Postoperative Wound Healing Research Articles

Impact of smoking cessation on healing after foot and ankle surgery

IntroductionPerioperative smoking is the main risk factor for the development of postoperative cutaneous wound healing complications. We require that all patients undergoing elective foot and ankle surgery stop smoking (6 weeks before and 3 months after) and this abstinence is monitored with a preoperative cotinine test. We therefore wanted to understand how this impacted wound healing in elective foot and ankle surgery: do wounds heal differently in patients who quit smoking for surgery, former smokers and nonsmokers? HypothesisOur hypothesis was that patients who stopped smoking for an upcoming surgery had the same wound healing complications as nonsmokers and former smokers. Materials and methodsThis was a historical, single-center, single-surgeon cohort study of adult patients who underwent an elective ankle or foot surgery between June 2016 and July 2017. Patients were divided into 3 groups: group 1 smokers who stopped for surgery, group 2 former smokers, and group 3 nonsmokers. The primary endpoint was the occurrence of wound healing complications during the wound care consult scheduled 3 weeks after surgery. ResultsA total of 256 patients with a mean age of 58±14.2 years (range, 18–88) were included. Group 3 had more women and a lower BMI than the other groups, but all the other demographic characteristics were similar. Smoking cessation was achieved in group 1 on average 2.5±1.3 months (range, 1–6) before surgery. There were a total of 20 wound healing complications or 7.5% of the cohort: 13% in group 1, 11.1% in group 2 and 6.4% in group 3. The univariate analysis found that the odds ratio was 2.3 when comparing Group 1 to Group 3 and 1.85 when comparing group 2 to group 3 (p=413). No significant risk factors for wound healing complications were found. Discussion/conclusionSmoking cessation for foot and ankle surgery seems to limit the risk of wound healing complications, with results close to those of former smokers and nonsmokers. Mandatory smoking cessation before surgery could be one of the solutions to prevent this frequent complication. Level of evidenceIII.

Does freeze dried amnion useful as scaffold for mesenchymal stem cell for repair of vesicovaginal fistula? An overview of proliferative and remodeling phase in the wound healing process

BackgroundSurgery is still the main solution for vesicovaginal fistula, but postoperative wound healing represents a challenge, and the recurrence rate remains high. There is a need to develop therapeutic methods to increase the success of therapy and women's quality of life. ObjectiveTo explore whether human freeze-dried amnion is useful as a mesenchymal stem cell scaffold for repair of vesicovaginal fistula through assessment of the proliferative and remodelling phases. MethodsThis experiment was undertaken using a New Zealand rabbit model. The research was divided into two stages: (1) an experiment to create a model of a vesicovaginal fistula; and (2) a laboratory experiment to close a vesicovaginal fistula as a result of the first stage. The second stage used a post-test-only control group design. The wound-healing process was assessed based on the expression of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), occludin and claudin-4. Data were analysed descriptively and statistically. ResultsExpression of PDGF, VEGF, FGF, occludin and claudin-4 in vesicovaginal fistula models sutured with human freeze-dried amnion was higher compared with models without human freeze-dried amnion. Significant differences were found in average expression of PDGF, VEGF, FGF, occludin and claudin-4. ConclusionHuman freeze-dried amnion plays a role in the wound-healing process in vesicovaginal fistula repair models. It is hoped that this research will improve urogynaecological services.

Depilation of the external auditory canal in transcanal and endaural otosurgery

Introduction. Literature review search did not show enough information to answer the question concerning the need to remove hair in the external auditory canal as a part of preoperative preparation of the surgical field in middle ear surgery with endaural and transcanal approaches.Aim of the study. To substantiate the removal of hair from the external auditory canal during transcanal and endaural otosurgery.Materials and methods. A prospective randomized study included 2 groups. In the first group, tympanoplasty and stapedoplasty were performed via endaural approach with and without hair removal in the external auditory canal. The effect on the intraoperative overview and postoperative wound healing was assessed. Shunting of the tympanic cavity in the second group, with transcanal approach, have been performed under the control of a microscope and endoscope. The evaluation was done via a questionnaire, it was given to the doctor before and after hair removal separately. Postoperative inflammatory reaction was also assessed.Results. Postoperative wound healing of the external auditory canal in the first group were considered comparable between the main and the control group, and had no complications. In the second group, inflammation was absent in all patients. Hair removal significantly improve the visibility in endaural and transcanal approach.Conclusions. Hair removal from the external auditory canal increases the visibility of the surgical field and facilitates the work of an otosurgeon. It is especially recommended as a preoperative preparation, especially for transcanal surgical interventions on the middle ear under endoscope control.

A comparative study of wound opening versus primary closure after fistulectomy in the lower anal fistula

Objectives. The aim of the study is to investigate the outcome of primary wound closure versus non-wound closure after fistulectomy in terms of postoperative pain and wound healing time. Materials and Methods. A prospective comparative randomized study was performed on patients admitted to the General Surgery Department of our Institute (Dec.1, 2019-Nov.31, 2021), with a diagnosis of low anal fistula and undergoing fistulectomy. 54 patients were included in the study and were assigned alternately and equally in group A (fistulectomy with laying open of wound) and group B (fistulectomy with primary closure), with 27 patients in each group. On day 1 postoperatively, the pain score was assessed by analog visual scale. Patients were followed for 6 weeks, and healing was assessed by visual examination of epithelialization at each follow-up visit. Results. In our study, the average healing time in group A was 20.77 days and in group B 14.07 days (the average healing time in group B is significantly longer than in group A, with P value of <0.00001). In our study, the average pain score among the participants in group A is 4, and among the participants in group B it is 2,148, with the value P <0.00001, which is statistically significant. Conclusion. Primary closure fistulectomy is a better method for treating low anal fistula due to the fact that it causes less pain, accelerated healing compared to wound opening fistulectomy. However, further studies are needed to compare other methods of treating low anal fistula.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Negative pressure wound therapy for surgical wounds healing by primary closure.

The effect of preoperative smoking and smoke cessation on wound healing and infection in post-surgery subjects: A meta-analysis.

A meta-analysis was performed to evaluate the preoperative smoking and smoke cessation on wound healing and infection in post-surgery subjects. A systematic literature search up to January 2022 incorporated 11 trials involving 218 567 subjects after post-surgery at the beginning of the study; 176 670 were smoke cessation or non-smokers, and 41 897 were smokers. Statistical tools like the dichotomous method were used within a random or fixed-influence model to establish the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the influence of preoperative smoking and smoke cessation on wound healing and infection in post-surgery subjects. Smoke cessation or non-smokers had significantly lower postoperative wound healing problems (OR, 0.59; 95% confidence interval, 0.43-0.82, P < .001), and surgical site wound infection (OR, 0.74; 95% CI, 0.63-0.87, P < .001) compared with smokers in post-surgery subjects. Smoke cessation or non-smokers had significantly lower postoperative wound healing problems, and surgical site wound infection compared with smokers in post-surgery subjects. Furthermore, evidence is needed to confirm the outcomes.

The Effect of Qingre Huayu Recipe on Wound Healing after Anal Fistulotomy in Sprague-Dawley Rats.

Anal fistula is a common anorectal disease. At present, most scholars believe that its pathogenesis is related to anal gland infection. Anal fistula cannot heal on its own after the onset and must be treated surgically. The wound of anal fistula surgery is open and polluted, and it belongs to three types of three-stage healing; it is the most difficult to heal among all surgical incisions, with a long course of disease, a lot of exudation, and pain for the patient; traditional Chinese medicine has rich experience in the treatment of postoperative wound healing of anal fistula. The study aimed to evaluate the mechanism of Qingre Huayu (QRHY) Recipe on wound healing after fistulotomy on SD rats. SD rats (n = 72) were randomized into three groups post-anorectal surgery. The rats in the positive control group were given potassium permanganate (PP), treatment group were given QRHY, and trauma model group were given 0.9% normal salinity. The changes in wound secretion, granulated tissue, and epithelium tissue were observed, and wound healing rates were evaluated by the discrepancies in wound area. HE and Masson's staining as well as transmission electron microscopy were also performed. The localization as well as the measurement of Ang1, Src, and VE cadherin expression in each group adopted real-time PCR, western blot, and immunohistochemistry (IHC) assays. Statistically higher wound healing rates were observed in QRHY group on days 3, 7, and 14 compared with other groups. Histological analyses showed highly significant increase in collagen and fibroblasts, less inflammatory cells, and vascular endothelial permeability in QRHY rats. The transmission electron microscopy revealed that the intact structure of tight junctions in endothelial cells and well-organized collagen and VE-cadherin, Ang1, and Tie-2 were upregulated by QRHY, while Src was inhibited. This study showed that QRHY can promote wound healing after anal fistulas.

The effect of platelet-rich fibrin on wound healing following strabismus surgery

Purpose To investigate the effect of platelet-rich fibrin (PRF) on post-operative wound healing following strabismus surgery in a rabbit model. Methods Nine New Zealand white rabbits were involved in the study. One of these nine rabbits was kept in control without having any operation. Both eyes of eight rabbits underwent superior rectus muscle (SRM) resection. After resection of SRM, PRF was applied to SRM of the right eyes. In the left eye, SRM was not wrapped with PRF and served as a control. The rabbits were sacrificed and enucleated 6 weeks after the surgery. Inflammation and vascular proliferation were assessed by staining with haematoxylin-eosin. Scar and fibrosis were examined by the Masson trichrome staining. Immunohistochemical staining was performed for a vascular endothelial growth factor (VEGF) and alpha-smooth muscle actin (α-SMA). Results There was no significant difference in terms of inflammation (p = 0.535), vascularization (p = 0.602), and fibrosis (p = 0.745) between the eyes. Immunohistochemical staining for VEGF demonstrated no significant difference (p = 0.745). However, significant staining for α-SMA was detected in PRF-treated eyes compared with control eyes (p = 0.037). Conclusion Consistent with the hypothesis that PRF facilitates wound healing as a biocatalyst, there was only a significant difference for α-SMA related to myofibroblast activity which is important for wound remodelling. Future comprehensive studies are needed to extend these results.

CYTOLOGICAL CHARACTERISTICS OF REGENERATIVE PROCESSES IN PURULENT WOUND DEPENDING ON THE TIME OF SURGERY (MORNING EVENING) AND CHRONOTYPE OF PATIENTS (MORNING AND EVENING CHRONOTYPE)

Healing of postoperative wounds is a staged process. At the early stage of the wound process is characterized by the presence of a large number of unchanged and altered erythrocytes, the latter are characterized by shrinkage, change in shape, the formation of clusters. Hemorrhages in a wound and the initial phenomena of an inflammation are defined. In the period of regeneration of wound healing, inflammatory phenomena gradually disappear, and regenerative processes are increasingly developed. n the study of the dynamics of healing of postoperative wounds, the most informative is the method of "superficial wound biopsy". For cytological material is taken by lightly scraping the surface layer of the wound with a special spatula. This method usually manages to obtain elements not only of the exudate and the superficial (granular-fibrinous) layer of the wound, but also newly formed cells. The cytograms obtained in this way provide significant information about the course of regenerative processes in the wound. [1]. Using the method of "surface biopsy" of wounds to determine the features of the regenerative processes in the wound depending on the time of surgery (morning evening) and the chronotype of patients (morning and evening).&#x0D; Cytological examination was performed using the method of "surface biopsy" of the wound [2]. The material for the study was taken by lightly scraping the surface layer of the wound with a spatula on the 1st, 3rd, 5th and 7th day of the postoperative period. The resulting material was transferred to a glass slide, evenly distributed in a thin layer, fixed and stained by Romanowski-Gimza [3]. The obtained preparations were studied using a microscope Biorex-3 BM-500T with a digital photomultiplier DCM 900 with programs adapted for research data. Cytometric study was performed by the method of standard planes [4] at a magnification of x1000, determined the average number of erythrocytes, unaltered neutrophilic granulocytes, naked nuclear neutrophilic granulocytes, macrophages, lymphocytes, fibroblasts, fibrin threads and collagen fibers in 10. Microphotography of the selected areas for illustrations was performed using a microscope Biorex-3 BM-500T with digital photomultiplier DCM 900.&#x0D; It is established that the time of surgery, depending on the patient's chronotype, affects the course of the postoperative period and the wound healing process. Carrying out of operation according to the maximum activity of the patient reduces terms of realization of reparative process in a wound. Acceleration of hemostasis is accelerated and microcirculation and, accordingly, oxygenation of damaged tissues is restored faster. The number of unchanged and altered erythrocytes is probably lower in the superficial biopsies of wounds of patients who were operated with the chronotype in the most active time. In them, the dynamics of changes in the number of neutrophilic granulocytes indicates an earlier transition from the inflammatory stage of the wound process to regenerative. The obtained cytological data indicate the implementation of the reparative process 2 days earlier.

Nasal irrigation with Zatoxin Rinse in postoperative care

Aim: The aim of this study was to assess the effect of nasal irrigation with isotonic sodium chloride and sodium bicarbonate solution in the form of Zatoxin Rinse kit on the process of postopera-tive wound healing and resolution of inflammation in patients who undergo surgery of the nasal cavity or paranasal sinuses. Moreover, our study also compared the effectiveness of na-sal irrigation with Zatoxin Rinse kit to the use of saline spray, when applied for 4 weeks after nasal septum surgery. Material and methods: Multicenter observational studies were conducted with the use of a questionnaire which was filledout on two consecutive visits, scheduled with a 1-month interval. These questionnaires applied to patients who underwent endoscopic surgical intervention in the nasal cavity and paranasal sinuses and were therefore qualified for this study. The study group included 71 patients (mean age: 42.87 ± 13.22 years; 29 female and 42 male) suffering from the following disorders: chronic rhinosinusitis (CRS) with polyps, n = 25; CRS without polyps, n = 19; de-viated septum, n = 27. The control group included 7 patients with deviated septum (using saline nasal products/seawater spray). Based on the questionnaire results and ENT examina-tion, the severity of inflammation and effectiveness of wound healing were assessed with the use of: SNOT-22 (sino-nasal outcome score), Visual Analogue Scale (VAS) and endoscopic examination of nasal cavities. Results: The median value for results obtained from the SNOT-22 questionnaire was 38 points (IQR = 36) in CRS without polyps, 33 points (IQR = 24) in CRS with polyps and 26 points (IQR = 19) in deviated septum. The median values for all scores recorded in specific subgroups after 4 weeks of applying Zatoxin Rinse were as follows: patients with CRS with polyps: 7 points (IQR = 9.5), patients with CRS without polyps: 5 points (IQR = 13), patients with deviated septum: 6 points (IQR = 9). Postoperative nasal discharge was observed to be the most fre-quent in patients with CRS: among patients suffering from CRS with polyps, the median VAS scale result was 6 points (IQR = 4), while the median for patients diagnosed with CRS without polyps was 6 points (IQR = 5) and 3 points (IQR = 4) in the group with deviated septum. The feeling of impaired nasal patency in the postoperative period was reported to be the strongest in patients diagnosed with CRS without polyps: 8 points (IQR = 5), as com-pared to 5 points (IQR = 4.5) in patients with CRS with polyps and 5 points (IQR = 7) in the deviated septum group. Postoperative smell disorders were observed to be expressed as more severe among patients with CRS without polyps: 6 points (IQR = 4) and less severe in pa-tients with CRS with polyps: 4 points (IQR = 7). After 4 weeks of healing aided by irrigation of paranasal sinuses with the use of Zatoxin Rinse kit, patients from all subgroups experienced a statistically significant reduction in the severity of all parameters assessed by the VAS scale. In the endoscopic assessment of nasal cavities with the use of Lund-Kennedy scoring system, conducted prior to irrigating nasal cavities with the Zatoxin Rinse kit, the highest results were recorded in patients diagnosed with CRS with polyps: 10 points (IQR = 9.5), as compared to 8 points (IQR = 6) in patients with CRS without polyps and 6 points (IQR = 5) in patients with deviated septum. After 4 weeks, the median result in CRS with polyps group was 3 points (IQR = 3.5), while the CRS without polyps and deviated septum groups recorded the same median result of 3 points (IQR = 3). Conclusions: (1) Nasal irrigation with Zatoxin Rinse is characterized by good tolerability and is easy to per-form. No adverse effects of nasal irrigation were identified among 71 examined individuals and patients were satisfied with the application method provided by the Zatoxin Rinse kit; (2) Zatoxin Rinse promotes healing of postoperative wounds in patients who undergo surgical intervention in the paranasal sinuses or in the nasal septum, as compared to the use of saline spray.

Antibiotic artificial bone implantation and external fixation for the treatment of infection after intramedullary nail fixation: a retrospective study of 33 cases

ObjectiveTo explore the clinical effect of antibiotic artificial bone implantation and external fixation in the treatment of infection after intramedullary nail fixation.MethodsWe retrospectively reviewed the clinical data of patients with infection after intramedullary nail fixation treated from March 2010 to August 2020. There were 27 males and 6 female, aged from 12 to 67 years (average 42.27 years), 18 cases on the left side and 15 cases on the right side. Among them, 20 cases were open fractures with initial injury and 13 cases were closed fractures. All patients were treated with intramedullary nail removal, local debridement, antibiotic artificial bone implantation and external fixation. Because of bone defects, 19 patients underwent secondary autologous cancellous bone grafting after infection control. Postoperative wound healing, related inflammatory indicators, fixation time, and bone healing time were recorded and followed up.ResultsThe 33 patients were followed up with period of 10 ~ 98 months (average 62.7 months). One patients failed to control the infection effectively after treatment, so received antibiotics artificial bone implantation again. Two patients also received antibiotic artificial bone implants again due to the recurrence of the infection. After treatment, infection was controlled and the fracture healed well. One patient received vacuum sealing drainage (VSD) due to persistent postoperative exudation, and five patients were also cured successfully after continuous dressing. Two patients had sinus tract after surgery, and the wound was cured by continuous dressing change. Nineteen patients received autogenous iliac bone grafts for healing due to bone defects ranging from 3 to 6.5 cm (average 4.15 cm) after infection control. The external fixation time of 33 patients ranged from 4 to 16 months (average 7.79 months), the bone healing time ranged from 4 to 13 months (average 6.67 months), and the related inflammatory indexes returned to normal within 2–8 weeks (average 4.48 weeks).ConclusionAntibiotic artificial bone implantation and external fixation is an effective method for the treatment of infection after intramedullary nail fixation.

153 The Patient Perspective on Day Case Arthroplasty

Abstract Introduction Day Case Arthroplasty has been validated as a safe strategy for reducing length of stay for patients undergoing elective arthroplasty. With the ongoing recovery of elective activities following the COVID pandemic and long waiting lists; day case arthroplasty offers a solution for both hospitals and patients. Reducing length of stay will reduce the cost of day case arthroplasty which benefits hospitals, whilst the faster discharge reduces unnecessary exposure to an increased risk of COVID for patients. This study aims to establish the patient perspective on day case arthroplasty to inform the set-up of a patient cantered day case arthroplasty service. Method Data was collected at routine preoperative assessment clinics via a structured questionnaire which combined both quantitative and qualitative methods. The questionnaire covered patient demographics, issues pertaining to same-day discharge, level of concern related to common problems faced by patients after joint replacement surgery and patient preference for same day discharge versus more traditional rehabilitation methods. Results The study included 79 patients with 43% preferring same day discharge. Postoperative pain, surgical complications and wound healing were the most significant concerns elicited. Patients who preferred same day discharge were statistically younger. The majority of patients felt that their rehabilitation could be completed at home. Conclusions The results of this study highlight the demand for day case arthroplasty in this cohort of patients with younger patients preferring same day discharge. Identifying significant concerns will be important to formulate effective perioperative protocols to ensure successful implementation of a patient cantered day case arthroplasty service.

Management of acetabulum fracture with contralateral neck of femur in an obese patient: a rare case report

&lt;p class="abstract"&gt;Acetabular fractures are complex fractures that pose a challenge for orthopaedic trauma surgeons due to their extension into the hip joint. The simultaneous occurrence of contralateral neck of femur fracture in an obese patient makes postoperative wound healing and rehabilitation even challenging. Here, we report a case of management of acetabulum fracture with contralateral neck of femur fracture in an obese patient. We are reporting a case of a 50-year-old obese female from Chennai who presented to the Department of Orthopaedics, SRIHER, Chennai, with complaints of bilateral hip pain and inability to weight bear on bilateral lower limb, following a high-velocity road traffic accident. She was diagnosed to have left acetabulum fracture with right hip displaced neck of femur fracture. We managed her with right hip bipolar hemiarthroplasty and left acetabulum open reduction and internal fixation. 6 month follow up showed excellent radiological and functional outcome. This case report highlights how obesity alters the surgical and medical management in obese patients with contralateral acetabulum and neck of femur fracture and the importance of a multidisciplinary approach in such polytrauma patients.&lt;/p&gt;

Modifying effect of obesity on the content of sex hormones and their receptors in endometrial adenocarcinoma and its surrounding tissue

To study the effect of comorbid pathology: obesity of degree 2-3 on the level of sex steroid hormones and their receptors in the tumor and its surrounding tissue in patients with endometrial cancer (EC). Materials and methods. In 30 patients with endometrioid adenocarcinoma T1-3N0-1M0 (the main group, 15 females with obesity grade 2-3 (BMI≥35); the reference group 15 females with normal BMI) in samples of the tumor and its perifocal zone taken after surgical treatment, the levels of estradiol (E2), estrone (E1), testosterone (T), progesterone (P4), androgen receptors (AR), progesterone receptors (RP4), estrogen receptors (ERα and ERβ) were determined by ELISA method. Statistical analysis was performed with STATISTICA 10.0. Results. Obese EC patients showed longer healing of postoperative wounds, slow recovery, and more frequent tumor metastasizing to regional lymph nodes. In the tumor samples in all patients, compared with the intact endometrium, the levels of estrogens, testosterone and their receptors were higher. Obesity accompanying the malignant process led to a local increase in the levels of estrogens, testosterone, progesterone and AR, ERα and ERβ in the tumor. In the tumor samples, there were no significant differences from the presence of obesity in the levels of RP4. In the perifocal zone of the tumor in patients with comorbid pathology, compared with the parameters in the reference group, the level of E2, P4 and T was also higher, but the content of all steroid receptors was lower. Conclusion. Obesity aggravates hyperestrogenism and progesterone deficiency in adenocarcinoma and increases its enrichment with the androgen and estrogen receptors with the prevalence of ERα over ERβ that may cause the autocrine-paracrine regulation of the growth and metastasizing of the malignant process in patients with endometrial cancer.

ОПТИМИЗАЦИЯ УХОДА ЗА ХИРУРГИЧЕСКОЙ РАНОЙ ПОСЛЕ УРЕТРОПЛАСТИКИ У ДЕТЕЙ С ГИПОСПАДИЕЙ

Objectives. To develop optimal postoperative wound care tactics for boys with hypospadias. Methods. The patients (128) with hypospadias aged from 11 months to 7 years were examined. The main group A consisted of 83 (64.8%) patients in whom we used a special bandage. It includes layer by layer of soft polyamide net two-sided onlay coated with soft silicone and adhesive properties, abundantly treated with an antimicrobial ointment containing an osmotic agent, sterile absorbent wipes with non-woven material, a circularly applied elastic bandage and an adhesive plaster with porous non-woven material. The dressing usually held up to 5 days. Group B included 45 (35.2%) patients with hypospadias, in whom we used a conventional sterile circular gauze bandage with antimicrobial ointment. The gauze bandage changed daily. For all clinical symptoms the groups were comparable in age. Postoperative wound healing had been monitored for 10 days after urethroplasty. The emphasis was made on such criteria as bleeding with hematoma formation, copious exudate excretion, penis skin hyperemia, «soft» and «dense» edema, drying crust (scab), skin sutures dehiscence, hypergranulation and necrosis. Results. In group A, problems with the skin flap and postoperative wound were detected only in 17 (20.5%) boys on the second or third day after removal of the special bandage. In the postoperative period, 41 (91.1%) patients in group B had «painful» skin changes in the area of the postoperative wound, which appeared almost the next day after surgery. Conclusion. The use of special bandage delays in time the contact of microbiota penis tissues compromised by surgery and the external environment, which, no doubt, improves the healing of skin grafts in the early postoperative period, and therefore reduces the number of urethroplasty complications. What this paper adds For the first time in patients with hypospadias, the process of postoperative wound healing was analyzed depending on the type of dressing. It was established that the use of a long-term bandage with a soft polyamide mesh doublesided pad with a silicone contact layer and adhesive properties compared to a traditional gauze bandage, which was changed daily, optimized the tactics of postoperative wound care in boys with hypospadias and minimized the number of urethroplasty complications.

The risk factors of the postoperative poor wound healing in spinal tuberculosis patients: A single centre retrospective cohort study.

The purpose of this study is to find out the risk factors of poor wound healing (PWH) in spinal tuberculosis (STB) patients. A total of 232 STB patients who underwent debridement surgery between January 2012 to June 2020 were included in this retrospective study. The study cohort was divided into two groups according to the presence or absence of PWH. The clinical characteristics of STB patients who developed PWH were evaluated, and risk factors were found using logistic regression analysis. Of the 232 patients, 30 developed PWH. Multivariate binary logistic regression analysis showed that pulmonary tuberculosis, long operation time and low postoperative albumin level were independent risk factors for PWH in STB patients. Receiver operating characteristic curve analysis showed that the optimal cutoff value of PWH in operation time and postoperative albumin are 200 minutes and 30 g/L, respectively. Pulmonary tuberculosis, long operation time and low postoperative albumin level are independent risk factors for PWH following surgery for STB. Curing pulmonary tuberculosis, controlling operation time and supervising postoperative serum albumin may decrease the risk of PWH among STB patients.

Preoperative Transcutaneous Oxygen Perfusion Measurements in Predicting Atraumatic Wound Healing After Major Lower Extremity Amputation.

This study examined the correlation between preoperative transcutaneous oxygen perfusion (TcPO2) measurement and the success of wound healing after major lower extremity amputation. There is no validated consensus on how to accurately determine appropriate amputation levels. A TcPO2 greater than 30 to 40 mm Hg is widely cited as a positive predictor of postoperative wound healing, but its validity has not been well defined. A retrospective chart review was performed for patients who underwent above-knee amputation (AKA), through-knee amputation, or below-knee amputation (BKA) at a single institution from 2012 to 2018 with preoperative TcPO2 values and a minimum 30-day postoperative clinical follow-up. This review yielded 141 total amputations: 93 BKAs, 6 through-knee amputations, and 42 AKAs. Fifty-five amputations were unsuccessful, defined by postoperative wound dehiscence or infection. Of these, 37 were BKAs, 4 were through-knee amputations, and 14 were AKAs. There was a significant difference in preoperative TcPO2 between the successful and unsuccessful amputations, at 46.2 and 38.3 mm Hg, respectively (P=.02). A TcPO2 of 30 to 40 mm Hg showed a 68.8% success rate, and a TcPO2 of less than 20 mm Hg showed an 18.2% success rate. A receiver operating characteristic curve for TcPO2 predicting amputation success had an area under the curve of 0.53 for AKAs and 0.61 for BKAs; the diagnostic ability is far from prognostic. There is no linear association between TcPO2 and success rate. A TcPO2 of less than 20 mm Hg has a high positive predictive value for failure, but higher levels are not 100% predictive of wound healing success after amputation, as previously reported. [Orthopedics. 2022;45(3):174-180.].

Effectiveness of Knotless Barbed Sutures for Intraoral Closure after Impacted Mandibular Third Molar Surgery: A Split Mouth Randomized Clinical Trial

Objectives: The purpose of this clinical trial is to assess the efficiency of 3-0 knotless barbed suture (polydioxanone) with 4-0 polyglactin 910 (vicryl) in wound closure following impacted mandibular third molar surgery.&#x0D; Methods: The split-mouth study involved 20 patients who were referred to the Oral Surgery Clinic at the Department of Oral and Maxillofacial Surgery for bilateral mandibular third molar impaction with equal difficulty index. Simple randomization was used to distribute the samples. Following extraction, the wounds were closed with 3-0 knotless sutures for the study group and 4-0 polyglactin 910 (vicryl) for the control group. Following surgical extraction in relation to infected mandibular molars under local anesthesia, the clinical outcome parameters that were measured were (1) time taken to achieve wound closure and hemostasis, and (2) post-operative wound healing using "Landry's wound healing index" on the 1st, 3rd, and 7th post-operative days.&#x0D; Results: In this study, we discovered that the average time taken to approximate a wound was 2.69 minutes for the study group and 4.27 minutes for the control group. The research and control groups had a statistically significant difference in suturing time (p-value&lt; 0.05). On all postoperative review days, wound healing in the study group was shown to be better and statistically significant than in the control group (p-value &lt;0.05).&#x0D; Conclusion: Within the limitations of the present study, knotless barbed suture is a promising alternative to conventional sutures for intra-oral wound closure as it reduces suturing time and facilitates effective wound closure following surgical removal of impacted mandibular third molars.

Analysis of the efficacy of a modified posteromedial approach for Klammer III posterior Pilon fractures

PurposeTo analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture. MethodsA retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019. Before the surgery, the patients were fully relieved of swelling and pain, and a comprehensive examination was carried out. The posteromedial approach exposed the posterior and medial fracture block of the distal tibia. According to the fracture of external malleolus, it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor, and then perform a fracture reduction and internal fixation. Postoperatively, the patients were treated with analgesia, detumescence, anticoagulation and rehabilitation exercise. The American orthopaedic foot and ankle society (AOFAS) score and visual analogue score were recorded at regular follow-up after surgery. A t-test was used for the comparison of the preoperative and final AOFAS score. ResultsThere were 7 male and 13 female (n = 20) included in the study, aged 22 to 88 years (average age 54.2 years). The injury mechanisms were falling from a height (n = 7), traffic accident (n = 6), walking injury (n = 2) and heavy injury (n = 5). The postoperative follow-up duration was 12–24 months (mean 16.95 months). The AOFAS score of the 20 patients before and after surgery were compared. The preoperative AOFAS score was 38.90 ± 3.91, and the final AOFAS score was 80.55 ± 4.20, (p < 0.001). The mean final visual analogue scores at rest, active and weight-bearing walking were 0.30, 0.85 and 1.70, respectively. One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment. ConclusionIn the treatment of Klammer III posterior Pilon fractures, the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus, achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves, and have a better prognosis.

Adsorbent Dressings from Sodium Carboxymethyl Cellulose With Silver Ions in Primary Knee Arthroplasty: A Randomized Trial

Background. The ideal wound dressing should have complex positive affect on a postoperative wound healing: absorb excessive wound exudate, allow adequate gas exchange, prevent secondary infectious complications, create optimal humidity, be durable and not to restrict patients mobility, which is crucial for early mobilization after total knee arthroplasty. We carried out this research to asses the effectiveness and safety of contemporary adhesive wound dressings and if they do have the abovementioned qualities.&#x0D; Aim to assess the effect of using absorbing wound dressing made from sodium carboxymethyl cellulose with silver ions on the quality of rehabilitation and the rate of superficial infection occurrence in patients who underwent total knee joint arthroplasty.&#x0D; Methods. This prospective randomized (simple randomization) paralleled open study included 200 patients with terminal stage knee arthritis, who required total knee joint arthroplasty. Patients were divided into three groups, in two of the groups the innovate wound dressing made from sodium carboxymethyl cellulose with silver ions was used, in the third group traditional wound dressing was used.&#x0D; Results. In the course of this study, it was confirmed that there was no statistically significant difference in pain syndrome intensity in the early postoperative period or Knee Society Score (KSS) at 3 months postoperatively in regard of type of wound dressing and time of its application. Subjectively the most comfortable wound cover method for the patients was the usage of adhesive dressings with silver impregnation from the first day postoperatively. As complications we observed epidermal blistering under the dressing, superficial wound necrosis, superficial wound infection and formation of prominent and rough postoperative scars. The highest rate of blistering was observed in patients with traditional patch wound dressing.&#x0D; Conclusions. The usage of absorbing wound dressing made from sodium carboxymethyl cellulose with silver ions in our current study did not affect the rate of infectious complications and did not have any negative effects on rehabilitation. The usage of innovate dressings reduced the rate of epidermal blistering associated with dressings.