, with one case requiring further resection. The median operative time was 175min, and the median hospital stay was 5days. No intraoperative conversion from SPR-TAMIS to laparoscopic or conventional transanal excision was required. No mortalities or major postoperative complications occurred; however, one patient (7.1%) experienced minor morbidity manifesting as wound dehiscence (Clavien-Dindo grade I). No recurrence was observed during the 24-month follow-up. In our early experience, SPR-TAMIS is a safe and feasible surgery for selected early stage rectal cancers, offering enhanced visualization and stable maneuverability transanally. This platform may have potential advantages for the excision of larger or more proximal lesions.

Prospective analysis of STRATAFIX™ symmetric PDS plus suture for fascial closure in spinal surgery: a pilot study

Wound closure is an integral part of every spinal procedure. Effective and secure wound closure is paramount in the prevention of infection, wound dehiscence and the preservation of cosmesis. Barbed suture technologies such as STRATAFIX™ Symmetric have been studied and are used in a variety of specialties, including obstetrics and orthopedic surgery, but is underutilized in neurosurgery. This study aims to assess the time and rate of closure using STRATAFIX™ Symmetric technology for fascial closure and compare this method to the more traditionally used method of fascial closure using braided absorbable sutures below the epidermis. 20 patients were recruited for the study. 10 patients underwent fascial approximation with braided absorbable sutures and definitive fascial closure with STRATAFIX™ Symmetric. In the control group, fascial closure was completed entirely with interrupted braided absorbable stitches. Patients assigned to STRATAFIX™ Symmetric group had shorter mean time for fascial closure, faster rate of average fascial closure, and lower number of total sutures used. The use of barbed suture technology such as STRATAFIX™ Symmetric may reduce the time to closure in thoracolumbar spine surgery without increasing the risk of adverse events. This pilot study forms the framework for a larger randomized, controlled trial appropriately powered for such an analysis.

Utility of Keystone Flap in Armory of Dermatosurgeons

Abstract Purpose and Background: To create awareness among dermatosurgeons about the versality of keystone flaps in re-surfacing post-excisional small, medium and large skin defects. Aims and Objectives: Single-staged tension free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome. Material and Methods: This retrospective study was conducted, between October 2021 – January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years. Sixteen Keystone flaps (type IIA n=13, Omega cum Sydney melanoma unit modification n=3) were utilized for resurfacing skin defects arising after excision of basal cell carcinoma (n=3) and benign hairy nevus (n=2) on cheek, basal cell carcinoma forehead (n=1), electric burns on deltoid (n=2), giant neurofibroma back (n=1), tattoo forearm (n=3), chronic non-specific granuloma thumb (n=2) and pilonidal sinus disease (n=2). Skin with maximum expansibility was chosen as donor site with utmost care of facial lines and its aesthetic subunits. Flaps were dissected all around preserving maximum number of hand-held doppler-identified perforators in pedicular area. Sutures were removed on 10th to 15th post-operative day. Follow-ups ranged from 2 to 15 months. Results: None had wound dehiscence or loss of flap. Conclusion: Keystone flaps have defect-adaptive design, simple bio-geometry, technical simplicity, decreased downtime, cost effectivity and efficiency and can be designed to resurface post-excisional skin defect from head to toe with acceptable results, therefore should strongly be considered by dermatosurgeons while excising skin lesions.

Role of nutrition in orthopedic trauma and surgery-A prospective study

: Nutrition is an age-old issue of human civilization with approximately 40% undernourished hospitalized inpatients. This has effect on surgery as healthy individuals have better tolerance than malnourished patients. : This study was designed to evaluate the effect of nutrition on patients who had undergone different types of Orthopedics surgeries. This prospective research involved 200 participants who received various orthopedic surgeries at a tertiary care facility. The evaluation of nutritional status involved measuring anthropometric (BMI) and biochemical markers (pre-albumin and transferrin) before, after, and three months after surgery for various age groups, genders, comorbidities like diabetes and hypertension, as well as for complications like urinary tract infections and surgical wound dehiscence. Version 16 of the SPSS statistical analysis program was used for the analysis. Chi Square and the repeated variable ANNOVA test were the tests employed.: 113 patients were followed up prospectively with 4.42% under nourishment rate. Nutritional markers were statistically significant values at pre,post and at 3 months of post op. Diabetes and age more than 40 years were two important parameters affecting nutrition of patients undergoing different orthopedic surgeries. Surgical wound infection was not related to nutritional status of the patient in this study. Pre albumin was found to be a better predictor of nutrition than transferrin.: This study clearly showed that nutrition has tremendous impact on the outcome different orthopedics surgeries. But needs more extensive research with huge sample size to prove the same in a more accurate way.

Drains in Abdominoplasties: The Less the Better?

Drains are traditionally inserted during surgery for reduction of fluid accumulation in the post-operative period. The appearance of drained fluids and their quantity can be early predictors of complications. Over the years, several studies have been conducted in attempt to determine the optimal number of drains that result in low rates of fluid accumulation with minimal impairment of quality of life. Determine the optimal number of suction drains in abdominoplasty procedures. Retrospective cohort study, analyzing all abdominoplasty patients operated by a single surgeon. Patients were stratified into 3 groups based on number of drains inserted at the end of the procedure. Rate of complications was compared between the groups and a multivariate logistic regression model was computed for the development of complications. Seven-hundred and forty three patients were included in the analysis of this study. No drains were inserted in 355 patients (45%), whereas a single drain was inserted in 153 (20.6%) 2 drains in 255 patients (34.4%). Patients for whom a single drain was inserted intra-operatively, experienced at a statistically significant lower rate, surgical site infections (OR = 0.235), hypertrophic scars (OR = 0.326), wound dehiscence (OR = 0.272), as compared to patients with no drains. On the contrary, insertion of single drain was associated with a statistically significant higher risk for development of seroma (OR = 6.276) and the need for revision surgery (OR = 2.452). Insertion of a single drain is associated with a lower risk of SSI and wound- dehiscence, but a greater risk for seroma development that requires surgical intervention. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Safety and Efficacy of One vs Two Incision Broström Gould with Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery

Surgical intervention, such as the Broström-Gould procedure, is typically indicated for patients with chronic lateral ankle instability. In this study, we are comparing the safety and efficacy of the Broström-Gould procedure with peroneal tendon debridement, a sliding lateralizing calcaneal osteotomy, and adjuvant procedures performed with a single- versus double-incision approach. Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into 2 groups: undergoing either a 1-incision (n = 53) or a 2-incision approach (n = 47), both with a lateralizing calcaneal osteotomy. A significant difference in skin bridge breakdown was observed between the 2-incision (n = 6 [13%]) and 1-incision groups (n = 0 [0%]). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the 2 groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts. The described Broström-Gould procedure shows promise for treating chronic ankle instability. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the 1incision group highlights the approach's safety and potential benefits in reducing wound-related complications.

A 10/14 French silicone urinary catheter with inflatable balloon used as novel expansion device in lid reconstruction surgery.

To describe the surgical technique using a 10/14 French silicone urinary catheter as a novel tissue expander for repair of defects after removal of eyelid tumors. This device recruits additional tissue by tissue expansion for repair of large eyelid defects. A prospective noncomparative, interventional case study was conducted over a period of 3 years in which 30 patients were enrolled. All the 30 patients were selected for upper or lower lid Tenzel rotational flap after removal of large malignant tumor, using the tissue expander. A 10/14-French silicone urinary catheter was placed in the periocular region and expanded by graded inflation with normal saline to a total volume of 10 or 14 ml, respectively, over a period of 3 days. On the fourth day before the planned surgery, the catheter balloon was deflated and a modified Tenzel rotational flap was performed to close the defect. Postoperative blink reflex was preserved. There were no cases of wound dehiscence. There was a significant reduction of incision length in upper and lower lid reconstruction with modified Tenzel flap reconstruction. This approach allows for temporary tissue expansion, permitting the closure of large eyelid defects, typically not possible with a conventional Tenzel flap. This also provides excellent functional outcomes without closing patients' eyelids (which limits vision for weeks to months) as is typical of other reconstructive modalities (e.g. Cutler Beard procedure). The device is cost-effective and readily available. The authors believe it is an excellent alternative in the developing world where access to more expensive options is limited.

Impact of systemic lupus erythematosus (SLE) on outcomes following aseptic and septic revision total knee arthroplasty: an analysis of the 2005-2018 nationwide inpatient sample.

Systemic lupus erythematosus (SLE) can adversely affect surgical outcomes, and the impact on revision total knee arthroplasty (TKA) outcomes is unclear. This study aimed to explore the impact of SLE on in-patient outcomes of revision TKA. The Nationwide Inpatient Sample (NIS) database from 2005 to 2018 was searched for patients aged ≥ 18years old who received revision TKA. Patients with and without SLE were propensity score matched (PSM) at a 1:4 ratio. Associations between SLE and in-hospital outcomes were examined using regression analyses. The study included 133,054 patients, with 794 having SLE. After 1:4 PSM, data of 3,970 patients were analyzed (SLE, 794; non-SLE, 3,176). Multivariate-adjusted analyses revealed that SLE patients had a significantly higher risk of postoperative complications (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI]: 1.05-1.44, p = 0.011), non-routine discharge (aOR = 1.22, 95% CI: 1.02-1.46, p = 0.028), major blood loss (aOR = 1.19), respiratory failure/mechanical ventilation (aOR = 1.79), acute kidney injury (AKI) (aOR = 1.47), and wound dehiscence (aOR = 2.09). SLE patients also had a longer length of hospital stay (aBeta = 0.31) and greater total hospital costs (aBeta = 6.35) compared to non-SLE patients. Among those with aseptic failure, SLE patients had a significantly higher risk of postoperative complications (aOR = 1.23) and non-routine discharge (aOR = 1.36). SLE is independently associated with worse in-hospital outcomes in patients undergoing revision TKA. This study highlights the importance of heightened vigilance and tailored perioperative management for patients undergoing major surgeries in the background of SLE. Key Points • SLE significantly increases the risk of non-routine discharge, major blood loss, respiratory failure, acute kidney injury, and wound dehiscence, in patients undergoing aseptic and septic revision TKA. • Patients with SLE experience longer hospital stays and higher hospital costs compared to those without SLE. • The study's findings highlight the necessity for healthcare providers to consider the presence of SLE as a critical factor in preoperative planning and postoperative care to improve outcomes in revision TKA patients.

Ensuring Neurosurgical Equity: Setup for Safe Ventricular Endoscopy and Predictors of Clinical Outcome in a Resource-Limited Health Care System

Background/ObjectiveNeuroendoscopic surgeries require specialized equipment, which may not be universally available or equitably distributed in most neurosurgical units of resource-limited healthcare systems. This review reports on the use of locally available resources to perform safe ventricular endoscopic surgeries in patients with hydrocephalus and cystic craniopharyngioma, in a resource-limited health care system. MethodsThis study, described the use of locally available resources to perform intraventricular endoscopic surgeries, and retrospectively reviewed a three-year outcome of these surgeries, The authors, used a 24Fr, 2-way Foley's catheter, that served as an endoscopic working sheet. A transparent 9mm naso-tracheal tube, that served as a retractor and a peel-away sheet. An intravenous fluid (IVF) giving set, was used for irrigation, and a metallic stylet of External ventricular drain(EVD) was used for third ventricular floor or cyst wall fenestration. ResultsTwenty-one intraventricular endoscopic surgeries were performed, consisting; of endoscopic third ventriculostomy (ETV), septostomies, cystostomies, and intraventricular biopsies. Mortality occurred in four patients, with one of the mortality, directly related to intraoperative hemorrhage. Most (3/21) of the complications were post-operative CSF leakage and partial wound dehiscence. Of the 17 surviving patients, the ETV success rate was 82.4% (14/17). Logistic regression analysis revealed that the patient's age, etiology, ETV success score (ETVSS) and procedure performed were not predictive of ETV success or mortality. ConclusionsPatients accessing neurosurgical care in resource-limited healthcare systems can benefit from safe and successful intraventricular endoscopy. However, this may require the innovative use of locally available resources that can be adapted to local neurosurgical needs.

Postoperative Nausea and Vomiting in the Ambulatory Surgery Center: A Narrative Review.

Postoperative nausea and vomiting (PONV) is a common complication of ambulatory surgery, leading to numerous deleterious effects such as decreased patient satisfaction, prolonged recovery unit stays, and rarely, more serious complications such as aspiration pneumonia or wound dehiscence. In this paper, we present a narrative review of the literature regarding common risk factors for PONV including patient factors, surgical factors, and anesthetic factors. We then will review anesthetic techniques and antiemetic drugs demonstrated to mitigate the risk of PONV. Finally, we discuss the potential economic benefits of PONV prophylaxis in the perioperative ambulatory setting.

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review.

Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using neuraxial anaesthesia as the primary anaesthetic technique in emergency laparotomies. We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Neuraxial anaesthesia was employed as the main anaesthetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoperative pain control, the incidence of postoperative complications, and mortality rates. Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in seven patients (44%). The observed mortality rate was relatively low at 6% (one patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that neuraxial anaesthesia may be a useful alternative in emergency settings. However, the occurrence of postoperative complications in 44% of patients indicates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this technique on patient outcomes in emergency laparotomies.

Incidence and related risk factors for postoperative delirium following revision total knee arthroplasty: a retrospective nationwide inpatient sample database study.

Postoperative delirium (POD) is a common surgical complication. However, the incidence and risk factors associated with postoperative delirium after revision total knee arthroplasty (rTKA) have not been comprehensively explored through extensive national databases. Utilizing the National Inpatient Sample (NIS), the largest comprehensive U.S. hospital healthcare database, we undertook a retrospective investigation involving 127,400 patients who underwent rTKA between 2010 and 2019. We assessed various aspects, including patient demographics, hospital characteristics, pre-existing medical conditions, and perioperative complications. The overall incidence of postoperative delirium (POD) in patients undergoing rTKA between 2010 and 2019 was 0.97%. The highest incidence rate of 1.31% was recorded in 2013. Notably, this patient cohort demonstrated advanced age, increased burden of co-morbidities, prolonged hospital stays, increased hospitalization costs, and elevated in-hospital mortality rates (P < 0.001). Moreover, non-elective admissions, non-private insurance payments, and a preference for teaching hospitals were commonly observed among these patients. During their hospitalization, individuals who developed delirium subsequent to rTKA were more prone to experiencing certain perioperative complications. These complications encompassed medical issues like acute myocardial infarction, continuous invasive mechanical ventilation, postoperative shock, sepsis, stroke and other medical problems. Additionally, surgical complications including hemorrhage / seroma / hematoma, irrigation and debridement, prosthetic joint infection, periprosthetic fracture, and wound dehiscence / nonunion were noted. Several risk factors were found to be linked with the development of POD. These included advanced age (≥ 75years), alcohol abuse, coagulation disorders, congestive heart failure, depression, fluid and electrolyte imbalances, and more. Conversely, female sex, having private insurance, and undergoing elective hospitalization emerged as protective factors against POD. Our findings suggest that the general prevalence of POD in rTKA is relatively low according to NIS. There was a significant connection between the POD of rTKA and advanced age, prolonged length of stay (LOS), more in-patients' costs, higher in-hospital mortality rate, increased comorbidities, postoperative medical complications and postoperative surgical complications. This study helps to understand the risk factors associated with POD to improve poor outcomes.

Simplified medial canthoplasty: Technique and early postoperative complications in 601 dogs (1180 eyes).

To present a novel modified medial canthoplasty (MCP) technique, the application in 601 dogs (1180 eyes), and a review of the early postoperative complications related to the technique. Macroblepharon and nasal entropion is a common presentation in many brachycephalic dog breeds promoting chronic keratitis. The previously described MCP techniques limit the medial shortening of the eyelids to the location of the lacrimal puncta. A novel technique was developed allowing for a more extensive eyelid shortening nasally. The modification of the here described technique includes the longitudinal splitting of the lacrimal canaliculi allowing for an extensive shortening of the lids beyond the lacrimal puncta. Records of 601 dogs which underwent the modified MCP were reviewed regarding breed, indications for surgery, follow-up, and early postoperative surgical complications. Descriptive statistics were applied. Six hundred one dogs (1180 eyes) were included in this study. Twenty-four different breeds underwent the simplified MCP with the Pug (n = 403) being the most represented breed. Indications were macropalpebral fissure, medial entropion, pigmentary keratitis, trichiasis by haired caruncle, strabismus after globe prolapse, and facial nerve paralysis. The overall complication rate was 1.01% (12/1180) and consisted of wound dehiscence 0.59% (7/1180), corneal ulceration caused by suture material 0.25% (3/1180), and wound infection (2/1180). None of the 601 operated dogs developed serious complications related to the surgical technique. The simplified MCP is a novel technique with a very low complication rate.

Indications, operative techniques, and outcomes of occipital artery-vertebral artery bypass: an institutional series.

Posterior circulation cerebral bypasses often show higher risks and lower patency. Only few reports discussed occipital artery (OA)-vertebral artery (VA) bypasses. We present our illustrative cases to address current gaps in the literature on OA-VA bypass. A single-center retrospective review was conducted to include all institutional cases of OA-VA bypass, discussing the technique and outcomes. Four institutional cases undergoing a total of 5 bypasses were evaluated, including 3 males and 1 female, with median age of 65years (range, 62-73). All patients had vertebrobasilar insufficiency (VBI) with recurrent strokes/TIAs due to intracranial atherosclerosis, leading to unilateral VA stenosis with contralateral occlusion (1, 25%), bilateral VA stenosis (1, 25%) or occlusion (1, 25%). Medical management included aspirin for all cases (100%), with clopidogrel in 3 (75%). Surgery was performed through a far lateral approach, connecting the OA to the VA-3 segment, with no inter-positional graft. One patient underwent contralateral OA-VA bypass 6months after the prior surgery due to worsening of the contralateral VA stenosis. Bypass patency was confirmed in all cases with post-operative angiography. All patients had clinical improvement, with one case of wound dehiscence managed conservatively. All patients were alive at last follow-up (median 7.0months; range: 1.5-18). OA-VA bypass is a challenging yet effective strategy in selected patients with VBI. Current literature lacks unique definitions of surgical indications and techniques, which we addressed in our series. Surgical education should focus on expanding the microsurgery anatomy knowledge.

A Sustainable Solution for Reducing Draping Waste in Cleft Surgeries.

This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair. A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques. All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists. The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison. Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards. Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence. The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group. Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes.

Comparative Efficacy of Wound Drainage and Non-Drainage in Posterior Spinal Surgery

Background: The recent trend has been toward recommendation of nondrainage in spinal surgery. However, the use of drains following posterior spinal surgery is still controversial. It has been claimed that wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Suction drainage is used to minimize infection, prevention of wound swelling, improvement of the local wound environment, prevent hematoma and /or seroma formation. The aim of this study was to determine the incidence of post-operative complications after posterior lumbar instrumentation with and without a subfascial drain. Methods: This is prospective analysis of 32 adult (≥18 years old) spine patients that underwent elective and emergency posterior lumbar instrumentation at Kathmandu Medical College Teaching Hospital, from January to December 2023. There were randomly assigned 16 (50%) patients who had a post-operative drain and 16 (50%) patients who did not have a postoperative drain (No-Drain: n=16; Drain-Use: n=16). Patient demographics, comorbidities, intra- and post-operative complication rates were collected for each patient. The primary outcome investigated in this study was pain, the need for post-operative transfusion, dressing changes, surgery – discharge interval, the rate of post-operative complications, specifically surgical site infections (SSI) and hematoma formation. Data was analyzed using SPSS statistics version 29 (IBM Corp., New York). Results: Our study revealed that no significant differences regarding wound infection (P = 1), hematoma, neurological injury, estimated blood loss (P = 0.3), or dry and moderate dressing drainage between the groups. There were no 30-day hospital readmission or incidence of 30-day wound dehiscence, draining wound or bleeding between both patient groups. Conclusions: There is no obvious advantage of the application of suction drains for spinal surgery. There was no significant difference in the rate of infection or wound healing and no patient developed a postoperative neurologic deficit. However, a decision of wound drainage or wound non-drainage should be individualized for each patient because many factors affect the outcomes.