Developed Wound Complications Research Articles

The Prevena Restor Bella.FormTM in the management of lower limb traumatic wounds

Objectives: The Prevena Restor Bella.FormTM is a novel closed incisional negative pressure wound therapy with a 14 day lifespan and a large contact area. This study aims to demonstrate the utility of the Prevena Restor Bella.FormTM in high risk lower limb traumatic wounds. Methods: 4 consecutive patients with complex traumatic lower limb wounds were included. The Prevena Restor Bella.FormTM was applied as a primary therapy or an adjunct to soft tissue reconstruction. Wounds were monitored fortnightly, limb circumference measured and patient satisfaction assessed by a questionnaire. All 4 patients healed within 6 weeks of Prevena application. Results: No cases developed wound complications. Limb oedema, assessed by circumference, decreased in all patients within 2 weeks. All patients were satisfied with the Prevena Restor Bella.FormTM with regards to comfort and mobility. Conclusions: Prevena Restor Bella.FormTM demonstrated clinical effectiveness in all patients, and was universally well tolerated. Level of Evidence: IV

Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study.

Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.

SP7.11 Outcomes of Elective and Emergency Surgical Repair of Incisional Hernia - A Comparative Observational Study

Abstract Aims Incisional hernia (IH) is a common complication after abdominal surgery. This study aims to describe and compare the outcomes of IH's elective and emergency surgical repair. Methods A single-centre comparative retrospective study including all patients who had surgical repair of IH. The patients were divided into Group I (Emergency) and Group II (Elective). A comparison was made between the two groups. Results 262 patients were identified with a mean age of 61.8 SD±14.2 years, and 152 (58%) were females. More than 58% had at least one comorbidity. 169 (64.5%) had elective, and 93 (35.5%) had emergency repair. Patients undergoing emergency repair of IH were significantly older and had higher BM, p= 0.031 and 0.002, respectively. The overall complication rate in the full cohort was 46.2%, and the significant complication rate (Clavien-Dindo III and IV) was 9.54%. The 30-day and 90-day mortality rates were 6 (2.3%) and 7 (2.68%), respectively. In the emergency group, the complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p= <0.001, 0.002 and 0.001, respectively. The emergency group had a significantly longer hospital stay, and more of them needed a higher level of care, p= <0.001 each. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) patients had a recurrence, and 41 (15.71%) had 90-day readmissions without significant differences between the two groups. Conclusions IH is associated with medical comorbidity and high BMI. Emergency repair of IH is associated with higher complication rates and mortality compared to elective repair.

D104. Use Of SPY-QP To Predict Mastectomy Skin Flap Wound Complications in Immediate Breast Reconstruction

PURPOSE: SPY-QP® enables surgeons to assess relative perfusion quantitatively and in real-time; however, studies assessing its utility in predicting wound complications following breast reconstruction are limited. METHODS: Perfusion values were prospectively collected on patients undergoing staged breast reconstruction. There is currently no consensus on cut-off values for low perfusion, therefore the following values were used: 33% (reported by Moyer et al) and 30.0145% (calculated by the Youden index based on a logistic regression model). RESULTS: Twenty-four patients with 34 breasts underwent tissue expander (TE) placement at the time of mastectomy. SPY-QP was used after the TE was placed and filled with air to better reflect the postoperative state of the skin flaps. 4 breasts developed wound complications in areas with corresponding SPY-QP values of less than or equal to 30% (9.0-30.0%). The 33% cut-off yielded an odds ratio (OR) of 20.368 (95% CI: 0.9-450.7) for wound development, whereas the 30.0145% cut-off yielded an OR of 28.201 (95% CI: 1.3-632.8). When adjusted for nitroglycerin ointment usage, the OR was 16.827 (95% CI: 0.8-363.0), suggesting that it may interfere with wound development. CONCLUSION: SPY-QP® can safely predict wound development in breast reconstruction patients and guide clinical management of breast skin flaps. We suggest using a perfusion cut-off value of 30.0145%; however, larger, prospective studies are needed.

Prophylactic Muscle Flaps Decrease Wound Complication Rates in Patients with Oncologic Spine Disease.

Patients with oncologic spine disease face a high systemic illness burden and often require surgical intervention to alleviate pain and maintain spine stability. Wound healing complications are the most common reason for reoperation in this population and are known to impact quality of life and initiation of adjuvant therapy. Prophylactic muscle flap (MF) closure is known to reduce wound healing complications in high-risk patients; however, the efficacy in oncologic spine patients is not well established. A collaboration at our institution presented an opportunity to study the outcomes of prophylactic MF closure. The authors performed a retrospective cohort study of patients who underwent MF closure versus a cohort who underwent non-MF closure in the preceding time. Demographic and baseline health data were collected, as were postoperative wound complication data. A total of 166 patients were enrolled, including 83 patients in the MF cohort and 83 control patients. Patients in the MF group were more likely to smoke ( P = 0.005) and had a higher incidence of prior spine irradiation ( P = 0.002). Postoperatively, five patients (6%) in the MF group developed wound complications, compared with 14 patients (17%) in the control group ( P = 0.028). The most common overall complication was wound dehiscence requiring conservative therapy, which occurred in six control patients (7%) and one MF patient (1%) ( P = 0.053). Prophylactic MF closure during oncologic spine surgery significantly reduces the wound complication rate. Future studies should examine the precise patient population that stands to benefit most from this intervention. Therapeutic, III.

Surgical treatment outcome of children with neural-tube defect: A prospective cohort study in a high volume center in Addis Ababa, Ethiopia

IntroductionPrevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric neurosurgical specialty center. Research questionThe primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality. Material and methodsSingle-center prospective study of all surgically treated NTDs from April 2019 to May 2020. ResultsA total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01). Discussion and conclusionThe study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.

Risk Factors for Wound Complications Following Conversion TKA after Tibial Plateau Fracture.

The purpose is to investigate the incidence of wound complications for total knee arthroplasty (TKA) following tibial plateau open reduction and internal fixation (ORIF). A prospective arthroplasty registry was queried for patients with CPT codes for primary TKA, tibial plateau ORIF, removal of hardware (ROH), and diagnosis of post-traumatic arthritis. Patients were included if they had undergone tibial plateau ORIF and subsequent TKA. Chart review was performed to obtain demographic, clinical and post-operative information. Twenty-one patients were identified, with average age of 56.23 ± 13.2years at time of tibial plateau ORIF and 62.91 ± 10.8years at time of TKA. Seven (33.3%) patients had a tibial plateau fracture-related infection (FRI). Eight (38.1%) patients underwent ROH prior to TKA. Seven (33.3%) patients' TKA incision incorporated the prior plateau incisions. Eight (36.4%) patients developed wound complications following TKA and 5 (23.8%) developed an acute periprosthetic joint infection (PJI) following TKA and had the plateau incision incorporated into the TKA incision. FRI history did not increase the rate of wound complications but did increase the rate of ROH prior to TKA. Previous FRI involving tibial plateau repair surgery doesn't correlate with PJI after conversion TKA for post traumatic OA. Surgeon-controlled factors such as staged ROH and incision placement can help reduce the rate of wound complications following TKA performed after tibial plateau ORIF. Prognostic Level IV. The online version contains supplementary material available at 10.1007/s43465-022-00709-1.

Open Anterior Component Separation for Complex Incisional and Ventral Hernias—When and How? Case Series Analysis

Abstract Closing the midline in patients with incisional hernias is the cornerstone for a functional reconstruction with low morbidity, low recurrence rates, and good cosmetic results, which is the ideal outcome for every hernia surgeon. However, in patients with large hernias (usually over 10 cm width) or in loss of domain cases, this goal is difficult to achieve. Anterior component separation with or without mesh reinforcement has been the procedure of choice for these patients despite its high rate of wound complications. The goal of our study is to evaluate the opportunity and necessity of the anterior component separation in patients with complex incisional or ventral hernias (defects larger than 10 cm, infected meshes). Data of patients with large incisional/ventral hernia operated using anterior component separation technique in the past 10 years were re-visited and analyzed from hospital records between January 2012 and December 2020. Demographic data (age, gender, body mass index, ASA score) and the main steps of the technique were recorded. Data were reported as mean and standard deviation. We used the anterior component separation in 66 cases, mainly for septic conditions (open abdomen, chronic and extended infections of the abdominal wall, chronic-infected meshes). For large parietal defects with aseptic local condition, we used mesh-reinforced anterior component separation (five patients). Mean age was 68.7 years. Among them, 29 patients developed wound complications (hematoma, seroma, infection). Mean hospital stay was 12.6 days. Recurrence was 18% in patients without mesh and zero in patients with mesh reinforcement after a minimum one-year follow-up. Anterior component separation is still a valid procedure in patients with large abdominal defects especially when a septic wound is to be closed. For large parietal defects, if a wide subcutaneous dissection is required, mesh-reinforced anterior component separation remains a valid alternative in abdominal wall reconstruction in certain cases (mainly aseptic conditions).

Preoperative arterial embolization and wound complications after resection of malignant bone tumor in the pelvis: a nationwide database study.

Massive intraoperative blood loss is common in pelvic malignant bone tumor surgery, and preoperative arterial embolization may be used in selected cases. Preoperative arterial embolization reportedly increases wound complications in pelvic fracture surgery, but little evidence is available regarding pelvic bone tumor surgery. Using a Japanese nationwide database (Diagnosis Procedure Combination database), we searched for patients who underwent pelvic malignant bone tumor surgery between July 2010 and March 2018. The primary endpoint was wound complications, defined as any wound requiring re-operation, negative pressure wound therapy or both. Univariate analyses (the chi-squared test for categorical variables, the unpaired t-test for continuous variables) and multivariate logistic regression analyses were performed to examine the association between preoperative arterial embolization and wound complications. Among the 266 eligible patients, 43 (16%, 43/266) underwent embolization and 69 (26%, 69/266) developed wound complications. In the univariate analyses, preoperative arterial embolization (P<0.001), duration of anesthesia (P<0.001), the volume of blood transfusion (P<0.001) and duration of indwelling drain tube (P<0.001) were associated with wound complications. In the multivariate logistic regression analysis, preoperative arterial embolization was significantly associated with wound complications (odds ratio, 3.92; 95% confidence interval, 1.80-8.56; P=0.001). Preoperative arterial embolization may be associated with increased wound complications after pelvic malignant tumor surgery.

Clinical and PROMIS Outcomes of Maisonneuve Fractures

Category:Ankle; TraumaIntroduction/Purpose:Torsional injury to the foot and ankle may result in high fibular fracture with disruption of the syndesmotic ligaments, interosseous membrane, and other associated injuries to medial, posterior structures of the ankle. High Fibular Fracture at the fibular neck is referred as Maisonneuve Fracture of Fibula (MFF). These injuries are often missed or misdiagnosed as ankle sprains. Most of the current classification consider MFF a variant of ankle fracture with disruption of syndesmosis and high fibular fracture {Lauge Hansen PER, AO C3, Weber type C}. Only a few articles have described associated injuries and surgical treatment outcomes. The study's primary aim is to evaluate the associated injuries of MFF and the outcomes of our treatment approach.Methods:All patients undergoing syndesmotic fixation (CPT 27829) at a large tertiary academic center from 2012-2020 were identified. In these 748 patients, patient radiographs were reviewed to identify patients with Maisonneuve fractures (AO-44C3). Medical records were reviewed for patient characteristics, energy information of original injury, operative variables, and complications. Radiographic reduction was assessed on standard radiograph with assessment of the tibiofibular clear space and tibiofibular overlap on AP and mortise views, talocrural angle, the medial clear space, shenton line, and fibular station. An abnormality in one of these parameters was considered an abnormal reduction. Patients were contact to complete PROMIS Physical function and Pain Interference postoperatively. A total of 24 patients with Maisonneuve fractures were identified and included in analysis. Eleven patients completed PROMIS outcomes measures for a response rate of 55%, as four patients were deceased or incarcerated at the time of survey.Results:The average age was 45.3 (16 SD) with a mean BMI of 31.3 (10.4 SD). Nineteen patients were male (79.2%) with only 5 females (20.8). The mechanism of injury was low energy in 16/24 patients (66.7%) leaving 8 (33.3%) patients with high energy mechanisms. In addition to the high fibular fracture, a total of 13 patients (54.2%) had a posterior malleolar fracture, 11 (45.8%) had a medial malleolar fracture, and 8 (33.3%) had a deltoid ligament injury. Seven patients (29.2%) received screw fixation compared to 14 patients (58.3%) with tightrope fixation. Three patients (12.5%) received both tightropes and screws. No patient developed wound complications, and two patients underwent reoperation. Abnormal reduction occurred in 5/24 patients (20.8%) at final clinical follow up. At a median of 20 months (25 IQR) postoperatively, the median PROMIS physical function and pain interference scores were 41.2 (13.0 IQR) and 52.8 (4.8 IQR), respectively.Conclusion:Maisonneuve fractures are an extremely rare ankle fracture variant with a diverse subset of injury patterns. Our results show the clinical outcomes of Maisonneuve fractures are largely satisfactory in terms of wound complications and intermediate term outcomes. While 21% of patients were determined to have abnormal reduction postoperatively, we are limited by the inherent difficulties of assessing syndesmosis on plain radiographs rather than advanced imaging. PROMIS outcome scores demonstrate Maisonneuve fractures patients are more impacted by loss of function than pain, but both are within a standard deviation of the population mean.

Management of incisional hernias in liver transplant patients

PURPOSE: The purpose of this study is to describe an optimal management strategy for incisional hernias in liver transplant patients. METHODS: Patients were identified who underwent open preperitoneal hernia repair for incisional hernia following liver transplantation. Perioperative management and surgical technique were described; wound complications and hernia recurrence were the primary outcomes assessed. RESULTS: A total of 17 patients met our criteria. All patients were on immunosuppression, and one patient (5.9%) had sirolimus stopped prior to the operation. One patient (5.9%) quit smoking, and two patients (11.8%) required optimization of their diabetes to have an A1c ≤7.2. Two patients (11.8%) received botulinum toxin A preoperatively due to significant loss of domain. The mean size of the biologic mesh was 818.8 ± 210 cm2, one patient (5.9%) received an anterior component separation and four (23.5%) received a panniculectomy. Postoperatively, three patients (17.7%) developed wound complications and one patient required reoperation for seroma. There were no 30-day readmissions and no hernia recurrences with mean follow-up time of 21.6 ± 11.6 months. CONCLUSION: The use of preperitoneal biologic mesh is an effective method for the management of incisional hernia in liver transplant patients; perioperative optimization and care are also influential in assuring positive outcomes for patients.

Risks factors FOR wound complications after cesarean section

ObjectiveThe primary outcome was to determine risks factors for wound complications after cesarean section. Secondary outcome was the management of these complications. Study DesignWe performed a retrospective cohort study of consecutive cesarean deliveries performed at a secondary care facility between June 2017 and June 2019. Composite wound complications included infection, disruption and fluid collection occurring 30 days post-operatively. Medical records were reviewed and data including patient demographics, comorbidities, intra-partum characteristics were evaluated as potential risk factors for wound complications using multivariate logistic regression. Secondarily, post-operative management of wound complications was described. ResultsAmong 1520 patients undergoing cesarean section during the period of study, 67 developed wound complications (4.4 %). Mean Duration of local wound care was 41.35 days (2–95). Mean number of wound care related visits in our hospital was 4.85(1–11). Multivariate logistic regression analysis showed 2 significant independant risk factors: preeclampsia with OR 5.60, 95 % CI 2.83, 11.11 (p:<0.001), and premature rupture of the membranes with OR 9.76, 95 % CI 2.13, 44.77 (p: 0.003). ConclusionPreeclampsia and premature rupture of the membrane were independent risk factors for wound complications after cesarean section. Information regarding higher rates of wound complications and preventive measures should be provided to high-risk women prior to surgery.

Adverse Events Following Minimally Invasive Achilles Tendon Repair.

The rate of wound complications following traditional open Achilles tendon repair is reported at 7.6%. The purpose of this study is to characterize the rate of wound and other early complications following a specific minimally invasive Achilles tendon repair technique, and to identify any factors associated with increased risk. The postoperative courses of 99 patients who underwent minimally invasive Achilles tendon repair by 2 surgeons at separate academic medical centers were retrospectively reviewed. Mean follow-up was 8.1 months (range 3.0-24.6 months). Repair technique was similar in all cases with the exception that 71 procedures used a longitudinal incision and a tourniquet, while 28 procedures used a transverse incision and no tourniquet (surgeon preference). The rates of complications were compared between patients with differing baseline and procedural characteristics. Of the 99 patients included in the study, 2 (2.0%) developed wound complications. There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (2.8% vs 0%; P = 1.000). Four patients (4.0%) developed sural neuropraxia. One patient developed deep venous thrombosis. There were no cases of rerupture. At final follow-up, all 99 patients had intact Thompson tests and well-healed wounds. The rate of wound complications following minimally invasive Achilles tendon repair is low at 2.0%. Patients should be counseled that although risk for wound complications may be lower with this minimally invasive technique, there are risks for sural neuropraxia and deep suture reaction. Level III, Retrospective study.

Predictors of Postoperative Complications in Patients Undergoing Below Knee Amputation

To identify risk factors for development of wound complications in patients undergoing a below knee amputation (BKA). Retrospective chart review was performed of patients who underwent BKA between January 1, 2014, and December 31, 2016. Data on patient demographics, preoperative comorbidities, limb salvage attempts (LSA) before amputation, and outcomes after BKA were collected for each limb analyzed. LSAs were defined as endovascular revascularization, open surgical revascularization, wound debridement requiring intravenous sedation or general anesthesia, and amputation at or below the level of transmetatarsal amputation. Postoperative wound complications were defined as residual limb wound infection or nonhealing wound. Primary outcome was the need for procedural reintervention on the ipsilateral limb within 12 months of the initial amputation (washout, debridement, or revision to higher level). There were 155 BKAs identified in 129 patients. Mean age at amputation was 63.7 ± 11.7 years. Of BKAs, 72.3% were performed on male patients. Mean follow-up was 836 days after index amputation. Patients with a history of deep venous thrombosis (DVT) in either lower extremity before amputation had a higher risk of developing post-BKA wound complications (26.7% vs 12.7%; P = .034). Of patients who did not have a preoperative popliteal pulse, 60.0% developed wound complications within 12 months, compared to 24.2% of those with a popliteal pulse (P = .004). Additionally, of patients without a popliteal pulse, 31.3% eventually needed revision to above the knee amputation, compared to 9.7% of those with a popliteal pulse (P = .013). If a patient experienced a complication after any LSA (postoperative DVT, Clostridium difficile, community-acquired infection, need for postoperative transfusion, acute cardiopulmonary event, or need for unplanned surgical reintervention within 24 hours), their risk for developing wound complications after BKA more than doubled (45.6% vs 22.0%; P = .003). Patients admitted more than 17 cumulative days after LSAs were more likely to experience a BKA complication (38.1% vs 22.0%; P = .030). Patients who underwent two or more prior revascularizations experienced a higher rate of BKA complications (36.7% vs 21.0%; P = .032). Risk factors for wound complications after BKA include prior DVT, absence of a popliteal pulse, complications with prior LSA, longer total admissions for LSA, and multiple revascularizations before amputation. Absence of a popliteal pulse increases the risk of eventual need for above the knee amputation by over three-fold. This research suggests that a complete pulse examination and greater scrutiny regarding the usefulness of multiple LSAs may decrease rates of wound complications after BKA.

Skeletal muscle measurements predict surgical wound complications but not overall survival in patients with soft tissue sarcoma.

It is unknown whether sarcopenia influences treatment outcome in patients with soft tissue sarcoma. Herein, we aimed to elucidate the impact of sarcopenia on sarcoma treatment. A total of 163 soft tissue sarcoma patients were included. Skeletal muscle measures were calculated using computed tomography images. Skeletal muscle area (SMA) and density (SMD) at the L3 level were extracted, and SMA was normalized by height as skeletal muscle index (SMI). The skeletal muscle gauge (SMG) was calculated by multiplying SMD×SMI. The relationship of skeletal muscle measures and clinical factors to wound complications and prognosis was evaluated, and classification and regression tree (CART) analysis was used to develop classification models for risk groups of surgical wound complications. Thirty-three patients developed wound complications. In univariate analysis, age (P=0.0022), tumour location of adductor compartment of the thigh (P=0.0019), operating time (P=0.010), blood loss (P=0.030), SMD (P=0.0004) and SMG (P=0.0001) were significantly correlated with complications. In multivariate analysis, lower SMG was an independent risk factor (P=0.031, OR=3.27). CART analysis classified three risk groups of surgical wound complications by SMG, age, tumour location and operating time, and area under the receiver operating characteristic curve (AUROCC) was 0.75. SMG was not associated with prognosis in univariate analysis (P=0.15). The SMG does not affect overall survival but predicts surgical wound complications.

PARAUMBILICAL HERNIA IN A SOUTHEAST ASIAN POPULATION

Background: Paraumbilical hernias are a common surgical problem constituting about 33% of all anterior abdominal wall hernias. Since Mayo popularized the simple suture repair, there has been a continuous evolution of different techniques for repairing paraumbilical hernias due to the high recurrence rate attendant to the simple suture repair. With the advent of mesh came significant wound complications that led surgeons to introduce the laparoscopic technique. However, there is as yet no consensus on the optimal repair technique for paraumbilical hernias. This study aimed to determine the clinical presentations, various repair techniques, and their outcomes in managing paraumbilical hernias. Materials and Methods: This was a prospective descriptive study that was carried out from August 2018 to July 2020. 75 patients who fulfilled the inclusion criteria were recruited for the study. Data was collected using a proforma. Variables of interest were age, sex, body mass index, co-morbidities, type of operation and duration, post-op pain score, duration of hospital stay, wound complications and recurrence. Follow up was for 6 months. Results: 57 patients were females, and 18 males. The mean age was 53 years. 12 patients had co-morbidities. 72 patients had BMI≥ 25kg-m2. 52 patients underwent open repair (simple suture or mesh) while 23 cases were repaired by laparoscopic mesh implantation (intra-peritoneal Onlay or pre-peritoneal Onlay mesh). All 18 emergency cases had an open repair. 17 patients in the open and 5 in the lap groups developed wound complications. Mean post-op pain on day 1 was 4.71+/-0.96 and 5.37+/-0.96 in the lap and open groups, respectively (p-value= 0.003). The mean duration of hospital stay was 5.3+/-1.0 and 7.6+/-3.8 in the lap and open groups, respectively (p-value

Timing of Adjuvant Radiation Therapy and Risk of Wound-Related Complications Among Patients With Spinal Metastatic Disease.

Study Design:This was an epidemiological study using national administrative data from the MarketScan database.Objective:To investigate the impact of early versus delayed adjuvant radiotherapy (RT) on wound healing following surgical resection for spinal metastatic disease.Methods:We queried the MarketScan database (2007-2016), identifying patients with a diagnosis of spinal metastasis who also underwent RT within 8 weeks of surgery. Patients were categorized into “Early RT” if they received RT within 4 weeks of surgery and as “Late RT” if they received RT between 4 and 8 weeks after surgery. Descriptive statistics and hypothesis testing were used to compare baseline characteristics and wound complication outcomes.Results:A total of 540 patients met the inclusion criteria: 307 (56.9%) received RT within 4 weeks (Early RT) and 233 (43.1%) received RT within 4 to 8 weeks (Late RT) of surgery. Mean days to RT for the Early RT cohort was 18.5 (SD, 6.9) and 39.7 (SD, 7.6) for the Late RT cohort. In a 90-day surveillance period, n = 9 (2.9%) of Early RT and n = 8 (3.4%) of Late RT patients developed wound complications (P = .574).Conclusions:When comparing patients who received RT early versus delayed following surgery, there were no significant differences in the rates of wound complications. Further prospective studies should aim to identify optimal patient criteria for early postoperative RT for spinal metastases.

Postoperative Wound Complications in Fungating Extremity Soft Tissue Sarcomas

Background: Among deep extremity soft tissue sarcomas, skin ulceration is infrequent. Fungating sarcomas may lead to infection or clinically significant bleeding. Data regarding management of ulcerating sarcomas is lacking. We sought to evaluate the outcomes of different treatments for these tumors.Patients and methods: A retrospective review of patients treated at two sarcoma referral centers with histologically confirmed extremity soft tissue sarcoma was performed from 2000-2018. Patient demographics, clinicopathologic, and treatment factors were analyzed in terms of method of resection, receipt of radiation, and wound complications.Results: Overall, 22 patients had fungating lesions. Most patients were male with tumors of the distal extremity.Median tumor size was 8 cm. Half had undifferentiated pleomorphic sarcoma histology, followed by myxofibrosarcoma (n=5), leiomyosarcoma (n=3), or other (n=3). Fifteen patients (68%) underwent limb-preserving resection, of which 7 underwent adjuvant radiation. Six patients (27%) developed wound complications, which occurred equally between amputation versus local excision (p = 0.93). Among local excision patients, one who received adjuvant radiation developed a wound complication (14%), which was not significantly different from those who did not undergo radiation (n=3 of 8, 38%; p = 0.31).Conclusions: Similar rates of wound complications were seen between amputation and limb-preserving groups.Among patients who underwent local excision, the administration of adjuvant radiation therapy did not significantly increase wound complication rates.

Unusual Manifestation of a Mycobacterium bovis SB0950 Infection in a Domestic Cat

Mycobacterium bovis is the main agent of bovine tuberculosis, but has also zoonotic potential. An 8-month-old female domestic shorthaired cat imported from Ukraine developed wound complications after abdominal surgery. A second surgery performed in Germany showed a focal, partly cystic mass within the mesentery. Despite antimicrobial treatment, the cat did not recover and was humanely destroyed. Grossly, several abdominal lymph nodes were enlarged. Histopathology revealed a mild to moderate, multifocal, granulomatous to pyogranulomatous, partially necrotizing inflammation, most prominent in the abdominal cavity. Within the lesions there were acid-fast bacilli within the cytoplasm of macrophages demonstrated by Ziehl-Neelsen staining. Further investigations revealed M. bovis SB0950 in the affected tissues.

Risk Factors for Wound Complications Following Transmetatarsal Amputation in Patients With Diabetes

BackgroundThe goal of our study was to evaluate risk factors for wound complications in patients with diabetes mellitus undergoing transmetatarsal amputations (TMAs), given the paucity of research on this subject. Materials and methodsWe used the American College of Surgeons National Surgical Quality Improvement Program database. In this retrospective analysis, all surgical cases with a primary Current Procedural Terminology code for TMA from 2009 to 2015 were reviewed. ResultsA total of 2316 patients with diabetes mellitus who underwent TMA were identified. Overall wound complications occurred in 276 (11.9%) of patients. Univariate analysis showed that the operative time was significantly longer in patients who developed complications than those who did not (58.3 ± 39.5 versus 50.6 ± 39.4; P = 0.003). Furthermore, the rate of obesity was significantly higher among patients who developed wound complications than those who did not (47.1% versus 41.5%; P = 0.04). Multivariate analysis demonstrated that a longer operative time (odds ratio = 1.02; 95% confidence interval: 1.01-1.04; P = 0.01) and obesity (odds ratio = 1.60; 95% confidence interval: 1.06-2.40; P = 0.03) were independent risk factors for wound complications in our cohort. ConclusionsThese findings emphasize the importance of having heightened clinical vigilance in obese patients with diabetes mellitus undergoing this procedure, close postoperative follow-up, and limiting operative time when possible.