Incision Healing Research Articles

Application of extended trochanter osteotomy wire fixation combined with autologous bone graft in revision of total hip arthroplasty

To investigate the clinical effect of using lengthened trochanteric osteotomy wire fixation combined with autologous bone graft in patients undergoing revision total hip arthroplasty. From December 2010 to December 2018, 18 patients underwent revision of total hip arthroplasty with extended trochanteric osteotomy wire fixation and autogenous bone graft, including 8 males and 10 females with an average age of (78.89±3.32) years old ranging from 68 to 82 years. The time from the initial replacement to the revision was 9 to 22 (16.33±2.93) years. The patients were followed up regularly after operation. The healing time of osteotomy, the time of full weight-bearing activity, Harris score of hip joint and complications were recorded. All 18 patients were followed up for 16 to 38 months with an average of (25.78±6.65) months. The incision length was 16 to 21 cm with an average of (18.89±1.32) cm; the operation time was 105 to 128 min with an average of (115.44±6.59) min, the bleeding volume was 240 to 285 ml with an average of (267.44±13.77) ml. The healing time of osteotomy was 12 to 18 weeks with an average of (15.61±1.75) weeks. Harris score of hip joint was (47.11±5.04) before operation, (76.39±3.85) during full weight-bearing activities, and (82.22±2.76) at the final follow-up(P<0.05). During the follow-up period, there were no complications such as limb shortening, infection, poor incision healing, prosthesis loosening and sinking, and periprosthetic fracture. In revision total hip arthroplasty, the use of extended trochanteric osteotomy wire fixation combined with autologous bone graft can achieve satisfactory clinical results, but the surgeon needs to make a systematic plan for the pre-revision, intraoperative and postoperative recovery.

Clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis

Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.

Biomechanical analysis and effectiveness evaluation of zone Ⅰ+Ⅱ+Ⅲ reconstruction of hemipelvis with rod-screw prosthesis

To analyze the biomechanical properties of the rod-screw prosthesis based on a pelvic three-dimensional finite element model including muscle and ligament, and evaluate the effectiveness of zoneⅠ+Ⅱ+Ⅲ reconstruction of hemipelvis with rod-screw prosthesis in combination with clinical applications. A total of 21 patients who underwent hemipelvic tumor resection (zoneⅠ+Ⅱ+Ⅲ) and rod-screw prosthesis reconstruction between January 2015 and December 2020 were selected as the research subjects. Among them, there were 11 males and 10 females; the age ranged from 16 to 64 years, with an average age of 39.2 years. There were 9 cases of chondrosarcoma, 7 cases of osteosarcoma, 3 cases of Ewing sarcoma, and 2 cases of undifferentiated pleomorphic sarcoma. According to the Musculoskeletal Tumor Society Score (MSTS) staging, there were 19 cases of stage ⅡB and 2 cases of stage Ⅲ. Preoperative Harris Hip Score (HHS) and MSTS score were 54.4±3.1 and 14.1±2.0, respectively. Intraoperative 15 cases underwent extensive resection, 5 cases underwent marginal resection, and 1 case underwent intralesional resection. The CT image of 1 patient after reconstruction was used to establish a three-dimensional solid model of the pelvis via Mimics23Suite and 3-matic softwares. At the same time, a mirror operation was used to obtain a normal pelvis model, then the two solid models were imported into the finite element analysis software Workbench 2020R1 to establish three-dimensional finite element models, and the biomechanical properties of the standing position were analyzed. The operation time, intraoperative blood loss, and operation-related complications were recorded, and the postoperative evaluation was carried out with HHS and MSTS scores. Finally, the local recurrence and metastasis were reviewed. Finite element analysis showed that the peak stress of the reconstructed pelvis appeared at the fixed S1, 2 rod-screw connections; the peak stress without muscles was higher than that after muscle construction, but much smaller than the yield strength of titanium alloy. The operation time was 250-370 minutes, with an average of 297 minutes; the amount of intraoperative blood loss was 3 200-5 500 mL, with an average of 4 009 mL. All patients were followed up 8-72 months, with an average of 42 months. There were 7 cases of pulmonary metastasis, of which 2 cases were preoperative metastasis; 5 cases died, 16 cases survived, and the 5-year survival rate was 72.1%. There were 3 cases of local recurrence, all of whom did not achieve extensive resection during operation. The function of the affected limbs significantly improved, and the walking function was restored. The HHS and MSTS scores were 75.2±3.0 and 20.4±2.0 at last follow-up, respectively, and the differences were significant when compared with those before operation (t=22.205, P<0.001; t=11.915, P<0.001). During follow-up, 2 cases of delayed incision healing, 2 cases of deep infection, 1 case of screw loosening, and 1 case of prosthesis dislocation occurred, and no other complication such as prosthesis or screw fracture occurred. The stress and deformation distribution of the reconstructed pelvis are basically the same as normal pelvis. The rod-screw prosthesis is an effective reconstruction method for pelvic malignant tumors.

Surgical contraception of free-ranging female capybaras: Description and comparison of open and minimally invasive techniques.

To develop, describe, and evaluate 2 surgical techniques for contraception of free-ranging female capybaras. Prospective study. Cadaveric (n=3) and free-ranging female capybaras (n=21). Preliminary studies of surgical anatomy were performed on 3 capybara cadavers. Two different techniques for partial salpingectomy were evaluated in free-ranging female capybaras: bilateral minilaparotomy (LTG; n=11) or bilateral laparoscopy (LCG; n=10). Data concerning body weight, tubal ligation time, total surgical time, incision size, and intraoperative and postoperative complications were analyzed, as well as the clinical status and incisional healing 1 week postoperatively. Body weight (P=.214), ligation time of the left uterine tube (P =.901), and total surgical time (P =.473) were similar between the experimental groups. The ligation time of the right uterine tube was shorter in the LCG group (P =.0463). In the LTG, no differences were observed between the sides regarding the incision size (P=.478). No major intraoperative or postoperative complications occurred in either group. One LCG procedure had to be converted to LTG due to technical issues. All skin incisions healed without complication. Both procedures showed similar and satisfactory outcomes. The proposed techniques may be a suitable alternative to conventional laparotomy for contraception of female capybaras, especially under field conditions.

Does Topical Metronidazole-Chlorhexidine Combination Gel Improve Healing of Intraoral Incisions ? A Split-Mouth Comparative Study.

The oral cavity is a unique environment where wound healing needs to occur in the presence of heavily contaminated oral fluid often leading to infections at the suture site. Topical antimicrobial agents have proven to be effective in controlling intraoral infections. One such antimicrobial combination is Metronidazole-Chlorhexidine which has commonly been used to treat oral ulcers and gingival inflammation; however, there are no studies of its use in the healing of oral incisions. This split-mouth study comprised of 15 participants who received 30 intraoral incisions. Incisions were placed either simultaneously (Group 1) or at spaced intervals (Group 2) for various minor and major surgical procedures. Metronidazole -Chlorhexidine gel was applied to the study sites while the control sites were allowed to heal naturally. Pain, inflammation, and healing were assessed using visual analogue scale and healing index by Landry et al. The study sites showed better wound healing and decreased postoperative inflammation. There was a statistically significant decrease in post-operative pain in the study site in Group 1 but not in Group 2. Metronidazole-Chlorhexidine combination gel is a cost-effective, readily available, and safe medicament to improve healing of intraoral incisions and reduce post-operative inflammation and pain.

Clinical results of modified medial approach in the treatment of Pilon fracture with medial column compression

To explore the clinical results of modified medial incision in the treatment o f Pilon fracture with medial column compression and evaluate its safety. Thirty-one patients of Pilon fracture with medial column compressiom accepted surgical treatments in the Department of Foot and Ankle at Honghui Hospital of Xi'an Jiaotong University from January 2015 to January 2019. According to the imaging data at admission, 31 cases were diagnosed as closed Pilon fractures, and both preoperative X-ray and 3D CT scan were shown as medial column compressive fractures. All patients underwent modified medial incision with complete data, including 23 males and 8 females;ranging in age from 22 to 65 years old, with an average of (39.5±16.2) years old. All patients underwent modified medial approach combined with other approaches to expose the broken end of fracture. The time from trauma to operation ranging from 7 to 20 days, with a mean of(9.5±5.5) days. The incision and fracture healing were followed up regularly after operation. All patients were followed up with an average of(15.7±5.5) months(ranged, 13 to 25 months). Preoperative and postoperative routine X-ray and 3D CT examination showed anatomical reduction in 8 cases, and the anatomical reduction rate was 25.81%. Up to the latest follow-up, all 31 fractures had achieved bone healing, and the healing time ranged from 11 to 22 weeks, with a mean of (14.3±4.7) weeks. At the latest follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores ranged from 75 to 89, with a mean of 80.5±4.9, 24 patients got a good result, 7 fair. The improved medial approach for Pilon fracture can directly expose the posterior medial, medial and anterior medial of the distal tibia. After reduction under direct vision, the medial compressed and collapsed articular surface are fixed. The clinical curative effect is satisfactory and the wound complications are less. It is recommended for Pilon fracture where compression of the medial articular surface is predominant.

On the Effect of Electroacupuncture in Promoting Healing after High Tibial Osteotomy.

Purpose To explore the clinical effect of electroacupuncture in promoting the healing of the osteotomy area after high tibial osteotomy. Methods 50 patients with knee osteoarthritis who underwent open wedge high tibial osteotomy (OWHTO) were selected and randomly divided into the observation group and control group. The control group got the common postoperative treatment, and the observation group was added electroacupuncture from the 3rd day after the operation on the basis of the control group. The electroacupuncture acupoints were selected SP10, ST34, ST32, EX-LE2, ST40,KI6, KI3, SP6, and ST41, once a day, and 14 days were a course of treatment. And then we contrasted the index of the Lane-Sandhu X-ray score, the skin incision healing time, the swelling subsided time, Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC), and Lysholm in different time. Results The Lane-Sandhu X-ray score of the observation group was better than that of the control group at all time points (P < 0.05), and the time to achieve bone healing was about 2 weeks earlier than that of the control group. The skin healing and swelling were the subsided time in the osteotomy area. Both were better than the control group, and the difference was statistically significant (P < 0.05). The VAS score, WOMAC score, and Lysholm score of the two groups were significantly improved compared with preoperatively, and the difference was statistically significant (P < 0.05). The improvement of the observation group's VAS score, WOMAC score, and Lysholm score at 1 week, 4 weeks, and 8 weeks after the end of the treatment course was better than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion Electroacupuncture can quicken the healing of bone tissue and surrounding soft tissues in the osteotomy area after high tibial osteotomy, and at the same time, it can help the relief of knee joint pain and improve knee joint function.

A Modified Disposable Circumcision Suture Device with Application of Plastic Sheet to Avoid Severe Bleeding After Circumcision.

To evaluate the effectiveness of a modified disposable circumcision suture device (DCSD) with application of plastic sheet to avoid severe bleeding after circumcision and compare the surgical effects and other postoperative complications of two DCSDs. A total of 943 excess foreskin patients from January 2018 to January 2020 who underwent circumcision using two different DCSDs were recruited. Preoperative characteristics (patient age, height and weight), main surgical outcomes (surgical time, intraoperative blood loss, incision healing time) and postoperative complications (postoperative hemorrhage and hematoma rate, edema rate, incision infection rate, residual staples rate) were collected and analyzed. Patients' "satisfaction" or "dissatisfaction" was also investigated. Preoperative characteristics showed no significant statistical difference. The modified DCSD group has a lower intraoperative bleeding, postoperative hemorrhage or hematoma rate and residual staples rate compared with the conventional group. Incision healing time and incision infection rate between the two groups were similar. Nevertheless, conventional group has a shorter surgical time, a lower edema rate and a higher satisfaction rate. The modified DCSD with application of plastic sheet can avoid severe bleeding after circumcision effectively and can be served as a new choice for circumcision.

Role of Surf Redfish (Actinopyga mauritiana) in Wound Incision Healing Activities of Diabetic Mice

It is estimated that 6% of the US population suffer from diabetes with 15% of them experience diabetic foot. Several studies have explored the various benefits of sea cucumber for human being, including its antioxidant nature. This study aimed to investigate the effect of surf redfish, one species of the sea cucumbers, in diabetic wound healing. This was an animal experimental study performed at the Pharmacology and Pharmaceutical laboratory of the Faculty of Pharmacy, Universitas Tjut Nyak Dhien Medan, Indonesia, during the period of February- July 2019. Twenty five mice in diabetic condition were divided into five groups: control, standard, ethanol extract of surf redfish-1, ethanol extract of surf redfish-2, and ethanol extract of surf redfish-3 3. The surf redfish was obtained from Lamreh Village in Aceh and the ethanol was extracted using the maceration method. The parameters used for evaluating the efficacy of surf redfish ethanol extract were blood glucose level, length of wound incision, and histopathological features. Surf redfish extract presented a significant reduction of blood glucose level which that followed the increase in the dose of the ethanol extract (p-value &lt;0.05) where the most significant reduction was seen in the group with the highest dose on the last day. This trend was also seen for the length of the wound, where the reduction was significantly higher in treatment groups when compared to control (p-value &lt;0.05). The histological study also confirmed the improvement in the clinical appearance of wound by showing significantly increased fibroblast cell number and collagen density (p-value &lt;0.05). Overall, the surf redfish can help better incision's wound healing in diabetic condition.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

Effect of a combination of infrared irradiation and magnesium sulfate wet compress on infection and healing of episiotomy incision in puerperae

Purpose: To investigate the effect of a combination of infrared irradiation and magnesium sulfate wet compress on infection and healing of episiotomy incision in puerperae during spontaneous delivery.&#x0D; Methods: A total of 120 puerperae who underwent lateral episiotomy in Jinan Maternity and Child Hospital Affiliated to Shandong First Medical University from January 2019 to January 2020 were used as study subjects. They were randomly assigned to group A (n = 60) and group B (n = 60). Group B received external application of anerdian, while group A was treated with infrared irradiation and magnesium sulfate wet compress, in addition to receiving the treatment given to group B. The two groups were compared with respect to perineal edema, levels of inflammatory factors, wound pain grading, degree of incision healing, incision healing time, and incidence of infection.&#x0D; Results: Group A patients had significantly lighter perineal edema and more pronounced pain relief than group B patients (p &lt; 0.05). The number of puerperae with grade A healing and grade C healing in group A was significantly higher than that in group B (p &lt; 0.05). Incision healing time and incidence of infection were lower in group A than in group B (p &lt; 0.05).&#x0D; Conclusion: The combination of infrared irradiation and magnesium sulfate wet compress effectively mitigates perineal edema in puerperae, reduces pain, enhances the healing of incision, and lowers maternal infection. Thus, this combination strategy may have some merit in clinical practice.

The influence of Nutren on postoperative nutritional status, inflammation and incision healing in patients with colon cancer

To explore the impact of Nutren on postoperative nutritional status, incision healing and inflammation in patients with colon cancer (CC). Division of 94 patients with CC as the research object was into the observation group (51 cases) and the control (43 cases) on the grounds of postoperative enteral nutrition support (ENS). Analysis of the influence of Nutren on postoperative nutritional status, inflammation and incision healing was performed. No distinct differences between the two groups in surgical efficacy, survival rate, distant metastasis rate and recurrence rate after surgery of 2 years (P > 0.05); The incision healing time of the observation was shorter versus the control, and the incision healing was superior versus the control. Hemoglobin, albumin and total plasma protein of 14 d after operation were elevated versus the control, and c-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin (IL)-6 were declined versus the control (P < 0.05). Giving of enteral nutrition support is to patients after CC radical resection, which is available to ameliorate the nutritional status, accelerate incision healing, and decline inflammation.

Роль фиксированных комбинаций антибиотиков и глюкокортикоидов в офтальмохирургии

This paper reviews the relevance of fixed-dose combinations (FDC) of antibiotics (AB) and steroids in cataract surgery. Postoperative pharmacotherapy of phacoemulsification addresses two main issues — reducing inflammation and preventing infectious complications. Therefore, the question arises about the role of FDCs of ABs and steroids addressing both issues but in compliance with baseline principles. The most effective measure to prevent acute endophthalmitis is an intracameral injection of antibiotics at the end of surgery. Meanwhile, as early as after 10 hours, drug concentration reduces to a level that fails to prevent aqueous humor contamination with bacteria. Therefore, topical ABs, either monotherapy or FDC, are reasonable up to complete healing of phaco incisions (approximately after one week). The authors suggest a postoperative management algorithm after uneventful phaco involving topical administration of an FDC containing 0.5% levofloxacin and 0.1% dexamethasone QID at week 1. If inflammation (conjunctival redness and cells/flare) persists, switching to dexamethasone as monotherapy QID during week 2 (and withdrawal without tapering) is recommended. Keywords: phacoemulsification, endophthalmitis, prevention, inflammation, antibiotic, steroid, dexamethasone, fixed-dose combination, eye drops, withdrawal syndrome. For citation: Nikolaenko V.P., Belov D.F. Role of fixed-dose combinations of antibiotics and steroids in ophthalmic surgery. Russian Journal of Clinical Ophthalmology. 2022;22(1):58–61 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-58-61.

Study of Butorphanol, Dezocine and Dexmedetomidine in the Field of Accelerated Recovery of Gynecological Malignancies

Reducing the adverse stress response of patients in the perioperative period is the most basic principle of accelerated rehabilitation. It is well known that surgery will prompt the body to produce a corresponding stress response, thereby stimulating the body to release various hormones and inflammatory mediators, resulting in enhanced catabolism, which is not conducive to the healing of incisions and wounds. However, a series of measures of accelerated recovery in the perioperative period are precisely to reduce the occurrence of adverse stress reactions in patients. The purpose of this study is to systematically evaluate the efficacy and safety of the concept of fast recovery surgery in the operation of gynecological malignant tumors with the help of Meta analysis method, and to evaluate the efficacy and safety of fast recovery surgery concept in gynecological malignant tumor surgery. The use in tumor patients provides a basis for clinical surgeons to explore the best perioperative treatment plan. The experimental results show that the heart rate wake-up period of patients who use butorphanol 2 mg and dexmedetomidine 0.5 μg is shorter. For dezocine 10 mg and dexmedetomidine 0.5 μg, the heart rate wake-up time of group A was 68.82 minutes and 71.23 minutes, respectively. Butorphanol 2 mg and dexmedetomidine 0.5 μg were used to accelerate the recovery of patients with gynecological malignant tumors. have a certain effect.

Lateral Extensile Approach to the Calcaneus is Safe after Sinus Tarsi Incision: A Report of Two Cases

Category:Trauma; HindfootIntroduction/Purpose:While the optimal surgical approach for operative treatment of calcaneus fractures is controversial. Regardless of index approach, post-injury sequelae such as malunion may require subsequent extensile exposures for reconstruction. In the tenuous soft tissues overlying the Whether a lateral extensile approach is safe following a previous sinus tarsi exposure has yet to be demonstrated.Methods:In this case report, two individuals underwent an initial sinus tarsi approach for reduction and fixation of calcaneus fractures, but went on to malunion or subtalar arthritis. A 'sham' surgery consisting of skin incision and initial flap elevation was performed to evaluate the efficacy of a lateral extensile approach to the calcaneus after previous sinus tarsi incision.Results:In each instance, the patients experienced uneventful skin incision healing, and subsequently had successful reconstruction with distraction subtalar arthrodesis via lateral extensile exposures.Conclusion:The lateral extensile approach to the calcaneus may be safely performed following sinus tarsi exposure.

Analysis of the Effect of Posterior Lateral Malleolus Plate Fixation on the Curative Effect and Mechanical Stability of Complex Ankle Fractures.

This paper investigates the effect of lateral and posterior 1/3 tubular plate bone plate fixation on the curative effect, wound healing, and mechanical stability of complex ankle fracture. 80 patients with complex ankle fractures treated in our hospital from January 2018 to July 2020 are selected for the study, and 80 patients are randomly divided into posterior fixation group and lateral fixation group according to the number table method, with 40 patients in each group. Patients in the posterior malleolus fixation group are treated with posterior lateral malleolus plate fixation, and patients in the lateral malleolus fixation group are treated with lateral malleolus plate fixation. The differences in efficacy, mechanical stability, wound healing, visual analog scale (VAS) pain score, and American Association of Foot and Ankle Surgery (AOFAS) ankle function are compared. The subjects are followed up for 6 months until January 2022. In patients with complex ankle fracture, 1/3 tubular plate osteoplate fixation in the posterior lateral malleolus can improve clinical efficacy and mechanical stability, which is helpful to promote incision healing and reduce the risk of complications. The 1/3 tubular plate osteoplate fixation in the posterior lateral malleolus is worthy of clinical promotion and application.

The effect of a silver hydrogel sheet dressing on postsurgical incision healing after foot and ankle surgery.

IntroductionSilver hydrogel dressings are antimicrobial dressings with the potential to aid post-surgical healing. The purpose of this study is to evaluate the effects of a silver hydrogel dressing on postoperative scarring and complications.Methods40 foot and ankle patients (48.43 ± 16.82 years) were included in the study with 20 patients in each group. Postoperatively, the treatment group was treated with a silver hydrogel sheet dressing, and the control group was treated with a standard petroleum-based dressing. Follow-up was performed at two, six, and 12 weeks. Postoperative scarring and complications were evaluated and compared between groups. Scarring was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Scar length and width were measured using digital calipers and used to compute scar area.ResultsThe treatment group demonstrated statistically significant improvements in the POSAS observer score and observer opinion at six and 12 weeks (p < 0.001). Additionally, patient reported pain was significantly lower for the treatment group than the control group at 12 weeks (p < 0.001). Patient reported itch declined across time for both groups (p < 0.001) with significantly less itching reported by the treatment group (p = 0.027). Scar area was also significantly lower for the treatment group than the control group at six weeks and 12 weeks (p ≤ 0.002). Neither group experienced any postoperative complications.ConclusionThese results suggest that the inherent properties of the silver hydrogel dressing may improve postsurgical scarring. Lay SummarySurgical incisions result in scar, which can present both cosmetic and rehabilitation concerns after foot or ankle surgery. It is standard to use a petroleum-based dressing on incisions after surgery, however, advancements in incisional dressings have been made over the past 20 years. One such advancement is silver-impregnated hydrogel sheet dressings which have been shown to maintain a moist wound environment conducive to healing, while decreasing the chance of infection through its antimicrobial properties. This paper evaluates scar healing after foot or ankle surgery in patients treated with either the standard petroleum-based dressing, or the silver hydrogel sheet dressing. Patients who were treated with the silver hydrogel dressing had less itching and pain, as well as a smaller scar area than patients in the standard dressing group. Therefore, our results suggest that the silver hydrogel dressing may improve scarring after surgery.

Feasibility study on local infiltration anesthesia for postoperative analgesia in patients with hallux valgus

To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus. From September 2019 to December 2020, 48 patients with hallux valgus were treated surgically. According to different postoperative analgesia methods, the patients were divided into combined local infiltration group and intravenous analgesia pump group. There were 24 cases, in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old, with an average of (58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation, 20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once. There were 24 patients in intravenous analgesia pump group, including 3 males and 21 females;the age ranged from 23 to 81 years old, with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation, intravenous analgesia pump was used for analgesia. The basic flow was 2 ml / h;the self control dose was 0.5 ml;and the locking time was 15 min. Visual analogue scale (VAS) was recorded at 12, 24, 48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation. The occurrence of adverse drug reactions at 0 to 12 hours, 12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded. All patients were followed up, and the duration ranged from 14 to 17 days, with a mean of (14.60±0.92) days. There was significantdifference in VAS at 12, 24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group(P<0.05). There was no significant difference in VAS between the two groups 72 hours after operation (P>0.05). There was no significant difference in the number of adverse drug reactions between the two groups at 0 to 12 hours after operation (P>0.05);there was significant difference in the number of adverse drug reactions 12 to 24 hours after operation (P<0.05). No adverse drug reactions occurred in both groups 24 to 48 hours after operation. There was no significant difference in the grade of knife edge healing between the two groups after suture removal (P>0.05). Compared with intravenous analgesia pump group, ropivacaine combined with compound betamethasone can significantly reduce postoperative wound pain without increasing adverse drug reactions, and does not increase wound infection.

Bone cement filling combined with lumbo-iliac screw internal fixation in the treatment of benign sacroiliac joint tumours.

To investigate the method of reconstruction of the sacroiliac joint in patients who underwent benign tumour curettage and analyse the effect of internal fixation with lumbo-iliac screws and connecting rod insertion after filling the defect with bone cement. Twenty-four patients with benign sacroiliac joint tumours underwent curettage and filling of the defect with bone cement, followed by lumbo-iliac screw and connecting rod insertion. The visual analogue scale (VAS) was used to assess pain, and the Musculoskeletal Tumour Society (MSTS) score was used to assess hip function. All patients were followed-up for 24-96 months (average, 42.2months). The postoperative VAS score was significantly lower than the preoperative score (p< 0.05), while the postoperative MSTS score was significantly higher than the preoperative score (p< 0.05). One patient had delayed healing of the surgical incision; no complications occurred in the remaining patients. For benign sacroiliac joint tumours, the combination of filling of defects with bone cement and internal lumbo-iliac fixation can relieve pain quickly, and achieve good limb function.

A Modified Technique for Applying Closed Incision Negative Pressure Therapy Dressing Following Total Joint Arthroplasty.

Postoperative incisional management subsequent to total joint replacement arthroplasty is of importance to the orthopedic surgical team. The application of closed incision negative pressure therapy (ciNPT) to surgical incisions following replacement arthroplasty has demonstrated positive outcomes in orthopedics. This paper describes a technique involving the postoperative application of ciNPT over closed incisions originating from joint arthroplasty to facilitate a reduction in the incidence of surgical site complications (SSCs). To address any potential challenges that may be associated with ciNPT application and removal, the ciNPT dressing was applied to the knee incision with approximately 15 degrees of flexion utilizing the total knee bump to allow the knee to rest with flexion at that angle. For posterior hip replacements or revisions, the readily adjustable ciNPT dressing was enlisted for use to cover curvilinear incisions. The adhesive drape over the foam ciNPT dressing would be blocked to ensure that drain placement, if used, would not be incorporated with the hydrocolloid portion of the dressing. In order to properly apply the dressing, it was imperative that the hydrocolloid portion was not subject to any buckling. The dressing was walked over the foam ciNPT dressing to ensure that there was an absence of tension on the dressing. The manufacturer’s instructions support dressing use for a maximum of seven days with continuous subatmospheric pressure (-125 mmHg) applied to the closed incision. Applying the adhesive ciNPT drape over the ciNPT foam dressing with a minimal amount of tension is integral to attaining positive outcomes using ciNPT. Employing ciNPT may reduce the risk of delayed incisional healing and SSCs, which may alleviate providers from extra postoperative global visits.