Incidence Of Postoperative Hematoma Research Articles

To compare the superiority of electrocautery over the traditional scalpel for skin incisions

Background. This study was designed to assess whether electrocautery can be used for incising skin in various abdominal operations. To date, many trials have been conducted to this regard, but drew inconclusive. Methods. A prospective analysis of 60 patients was done. The age of the patients included in the trial ranged from age 15 to 60 years. The patients were randomized into two groups, namely “incision by scalpel” and “incision by electrocautery.” These populations were further subgrouped into those receiving Flank incisions, those receiving Kocher’s incisions, and those receiving Midline incisions. The parameters used to compare the two primary groups were pain (on the visual analog scale), blood loss from the incision, time taken to make the incision, incidence of postoperative wound infection, and finally the cosmetic appeal upon follow-up. Results. The results showed significantly less blood loss as well as less pain scores associated with electrocautery incisions over scalpel incisions. The electrocautery incisions also took less time to make. Although the time taken and the blood loss did not attain statistical significance in the Midline abdominal incisions, the results still favored use of electrocautery in midline as well as other incisions. Postoperatively, the rates of wound infection were comparable in both techniques (3 in scalpel and 2 in cautery incision.). The cosmetic appeal was superior in the incisions that employed use of electrocautery. Conclusions. The method of electrosurgical incision is seen to be an easily learned, safe, highly effective technique associated with lesser complications. Comparing the three incisions, less pain and less bleed was noted with use of electrocautery. Additionally, there was no incidence of postoperative hematomas, no delay in healing of wounds incised by diathermy and the aesthetic results obtained were superior with minimal scarring. The difference in the incidence of wound infections was not significant. We concluded that use of electrocautery is a suitable method of skin incision; especially when employed for Kocher’s abdominal incision and abdominal flank incisions, although its use in Midline abdominal incisions did not show significant superiority.

Donor-Site Morbidity Comparison between Endoscopically Assisted and Traditional Harvest of Free Latissimus Dorsi Muscle Flap

Endoscopically assisted harvest of free latissimus dorsi muscle flaps is being used more frequently in reconstructive microsurgery because it requires a smaller incision and leaves a more acceptable scar in the donor site. Donor-site morbidity was compared between groups of 22 latissimus dorsi muscles harvested using the endoscopically assisted technique and 26 using the traditional technique. The results revealed no statistically significant differences in the amount of intraoperative bleeding, the incidence of postoperative hematoma and seroma, and the incidence of donor-site wound infection as assessed by the surgeon. However, a patient questionnaire revealed that even though it did not reach a statistically significant difference, endoscopically assisted harvest of the latissimus dorsi muscle had less pain and allowed earlier and better movement of the upper extremity of the donor site. The patients' attitudes and feelings about the scar and overall satisfaction were also higher in the endoscopic group, which demonstrated a statistically significant difference.

Postoperative hematoma

This study examines the surgical practice at the Wessex Neurological Centre over the 5-year period from 1989 to 1993 to determine the incidence of postoperative hematoma and to identify risk factors for a perioperative bleeding disorder. The study includes only those postoperative hematomas (at any site) that followed and were related to a neurosurgical operation and were surgically evacuated. The study is prospective for the year 1993 and retrospective for the preceding years. Over the 5 years, 6668 operations were performed and 71 postoperative hematomas were surgically evacuated, accounting for an overall rate of 1.1% of operations. The records were available for 69 cases. The most frequent diagnosis leading to postoperative hematoma was meningioma surgery with a rate of 6.2% of cases (13 of 211); followed by craniotomy for trauma, 3.7% (7 of 192); aneurysm surgery, 2.6% (11 of 428); and intrinsic supratentorial tumors, 2.2% (10 of 451). Postoperative hematomas were intraparenchymal in 43% of cases, subdural in 5%, extradural in 33%, mixed in 8%, and confined to the superficial wound in 11%. The overall mortality was 32% (37% for intraparenchymal and 12% for extradural). Risk factors for a perioperative bleeding disorder were present in two-thirds of the patients. Administration of antiplatelet agents (aspirin and nonsteroidal anti-inflammatory drugs) was the most commonly associated risk factor. At least 75% of these identified risk factors could potentially have been avoided or corrected.

Improved long-term patency of infragenicular polytetrafluoroethylene grafts

This article reviews late graft patency and the incidence of postoperative complications in 75 infragenicular polytetrafluoroethylene bypass grafts (20 posterior tibial, 26 anterior tibial, and 29 peroneal). All patients received a heparin infusion after operation and were switched to warfarin before discharge to maintain coagulation parameters (prothrombin time and partial thromboplastin time) approximately twice that of control subjects. Primary procedures were done in 14 patients (19%), and the remaining patients had one or more previous procedures. Ninety-seven percent of patients had limb-threatening ischemia. Graft patency was confirmed by interval examinations and Doppler ankle pressure measurements. The mean follow-up was 36 months, and long-term graft patency (4 years) was determined by life-table analysis. The 2-year cumulative patency rate for this group was 45% and the 4-year patency rate was 37%. The latter is significantly better than the patency rates of 12% reported for similar untreated randomized grafts. Anticoagulation was subtherapeutic in 15 patients at the time of graft thrombosis, and if these were excluded, the 2- and 4-year patency rates were 58% and 50%, respectively. Hematomas requiring drainage occurred in 10 patients (13.3%) and six patients (8%) developed wound infections, but graft infection occurred in only two patients. Two patients (2.6%) developed late bleeding complications necessitating cessation of the warfarin. There was one fatal perioperative myocardial infarction (1.3%) and four late deaths, none of which were related to the warfarin therapy. Although the incidence of postoperative hematoma and wound infection was increased, late complications occurred infrequently. Long-term adjunctive anticoagulation therapy extended graft patency in this difficult group of patients, most of whom would have otherwise required amputation.

Improved long-term patency of infragenicular polytetrafluoroethylene grafts.

This article reviews late graft patency and the incidence of postoperative complications in 75 infragenicular polytetrafluoroethylene bypass grafts (20 posterior tibial, 26 anterior tibial, and 29 peroneal). All patients received a heparin infusion after operation and were switched to warfarin before discharge to maintain coagulation parameters (prothrombin time and partial thromboplastin time) approximately twice that of control subjects. Primary procedures were done in 14 patients (19%), and the remaining patients had one or more previous procedures. Ninety-seven percent of patients had limb-threatening ischemia. Graft patency was confirmed by interval examinations and Doppler ankle pressure measurements. The mean follow-up was 36 months, and long-term graft patency (4 years) was determined by life-table analysis. The 2-year cumulative patency rate for this group was 45% and the 4-year patency rate was 37%. The latter is significantly better than the patency rates of 12% reported for similar untreated randomized grafts. Anticoagulation was subtherapeutic in 15 patients at the time of graft thrombosis, and if these were excluded, the 2- and 4-year patency rates were 58% and 50%, respectively. Hematomas requiring drainage occurred in 10 patients (13.3%) and six patients (8%) developed wound infections, but graft infection occurred in only two patients. Two patients (2.6%) developed late bleeding complications necessitating cessation of the warfarin. There was one fatal perioperative myocardial infarction (1.3%) and four late deaths, none of which were related to the warfarin therapy. Although the incidence of postoperative hematoma and wound infection was increased, late complications occurred infrequently.(ABSTRACT TRUNCATED AT 250 WORDS)

The Fate of Breast Implants with Infections Around Them

In a retrospective study of 41 infected breasts following the insertion of implants, a high incidence of postoperative hematoma was noted. When infection occurred, cultures usually demonstrated the causative organism to be Staphylococcus aureus. Treatment by conservative drainage and vigorous antibiotics was generally successful in salvaging those implants which had been inserted through an areolar incision for simple augmentation, or under the pectoralis muscle (or a dermal pedicle) after a subcutaneous mastectomy. Those patients whose augmentations had been done through an inframammary incision, or whose implant after a subcutaneous mastectomy was under the skin flap, had a statistically higher incidence of implant loss. Most breasts will salvaged implants became firm.