Drainage Incision Research Articles

A novel method in the removal of impacted mandibular third molar: buccal drainage

Food impaction after impacted mandibular third molar extraction is a serious problem that should not be ignored. Incomplete suturing of the distal incision in the conventional method is the main cause of food impaction and delayed wound healing. The present study introduces a novel suture and drainage technology that requires hermetic suturing of the distal incision and rubber drainage for buccal drainage. 76 patients with horizontally/mesially impacted third molars (bilateral) were enrolled in this prospective study. An impacted tooth on one side of each patient was extracted by occlusal drainage using the conventional method, whereas the other side tooth was extracted by buccal drainage using the novel method. The differences in wound healing, facial swelling, bleeding and dry socket between the two sides of each patient were compared postoperatively, and the trends for patient selection of the surgical method were also compared. The results indicated that buccal drainage had obvious advantages in wound healing and reduced the risk of postoperative bleeding, and most patients preferred this technique; there were no significant differences in postoperative facial swelling or pain. Thus, buccal drainage can solve the problem of long-term food impaction induced by traditional incision postoperatively and is worthy of clinical promotion.

The origins of oral medicine in the Hippocratic collected works.

The collected works of Hippocrates describe for the first time in a systematic way a large number of oral diseases, such as ulcers, inflammations, abscesses and tumours from the epiglottis, mouth, tongue, palate, uvula and the sublingual area. Several of these case reports are remarkable for the accurate observation of clinical symptoms and signs, the aetiology, the pathogenesis and their therapeutic approach in relation to prognosis. The Hippocratic authors report cases of aphthae as part of a polysystemic disease, described many centuries later by Behçet and Adamantiades, while they associate features of splenomegaly from endemic malaria with gingivitis (ulitis). Benign lip ulcers, caused by sharp teeth bites, were distinguished from the difficult to treat herpes labialis (herpes) and from the necrotising nomae. Although staphylitis and angina (kynanche) were attributed to phlegm accumulation, they were recognised as true emergencies when they were associated with a swollen tongue and uvula. Several cases of kynanche with forward displacement of the first cervical vertebrae, atrophy of the uvula and oedema of the jaws are illustrated. A fatal outcome was anticipated in cases of phagedaenic ulcers of the teeth, causing necrosis and abscess formation. The therapeutic approach of oral diseases proceeded step by step, starting with simple regimens and progressing to invasive techniques, such as phlebotomy, surgical incisions for fluid drainage, and cauterisation. With the aim to avoid adverse events, special attention was paid to the correct timing of surgery and the maintenance of a patent airway with the insertion of small pharyngeal tubes.

Group B and F Beta Streptococcus Necrotizing Infection-Surgical Challenges with a Deep Central Plantar Space Abscess: A Diabetic Limb Salvage Case Report.

We present the case of a 66-year-old, type II diabetic male with a deep wound to the plantar-lateral aspect of his right hallux. On examination, the central plantar compartment of his right foot was moderately erythematous and tender on palpation. After obtaining a deep wound culture, treatment was complicated by a progression of a group B and F beta streptococcus, necrotizing infection. The patient underwent a right hallux amputation, followed by a plantar medial incision for drainage of an abscess to the medial and central plantar compartments of the foot. Due to the extent and limb threat of the infection, the patient ultimately underwent a transmetatarsal amputation. Advanced healing modalities were also employed to decrease wound healing times, which allowed the patient to achieve early weightbearing and return to activities of daily living. This study depicts how the astute podiatric surgeon needs to make a decision in a timely manner to surgically debride all nonviable and necrotic tissue in order to minimize further amputation and preserve foot function.

Neck abscess: An unusual clinical presentation of immunoglobulin G4 related disease

NA Laryngoscope, 126:1114-1116, 2016.

Reduced port laparoscopic surgery for rectal cancer.

See Article on Page 16-22 Due to the significant improvement in minimal invasive surgery, a large group of surgeons has focused on cosmetic results and minimization of the number and the size of the ports. In addition, a single-incision laparoscopic colectomy was recently introduced to reduce patient's trauma related with conventional multiport approaches. In a single-incision laparoscopic colectomy, all trocars are inserted through one umbilical incision. However, published studies are limited, for the most part, to the right colon [1] and the sigmoid colon [2], and single-incision laparoscopic surgery in the field of rectal surgery is very rare [3] because of the difficulties in many cases in securing the surgeon's operative field [4]. One study reported that the rectum was vertically lifted by using a suspension bar to obtain the operative field [4]. Transecting the lower rectum via an umbilical port and securing a sufficient distal margin is very challenging because of the technical limitation that the tip of the laparoscopic stapler can be bent only 45 degrees. Numerous studies of single-incision laparoscopic rectal surgery in which multiple staplers were used for making an incision have reported that the chance of anastomotic leakage was decreased when the number of linear stapler used in lower rectum transection was reduced [5, 6]. Pelvic drainage after rectal surgery is required for the early detection of anastomotic leakage and to avoid reoperation. A single incision site after the rectal incision can be used as an incision for drainage in reduced port laparoscopic rectal surgery. In this study, the authors performed reduced port laparoscopic surgery on 20 colorectal cancer patients by using an umbilical port and an additional port in the right lower quadrant. The operation time (231 minutes), blood loss (100 mL), number of staplers, days to first soft diet, length of hospital stay, number of lymph nodes harvested, circumferential resection margin involvement, complications, and the rates of local recurrence and distant metastasis were comparable to those reported in other studies. However, the authors stated that further studies were needed to confirm the benefits of the procedure [7]. A reduced port procedure allows surgeons to secure a distal resection margin and is an easier surgical procedure for treating patients with low rectal cancer than procedures using only an umbilical port. Furthermore, that the incision can be utilized for pelvic drainage for a safer operation is worth mentioning. For the validation of the advantages of such procedures, further multicenter and comparative studies are demanded.

Images of deep neck space infection and the clinical significance

Deep neck infection is not difficult to diagnose clinically, but correct localization of the involved space for timely incision and drainage is not easy without assistance of imaging. To investigate the images of deep neck space infection of phlegmon and abscess and the role of imaging examination in correct localization and treatment. Between June 2004 and June 2010, 28 patients were diagnosed with deep neck infection (14 men, 14 women; age range, 17-72 years; mean age, 46 years). Clinical presentations included neck swelling, pain, dysphagia, fever, and elevated white blood cell count. Of the 28 cases, 20 had computed tomography (CT) scans, 18 had magnetic resonance imaging (MRI) examinations, and 10 had both CT and MRI. All 28 patients were confirmed by CT and/or MRI to have deep neck infection, with 11 cases in the retropharyngeal space, five in the parapharyngeal space, four in the masseteric space, and eight in multiple spaces. Thirteen cases had abscesses that were successfully treated with incision and drainage under CT guidance in combination with large doses of antibiotics, and 15 had phlegmon managed with large doses of antibiotics. Followed up for 5-20 months, all patients recovered completely. Two patients were confirmed by imaging examination to have retropharyngeal infection spreading to the superior mediastinum with abscess formation and another two patients had multiple space infection because inappropriate puncture or incision for drainage without imaging guidance in these patients caused the spread of infection. Clinical diagnosis was not accurate with only 12 patients (42.9%) being correctly diagnosed of the exact deep neck space involved before imaging confirmation. CT and/or MRI made the correct diagnosis in all 28 patients. CT and/or MRI also directly changed the treatment plan in seven patients and contributed to the recovery of these patients. CT and MRI play a crucial role in both the diagnosis and correct puncture and incision for drainage of the deep neck space infection.

両側扁桃周囲膿瘍5例の検討

Peritonsillar abscesses are the most common deep neck infection in adults, however, bilateral cases are rare. We report herein on five patients who were diagnosed as having bilateral peritonsillar abscesses. In three of the five cases, we could not at first make a diagnosis of bilateral peritonsillar abscesses, but we suspected tonsillitis based on no laterality in the appearance of the pharynx before the CT scan.However, the CT scan in these patients showed bilateral peritonsillar abscesses. Along with intravenous administration of antibiotics, removal of the abscesses was performed by needle aspiration in one case, and incision for drainage in four cases. Interval tonsillectomy was carried out in three cases.Enhanced CT should be considered in patients presenting with high fever, severe throat pain, high values of C-reactive protein & white blood cells, and dyspnea.

Large-Scale Seismogenic Deformation of A Carbonate Platform Straddling the Precambrian-Cambrian Boundary, Karatau Range, Kazakhstan

Abstract The Berkuty Member of the Ediacaran Kyrshabakty Formation in the Malyi Karatau Mountains of southern Kazakhstan immediately underlies some of the world's largest sedimentary phosphate deposits of earliest Cambrian age. This 5–30 m thick unit, exposed over > 40 km strike length, is a complex carbonate unit that was formed by regional seismic deformation of semiconsolidated carbonate. Three subdivisions are recognized. The lower unit (Unit 1), ∼ 3–5 m thick, is regionally shortened by meter-scale flexural folds, and shows thrusting and imbrication of underlying siliciclastic units; local extension is accommodated by soft-sediment boudinage. The middle unit (Unit 2), ∼ 2–5 m thick, consists largely of a megabreccia of angular to subrounded dolomite clasts up to a meter across. The upper unit (Unit 3), up to 3 m thick, consists of microbially laminated dolobindstone, dolorudstone, and flat-pebble conglomerate, cut by syndepositional, low-angle normal faults. Channelization and bank-margin slumping at the top of Unit 3 was followed by karsting, prior to the formation of a high-energy, shallow-water, carbonate–phosphatic coastal environment. We interpret the Berkuty Member as an example of an incompletely and unevenly lithified carbonate platform deformed by at least one large seismic event (Mb greater than approximately 8). Deformation of the lower unit included local sliding, imbrication, and folding, whereas the middle unit was deformed by in-situ disaggregation due to extensive shaking. Regional coseismic or early postseismic uplift of soft sediment, possibly above sea level, led to widespread gravitational collapse, rapid drainage incision, and drainage fill by bank collapse and conglomeratic wedges. While each of the deformational features and stratigraphic elements observed in this unit is not diagnostic of a seismogenic origin, the remarkable lateral extent in outcrop, the wide range of structures related to soft-sediment deformation, their systematic lateral variability, and the internal process-related stratigraphy demonstrates in an exemplary way the manner in which single soft-sediment deformation events can produce a large array of features over a broad area, largely due to minor rheological differences.

Late Quaternary active faulting and landscape evolution in relation to the Gowk Fault in the South Golbaf Basin, S.E. Iran

We present ten infra-red stimulated luminescence (IRSL) ages of feldspar grains within lake-bed sediments and alluvial fan gravels displaced by the Gowk Fault, SE Iran. Our results show that lake deposition in the South Golbaf basin was ongoing from at least 13.5ka (the deepest exposed sediments) until the mid-Holocene. Furthermore, the South Golbaf palaeo-lake is likely to have spilled into the neighbouring Golbaf basin at 6.3±0.2ka. This event led to a widespread incision of the lake-bed and neighbouring alluvial fan surfaces as the drainage systems adjusted to the new base-level. Our constraint on the age of the South Golbaf palaeolake, combined with measurements of 30±5m of right-lateral displacement of stream channels incised into the lake-beds, yields a slip-rate of 3.8–5.7mm/yr. The deposition of alluvial fans around the margins of the South Golbaf depression appears to have largely ended by 12.9±0.7ka. Right-lateral displacements of up to 60m are observed in streams cut into the fan surfaces, yielding a second slip-rate estimate of ~4.4–4.9mm/yr. Much of the widespread incision of the ~12.9ka fan surfaces does not appear to have taken place until ~6ka later, when overtopping of the South Golbaf palaeolake and the adjustment of drainage to a lower base-level, promoted widespread drainage incision.

La secuencia de terrazas cuaternarias del río Alcanadre (provincia de Huesca): caracterización y consideraciones medioambientales

A very extensive sequence of Quaternary fluvial terraces composed of nine strath levels (from Qt1 to Qt9) has been recognized in the Alcanadre River valley (Ebro basin, Huesca province). New mapping, altimetric, stratigraphic, pedogenic and chronological data have been supplied. A braided fluvial sedimentary environment is deduced. The confinement of the fluvial system increases as a response to drainage incision. Pedogenic carbonate morphology reaches highest development (stage VI) with the age. Palaeomagnetic data indicate that, tentatively, the age of Qt1 is near 1000 ky and the age of Qt2 is around 780 ky. In addition, numerical ages of Qt5, Qt6 and Qt7 are 44 ± 2 ky, 19 ± 2 ky and 10 ± 1 ky respectively by using Optically Stimulated Luminescence (OSL). This Upper Pleistocene chronology matches well with the regional fluvial chronostratigraphy recorded in non-glaciated river valleys. It is correlated to cold periods MIS3, LGM and YD at global scale. In a palaeoenvironmental scenario dominated by periglacial conditions, fluvial aggradation is enhanced by high sediment supply from slopes and a seasonal behaviour of rainfalls.

Efficacy of three different surgical methods in treatment for bacteria liver abscess

Objective To discuss the clinical effect of the ultrasound or CT-guided percutaneous pus or catheter drainage (CT-PDLA),laparoscopic liver abscess drainage (LD-LA) and abdominal liver abscess incision and drainage (IDLA).Methods 103 cases of pyogenic liver abscess were randomly divided into three groups,which were CT-PDLA group (Group A,35 cases),LD-LA group (Group B,n =34 cases) and IDLA group (Group C,34 cases),and the clinical effects of three groups were compared.Results All patients were cured,the total efficiency of Group A was 100％,Group B for 97.06％,Group C for 82.35％,there was statistical significant difference between them (P＜0.05),but there was no significant difference between Group A and Group B(P＞0.05),there were no significant difference in the biochemical markers of three groups(P＞0.05),for the after conventional indicators,Group A was better than that Group B and Group C (P＜0.05).Conclusion Under the same conditions,exact indications,the CT-PDLA treatment BLA is reliable,simple,economical,having advantages of small trauma,low complications and high cure rate,which can be the preferred treatment choice for bacterial liver abscess. Key words: Bacterial liver abscess; Ultrasound-guided; Laparoscopic drainage; Open drainage

Single-Incision plus One Port Laparoscopic Anterior Resection for Rectal Cancer as a Reduced Port Surgery

Only limited data in the literature about single-incision laparoscopic rectal surgery, because the laparoscopic stapler does not allow low rectal transection without sufficient distal margins from the umbilicus port. We have developed single-incision plus one port laparoscopic anterior resection of the rectum (SILS+1-AR) as a reduced port surgery in which we can utilize the incision for drainage as an additional access route for laparoscopic procedures including the transection the lower rectum. A Lap protector (LP) mini was inserted through a 2.5 cm transumbilical incision, and an EZ-access was mounted to LP and three 5-mm ports were placed in EZ-access. A 12 mm port was inserted in right lower quadrant. Almost all the procedures were performed with usual laparoscopic instruments, and the operative procedures were much the same as in usual laparoscopic low anterior resection of the rectum using a flexible 5mm scope. The rectum was transected normally using only one endoscopic linear stapler inserted from the right lower quadrant port. We underwent modified SILS+1-AR in 16 patients with advanced rectal cancer. In all cases, there was no need to extend the skin incision. We transected the lower rectum with one laparoscopic stapler in all six cases. Postoperative follow-up did not reveal any umbilical wound complications or recurrences. The safety and feasibility of SILS+1-AR for advanced rectal cancer was established in this study. However, further studies are needed to prove the advantages of this procedure to conventional laparoscopic law anterior resection.

Persistent inguinal seroma managed with sprinkling of talcum powder: a case report

IntroductionWe present a new method to treat recurrent seromas, which is based on our experience with a patient who had recurrent groin seroma and was treated successfully with a sprinkling of talcum powder in the seroma cavity.Case presentationA 67-year-old Caucasian man with a suprapubic recurrent right groin hernia underwent inguinal hernioplasty with a polypropylene plug. Three days later the patient presented with a right groin fluctuating mass beneath the surgical wound with no signs of infection, and was discharged after seroma aspiration. After 23 days of increasing drainage, the seroma cavity was thoroughly dried with clean gauze swabs, and four g of sterilized dry talcum powder was sprinkled into the seroma cavity with a five-cc syringe. A compressive dressing was placed, and the patient was discharged. One week after the sprinkling of talcum powder, the surgical wound was almost closed with only minimal oozing from the drainage incision. The patient did not report any adverse effects. Two weeks later, the wound was fully healed.ConclusionTalcum powder sprinkling could be an effective, quick, and safe method for the treatment of inguinal seromas after inguinal hernioplasty when conservative management has failed. Nevertheless, larger series are needed before assessing this technique as the treatment of choice.

Anterior ilioinguinal incision for drainage of high-located perianal abscess

Most perianal abscesses originate from infected anal glands at the base of the anal crypts. Most abscesses below are usually drained through perianal incision and can be treated successfully. However, when perianal abscesses extend to the high intrapelvic cavity, it may be inadequate treatment through a single route incision through a perianal approach. The aim of this technical note is to show that combined anterior ilioinguinal and perianal incisions may provide optimal surgical field and multiple drainages. Here, we report a 56-year-old male patient with perianal-originating parapsoas abscesses. Residual abscess still remained after initial perianal incision and drainage after 1-month treatment. We presented combined anterior ilioinguinal and perianal incision technique methods for proper drainage in this complicated case. No recurrent or residual abscess remained after 2 weeks of operation. So, combined anterior ilioinguinal incision is feasible for high-located perianal abscess.

The clinical features of severe multi-space infections of the head and neck in patients with diabetes mellitus compared to non-diabetic patients

We have recorded the clinical features of diabetic patients with multispace infections of the head and neck and compared them with those of non-diabetic patients. We retrospectively studied 191 patients who were treated for severe multispace infections of the head and neck, and compared the patients’ background, the aetiology of the infection, clinical variables, laboratory values (microbiology, and blood glucose concentration, white cell count (WCC), and percentage of neutrophils on admission) and treatment (the number of incisions, complications and duration of hospital stay). Statistical analyses of the differences between groups were made with Student's t test, the chi square test, and analysis of variance, as appropriate. Diabetic patients had more spaces involved concurrently (P=0.02), required more incisions for drainage (P=0.002), had longer hospital stays (P<0.0001), and developed more complications (P=0.02). Two diabetic patients died. We conclude that diabetic patients are more likely to develop complications and the complications are more likely to be severe than those in non-diabetic patients.

Electrical resistivity tomography applied to the study of neotectonic structures, northwestern Precordillera Sur, Central Andes of Argentina

Abstract The Precordillera, which is one of the main morphotectonic units along the Pampean flat-slab subduction segment of the Central Andes of Argentina, is characterized by its high neotectonic activity. Thus, the study of the Late-Cenozoic to Recent deformation along this zone directly contributes to the seismic hazard characterization of the region. The Paleozoic and Mesozoic geological history of the southern sector of the Precordillera (Precordillera Sur) resulted in an inhomogeneous basement whose mechanical anisotropies seem to control the Andean structural features. As the northwestern edge of the Precordillera Sur and its piedmont sector shows no Cenozoic rocks, it is not possible to use them as a tool to reconstruct the tectonic deformation of this age. However, the presence of a regional Pre-Cenozoic tilted erosion surface can be use as a structural marker. The Andean tectonic deformation is here represented by some scattered Cenozoic to Recent structural highs carved in Paleozoic rocks and Quaternary sediments and by drainage modifications within the Quaternary alluvial fans. The aim of this contribution is to present a geophysical study of two piedmont neotectonic structural features: the Yalguaraz structural high and a subtle drainage incision anomaly. We studied the shallow subsurface character of these structural features by means of electrical resistivity tomographies in order to evaluate the subsurface presence of the erosion surface, its structural fabric and its relationship with Late-Cenozoic to Recent tectonic structures. This methodology showed to be effective and useful in the study of such features. We interpreted the Yalguaraz fault as a subvertical NE-dipping reverse fault, related to a fault scarp retreat of about 50–70 m. Furthermore, its NW-trending could be associated with mechanical anisotropies, likely Paleozoic in age. According to analyses of aerial photographs, the oldest aggradation level of the study zone (Early–Middle Pleistocene) could be affected by the activity of the Yalguaraz fault. The youngest Quaternary deposits (Holocene) do not show surface as well as subsurface evidence of deformation. In the case of the studied Quaternary drainage incision anomaly, the performed electrical resistivity tomography corroborates the relationship between these elements and incipient tectonic deformation.

Landscape history of the Marlborough Sounds, New Zealand

The Marlborough Sounds is a large and spectacular network of rias or drowned valleys. The Sounds were formed by stream incision and dissection of uplifting rocks followed by subsidence and marine incursion into the valleys. The evolution of the Marlborough Sounds is examined using a combination of seismic-reflection lines from the offshore Wanganui Basin, topographic data and seafloor bathymetry. Drainage incision produced valleys and ridges in the Sounds that were part of a mountainous region which reached maximum altitudes of c. 2000 m and extended northwards across the basin to the Wanganui coast. Sedimentary strata as old as c. 5 Ma infill this palaeotopography in the basin, suggesting that topography in the Sounds formed primarily during the Miocene. This topography started to submerge in the Sounds at c. 1.5 Ma when the Wanganui Basin stepped southwards by about 50 km. At the present outer edge of the Sounds, the average rates of subsidence since this time have been low (c. 0.3 mm a−1) and the resulting accommodation space in the valley system filled by sediments. As a consequence of sedimentation, the absolute altitude of valley floors remained approximately constant relative to a fixed earth datum. Thus, while subsidence was important for bringing strongly dissected topography close to sea level, isostatic sea-level rises are inferred not to have been responsible for submergence of the Sounds region. Instead, marine inundation may have been primarily driven by eustatic sea-level changes which resulted in ephemeral submergence during interglacial periods when sea levels were highest. The present coastline in the Marlborough Sounds formed c. 7 ka ago, and similar highstand sea-level configurations probably occurred about every 100 ka throughout the Late Quaternary.

Endoscopic sonography in the diagnosis and treatment of a gastric wall abscess: A case report and review of the literature

We report a case of a gastric wall abscess in a 50-year-old man who presented with epigastralgia and fever. Gastroscopy revealed a subepithelial lesion on the posterior wall of the gastric body into the antrum. A follow-up abdominal CT scan showed cystic lesions around the stomach. Endoscopic sonography helped to diagnose a gastric wall abscess. The gastric wall abscess was treated endoscopically with a needle knife incision for internal drainage. The patient was treated with antibiotics for 1 week and was discharged without complication. A follow-up endoscopy with endoscopic sonography 1 month later revealed complete resolution of the lesion.

Posterior migration of Ahmed glaucoma valve tube in a patient with Reiger anomaly: a case report

BackgroundTo describe, a yet non-documented complication of GDI surgery (glaucoma drainage incision surgery) - anterior to posterior segment migration of Ahmed Glaucoma Valve (AGV) tube.Case PresentationWe report a young 9 year old boy, diagnosed with refractory glaucoma with Reiger anomaly. History included of poor vision in both eyes, left more than right with glare since childhood. He underwent GDI surgery with AGV implantation following which he developed posterior migration of AGV tube. The detailed ocular history, ophthalmic findings, clinical course, surgical management and development of the posterior tube migration is discussed.ConclusionPosterior Migration of AGV tube has yet not been described. Also there is a role of expectant management of the complication in this case as evidenced by the benign course of events.

Puerperal mastitis requiring hospitalization during a nine-year period

To review the clinical and microbiologic features of isolates among patients with puerperal mastitis requiring hospitalization. Between January 2000 and December 2008, postpartum patients who were hospitalized for mastitis were enrolled. The clinical characteristics, microbiologic results, management, and outcomes were reviewed. One hundred twenty-seven cases were enrolled. Seventy-six patients (59.9%) underwent incision and drainage for abscess drainage, all of whom discontinued breastfeeding. Staphylococcus aureus and coagulase-negative staphylococci were the most common isolates. Among 81 isolates of S aureus, 52 (64.2%) were resistant to oxacillin. Patients undergoing incision and drainage were more likely to discontinue breastfeeding, had a longer duration of symptoms, a longer hospitalization, a higher platelet count and higher rates of infection caused by S aureus and oxacillin-resistant S aureus. Oxacillin-resistant S aureus has emerged in patients with puerperal mastitis during the past decade, and often necessitates incision and drainage, which results in discontinuation of breastfeeding.