Incidence Of Dehiscence Research Articles

Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy.

Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population. Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds. Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001). This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents.

Early Seroma Treatment Protocol Based on US-Guided Aspiration in DTI Prepectoral Reconstruction: A Prospective Study

IntroductionSeroma is a common complication after prepectoral prosthetic breast reconstruction with ADM, leading to wound dehiscencse, infection, and even loss of reconstruction at last. A new ultrasound (US) guided follow-up protocol has been applied to compare primary and secondary complications incidence and their treatment, and evaluate the effect of precocious seroma detection and its evacuation in reducing secondary complications. MethodsWe enrolled 406 patients from January 1st, 2021 to July 1st, 2023 who underwent mastectomy and 1-stage prepectoral reconstruction with ADM. Experimental group counted 96 patients, whom have been treated as protocol fashion, therefore with multiple US-guided evaluations and eventual evacuations along with postoperative period; control group (310 patients) has exclusively been clinically evaluated. ResultsSeroma incidence detected rate among experimental group, after 1-year follow-up, was 32.2%, compared to 16.8% in control cohort, additionally no other secondary complications were detected in the first group. Referring to the wound dehiscence incidence, a statistically significant higher frequency was observed in control group compared with treatment 1 (21.2% vs. 0%; P = .0027). ConclusionsSeroma and correlated secondary complications may lead to additional surgeries, higher sanitary costs and even reconstructive failure. With a seriated US follow-up protocol application, the surgeon could promptly manage and treat seroma, decreasing additional complications rate, particularly wound dehiscence. Level of EvidenceIII.

Application of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back

To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation. The operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence. For the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.

Alveolar bone changes around maxillary incisors after intrusion and retraction with controlled tipping versus bodily movement : Aretrospective cone-beam computed tomography study.

To compare the effect of maxillary incisor intrusion and retraction with controlled tipping (CT) versus bodily movement (BM) in extraction cases on alveolar bone height and thickness, using cone-beam computed tomography (CBCT). Correlations between changes in alveolar dimensions and crown or root retraction, incisor inclination, and intrusion were also investigated. In all, 144 incisors of 36 women were retrospectively evaluated. All patients were treated with anterior intrusion and retraction with either controlled tipping (CT) (group1) or bodily movement (BM) (group2). CBCT scans were taken before and after retraction and intrusion and measurements of alveolar bone height and thickness at the level of mid-root and root apex were measured. The prevalence of dehiscence was also calculated. Labial bone thickness (BT) increased at the level of the root apex with increased total BT in the CT group (p < 0.05). The BM group showed decreased palatal BT. Significant vertical bone loss with an increased incidence of dehiscences occurred on the palatal side in both groups. Changes in palatal bone area was negatively correlated with the amount of root apex retraction, while the total BT at the level of root apex was positively correlated with amount of intrusion. Bodily retraction can result in reduced palatal bone dimensions and an increase risk of iatrogenic sequelae following anterior retraction in extraction cases. Vertical bone loss and an increased incidence of dehiscences is to be expected following anterior retraction. Careful attention must be paid to the bone boundary conditions to avoid moving the incisors out of the alveolar housing.

Rates of major complications and flap loss for abdominally based breast reconstruction in obese patients are independent of WHO class of obesity

Obesity is a risk factor for complications following autologous breast reconstruction. Little is known regarding outcomes based on the degree of obesity. This study compares breast reconstruction outcomes and complication rates for the three classes defined by the body mass index (BMI)-based WHO classification. The authors conducted a retrospective chart review identifying obese patients who underwent abdominally based breast reconstruction between January 2011 and January 2021. Patients were stratified by BMI class [class 1 (C1)=30-34.99kg/m2, class 2 (C2)=35-39.99kg/m2, and class 3 (C3)=40kg/m2 +]. Outcomes were compared. A total of 232 patients (395 flaps) were included with 138 patients were classified as C1, 68 patients as C2, and 26 patients as C3. Rates of any complication (80%) and at least one major complication (31%) did not vary significantly (P=0.057, 0.185). Individual rates of 30-day readmission (18%) or reoperation (26%) did not vary significantly (P=0.588 and 0.059). Rates of seroma (C1=15%, C2=16%, and C3=35%), hernia (C1=0%, C2=4%, and C3=8%), and incisional dehiscence (C1=30%, C2=44%, and C3=62%) were associated with significantly increased risk with higher classes of obesity (P<0.05). The rate of flap failure did not vary significantly (P=0.573). The risk of major complications and total flap loss associated with abdominally based breast reconstruction does not differ between the classes of obesity. Although complication rates are high overall in the obese population, detrimental complications do not vary between the classes. Patients should be counseled regarding their individual risk without the need for arbitrary BMI cutoffs.

Vaginal Cuff Dehiscence and a Guideline to Determine Treatment Strategy.

In this retrospective study, our aim was to investigate a novel treatment strategy guideline for vaginal cuff dehiscence after hysterectomy based on the mode of operation and time of occurrence in patients who underwent hysterectomy at Severance Hospital between July 2013 and February 2019. We analyzed the characteristics of 53 cases of vaginal cuff dehiscence according to the mode of hysterectomy and time of occurrence. Out of a total of 6530 hysterectomy cases, 53 were identified as vaginal cuff dehiscence (0.81%; 95% confidence interval: 0.4-1.6%). The incidence of dehiscence after minimally invasive hysterectomy was significantly higher in patients with benign diseases, while malignant disease was associated with a higher risk of dehiscence after transabdominal hysterectomy (p = 0.011). The time of occurrence varied significantly based on menopausal status, with dehiscence occurring relatively earlier in pre-menopausal women compared to post-menopausal women (93.1% vs. 33.3%, respectively; p = 0.031). Surgical repair was more frequently required in cases of late-onset vaginal cuff dehiscence (≥8 weeks) compared to those with early-onset dehiscence (95.8% vs. 51.7%, respectively; p < 0.001). Patient-specific factors, such as age, menopausal status, and cause of operation, may influence the timing and severity of vaginal cuff dehiscence and evisceration. Therefore, a guideline may be indicated for the treatment of potentially emergent complications after hysterectomy.

PO-02-059 INFLAMMATORY REACTION TO ANTIBIOTIC ELUTING POUCH MASQUERADING AS RECURRENT CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTION

Absorbable antibacterial envelopes mitigate risk of pocket infections during repeat cardiac implantable electronic device (CIED) procedures. Despite use of antibacterial envelopes, risk of CIED infection persists. However, hallmark signs of CIED infection including incisional erythema, drainage, and wound dehiscence overlap with a less common clinical entity – allergic reaction. To present a case of recurrent CIED wound dehiscence secondary to an inflammatory response to the antibacterial envelope proven with histological evaluation. N/A A 52-year-old male with remote aortic valve replacement complicated by complete heart block and a dual chamber pacemaker (DC PPM) underwent generator change with use of a Tyrx antibacterial pouch. One week later, he developed partial wound dehiscence and cloudy incisional drainage. The patient was started on antibiotic therapy and underwent percutaneous system extraction with placement of an externalized right ventricular lead. Pocket cultures were negative. A contralateral DC PPM was inserted with a Tyrx pouch. The patient completed a course of antibiotics. Within two weeks of placement, he presented with recurrent wound dehiscence. The new device was removed with a pathologic specimen obtained from the presumably infected pocket and an externalized pacing lead was placed. Cultures were again negative. The pathologic specimen demonstrated foreign body response with lymphoplasmacytic and focal neutrophilic inflammation most consistent with allergic reaction. The patient underwent implantation of a low-lateral left-sided DC PPM distant from the prior site without the use of a Tyrx antibacterial envelope. The patient was discharged without antibiotics with no evidence of infection or inflammation at the new site over a follow up period of 6-months. Allergic reaction to Tyrx antibiotic envelope should be considered with wound dehiscence, particularly if recurrent. Tissue biopsy with foreign body response can elucidate an allergic mechanism.

PC31. Splenius Capitis Muscle Flap for Treatment of Chiari I Malformation Decompression Reconstruction - A Case Series

PURPOSE: The purpose of this study is to report outcomes of patients who have undergone the splenius capitis muscle flap for posterior neck space obliteration after Chiari I malformation decompression procedures. METHODS: The Institutional Review Board exemption was obtained. Patients who underwent Chiari I malformation decompression with splenius capitis muscle flap reconstruction were evaluated. Patient demographics, prior surgical intervention; variations in surgical techniques, as well intraoperative and postoperative complications were analyzed between the years of 2009 and 2022. RESULTS: A total of 22 patients who had undergone Chiari I malformation decompression with splenius capitis muscle flap reconstruction were identified. Age ranged between 16 and 59, with 19 (86.4%) females and 3 (13.6%) males. Six complications were identified, with 2 patients experiencing a CSF leak, 2 with superficial wound infection, and 2 with incisional dehiscence. The CSF leak patients were treated with a lumbar drain placement and healed without compromising the reconstruction. Likewise the superficial wound dehiscence and infection did not compromise muscle coverage with successful healing outcomes. Finally, none of the patients experienced donor site functional morbidity. CONCLUSION: The splenius capitis flap is a safe and effective muscle flap for posterior neck space obliteration in Chiari I malformation decompression procedures. With six patients experiencing surgical site dehiscence/infection and CSF leak, all patients healed with minimal intervention and no reconstruction compromise. [1] Elsahy NI, Achecar FA. Use of the splenius capitis muscle flap for reconstruction of the posterior neck and skull in complicated Arnold-Chiari malformation. Plast Reconstr Surg. 1994;93(5):1082–1086.

PC13. Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease: A Single Center Experience

PURPOSE: Patients with inflammatory bowel disease (IBD) are at increased risk for postoperative complications due to prior surgical history, poor nutritional status, and immunomodulation. We investigate surgical outcomes after abdominal wall reconstruction (AWR) in patients with IBD. METHODS: A single-institution, retrospective review was performed of all patients with IBD undergoing abdominal wall reconstruction from 2016 to 2022. RESULTS: Fifty-eight patients were included, with 31 patients with Crohn’s disease and 27 patients with ulcerative colitis. The average age was 52.3 (±14.5) years and average BMI was 26.7 (±4.5) at time of surgery. Seventeen (29.3%) patients were on a steroid or immunomodulator prior to surgery. Patients had an average of 3.1 (±1.8) prior abdominal surgeries; 14 (24.1%) patients had prior hernia repair. The hernia breakdown was commonly midline 38 (65.5%) and parastomal 9 (15.5%). Biologic mesh was used in 7 (12.1%) cases. Postoperatively, 7 (12.1%) patients experienced major complications; 6 patients required takeback for abscess drainage (3), small bowel obstruction/perforation (2), or ileostomy revision (1), and 1 patient had sepsis and liver failure requiring prolonged care. Minor complications were seen in 19 (32.8%) patients, consisting of ileus or high ostomy output (13), superficial surgical site infection (3), and incisional breakdown or dehiscence (3). Patients were followed for an average of 314 (± 310.6) days. There were no instances of abdominal bulge and 1 patient with hernia recurrence. CONCLUSION: AWR in the IBD patient population can be performed with low complication rates. Most AWR were performed without mesh without compromising hernia recurrence rates.

The Fate of the Patient With Superficial Dehiscence Following Direct Anterior Total Hip Arthroplasty

BackgroundDirect anterior approach (DAA) total hip arthroplasty (THA) has been associated with higher rates of superficial incisional dehiscence. However, limited data are available regarding the outcomes following initial treatment of this complication. This study aimed to evaluate patient risk factors, reoperations, and revisions in those who developed superficial wound dehiscence following DAA THA. MethodsWe identified 3,687 patients who underwent a primary DAA THA between 2010 and 2019 from our enterprise total joint registry. Of these, 98 (2.7%) patients developed a superficial wound dehiscence requiring intervention [irrigation and debridement (n = 42) or wound care with or without antibiotics (n = 56)]. Dehiscence was noted at a median of 27 (range, 2-105) days. These patients were compared to patients who did not have a superficial wound complication (n = 3,589). Landmark survivorship analysis was performed to account for immortal time bias with a 45-day landmark time. ResultsPatients who had superficial wound dehiscence compared to those who did not, were more often women (64 versus 53%, P = .02) and had increased mean body mass index (33 versus 29, P < .001). There was no difference in 4-year survivorship free from any revision between cohorts (97 versus 98%, respectively, P = .14). There were 2 (2.0%) revisions in the superficial dehiscence group: 1 for periprosthetic joint infection and 1 for aseptic femoral loosening. ConclusionSuperficial wound dehiscence following DAA THA was associated with higher body mass index and was more common in women. Fortunately, with proper index management, the risk of revision THA and periprosthetic joint infection was not increased for these patients.

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus

To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Correction of the High Fold in Difficult Secondary Blepharoplasty Through Retro-Orbicularis Oculi Fat Transposition and Augmentation in Asians.

Secondary blepharoplasty to correct a high crease is considered challenging for most surgeons, especially in patients who show overly excessive removal of eyelid tissue in Asians. Therefore, we define a typical difficult secondary blepharoplasty as when patients present too high eyelid fold with excessive tissue resection and preaponeurotic fat deficiency. This study provides the technique of retro-orbicularis oculi fat (ROOF) transferring and volume augmentation to reconstruct eyelid anatomical structure on the base of a series of difficult secondary blepharoplasty cases in Asians and assess the effectiveness of the method in the meanwhile. This was a secondary blepharoplasty cases-based retrospective observational study. From October 2016 to May 2021, a total of 206 cases were performed blepharoplasty revision surgery to correct high folds. Among them, a total of 58 cases (6 men, 52 women) diagnosed with difficult blepharoplasty were applied ROOF transferring and volume augmentation to correct high folds and were followed up on time. Depending on the distribution of ROOF of different thicknesses, we designed 3 different methods of harvesting and transferring ROOF flaps. The mean follow-up for patients in our study was 9 months, a range of 6 to 18 months. The postoperative results were reviewed, graded, and analyzed. Most patients (89.66%) were satisfied. No postoperative complications were observed, such as infection, dehiscence of incision, tissue necrosis, levator dysfunction, or multiple creases. The mean height of the mid, medial, and lateral eyelid folds decreased from 8.96 ± 0.43, 8.21 ± 0.58, and 7.96 ± 0.53 mm to 6.77 ± 0.55, 6.27 ± 0.57, and 6.65 ± 0.61 mm, respectively. Retro-orbicularis oculi fat transposition or/and its enhancement contributes significantly to the reconstruction of the physiology of the eyelid structure and provides an available surgical option for the correction of too high folds in blepharoplasty.

The impact of Allgower-Donati suture pattern and postoperative sweet foods on wound suture breakage in experimental rats

BackgroundWound gnawing and/or scratching in rats often occurs in experimental models, causing suture breakage and wound dehiscence, and consequently affecting experimental results and wasting resources. This study aimed to investigate the impact of the combined postoperative use of the Allgower-Donati (A-D) suture pattern and sweet foods on suture breakage, inflammation, and healing in wounds. Materials and methodsSprague Dawley (SD) rats (n = 48) were treated for linear wounds on the back by four procedures: simple suture, simple suture with postoperative sweet foods, A-D suture, and A-D suture with postoperative sweet foods. Additionally, CD68 immunofluorescence and CD31 immunohistochemistry were used to analyze wound inflammation and vascularization, respectively, on postoperative day 7. Sirius red staining was used to assess collagen deposition on postoperative day 14. ResultsGnawing and scratching of wound sutures were significantly reduced in treated rats (P < 0.01). Neovascularization and collagen deposition were significantly increased (P < 0.001), and inflammatory responses were significantly reduced (P < 0.001) in animals receiving AD sutures and postoperative sweet foods. CD31/CD68 analyses showed that A-D suture and postoperative sweet foods regulated wound angiogenesis and attenuated wound inflammation. ConclusionsSweet food provision after A-D suture union surgery could reduce wound gnawing and/or scratching, suture breakage, incisional dehiscence, wound inflammation, and promote wound healing in rats.

Estudio comparativo de la extracción de la pieza de nefrectomía laparoscópica mediante una incisión de tipo Pfannenstiel

ObjectivesThe aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. Materials and methodsRetrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. ResultsPatients in Pfannenstiel group presented a rate of wound complications of 11.72% vs 27.34% with other incisions, p = 0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs 12.5%, p = 0.047) and seroma (3.1% vs 7.8%, p = 0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR = 0.34, p = 0.005). ConclusionsThe Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

Lower uterine segment thickness is assessed by ultrasound in individuals who have had prior caesarean sections

Introduction: The increased number of caesarean births is causing a great deal of professional and public worry. Using transvaginal and abdominal ultrasonography, estimate the critical thickness over which a safe vaginal birth is foreseeable in women who have previously had caesarean delivery. Method: 50 pregnant women who had previously had a caesarean section served as the case group in a case-control research, whereas 50 pregnant women who had never undergone a caesarean section served as the control group. The gestational age was between 38 and 40 weeks. The thickness of the LUS was measured using TA and TV ultrasonography in both groups; in the study group, a thickness of >2 mm was regarded as good healing and a thickness of 2 mm as poor healing; the mode of delivery for women was either trial VBAC (unless an obstetrical indication for CS existed) or ERCS. There was a correlation between U/S measures and every intraoperative LUS manifestation and delivery result. Result: The total VBAC success rate was 52%, the incidence of dehiscence was 4%, and there was no uterine rupture. The overall VBAC success rate was 84%. Between TA and TV ultrasonography, there was a 95% correlation. The ROC curve's crucial cut off value for safe LUS thickness was 2.5mm. Conclusion: In women who have had a prior caesarean section, sonography enables a reliable measurement of the LUS thickness, making it theoretically possible to utilise it to foretell the risk of uterine rupture during a trial vaginal delivery.

Evaluation of long-term outcome after lung lobectomy for canine non-neoplastic pulmonary consolidation via thoracoscopic or thoracoscopic-assisted surgery in 12 dogs.

To report outcomes of thoracoscopic (TL) and thoracoscopic-assisted lung lobectomy (TAL) for treatment of non-neoplastic pulmonary consolidation (PC) in dogs. Retrospective case series. Twelve client-owned dogs. The medical records of 12 dogs that underwent TL or TAL for PC at 3 veterinary institutions between 2011 and 2020 were reviewed. Signalment, history, physical examination, diagnostics, days in hospital, anesthetic and procedure times, intraoperative/postoperative complications, conversion rates, duration of indwelling thoracic drain, and long-term outcomes were recorded. Nine patients underwent a TL approach and 3 underwent TAL. In those that underwent TL, conversion to an intercostal thoracotomy was performed in 4 out of 9 dogs. Conversion was performed due to adhesions (n=3) or poor visualization (1). Histopathologic examination was consistent with pneumonia due to an infectious process (n=10), bronchioalveolar malformation with abnormal cilia (1), and left-sided cardiac insufficiency vs. pulmonary alveolar proteinosis (1). The mean duration of hospital stay was 4 days (range, 1-6 days). Complications occurred postoperatively in 7 dogs and included self-limiting hemorrhage (n=3), self-resolving pneumothorax (2), incisional dehiscence (1), and severe dyspnea in a brachycephalic breed leading to euthanasia (1). For the 11 dogs that survived the perioperative period, there was no evidence of recurrence with a median follow up of 24 months (range, 5-120 months). Thoracoscopic (TL) and thoracoscopic-assisted lung lobectomy (TAL) is a reasonable surgical approach in select dogs with PC. Conversion rates were higher than those historically reported for dogs undergoing thoracoscopic lung lobectomy for primary lung tumors.

Parental involvement in postoperative pain management among children in a urology ward: A best practice implementation project.

Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence-based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence-Based Nursing Center's Evidence-based Continuous Quality Improvement Model. Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre-implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence-based interventions implemented to improve compliance. A follow-up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. At the baseline audit, compliance with the evidence-based criteria was 0%-71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow-up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

Effect of augmented corticotomy-assisted presurgical orthodontic treatment on alveolar bone fenestration and dehiscence in skeletal class III patients

Background/purposeAlveolar bone fenestration and dehiscence is common in untreated patients and potentially harmful. This study was to evaluate the effect of augmented corticotomy (AC) on the prevention and treatment of alveolar bone defects in skeletal class III high-angle patients during presurgical orthodontic treatment (POT). Materials and methodsFifty patients with skeletal Class III high-angle malocclusion were enrolled, of whom 25 patients (G1) underwent traditional POT and 25 patients (G2) received AC during POT. The alveolar bone fenestration and dehiscence around the upper and lower anterior teeth were measured by CBCT. The incidence and transition of fenestration and dehiscence in the two groups were compared by the chisquare and Mann‒Whitney rank-sum tests. ResultsBefore treatment (T0), the incidence of fenestration and dehiscence around the anterior teeth of all patients was 39.24% and 24.10%, respectively. After POT (T1), the incidence of fenestration in G1 and G2 was 49.83% and 25.86%, respectively, and the incidence of dehiscence in G1 and G2 was 58.08% and 32.07%, respectively. For teeth without fenestration and dehiscence at T0, more anterior teeth in G1 exhibited fenestration and dehiscence at T1 than in G2. For teeth with fenestration and dehiscence at T0, most transitions in G1 were maintained or worsened, but “cure” cases were observed in G2. After POT, the cure rates of fenestration and dehiscence in G2 were 80.95% and 91.07%, respectively. ConclusionDuring the POT of skeletal Class III high-angle patients, augmented corticotomy can significantly treat and prevent alveolar bone fenestration and dehiscence around anterior teeth.

Comparative study of intact specimen extraction in laparoscopic nephrectomy by Pfannenstiel incision

ObjectivesThe aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. Materials and methodsRetrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. ResultsPatients in Pfannenstiel group presented a rate of wound complications of 11.72% vs. 27.34% with other incisions, p=0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs. 12.5%, p=0.047) and seroma (3.1% vs. 7.8%, p=0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR=0.34, p=0.005). ConclusionsThe Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

Autologous bone fragments for skull reconstruction after microvascular decompression

BackgroundVarious methods are used to reconstruct the skull after microvascular decompression, giving their own advantages and disadvantages. The objective of this study was to evaluate the efficacy of using autologous bone fragments for skull reconstruction after microvascular decompression.MethodsThe clinical and follow-up data of 145 patients who underwent microvascular decompression and skull reconstruction using autologous bone fragments in our hospital from September 2020 to September 2021 were retrospectively analyzed.ResultsThree patients (2.06%) had delayed wound healing after surgery and were discharged after wound cleaning. No patient developed postoperative cerebrospinal fluid leakage, incisional dehiscence, or intracranial infection. Eighty-five (58.62%) patients underwent follow-up cranial computed tomography at 1 year postoperatively, showed excellent skull reconstruction. And, the longer the follow-up period, the more satisfactory the cranial repair. Two patients underwent re-operation for recurrence of hemifacial spasm, and intraoperative observation revealed that the initial skull defect was filled with new skull bone.ConclusionThe use of autologous bone fragments for skull reconstruction after microvascular decompression is safe and feasible, with few postoperative wound complications and excellent long-term repair results.