Wound Drainage Research Articles

Superficial parotidectomy: three-year experience using modified Blair's incision

Background: This study presents a series of parotidectomy for superficial benign parotid tumors.Methods: 18 patients had freely mobile superficial benign parotid lesions of grade zero on House-Brackmann facial nerve grading system underwent parotidectomy through modified Blair incision, with meticulous dissection of the main trunk and branches of facial and the greater auricular nerves with parotid duct sparing. Postoperative (PO) facial nerve functions were assessed and graded after patient was fully conscious, on the 5th PO day, and 6th PO month. Collected data included operative time, intraoperative blood loss, duration of hospital stay, wound drainage and PO complications.Results: Mean operative time was 115 (±20.4) minutes and mean intraoperative blood loss was 250 (±60). PO analgesia was provided as non-steroidal anti-inflammatory drugs injection on patient's request. Mean duration of PO hospital stay was 8 (±1.9) hours and of wound drainage was 3 (±0.7) days. No wound infection nor seroma had developed and stitches were allowed for spontaneous removal. Immediate postoperatively 4 patients (22.2%) had incomplete facial nerve weakness; 3 of grade II and one of grade III, at the 5th day PO, two patients still had grade II nerve affection and at the 6th PO month, one patient (5.5%) still had grade II nerve affection.Conclusions: superficial parotidectomy through modified Blair's incision is feasible, safe and allows nerve, vessels and duct sparing even for cases with recurrent swelling. Incomplete facial weakness was encountered in only one patient at the 6th month PO, but was of grade II.

Is it Safe to Continue Clopidogrel in Elective Hip and Knee Arthroplasty?

BackgroundNo evidence-based guidelines exist for the perioperative use of clopidogrel in elective hip and knee arthroplasty patients. This study compares the preoperative, intraoperative, and postoperative outcomes of total hip and knee arthroplasty in patients maintained on clopidogrel and with patients whose clopidogrel was held before surgery. MethodsWe retrospectively identified 158 patients taking clopidogrel before undergoing elective total hip or knee arthroplasty. Patients were stratified for having clopidogrel held or continued, based on the interval between latest dose and date of surgery. The primary end points were receipt of transfusion and readmission within 90 days of surgery. Secondary end points were the incidence of complications such as bleeding, infection, re-operation, and major cardiac or neurologic events such as myocardial infarction or stroke during the 90-day postoperative period. ResultsThe two cohorts had similar demographics. Patients who continued clopidogrel were more likely to receive a blood transfusion postoperatively (9.1% vs 0%, P = .005), but there was no difference in wound drainage (P = .65), wound infection (P = .24), readmission (P = .74), major complications (P = .64), length of stay (P = .70), or mortality (P = .42). Patients who continued clopidogrel before surgery were more likely to have received general anesthesia (P < .001) per anesthesia protocol, however, three such patients did receive spinal anesthesia without any complications. With cementless implants, blood loss was not different between clopidogrel groups. ConclusionPatients undergoing elective total hip and knee arthroplasty may be safely maintained on clopidogrel without an increased risk of wound complications, infections, length of stay, readmission, reoperation, major medical complications, or mortality. Further prospective research is warranted to confirm the effects of continuing clopidogrel in patients undergoing elective hip and knee arthroplasty.

Transperineal pelvic drainage combined with lateral position to promote perineal wound healing after abdominoperineal resection: A prospective cohort trial.

Background:For the rectal cancer <5 cm from anal margin, extralevator abdominoperineal resection (eAPR) has been accepted widely by surgeons. However, the rate of perineal infection following up eAPR is approximately 70%. We did the study with the aim of evaluating the effect and safety of transperineal pelvic drainage combined with lateral position (TPDLP) on perineal wound in patients undergoing eAPR.Methods:Patients were randomly assigned to N-TPDLP group (standard arm) or TPDLP group (intervention arm). In the standard arm, surgery was completed after abdominal drainage tube was placed in pelvic. Comparatively, an additional transperineal wound drainage tube was applied in the experimental arm. Postoperatively, patients of both 2 groups were informed not to sit to reduce perineal compression until the perineal wound healed. But lateral position was demanded in the intervention arm. The primary endpoint was the rate of uncomplicated perineal wound healing defined as a Southampton wound score of <2 at 30 days postoperatively. Patients were followed for 6 months.Results:In total, 60 patients were randomly assigned to standard arm (n = 31) and intervention arm (n = 29). The mean perineal wound healing time was 34.2 (standard deviation [SD] 10.9) days in TPDLP arm, which significantly differ from 56.4 (SD 34.1) in N-TPDLP arm (P = .001). At 30 days postoperatively, 3 (10%) of 29 patients undergoing TPDLP were classified into grade 4 according to Southampton wound score, however, 16 (52%) of 31 patients were classified into grade 4 in control arm, and significantly difference was observed between randomization groups (P = .001). What's more, perineal wound pain was assessed at 30 days postoperatively, and it is discovered that the pain degree of patients in control arm was significantly more severe than the interventive arm (P = .015).Conclusion:In the present study, we found that TPDLP generated a favorable prognosis for perineal wounds with acceptable side-effects.

Case of a Deep Neck Abscess During Treatment for COVID-19

Patient: Male, 55-year-old Final Diagnosis: COVID 19 infection • deep neck infection • pyogenic arthritis Symptoms: Neck pain • shoulder pain Medication: Antibiotics Clinical Procedure: Incisional drainage Specialty: Otolaryngology Objective: Unusual clinical course Background:COVID-19 is treated using antiviral and immunosuppressive drugs. Therefore, patients treated for COVID-19 may have an increased risk of secondary infection and a masked inflammatory response. We present a case of a deep neck abscess caused by pyogenic sternoclavicular arthritis during treatment for COVID-19.Case Report:A 55-year-old man with COVID-19 was admitted to the hospital with hypoxemia. He was then treated with remdesivir, tocilizumab, and dexamethasone and was placed in the prone position. When his condition stabilized, pain in the left shoulder appeared. There was no fever or elevation in inflammation markers, and he was administered analgesics. However, the pain worsened and redness of the left neck appeared. Plain computed tomography (CT) showed swelling of the left neck muscles. Because cellulitis was suspected, he was treated with antibiotics, but his symptoms did not improve. Three days after the plain CT, contrast-enhanced CT showed sternoclavicular arthritis, deep neck abscess, and mediastinal abscess. Therefore, an emergency incisional drainage was performed under general anesthesia. Wound cleaning and drainage were continued after surgery, and after drainage tubes were removed, the patient was discharged on postoperative day 17.Conclusions:Cervical infections after COVID-19 treatment have been reported in a few cases. Particularly, deep neck abscesses require more attention since they could be fatal if not treated immediately. If a secondary infection is suspected in a patient treated with immunosuppressive drugs for COVID-19, a thorough physical examination should be performed to avoid misdiagnosis.

The Use of Calcium Sulphate Beads in the Management of Osteomyelitis of Femur and Tibia: A Systematic Review.

Calcium sulphate is a recent alternative for delayed antibiotic elution in infected bones and joints. The purpose of this study is to evaluate the use of antibiotic impregnated calcium sulphate (AICS) beads in the management of infected tibia and femur, with regards to patient outcomes and complication rates (including reinfection rate, remission rate and union rate). Searches of AMED, CINAHL, EMBASE, EMCARE, Medline, PubMed and Google Scholar were conducted in June 2020, with the mesh terms: "Calcium sulphate beads" or "Calcium sulfate beads" or "antibiotic beads" or "Stimulan" AND "Bone infection" or "Osteomyelitis" or "Debridement" AND "Tibia" or "Femur". Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of interventions (ROBINS-i) tool, and quality assessed via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Out of 104 relevant papers, 10 met the inclusion criteria for data extraction. Total infection remission was 6.8%, which was greater than that of polymethylmethacrylate (PMMA, 21.2%). Complication rates varied. The main issue regarding AICS use was wound drainage, which was considerably higher in studies involving treatment of tibia alone. Studies using PMMA did not experience this issue, but there were a few incidences of superficial pin tract infection following surgery. Where AICS was used, it was consistently effective at infection eradication, despite variation in causative organism and location of bead placement. Wound drainage varied and was higher in papers regarding tibial cases alone.

204 Identifying Barriers to and Strategies for Implementing Same-Day Discharge after Mastectomy

OBJECTIVES/GOALS: Same-day discharge (SDS) after mastectomy without reconstruction (MwoR) is cost-effective with equivalent complications rates when compared to patients discharged the day after surgery. Despite this, facilities SDS rates after MwoR vary from &lt;10%-80% (20% overall). We aimed to explore barriers to and strategies for implementing SDS after MwoR. METHODS/STUDY POPULATION: We conducted semi-structured interviews with surgeons currently performing MwoR and practicing in the state of Michigan. Recruitment was done through purposeful and snowball sampling methods. Interviews ranged from 40-60 minutes in length. The interview guide was based on the Tailored Implementation of Chronic Disease framework. Interviews were transcribed then analyzed by 3 independent reviewers. A framework matrix was created to identify common themes. RESULTS/ANTICIPATED RESULTS: Participants (n=15) included general surgeons, breast surgeons, surgical oncologists, and both university and non-university affiliated practices were represented. Surgeons either discharged patients the same-day or the day after MwoR. All surgeons who didnt routinely discharge patients the day of surgery (n=9) believed their facility had the resources to implement this practice and it would be safe for most patients. Identified barriers to same-day discharges included provider preoperative expectation setting, patient anxiety about managing their wound drain, and practice standards at their facility. Potential strategies for implementation included incorporating drain teachings with patients before surgery and explaining the benefits of same-day discharge with other providers at your facility. DISCUSSION/SIGNIFICANCE: We identified novel barriers to same-day discharge after MwoR. These barriers are potentially targetable with interventions addressing patient anxiety surrounding drain management, and education of providers across the care continuum.

TB or Non-TB, How to Treat These Infections in a Heart Transplant Patient (That is the Question!)

<h3>Introduction</h3> Driveline exit site infections (DLESi) are common complications of left ventricular assist device (LVAD) therapy. Rarely, non-tuberculosis mycobacteria (NTB) cause such infections. We present a case showing successful treatment of a DLESi due to <i>Mycobacterium chelonae</i> which first became clinically apparent after orthotopic heart transplant (OHT). <h3>Case Report</h3> A 61-year-old male with a dilated cardiomyopathy received a Heartmate 3 LVAD followed 4 years later by OHT. Prior to OHT, no infections were reported. Two months after OHT, an abdominal wall abscess at the former driveline exit site was treated with incision and drainage. Abdominal wound drainage continued, with appearance of satellite lesions and chest wall nodules. Although initial cultures were negative, wound cultures collected 3 months later, grew <i>M. chelonae</i>. For rare NTM related DLESi, a standardized regimen is not established. Hence, commonly used macrolide, quinolone, and linezolid were started. Azithromycin was initially chosen over the more frequently studied clarithromycin due to the latter's interaction with tacrolimus. Linezolid was stopped due to pancytopenia and the ensuing susceptibility report showed quinalone resistance. As a result, the patient was functionally on macrolide monotherapy which led to a recurrence of nodules. Thus, multiple antibiotic regimens were started in succession (Figure). The final clofazimine, azithromycin, and tigecycline based regimen was clinically effective, but caused intolerable diarrhea that led to self-discontinuation of treatment after ∼9 months of therapy. He remains asymptomatic 1-year since antibiotic termination. <h3>Summary</h3> Picking an antibiotic regimen for rare, difficult-to-treat NTB related DLESi involves using the sensitivity analysis while accounting for drug-drug interactions with immunosuppressive medications. Our case demonstrates efficacy of a macrolide and clofazimine based regimen for treatment of a LVAD associated NTB infection in an OHT patient.

Role of Drain in the Wound for Prevention of Superficial Surgical Site Infection Following Open Choledocholithotomy

Background: Surgical site infections (SSIs) are still a major problem in surgical practice. Despite the preventive strategies such as antibiotic prophylaxis and anti-septic skin cleansing, the SSI rate remains above 15 % after general abdominal surgery. This complication is also common after open choledocholithotomy. Several studies have shown that wound drainage is beneficial for reducing infection; however, there is a paucity of data regarding its benefit in open choledocholithotomy. Objective: To assess the effectiveness of placing a drain in the subcutaneous plane in order to reduce superficial SSI after open choledocholithotomy. Methods: Following convenience sampling, a total of 44 patients who underwent open choledocholithotomy from March 2019 to July 2021 were included in the study. Patients were divided into two groups. A subcutaneous closed suction drain was inserted in 19 patients (group I) and no subcutaneous drain was placed in 25 patients (group II). Daily drain collection was recorded in the case group. All the patients were examined and evaluated postoperatively for detection of wound seromas, superficial SSIs, and wound dehiscence. Data analysis and presentation made by statistical software SPSS 22 windows version 10. Results: It was observed that 10.5% of patients had SSI in group I and 60.0% in group II. The difference was statistically significant (p=0.001) between the two groups. The mean postoperative hospital stay was 11.58±2.91 days in group I and 15.04±5.78 days in group II. The difference in length of postoperative hospital stay was statistically significant between the two groups. Organisms isolated from bile culture and wound swab culture both are dominated by Escherichia coli. Conclusion: The placement of a drain in the wound in open choledocholithotomy showed a positive impact on the prevention of superficial surgical site infection. It also significantly reduces the length of hospital stay and SSSI rate.

Closed-Incision Negative-Pressure Wound Therapy after Resection of Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized Trial.

Wound healing after resection of large soft-tissue tumors is often impaired by large dead space and fluid collection. Recently, the authors were able to show an association of wound complications with worse oncologic outcome in soft-tissue sarcomas. The aim of the study was to examine the value of closed-incision negative pressure wound therapy on postoperative wound drainage and wound complications after soft-tissue tumor resection. Patients for whom resection is planned of a soft-tissue tumor larger than 10 cm in diameter of the extremities or the trunk were allocated randomly to one of two groups. After wound closure, patients in the study group received closed-incision negative-pressure wound therapy for a duration of 5 days, whereas those in the control group received regular dressings. The amount of drainage fluid, course of wound healing, length of hospital stay, and wound edge perfusion at postoperative day 5 measured by white-light infrared spectroscopy were compared. Sixty patients could be included in the study with even distribution to both study arms, meeting the goal. The postoperative course of wound drainage volume was significantly lower in the study group, and hospital stay was significantly shorter, with 9.1 ± 3.8 days versus 13.9 ± 11.8 days. The occurrence of wound complications was significantly lower in the study group on time-to-event analysis (one versus six). Tissue spectroscopy revealed a significantly higher oxygen saturation increase in the wound edge for the study group versus the control group. Closed-incision negative-pressure wound therapy should be considered for patients undergoing resection of large soft-tissue tumors. Therapeutic, II.

Polytrauma in the Geriatric Population: Analysis of Outcomes for Surgically Treated Multiple Fractures with a Minimum 2Years of Follow-Up.

This study analyzed the clinical and radiological outcomes of geriatric polytrauma patients who had multiple fractures surgically treated and a minimum of 2years of follow-up. Eighty-six geriatric patients with polytrauma and multiple fractures which were surgically treated in orthopedics and who had a minimum of 2years of follow-up were retrospectively analyzed. Patients' demographic characteristics, comorbidities, and follow-up time were recorded. The mechanism of injury, fracture type and location, Injury Severity Score (ISS), American Society of Anesthesiologists (ASA) score, duration of hospital stay, complications, and 1-year mortality were also recorded. Fracture union, implant failure, and refractures/misalignment were analyzed from radiographs. There were 34 (39.5%) male and 52 (60.5%) female patients. Mean age was 73.5years with an average follow-up time of 32.9months. Patients had more low-energy traumas and more lower extremity, comminuted fractures. On the contrary, high-energy traumas and femur/pelvic fracture surgeries had higher associated mortality. The mean ISS score was 26.3. The most common ASA score was ASA3 (75.8%). The most common clinical and radiological complications were prolonged wound drainage and implant failure. The total 1-year mortality rate was 22.1%. Patients with high ASA scores and patients with lower extremity fractures (femoral/pelvic fractures) also had significantly increased mortality rates. No significant relation was detected between mortality and ISS, fracture type, number of fractures, and duration of hospital stay. Orthopedic surgeons must be alert about the possible complications of femoral fractures and comminuted fractures including pelvic girdle. Surgically treated, multifractured patients with high-energy trauma, advanced age, and high ASA scores are also at risk for mortality regardless of the ISS, comorbidities, and duration of hospital stay. Pulmonary thromboemboli must be kept in mind as a significant complication for mortality.

Validation of the diagnostic criteria of the consensus definition of fracture-related infection

BackgroundThe recently developed fracture-related infection (FRI) consensus definition, which is based on specific diagnostic criteria, has not been fully validated in clinical studies. We aimed to determine the diagnostic performance of the criteria of the FRI consensus definition and evaluated the effect of the combination of certain suggestive and confirmatory criteria on the diagnostic performance. MethodsA multicenter, multi-national, retrospective cohort study was performed. Patients were subdivided into an FRI or a control group, according to the treatment they received and the recommendations from a multidisciplinary team (‘intention to treat’). Exclusion criteria were patients with an FRI diagnosed outside the study period, patients younger than 18 years of age, patients with pathological fractures or patients with fractures of the skull, cervical, thoracic and lumbar spine. Minimum follow up for all patients was 18 months. ResultsOverall, 637 patients underwent revision surgery for suspicion of FRI. Of these, 480 patients were diagnosed with FRI, treated accordingly, and included in the FRI group. The other 157 patients were included in the control group. The presence of at least one confirmatory sign was associated with a sensitivity of 97.5%, a specificity of 100% and a high discriminatory value (AUROC 0.99, p < 0.001). The presence of a clinical confirmatory criterion or, if not present, at least one positive culture was associated with the highest diagnostic performance (sensitivity: 98.6%, specificity: 100%, AUROC: 0.99 (p < 0.001)). In the subgroup of patients without clinical confirmatory signs at presentation, specificities of at least 95% were found for the clinical suggestive signs of fever, wound drainage, local warmth and redness. ConclusionsThe presence of at least one confirmatory criterion identifies the vast majority of patients with an FRI and was associated with an excellent diagnostic discriminatory value. Therefore, our study validates the confirmatory criteria of the FRI consensus definition. Infection is highly likely in case of the presence of a single positive culture with a virulent pathogen. When certain clinical suggestive signs (e.g., wound drainage) are observed (individually or in combination and even without a confirmatory criterion), it is more likely than not, that an infection is present.

The Wound Dressing Influenced Effectiveness of Cryotherapy After Anterior Cruciate Ligament Reconstruction: Case–Control Study Comparing Gauze Versus Film Dressing

PurposeTo compare the clinical effectiveness of cryotherapy after anterior cruciate ligament reconstruction using 2 different wound dressings, conventional postoperative gauze dressings and polyurethane semipermeable transparent film dressings.MethodsIn total, 60 patients who had undergone arthroscopic anterior cruciate ligament reconstruction with an autogenous patellar tendon were assigned to 2 groups. The surgical wound was covered with 5 sheets of gauze with an elastic bandage (control group) in 30 patients and film dressing was used (film group) in the remaining 30 patients. Silicone drainage catheters were inserted at the intercondylar notch, beside the distal outlet of the tibial tunnel for 2 days. After 1 hour of cooling using the device, the knee was chilled with an ice bag every 2 hours until the next morning. The severity of pain was evaluated by the number of times an analgesic, 50 mg of diclofenac sodium suppositories, had to be administered in the 24 hours after surgery. The amount of drainage during the following 2 days, the range of motion at 21 days, the change of hemoglobin concentration at 1 and 7 days, and C-reactive protein (CRP) at 1 and 7 days were examined.ResultsThe number of patients who used an analgesic was 18 in the control group and 7 in the film group (P = .003). The amount of drainage was 165.2 ± 72.9 mL in the control group and 289.7 ± 77.6 mL in the film group (P < .001). The postoperative CRP value was 0.77 ± 0.65 mg/dL at 1 day in the control group and 0.39 ± 0.42 mg/dL in the film group (P = .009). No statistical difference was seen for hemoglobin concentration at 1 or 7 days, CRP at 7 days or range of motion at 21 days.ConclusionsIn this study, we found that film dressing enhanced the effect of cryotherapy with respect to pain control, wound drainage, and inflammation immediately after surgery compared with traditional gauze dressing with elastic wrap.Level of EvidenceIII, case–control study.

Acetic Acid Use in Chronic Wound Healing: A Multiple Case Series.

Acetic acid is bacteriostatic or bactericidal to many gram-negative and gram-positive microorganisms, especially Pseudomonas. Nevertheless, it has also been found to possess cytotoxic effects in concentrations as low as 0.25% inhibiting the epithelialization process during wound healing. In this multiple case series, we present 2 cases of chronic traumatic leg wounds treated with gauze moistened with acetic acid (0.25%), which were covered with a securing dressing and compression stockinet. Both patients were told to apply gauze moistened with acetic acid (0.25%) twice daily. In both cases, the wound progressed to blue-green drainage and wet yellow slough tissue to near-complete beefy granulation tissue. At this point, acetic acid was replaced with collagen or petrolatum dressing until complete wound closure was achieved. The treatment of these wounds illustrated successful use of acetic acid for chronic wound care. Our experience with these cases suggests that appearance of blue-green wound drainage and wet yellow slough tissue is a reasonable indication for the use of gauze moistened with acetic acid (0.25%). Further research is needed to test the efficacy of these principles in guiding acetic acid use in wound care.

Acute normovolemic hemodilution as an alternative to hardware-assisted blood-saving techniques in operations for the correction of spinal deformities in patients with grade III-IV scoliosis

There were 45 adolescent patients with scoliosis of III-IV degree who underwent operative correction of the spine deformity by Cotrel-Dubousset system. Intraoperatively 26 patients received autologous shed blood reinfusion collected from wound drainage (mean 17.3+5.6 ml/kg), no donor erythrocytic mass was transfused. In 19 patients presurgical normovolemic hemodilution with 500 ml blood donation was performed. Reinfusion of that blood as well as the transfusion of donor washed off erythrocytes (mean 13.8+1.3 ml/kg) were performed at the peak of blood loss. Marked differences in patients condition were noted neither during surgical intervention nor in the postoperative period. It was concluded that normovolemic hemodilution in combination with transfusion of donor washed off erythrocytes may be the alternative to reinfusion of autologous shed blood if the later could not be performed.

A rare but troublesome complication of cesarean section: the uterocutaneous fistula. Report of two cases and review of literature

Abstract Objectives The occurrence of a uterocutaneous fistula (UCF) as an uncommon and severe complication of caesarean section (CS). The aim of this study was to describe two cases of UCFs after CS and to discuss about symptoms, diagnosis and treatment. Case presentation Both women few days after CS had surgical site infection, fever and elevation of lab inflammation markers. bacterial culture of the wound drainage was positive for Escherichia Coli and Enterococcus Faecalis. Conclusions Fistula between uterine and skin is a rare condition but should be considered with signs of inflammation after cesarean section; 2D/3D ultrasound evaluation appears to be useful for diagnosis of UCFs when combined with CT fistulography and MRI in order to obtain early diagnosis and, consequently, a conservative surgery.

Intraoperative Navigation in Spine Surgery: Effects on Complications and Reoperations

Intraoperative navigation during spine surgery improves pedicle screw placement accuracy. However, limited studies have correlated the use of navigation with clinical factors, including operative time and safety. In the present study, we compared the complications and reoperations between surgeries with and without navigation. The National Surgical Quality Improvement Project database was queried for posterior cervical and lumbar fusions and deformity surgeries from 2011 to 2018 and divided by navigation use. Patients aged >89 years, patients with deformity aged <25 years, and patients undergoing surgery for tumors, fractures, infections, or nonelective indications were excluded. The demographics and perioperative factors were compared via univariate analysis. The outcomes were compared using multivariable logistic regression adjusting for age, sex, body mass index, American Society of Anesthesiologists class, surgical region, and multiple treatment levels. The outcomes were also compared stratifying by revision status. Navigation surgery patients had had higher American Society of Anesthesiologists class (P < 0.0001), more multiple level surgeries (P < 0.0001), and longer operative times (P < 0.0001). The adjusted analysis revealed that navigated lumbar surgery had lower odds of complications (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77-0.90; P < 0.0001), blood transfusion (OR, 0.79; 95% CI, 0.72-0.87; P < 0.0001), and wound debridement and/or drainage (OR, 0.66; 95% CI, 0.44-0.97; P= 0.04) compared with non-navigated lumbar surgery. Navigated cervical fusions had increased odds of transfusions (OR, 1.53; 95% CI, 1.06-2.23; P= 0.02). Navigated primary fusion had decreased odds of complications (OR, 0.91; 95% CI, 0.85-0.98; P= 0.01). However, no differences were found in revisions (OR, 0.89; 95% CI, 0.69-1.14; P= 0.34). Navigated surgery patients experienced longer operations owing to a combination of the time required for navigation, more multilevel procedures, and a larger comorbidity burden, without differences in the incidence of infection. Fewer complications and wound washouts were required for navigated lumbar surgery owing to a greater proportion percentage of minimally invasive cases. The combined use of navigation and minimally invasive surgery might benefit patients with the proper indications.

Against drainage. Prof. D. Kulenkampf (Zntralbl. F. Chir. 1933, no. 38)

Against drainage. Prof. D. Kulenkampf (Zntralbl. F. Chir. 1933, no. 38) shares his experience of limiting the drainage of cavities and wounds. During operations on the brain and spinal cord, with strict adherence to asepsis, it is necessary to strive to tightly sew up the dura mater, and if this is not possible, then the skin wound.

Practice Alert: New ICD-10 Codes for MASD.

Practice Alert: New ICD-10 Codes for MASD.

Wound drainage in cardiac surgery

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить эффективность и безопасность стандартного и оригинального способов дренирования раны после кардиохирургических операций. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование были включены 180 пациентов (90 пациентов в каждой группе). Средний возраст больных в 1-й группе составил 58 [55; 65] лет, во 2-й группе — 59 [54; 64] лет. В 1-ю группу включены пациенты, которым дренирование осуществляли по оригинальной методике. Во 2-й группе использовали стандартный способ (двумя отдельными дренажами дренировали полость перикарда и ретростернальное пространство, при вскрытии плевральных полостей использовали еще 1—2 дополнительных дренажа). Пациентам выполняли аортокоронарное шунтирование и коррекцию клапанной патологии в условиях искусственного кровообращения. В послеоперационном периоде производили активную эвакуацию жидкости с помощь стандартной установкой «ОП-01» с разряжением 20 см вод. ст. <h3>РЕЗУЛЬТАТЫ</h3> Достоверных различий между группами по предоперационным и интраоперационным факторам риска выявлено не было за исключением длительности ИВЛ во 2-й группе и частоты хронических заболеваний легких в 1-й группе. Группы достоверно не различались в послеоперационном периоде по длительности стояния дренажей, объемам кровопотери и плеврального выпота и частоте послеоперационной пневмонии. Во 2-й группе у 16 (17,8%) пациентов на госпитальном этапе было выявлено скопление жидкости в полости перикарда. У 8 пациентов объем был незначительным (10—30 мл). У 8 (8,9%) пациентов было выполнено дренирование перикарда в условиях операционной (выпот более 250—300 мл). Пункция перикарда была сопряжена с дополнительным риском повреждения правого желудочка. В 1-й группе скопления жидкости в полости перикарда не наблюдали, потому что жидкость дренировали через фенестрацию в левую плевральную полость. <h3>ВЫВОД</h3> Предлагаемый способ дренирования позволяет проводить профилактику тампонады сердца без дополнительных манипуляций и сократить количество используемых дренажей до одного.

Effectiveness of a Subcutaneous Suction Drainage System for Reducing Surgical Site Infection in Off-Pump Coronary Artery Bypass Grafting

Objects: Surgical site infection (SSI) remains a major morbidity in patients undergoing cardiovascular surgery. This study evaluated the efficacy of subcutaneous suction drainage in decreasing the risk of SSI of the sternal wound in off-pump coronary artery bypass grafting (OPCAB). Materials and methods: We invested 106 patients, including 25 women (mean age 70.3 ± 9.6 years old), who underwent OPCAB. Patients were categorized into those with subcutaneous suction drainage of the sternal wound (S group, n = 73) and those without subcutaneous suction drainage (N group, n = 33), and their data were analyzed.Results: Compared with the N group, the S group had a lower incidence of SSI (N vs. S: 9.1% vs. 0.0%, p = 0.029) and significantly shorter hospitalization duration (N vs. S: 23.2 ± 10.5 vs. 16.6 ± 5.7 days, p < 0.001). No bacteria were isolated from patients with SSI. Patients with SSI were treated and completely cured with continuous negative-pressure wound therapy.Conclusions: Recent approaches to SSI prevention that include a subcutaneous suction drainage system can result in better outcomes by reducing the risk of SSI after OPCAB.