Early Postoperative Wound Complications Research Articles

To patch, or not to patch a common femoral artery, that is the question.

There is no strong evidence to support or reject the use of patch angioplasty (PA) after femoral endarterectomy (FE). The current study aimed to assess early postoperative complications and compare primary patency (PP) rates after FE in patients treated with PA versus direct closure (DC). This is a retrospective study of patients admitted during 06/2002-07/2017 with signs and symptoms of chronic lower limb ischemia (Rutherford categories 2-6). Patients with angiographically confirmed stenoses or occlusions of the common femoral arteries (CFAs) and managed with FE with or without PA were included in the study. Early postoperative wound complications were assessed. The PP analysis was based on imaging-confirmed data. The impact of PA on the patency was evaluated in a confounder-adjusted Cox regression model. PP rates were compared with log-rank between the PA and DC groups using Kaplan-Meier survival analysis in the propensity score-matched (PSM) cohorts. A total of 295 primary FEs were identified. The patients' median age was 75years. A total of 210 patients were managed with PA and 85 with DC. Altogether, 38 (12.9%) local wound complications were registered, 15 (5.1%) of which required re-interventions. There were 9 (3.2%) cases of deep wound infection, 20 (7.0%) seromas, and 11 (3.9%) cases of major bleeding, with no significant difference between the PA and DC groups. All of the infected patches were made of synthetic material, and 83% of them were removed. The PP analysis was performed on 50 PSM patient pairs with a median age of 74years. The median imaging-confirmed follow-up lengths were 77months (IQR = 47months) for the PA patients and 27months (IQR = 64months) for the DC patients. The preoperative median diameter of the CFA was 8.8mm (IQR = 3.4). The 5year primary patency rates of CFAs with a minimum diameter of 5.5mm managed with PA or DC exceeded 91%, p > 0.05. Female sex was associated with the loss of PP, odds ratio 4.17, p = 0.046. Wound complications after FE with or without patching are not uncommon and often lead to reoperations. The PP rates of CFAs with a minimum diameter of 5.5mm and accomplished with or without patching are comparable. Female sex is associated with the loss of patency.

The impact of non-closure of the platysma muscle layer on the cosmesis of thyroidectomy scar – a randomised double-blind controlled trial

BACKGROUND: The relevance of closing the platysma muscle layer after open thyroidectomy has received little interest in terms of research. The objective was to determine whether non-closure of the platysma muscle layer after open thyroidectomy impacts significantly on the cosmetic outcome of the resulting collar scar. METHODS: In this prospective randomised controlled clinical trial, patients were assigned randomly to have the platysma muscle layer closed or not closed. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Additional endpoints included operation time and early postoperative wound complications. RESULTS: Ninety-two patients were recruited, with 46 randomised to each group. The patient scar assessment subscale (PSAS) of the POSAS showed no significant difference in the scar cosmesis between the two groups six weeks after surgery (median PSAS: 16.5 vs 17.5; p = 0.514). The observer scar assessment subscale (OSAS) showed that the platysma muscle layer closure group had marginally better scars (median OSAS: 15 vs 17; p = 0.045). The size of the goitre did not make any significant difference in the scar cosmesis. There was no significant difference in the incidence of early postoperative wound complications as well as the median operation time. CONCLUSION: Not closing the platysma muscle layer had no significant impact on the scar cosmesis six weeks after open thyroidectomy, with no significant difference in the incidence of early postoperative wound complications and the operation time.

Transversus Abdominis Muscle Release (TAR) for Posterior Component Separation during Major Abdominal Wall Reconstruction

Abstract Background Ventral hernia repair is one of the most common operations performed today, yet when complex and huge it presents a true challenge for the surgical team. Aim of the Work To assess the feasibility, safety and efficacy of Transversus Abdominis release technique in management of ventral hernia with large defects. Patients and Methods This study is a prospective interventional study conducted at Ain Shams University Hospitals on 40 patients diagnosed as having ventral hernia with a defect equal to or more than 10cm in width and operated upon between October 2018 and October 2019 with minimal follow up of 6 months postoperatively. Results 40 ventral hernia patients were enrolled in the study. Mean operative time (in minutes) in TAR patient is 268.5min (4hr 28min) with SD ± 47.4. Postoperative pain evaluation using the visual analogue scale (VAS) score, the postoperative pain was assessed 48hrs postoperatively, the mean VAS score for TAR patient being (6.77 ± 1.70). Early Postoperative wound complications 10 (25.0%). Conclusion After this TAR technique are effective and reliable method in experienced hands.

Optimized approach to the surgical treatment of patients with large and giant postoperative ventral hernia

To optimize surgical approach in patients with large and giant postoperative ventral hernias through an analysis of early and long-term results of modern techniques of hernia repair. There were 680 patients with postoperative ventral hernia over a 15-year period who underwent surgery in the Sklifosovsky Research Institute for Emergency Care and Medical Unit of the Ministry of Internal Affairs (445 (65.4%) women, 235 (34.6%) men). Mean age of patients was 63.2±14.2 years. Middle and elderly (employable) age patients (45-74 years) prevailed in the study (n=510, 75%). Hernia repair using «sublay» technique was performed in 490 (72%) patients without severe comorbidities and relative volume of hernial protrusion up to 18%. Submuscular-inlay technique was used in 95 (14%) patients with significant comorbidities and those over 50 years old or with a relative volume of hernial protrusion over 18%. We have applied a modified repair technique for the last 3 years in 5 (0.75%) patients with a giant postoperative ventral hernia and anterior abdominal tissue deficiency (partial or complete absence of some anatomical structures, for example, rectus muscle). A hybrid technology was applied in 12 patients with severe concomitant diseases, hernias W2 according to European qualifications or recurrent hernias, significant adhesions in the abdominal cavity or hernial sac. Early postoperative wound complications occurred in 27 (5.5%) patients including hematoma (n=12, 2.5%), infiltration (n=7, 1.4%), wound suppuration (n=8, 1.6%). Other complications were observed in 6 (1.2%) patients: pneumonia, pulmonary embolism, intestinal obstruction. Lethal outcomes were absent. Recurrences in long-term period were found in 18 (3.7%) patients. Submuscular-inlay technique of hernia repair was followed by early postoperative wound complications in 5 (5.1%) patients including hematoma (n=3, 3.2%), infiltration (n=1, 1%), wound suppuration (n=1, 1%). There was no mortality. No other early postoperative complications were observed. Recurrences were detected in 5 (5.2%) patients. Preoperative intra-abdominal pressure was 7-10 mm Hg in all patients with tissue deficit. This value did not exceed 12 mm Hg after repair due to creation of a «specified diastasis». Lethal outcomes were absent. There were no early and long-term recurrences or wound complications. Analysis of early and long-term results of the modified hybrid repair of the anterior abdominal wall did not reveal recurrences, local and systemic complications. Persistent minor diastasis between rectus muscles reinforced with a mesh implant was observed in 3 (25%) out of 12 patients. Thus, optimized and personalized approach in patients with large and giant postoperative ventral hernias considers all intra- and postoperative risk factors.

A Study of Early post-operative wound complications of spina bifida aperta repair “Incidence and Risk Factors”

Background: Myelomeningocele is the single most common congenital anomaly that affects the CNSand vertebral column. The third world countries having a higher incidence. The management is usuallysurgical with relative high incidence of complications.Objectives: to evaluate the possible risk factors that may predispose to early wound complications ofmyelomeningocele.Methods: This prospective study was carried out in the Surgical Specialization Hospital in Medical CityComplex - Baghdad from 2009-2012. 147 cases were included in the study. Requested data weregestational age, type of delivery, gender, age at operation, type of suturing of the wound, tension ofsuturing, duration of operation, site of the lesion, ruptured vs non ruptured myelomeningocele, associatedshunting, peri-operative stay in hospital and associated jaundice.Result: Forty four (44 %) of the total developed complications. All premature infants developedcomplications. Hydrocephalic cases was associated with higher rate of complication (86%). Type ofdelivery, age at operation, duration of operation, ruptured cases and site of the lesion were not associatedwith complications.Conclusion: Myelomeningocele was predominantly affecting female. Most of the complications werewound infection with or without dehiscence, CSF leakage or seroma.

A Study of Early post-operative wound complications of spina bifida aperta repair “Incidence and Risk Factors”

Background: Myelomeningocele is the single most common congenital anomaly that affects the CNSand vertebral column. The third world countries having a higher incidence. The management is usuallysurgical with relative high incidence of complications.Objectives: to evaluate the possible risk factors that may predispose to early wound complications ofmyelomeningocele.Methods: This prospective study was carried out in the Surgical Specialization Hospital in Medical CityComplex - Baghdad from 2009-2012. 147 cases were included in the study. Requested data weregestational age, type of delivery, gender, age at operation, type of suturing of the wound, tension ofsuturing, duration of operation, site of the lesion, ruptured vs non ruptured myelomeningocele, associatedshunting, peri-operative stay in hospital and associated jaundice.Result: Forty four (44 %) of the total developed complications. All premature infants developedcomplications. Hydrocephalic cases was associated with higher rate of complication (86%). Type ofdelivery, age at operation, duration of operation, ruptured cases and site of the lesion were not associatedwith complications.Conclusion: Myelomeningocele was predominantly affecting female. Most of the complications werewound infection with or without dehiscence, CSF leakage or seroma.

Immediate Breast Reconstruction does not Delay Adjuvant Chemotherapy nor affect Clinical Outcome

Background: Post-operative complications are more frequent after immediate breast reconstruction and there are concerns that it adversely affects clinical outcome. Objectives: We reviewed the rate of early and late complications after immediate breast reconstruction and evaluated their impact on adjuvant treatments and outcome. Methods: Retrospective review was performed of 146 women who underwent immediate breast reconstruction after mastectomy for breast cancer from 1st January 2001 to 31st December 2010. Results: Median patient age was 46 years and all women had no major co-morbidities. More than half the women had early-stage cancers. Reconstruction was performed with a pedicled transrectus abdominis myocutaneous flap in 109 patients, a latissimus dorsi flap in 29, a free deep inferior epigastric perforator flap in 4 and implants were inserted in 4 patients. Two patients suffered a cerebrovascular accident and one a cardiac event but all recovered fully. Early post-operative wound complications within 30 days of surgery occurred in 25 patients (17%). All, except one, were managed conservatively. Late complications occurred in 18 patients and 7 patients underwent further surgery, which most often involved abdominal hernia repair. Complications were more frequent in older patients, diabetics and those with implants inserted (P<0.01, P=0.05, P=0.01 respectively). Adjuvant treatments proceeded as planned in most cases, with wound complications delaying initiation of chemotherapy for longer than 3 months in only 3 patients. We observed no correlation between post-operative complications and disease recurrence, whether local or distant (P=0.39, P=1.00 respectively) and reconstruction together with cancer surgery did not increase the likelihood of disease recurrence (P=0.08). Conclusions: Post-operative complications after immediate breast reconstruction did not delay planned adjuvant treatments nor did it increase the risk of disease recurrence. This study affirms the oncological safety of immediate reconstruction following mastectomy for breast cancer.

Associated Risks of Obesity and/or Metabolic Syndrome with Intra-operative or Post-Operative Occurrences in Patients with Open Ventral Hernia Repair

Metabolic syndrome and obesity are increasing in incidence worldwide and they carry with them a lot of health issues that might directly affect individuals or might be associated with higher risk of surgical complications represented in this study by open ventral hernia repair. A cohort study of 132 patients admitted electively for open ventral hernia repair to the surgical wards at Al-Sader teaching hospital in Najaf /Iraq from December 1st/ 2015 to October 1st/ 2016. All patients were followed for intra-operative occurrences and followed for 2 weeks postoperatively for any early post-operative complications. Of the total 132 patients, there were 44 patients (33.3%) having metabolic syndrome and there were 68 obese patients (66.6%) of which 37 having metabolic syndrome (54.4%). There was no significant association between intra-operative occurrences or early post-operative complications in obese patients with or without metabolic syndrome but there was a significant association between intra-operative occurrences and metabolic syndrome in patients having body mass index (BMI) below 30 Kg/m2. Diabetes was the only significant factor for early postoperative wound complications whether the patient had metabolic syndrome or not.

Prophylactic Preperitoneal Mesh Placement in Open Bariatric Surgery: a Guard Against Incisional Hernia Development

Incisional hernia is one of the most common late complications of open bariatric surgery. The aim of this study was to assess the safety and efficacy of preperitoneal prosthetic enforcement of midline incisions during open bariatric surgery in preventing incisional hernia development. This study randomized 64 morbidly obese patients admitted to undergo open bariatric surgery into two equal groups (I and II). A prophylactic sheet of polypropylene mesh was fixed in the preperitoneal space during wound closure in group I while in group II the wound was closed conventionally. This study included 51 females and 13 males ranged in age from 19 to 60 years. No significant difference was observed in mean age, mean preoperative body weight, mean body mass index, mean hospital stay, and mean follow-up period of either group. Three open procedures were done: vertical banded gastroplasty, Roux-en-Y gastric bypass, and vertical sleeve gastrectomy. No significant difference in mean operative time in either group for each operation was noted. Early postoperative wound complications were similar in either group. Incisional hernia incidence was significantly higher in group II, nine cases (28.1%), than in group I, one case (3.1%). Using prophylactic preperitoneal Prolene mesh during wound closure in open bariatric surgery is safe and effective in preventing incisional hernia development.

Incidence and implications of early postoperative wound complications after total elbow arthroplasty

Other than an awareness, there is little detailed information regarding wound problems after total elbow arthroplasty. The purpose of this study was to (1) determine the incidence of wound complications after elbow arthroplasty, (2) document the long-term implications, (3) characterize risk factors, and (4) discuss a management strategy. We hypothesize that the incidence of this complication can be reduced with careful preoperative planning. We reviewed 1749 total elbow arthroplasties. The average patient age was 61.5years (range; 30-91 years). Wound complications were diagnosed according to the criteria of the Centers for Disease Control and Prevention. We identified and studied 97 patients (5.5%) from the 1749 procedures. The most common problems were delayed healing and drainage in 34 and wound hematoma in 33, of which 9 (27%) progressed to secondary deep infection. Of the 97 patients, 86 (88.7%) healed with the retention of the implant, 24 (∼25%) progressed to a septic elbow, and 11 (∼50%) required resection. Patients with rheumatoid arthritis represented 33% of the entire sample, but represented 45.8% of those with septic complications. Posttraumatic arthritis patients represented 58% of the entire sample and only 33% of those with septic problems (P < .05). The overall incidence of serious wound complications was slightly less than anticipated; however, the significance was considerable. Patients with rheumatoid arthritis are most vulnerable. Persistent wound drainage showed a high correlation for deep infection and subsequent implant removal. Anticipation of potential problems and appropriate prophylactic management may avoid wound complications.

Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results

To analyse clinical and demographic factors of patients who suffered infection of the surgical site requiring mesh removal as a complication of prosthetic repairs, details of the hernioplasties in which meshes were implanted and their management and outcomes. Factors related to infection (demographic variables and characteristics of the repairs and mesh utilised) and the management before proceeding to mesh removal were obtained from patient charts. Collected specimens (meshes and tissues) from 32 consecutive patients were cultured and observed microscopically. The outcomes after mesh removal were prospectively evaluated. Twenty-two patients underwent incisional hernioplasties and ten inguinal hernioplasties; most of the procedures took a long time, and 28 patients presented early wound complications (seroma or haematoma). During the “implantation–removal” interval, some conservative treatments, such as drainages or sinus resection, were attempted under local anaesthesia. Twenty-two meshes were totally removed (nine after partial extraction); in the remaining ten cases partially removal was successful. Most of the meshes (24) were made of multi-filament polypropylene; microscopic observation of neighbouring tissues showed leucocyte infiltration, giant cell reaction, disorganisation of the collagen fibres and abscedation. Treatment of 32 patients required 51 operations. Following mesh removal, there were six recurrences and two fistulas of the bowel. The average follow-up was 40 months (30–97). Most of the infections requiring mesh removal were related to prolonged repair operations that presented untreated early postoperative wound complications. Partial extraction of meshes frequently leads to failures and complications. Surgical exploration should be performed under general anaesthesia to accomplish complete mesh extraction.

Chronic compartment syndrome. An unusual cause for claudication.

Chronic Compartment Syndrome (CCS) is usually caused by overuse injury in well-conditioned athletes (particularly runners). Less common causes of CCS include blunt trauma, venous insufficiency, and tumor. CCS is clinically manifested as claudication, tightness, and occasional paresthesia. Unlike other forms of overuse injury (tendonitis, stress fracture), CCS does not respond to rest, anti-inflammatory medications, or physical therapy. The diagnosis of this condition is confirmed by elevated compartment pressures (normal less than 15 mmHg; CCS greater than 20 mmHg). The only effective treatment is surgical compartment release. Two hundred nine patients have been surgically treated for CCS, 100 by subcutaneous fasciotomy (group I) and 109 by open fasciectomy (group II). These procedures were usually performed in ambulatory surgery using local anesthesia. Patients treated by open faciectomy instead of subcutaneous fasciotomy had fewer early postoperative wound complications (6% vs. 11%) and fewer late recurrences (2% vs. 11%).