Wound Drainage Research Articles

Subcutaneous barbed suture, as an adjunct to staples, reduces post-operative wound drainage in total knee arthroplasty

BackgroundProlonged wound drainage (>72 h), has been associated with increased risk of surgical site infection and prolonged hospital admission. This study reviews the outcome in three different wound closure methods, following total knee arthroplasty. We also analysed the cost effectiveness of these methods. MethodsA total of 69 patients undergoing total knee arthroplasty: 22 with stapled skin closure; 21 with tissue adhesive and stapled skin closure and 26 with subcutaneous barbed suture instead of a non barbed suture with stapled skin closure, were studied to review the number of dressing changes, prolonged wound drainage (>72 h), length of hospital stay and delayed discharge (>5 days). Statistical analysis was conducted using Minitab Statistical Software® and statistical significance was set at p < 0.05. ResultsThe median hospital stay for the staples only group was 4 days (inter-quartile range [IQR] 3–5), for the adhesive group was 4 days ([IQR] 3–6) and for the barbed suture group was 3 days ([IQR] 3–4) (p = 0.009). The rates of prolonged wound drainage for the staples only group was 8 (36.4%), for the adhesive group was 4 (19.0%) and for barbed suture group was 0 (0%) (p = 0.004). ConclusionThe use of subcutaneous barbed sutures was associated with reduced number of wound dressing changes, reduced risk of prolonged wound drainage and shorter hospital stay, as well as conferring a saving of at least £236.60 per patient, compared to the other two skin closure methods.

October 2021 Critical Care Case of the Month: Unexpected Post-Operative Shock

No abstract available. Article truncated after 150 words. History of Present Illness: A 55-year-old man with a past medical history significant for endocarditis secondary to intravenous drug use, osteomyelitis of the right lower extremity was admitted for ankle debridement. Pre-operative assessment revealed no acute illness complaints and no significant findings on physical examination except for the ongoing right lower extremity wound. He did well during the approximate one-hour “incision and drainage of the right lower extremity wound”, but became severely hypotensive just after the removal of the tourniquet placed on his right lower extremity. Soon thereafter he experienced pulseless electrical activity (PEA) cardiac arrest and was intubated with return of spontaneous circulation being achieved rapidly after the addition of vasopressors. He remained intubated and on pressors when transferred to the intensive care unit for further management. PMH, PSH, SH, and FH: • S/P Right lower extremity incision and drainage for suspected osteomyelitis as above • Distant history of endocarditis related …

Management of a Postoperative Orocutaneous Fistula with Transoral Negative Pressure Therapy

Orocutaneous fistulas are a common problem in head and neck reconstruction and can be a challenge to manage. They result in persistent wound drainage, poor healing, and delay in adjuvant therapy and may precipitate flap failure. Negative pressure wound therapy offers several benefits, including increasing granulation tissue formation, promoting wound contraction, and removing moisture to promote fistula closure. Its use in head and neck reconstruction has few documented attempts in the literature for managing complicated intraoral wounds. The goal of this study was to establish feasibility and efficacy of an intraoral NPWT for management of post-surgical orocutaneous fistulas.The patient was a 73-year-old female with a history of pT2N0M0 squamous cell carcinoma of the left buccal mucosa who had previously undergone primary resection and reconstruction with a parascapular free flap with adjuvant radiation. Ten years following her original treatment, she developed osteoradionecrosis with an orocutaneous fistula and a pathologic fracture. She underwent a segmental mandibulectomy and reconstruction with an osteocutaneous free flap.She had an uneventful postoperative course and was discharged on day 6. One-week post-discharge, the native oral mucosa overlying the fibula flap had broken down, and a significant orocutaneous salivary leak was present (Figure 1). Given the proximity of the salivary collection to the pedicle, there was concern this would compromise the anastomosis and result in flap loss. Any surgical intervention to correct the problem would require extensive remobilization of the existing inset or elevation of a second soft-tissue flap. Thus, the decision was made to pursue an alternative novel treatment option.Impressions were obtained and a stone model poured to fabricate an acrylic splint that could support the negative pressure device (Figure 2). The stent was relined with polyvinyl siloxane impression material to ensure adequate seal against the mucosa. The intraoral appliance would not initially hold suction because of the air leak from the cutaneous portion of the fistula, so a VAC sponge was adapted and a Y-connector was used to apply negative pressure to both sites simultaneously.The patient was able to tolerate wearing the device around the clock as continuous suction was able to be maintained. She followed up every third day to change the VAC dressing and to make adjustments as needed. She continued to be fed via Dobhoff tube during this period.On follow-up 2 weeks later, the patient had significant granulation tissue formation in her intraoral wound with almost complete closure.At this point, the intraoral device was discontinued, but the VAC dressing on the neck was maintained for an additional 2 weeks until the intraoral component of the fistula had closed completely and was no longer able to be probed (Figure 3).The principle aim of this study was to determine the efficacy and practicality of an intraoral wound VAC device in the management of an orocutaneous fistula. There was a positive benefit to healing of the orocutaneous fistula for this patient, as she had dramatic granulation tissue formation within 2 weeks of using the device. An intraoral wound VAC device seems a viable option for acute management of orocutaneous fistulas in select patients. The use of such a device would require significant patient compliance and commitment as well as technique sensitive dressing application that may not be suitable in all cases.

The draining surgical wound post total hip and knee arthroplasty: what are my options? A narrative review.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are successful orthopaedic procedures with an ever-increasing demand annually worldwide, and persistent wound drainage (PWD) is a well-known complication following these procedures. Despite many definitions for PWD having been proposed, a validated description remains elusive.PWD is a risk factor for periprosthetic joint infection (PJI). PJI is a devastating complication of THA and TKA, and a leading cause of revision surgery with dramatic morbidity and mortality and a significant burden on health socioeconomics.Prevention of PJI has become an essential focus in THA and TKA. Understanding the pathophysiology, risk factors and subsequent management of PWD may aid in decreasing the rate of PJI.Risk factors of PWD can be divided into modifiable and non-modifiable patient risk factors, pharmacological and surgical risk factors. No gold standard treatment protocol to address PWD exists; however, non-operative options progressing to surgical interventions have been described.The aim of this study was to review the current literature regarding PWD and consolidate the risk factors and management strategies available. Cite this article: EFORT Open Rev 2021;6:872-880. DOI: 10.1302/2058-5241.6.200054

Placement of Wound Drain After Anterior Circulation Aneurysm Clipping: A Single-Center Retrospective Study

Wound drain used to be a routine procedure after craniotomy for aneurysm clipping, although this was not based on clinical evidence. The purpose of our study was to determine the necessity of wound drain placement after anterior circulation aneurysm surgery. Retrospective analysis of patients with anterior circulation aneurysms treated by clipping in the Department of Neurosurgery, Wuhan University Zhongnan hospital from January 2019 to December 2019 was carried out. Demographic and clinical data, including age, sex, body mass index, disease history, results of the laboratory and imaging examinations, and surgical logs, were reviewed. A total of 236 patients (90 male and 146 female) were included in the analysis and were divided into a Drain group and a No Drain group according to whether postoperative wound drainage was applied. There was no statistical difference in the incidence of a postoperative extradural hematoma between patients in the 2 groups. However, the incidence of postoperative meningitis was higher in the Drain group than in the No Drain group (9.09% vs. 1.59%, P= 0.009), and the total length of stay and postoperative length of stay in the Drain group were also more extended than in the No Drain group (17.32 ± 6.45 vs. 14.43 ± 5.75, P= 0.005; 12.83 ± 5.07 vs. 9.82 ± 4.50, P= 0.007, respectively). Postoperative wound drain did not significantly reduce the incidence of an extradural hematoma after anterior circulation aneurysm surgery. On the contrary, it may be associated with an increased incidence of postoperative meningitis and length of stay. Given these findings, the postoperative drain should be maintained cautiously and meet more rigorous application criteria.

Autologous platelet-rich fibrin (PRF) augmentation as an add-on therapy in deep surgical site infections (dSSIs) after instrumented spinal surgery: preliminary results of a single institution case series

BackgroundDeep surgical site infections (dSSIs) after instrumented spinal surgery pose major therapeutic challenges. Standard treatment involves surgical debridement, wound drainage, and long-term antibiotic administration. Autologous platelet-rich fibrin (PRF) constitutes a biomaterial obtained from patients’ own blood that contains leukocytes, chemokines and growth factors boosting cicatrization. Due to favorable results reported from other surgical disciplines such as dentistry, orthopedics, maxillofacial and plastic surgery using PRF, the authors hypothesized that PRF augmentation will promote wound healing in dSSIs.ObjectiveTo report our preliminary results on the safety and efficacy of autologous-PRF as an add-on therapy on a pilot case series of persistent dSSI after instrumented spinal surgery.MethodsAmong the 293 patients who underwent dorsal decompression and stabilization of the cervical, thoracic, and lumbar spine due to degenerative diseases in our department, 12 patients (4%) presented persisting dSSI after standard wound debridement and antibiotic treatment. PRF augmentation was used during a second surgical revision as an add-on therapy to standard debridement. In all cases, the wound was primarily closed without drains.ResultsWound healing was completed between 14 and 21 days after the second surgical revision in all patients. At a median follow-up of 8 months (range: 6 to 18 months), no recurrence of dSSI nor complications were encountered in any case.ConclusionsOur preliminary results suggest that PRF augmentation in persistent dSSI after instrumented spinal surgery appears to be a safe and effective strategy to promote wound healing. Prospective controlled studies are required to define the efficiency of PRF more clearly in both treating and preventing dSSI.

The Influence of Perioperative Antibiotic Prophylaxis on Wound Infection and on the Colonization of Wound Drains in Patients After Correction of Craniosynostosis.

Objective: Evidence for the duration of perioperative antibiotic prophylaxis (PAP) after the correction of craniosynostosis in children is scarce. We evaluated the necessary duration of PAP to ensure a minimal rate of postoperative wound infections.Methods: In this monocentric, retrospective, and prospective pilot study, two PAP protocols were compared. From August 2017 to May 2018, treatment group 1 (TG 1) was treated using the standard PAP protocol with at least three doses of antibiotics. Between May 2018 and March 2019, a shortened PAP with a single-shot administration was given to treatment group 2 (TG 2a and b). Endpoints of this study were wound infection rate, colonization rate of wound drains, and the course of treatment reflected by clinical and laboratory data.Results: A cohort of 187 children underwent craniosynostosis correction: 167 were treated according to protocols-−95 patients with at least three doses (TG 1) and 72 patients with a single-shot of cefuroxime (TG 2a). Baseline characteristics were similar for both groups. We could not detect significant differences, neither for wound infection rates (TG 1: 1.1%, TG 2a: 0.0%, p = 0.38) nor for colonization rates of wound drains (TG 1: 4.8%, TG 2a: 10.5%, p = 0.27).Conclusions: Single-shot PAP had no adverse effects on the wound infection rate or the colonization rate of the wound drains compared with prolonged perioperative antibiotic prophylaxis. As a result, single-shot preoperative PAP is now applied to the majority craniosynostosis patients undergoing surgical correction in our unit.

9. The impact of nasal screening for methicillin-resistant staphylococcus aureus on surgical site infection after primary lumbar fusion

<h3>BACKGROUND CONTEXT</h3> Surgical site infections (SSI) constitute significant morbidity in spine surgery. Efforts at SSI prevention include preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization, with demonstrated success for arthroplasty patients along with vascular and cardiothoracic surgical patients. The variety of surgical approaches and anatomic regions within spine surgery can limit the impact of analyses at the subspecialty level. Despite the success of MRSA nasal screening and decolonization in reducing SSI rates in other disciplines, the impact on spine surgery is less understood. <h3>PURPOSE</h3> To determine the relationship between nasal MRSA testing and operative debridement rates for surgical site infection after primary lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study at two academic tertiary referral centers. <h3>PATIENT SAMPLE</h3> Adult patients (>18 years) were identified from January 2015 to March 2020 based on CPT codes for spinal instrumentation and fusion. Inclusion criteria were primary instrumented posterior lumbar fusion between 1-3 levels and exclusion criteria were revision surgery, tumor, infection, lateral-only surgery or operative surgeon with fewer than 20 cases. <h3>OUTCOME MEASURES</h3> Operative incision and drainage (I&D) of the index lumbar spine wound within 90-days after surgery was the primary outcome. <h3>METHODS</h3> Chart text, operative reports and laboratory reports were reviewed for data abstraction. Multivariable logistic regression modeling assessed for demographic differences between MRSA testing groups as well as factors contributing to I&D risk. <h3>RESULTS</h3> There were 2,148 patients included with a mean age 62.5 (SD 12.9), 56.9% female, and mean BMI 29.4 (SD 6.2). MRSA testing 90 days prior to surgery was completed in 884 (41.1%) of patients, and 19 (2.2%) of tested patients were colonized with MRSA preoperatively. Thirty-six (1.7%) patients underwent surgical I&D within 90 days of their index procedure for a surgical site infection. I&D risk was not associated with presence or result of MRSA testing, preoperative mupirocin prescriptions, or type of intraoperative antibiotic after controlling for surgeon. I&D risk was associated with higher BMI (5.7% increased risk for every 1 unit increase in BMI or a coefficient of 0.057, 95% confidence interval 0.017 to 0.097, p = 0.005) after controlling for age, diabetes and smoking status. <h3>CONCLUSIONS</h3> The present study demonstrates no difference in surgical I&D rates between patients who underwent MRSA testing, who had positive MRSA colonization or who underwent other interventions aimed at decreasing SSI rates such as preoperative mupirocin decolonization or addition of intraoperative vancomycin. Increased BMI was associated with risk of undergoing an operative I&D for surgical site infection, suggesting that patient factors dominate over clinical interventions in the prevention of surgical site infection after primary lumbar spine fusion. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Combined topical and intravenous administration of tranexamic acid further reduces postoperative blood loss in adolescent idiopathic scoliosis patients undergoing spinal fusion surgery: a randomized controlled trial

BackgroundTo indicate whether combined topical and intravenous (IV) administration of tranexamic acid (TXA) could further reduce the blood loss after surgery for adolescent idiopathic scoliosis (AIS) compared with IV-TXA alone.MethodsNinety AIS patients who underwent posterior spinal fusion were prospectively randomized to combined group (IV + topical- TXA group) and IV-TXA alone group. TXA was infused at a loading dose of 1 g from the beginning of the surgery with a maintenance dose of 10 mg/kg/h until the wound was closed. In the combined group, 2 g TXA was injected retrogradely through a drain, while an equivalent amount of normal saline was injected in the IV-TXA alone group. The drain tube was clamped for 2 h in both groups. The amount of wound drainage and transfusion rates were analyzed.ResultsThe drainage volume and duration of drain were significantly lower in the combined group compared with that in the IV-TXA alone group (372.0 ± 129.7 mL vs. 545.2 ± 207.7 mL, P < 0.001;64.7 ± 13.9 h vs. 82.0 ± 12.5 h, P < 0.001). Postoperative length of hospital stay was also significantly shorter in the combined group (6.5 ± 1.51 days vs. 7.95 ± 1.44 days, P < 0.05). Transfusion and complication rates were comparable between the two groups .ConclusionsIV injection of TXA combined with retrograde injection of TXA into a drain and clamping it for 2 h could further reduce the total volume of drainage in AIS patients who underwent spinal fusion surgery.Trial registrationChinese Clinical Trial Registry: ChiCTR1900024177, Registered 29 June 2019, http://www.chictr.org.cn/showproj.aspx?proj=40214

Enhanced Recovery Components for Posterior Lumbar Spine Fusion: Harnessing National Data to Compare Protocols.

This was a retrospective cohort study. The aim of this study was to assess the most commonly used components of enhanced recovery after surgery (ERAS) combinations and their relative effectiveness. Data is lacking on use and effectiveness of various ERAS combinations which are increasingly used in spine surgery. Posterior lumbar fusion cases were extracted from the Premier Healthcare claims database (2006-2016). Seven commonly included components in spine ERAS protocols were identified: (1) multimodal analgesia, (2) tranexamic acid, (3) antiemetics on the day of surgery, (4) early physical therapy, (5) no urinary catheter, (6) no patient-controlled analgesia, and (7) no wound drains. Outcomes were: length of stay, "any complication," blood transfusion, and hospitalization cost. Mixed-effects models measured associations between the most common ERAS combinations and outcomes, separately for 2006-2012 and 2013-2016. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Among 97,419 (74%; 2006-2012) and 34,932 (26%; 2013-2016) cases ERAS component variations decreased over time. The most commonly used combinations included multimodal analgesia, antiemetics, early physical therapy, avoidance of a urinary catheter, patient-controlled analgesia and drains (10% n=9401 and 19% n=6635 in 2006-2012 and 2013-2016, respectively), and did not include tranexamic acid. Multivariable models revealed minor differences between ERAS combinations in terms of length of stay and costs. The most pronounced beneficial effects in 2006-2012 were seen for the second most commonly (compared with less often) used ERAS combination(s) in terms of blood transfusion (OR: 0.65; CI: 0.59-0.71) and "any complication" (OR: 0.73; CI: 0.66-0.80), both P<0.05. In 2013-2016 the third most commonly used ERAS combination showed the strongest effect: blood transfusion OR: 0.63; CI: 0.50-0.78, P<0.05. ERAS component variations decreased over time; maximum benefits were particularly seen in terms of transfusion and complication risk reduction. These findings may inform future ERAS utilization and clinical trials comparing various ERAS protocols.

Urgent surgery for COVID-19\u2013positive pediatric patient

BackgroundWe present a case of COVID-19–positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure.Case presentationA 12-year-old, COVID-19–positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor.ConclusionSpinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19–positive patient in perioperative setting to avoid minimize the risk to healthcare providers.

Prevention of hemorrhagic complications during hybrid interference in the sleepy and coronary arteries under conditions of hypo-agregation and hypocaagulation

Hemorrhagic complications in patients after hybrid interventions including percutaneous coronary intervention and carotid endarterectomy are analyzed. Demonstrate a new method of hemostasis and wound drainage after carotid endarterectomy. It was found that at the preoperative stage, the coagulogram parameters were within the normal range, but the aggregatogram showed hypoagregation for two of the four inducers in all 84 operated patients. After the completion of the second stage of revascularization, the absolute partial thrombosed time in all patients was five to six times higher than normal in the coagulogram parameters. According to the aggregatogram, there was a total hypo-aggregation. All acute hematomas after carotid endarterectomy requiring revision were formed in patients with the traditional method of hemostasis and wound drainage after carotid endarterectomy (p = 0.038), which was associated with more frequent damage to the cranial nerves (p = 0.0002). Thus, the combined endpoint, including the indicator of cranial nerve damage + acute hematoma in patients with the traditional method of hemostasis and wound drainage after carotid endarterectomy, significantly exceeded it in patients who used a new tactic (local hemostatics with minimal electrocoagulation and installation of two drains in the paravasal and clitoral space) (p 0.0001). There were no cases of wound complications in the area of carotid endarterectomy. Thus, the new technique of hemostasis and wound drainage after carotid endarterectomy against the background of hypocoagulation and hypoagregation has shown its effectiveness and preventive role in the prevention of hemorrhagic complications, damage to the cranial nerves.

Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer.

BackgroundWound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events.MethodsA systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity.ResultsForty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates.ConclusionsConsiderable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses.Level of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Randomized Study of Wound Drainage on Early Complications After Lymph Node Dissection for Melanoma

IntroductionThe complication rate after axillary lymph node dissection (ALND) and inguinal lymph node dissection (ILND) in melanoma patients is high. The aim of this randomized non-inferiority study was to evaluate the effect of postoperative wound drainage on early complications after ALND and ILND. Materials and methodsBetween 2018 and 2020, 104 stage III melanoma patients operated on with ALND or ILND were randomized to a study group with complete wound drain removal 3 wk after surgery or a control group with progressive drain removal. The primary end point was overall early complications graded according to the modified Clavien-Dindo classification. Secondary endpoints were length of hospital stay and prognostic factors for early complications. ResultsOf the 99 patients analyzed, ALND was performed in 58 patients and ILND in 41 patients. Overall, 62 patients (62.6%) developed early complications: 30 in the study group and 32 in the control group (P = 0.53). The confidence interval for the difference in proportions of patients without early complications in the two groups was −0.27 to 0.11 (P = 0.42), hence non-inferiority could be claimed. Length of hospital stay was 5 d in the study group compared to 6 in the control group (P < 0.01). ILND was associated with increased risk of early complications compared to ALND (75.6% versus 53.4%, P = 0.04). ConclusionsComplete drain removal 3 wk after ALN and ILND in stage III melanoma patients did not increase the risk of early complications compared to progressive drain removal.

A Prospective, Randomized Evaluation of the Quality of Wound Closure With Barbed Versus Standard Suture After Total Joint Arthroplasty

Complications such as joint infection or delayed wound healing can lead to morbidity and elevated health care costs after total joint arthroplasty. The purpose of this study was to compare the quality of running knotless barbed suture vs standard monofilament suture wound closure with respect to wound drainage and healing complications after total joint arthroplasty. For this study, 1000 joint arthroplasty patients were prospectively randomized to have fascial, soft tissue, and skin closure with knotless barbed suture vs standard suture during the period 2016 to 2018. An absorptive dressing was used for 1 week postoperatively. Each dressing was weighed and the saturated surface area of the dressing measured. A total of 939 dressings were available for evaluation. Incisions were evaluated for wound healing at each postoperative visit. Of the 1000 joint arthroplasties performed, suture breakage or needle disengagement occurred similarly with the standard monofilament suture and the running barbed suture (13 times vs 6 times; P=.17). Dressings were weighed, and when standard monofilament sutures were used, an average of 1.2 g more postoperative bandage weight was recorded (P<.002). Postoperative wound complications including stitch abscess or wound irritation occurred more often with standard monofilament sutures than with running barbed sutures (16 times vs 5 times; P<.025). Optimal wound closure after joint replacement is critical to enhance soft tissue healing and minimize infection risk, which can be caused by excessive wound drainage. The positive results shown for the running barbed suture of this prospective study indicate the difference in quality of closure between the standard monofilament suture and the running barbed suture in hip and knee arthroplasty surgical sites. [Orthopedics. 2021;44(4):216-222.].

COVID-19 Infection and Cervical Abscess in a Three-Month-Old Infant

A three-month-old infant was referred to the emergency department with fever and a right cervical abscess. Nasopharyngeal swab was positive for SARSCoV- 2 infection. Main causes of infectious abscess and immunodeficiency disorders were ruled out. After a surgical drainage and an antibiotic therapy, clinical conditions of the infant improved, and Staphylococcus Aureus was found in the wound drainage culture. This is a possible, not yet described in infant patients, concurrent clinical manifestation of SARS-CoV-2 infection.

Сравнительная оценка динамики патогистологической картины гнойной раны экспериментальных животных с моделью фурункула в области головы и шеи при стандартном лечении и при использовании электрорефлексотерапии

The most common neodontogenic infectious and inflammatory processes affecting the skin are furuncles in the maxillofacial area. The task of effective treatment of patients with this disease is now becoming increasingly urgent which is largely due to the deterioration of the environmental situation, changes in the nature of nutrition and chronic stress. The purpose of the study is to make a comparative assessment of the results of the standard method of postoperative treatment and complex treatment using electroacupuncture based on the dynamics of the pathohistological picture of a purulent wound in experimental animals with a model of a boil in the head and neck. Materials and methods. Experimental studies were carried out on 20 guinea pigs of the same age and body weight, on which a model of a boil in the submandibular area was created. The boil was formed within 3 days, after which all experimental animals under local infiltration anesthesia underwent primary surgical treatment of the infectious and inflammatory focus with wound drainage. Then the animals were divided into two series. Series 1 received a standard treatment package in the postoperative period (antibiotics, daily dressings with mandatory drainage changes, instillation of the wound with antiseptic solutions). For series 2 of animals, the standard treatment was combined with an electroacupuncture treatment. The material for pathohistological examination was collected in the following terms: 3, 7, 14 and 21 days after the operation. Serial sections were made according to the standard procedure. The micro-preparations were examined using a light microscope. For comparison a descriptive method was used. Results and discussion. The most significant differences were found on the 21st day of observation when diffuse mononuclear cell infiltration of all layers of the dermis was detected in most of the series 1 micro-preparations which indicated the presence of productive inflammation. During the same period of observation, all the micro-preparations of series 2 showed a multilayered flat keratinizing epithelium without violating the integrity throughout. The papillary and reticular layers of the dermis showed no signs of inflammation. The appendages of the skin were traced throughout the entire field of vision without visible pathological changes. All of the above indicated no signs of inflammation. Conclusion. The results obtained clearly indicate the positive effect of electroacupuncture on both wound cleansing and the course of the processes of reparative regeneration of the skin

Effect of Mobilization on the Day of Surgery After Total Hip Arthroplasty in Elderly, Obese, and Severely Diseased Patients

BackgroundMobilization on the day of surgery after total hip arthroplasty (THA) is widely used. However, elderly, obese and severely diseased patients are often excluded from early mobilization. Therefore, it was our aim to investigate the effect of mobilization on the day of surgery with focus on these patients. Methods167 patients underwent THA via direct anterior approach. Exclusion criterion was the use of wound drainage. The patients were randomly allocated to two groups. Day 0 group was mobilized 4 hours after surgery, day 1 group the day after surgery. Primary outcome was the time to readiness for discharge (TRD). Secondary outcome was the occurrence of adverse events (vertigo, nausea, vomiting, severe pain) on the day of surgery. Group comparisons were calculated with respect to elderly (age ≥75 years), obese (BMI ≥30 kg/m2) and severely diseased patients (ASA≥3). ResultsTRD was shorter in day 0 group (3.25 vs 3.99 days, P < .01). The rate of adverse events on the day of surgery was similar in both groups (0.28 vs 0.25, P = .73). TRD differences were higher within all subgroups (3.85vs4.81; 3.25vs4.39; 4.08vs5.11days) while the rate of immediate adverse events was reduced (0.15vs0.24; 0.25vs0.3; 0.25vs0.33). Within 90 days 3 patients of group 0 underwent revision surgery, none of group 1 (P = .12). ConclusionMobilization on the day of surgery reduces the TRD without increasing the rate of immediate adverse events, regardless of age, BMI and ASA score. Future studies are needed to investigate if early mobility increases the 90-days complication rate.

Impact of Weight-Band Dosing of Tinzaparin for Venous Thromboembolism Prophylaxis on Persistent Wound Drainage in Adult Patients Undergoing Hip and Knee Arthroplasty.

Persistent wound drainage and venous thromboembolism (VTE) are potential complications of total joint arthroplasty, and these risks can be challenging to balance in clinical practice. Anecdotal observation has suggested that following joint arthroplasty, persistent wound drainage occurs more frequently with higher body weight and higher doses of tinzaparin when compared with lower body weight and lower doses of tinzaparin. The overall purpose of this study was to describe the impact of a tinzaparin weight-band dosing table for VTE prophylaxis on wound healing, thrombosis, and bleeding outcomes in patients undergoing total joint arthroplasty. This retrospective chart review included patients who underwent total hip or knee arthroplasty and received tinzaparin for thromboprophylaxis per their weight-banding category. The primary outcome was the incidence of persistent wound drainage. Secondary outcomes include the occurrence of VTE and clinically important bleeding during hospital admission. A total of 231 patients were included in the analysis. There was no significant difference in persistent wound drainage between the 3 weight categories, and there were no differences in rates of VTE or clinically important bleeding. Concurrent use of low-dose acetylsalicylic acid was associated with a 3-fold increased risk of persistent wound drainage (risk ratio = 3.35; 95% CI = 2.14-5.24; P = 0.00003). In joint arthroplasty patients, we observed no significant difference in rates of persistent wound drainage between various weight categories receiving different weight-banded doses of tinzaparin. Our results do not suggest that the current weight-band dosing table for tinzaparin needs to be adjusted to optimize patient outcomes.

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults

PurposeInguinal hernia is a common male surgical disease. Intervention carries a wide range of complications such as scrotal haematoma and seroma which may require surgical re-intervention or predispose patients to developing infections, pains or feeling of mass. This could lead to long hospital stay. Scrotal tamponade by bandaging or wearing of tight pants and elevation are practiced to reduce bleeding and haematoma formation. These methods require prolong use. Closed suction drains are scarcely used in resource-deprived communities due to high cost and non-availability.AimThis study was to determine the effectiveness of a closed non-suction drain in preventing scrotal collection requiring further surgical intervention and the predisposition to developing surgical site infection following nylon darn repair of inguinoscrotal hernia.MethodsForty (40) participants were recruited for a preliminary study and assigned into control and interventional groups (CG, IG) for purposes of inserting flexible feeding tube (FFT) wound drain after nylon darn (ND) repair. Daily measurement of drained scrotal collection was carried out in the IG till the day drainage was zero. Residual volumes in IG and wound collection in the CG who were not candidates for re-intervention were determined at 14th and 28th post-operative days using ultrasound scan. Data were analyzed using SPSS version 25.ResultsThree (3) patients (15.8%) in the CG required re-intervention. Surgical site infection rates for the CG and IG were, respectively, 2/19 versus 0/21 (ρ = 0.134).There was a numerical significant difference in the mean volumes of scrotal collections between the control (0.95 ± 0.42 ml) and the intervention group (0.44 ± 0.33 ml) [p value of 0.041] but with no clinical impact.ConclusionSimple inexpensive flexible feeding tube placement significantly reduced scrotal collection which forms a base for larger sample size in subsequent studies. This could reduce the feared risk of re-intervention, wound infection and long hospital stay post-operative.