Incision Site Research Articles

Investigation of the Effect of Local Anesthesia Application on the İncision Line on Patient Comfort in Patients Who Underwent Pfannestiel İncision-Prospective Case-Control Study Article Sidebar

AİM: It was aimed to investigate the effect of local anesthetic application on the Pfannenstiel incision line on patient comfort. METHODS: The study was carried out between 2021 and 2022. It was performed on 240 patients. The patients were categorized as Group 1 in which a local anesthetic was administered and Group 2, which was not administered a local anesthetic. It was performed on 120 hysterectomy cases operated under general anesthesia. 5 mg 0.5% bupivacaine was used as a local anesthetic. The patients were evaluated in terms of postoperative pain score, gas-gaita release time, postoperative mobilization, narcotic analgesic requirement, post-operative home comfort, daily return to basic work, and feeling like they used to be. For statistical analysis, SPSS Version 28.0.1 program was used. RESULTS: A statistically significant decrease was observed in postoperative 2nd-hour pain scores in Group 1 patients compared to Group 2 (p=0.007). A statistically significant decrease was found in the need for narcotic analgesics in Group 1 patients (p=0.04). Gas-stool release time was shorter in Group 1 patients compared to Group 2, and it was statistically significant (p=0.038). Mobilization was easier in the 1st group of patients and it was found to be statistically significant compared to the 2nd group (p=0.004). In other parameters, there was no difference between the two groups. CONCLUSİON: Applying local anesthesia to the incision site reduces pain in the first 2 hours postoperatively, earlier gas-gaita output, comfortable mobilization, and a decrease in the need for narcotic analgesics.

Patient and Surgeon Perceptions Regarding Microdiscectomy Surgery: A Cross-Sectional Analysis of Social Media Posts.

Social media offers a powerful and expanding platform for sharing the patient experience with a large audience through an unsolicited perspective. The content may influence future perceptions around surgical care. To analyze publicly available content on a major social media outlet related to microdiscectomy surgery based on perspective, location, timing, content, tone, and patient satisfaction. A query of content was performed for the study period 1 January 2019 to 1 January 2021. Relevant content was identified by hashtag "#microdiscectomy." The initial query returned 10,050 publicly available posts, and the 1500 most "liked" posts were included for evaluation. Content was subsequently classified, characterized, and analyzed. Patients created 72.9% of microdiscectomy-related content, and spine surgeons created 23.5%. Regarding region, 77.0% of posts originated in the United States. The majority portrayed the patient experience in the postoperative phase of care (86.0%), with the primary reference to activities of daily living (56.9%). Only 1.7% of posts depicted the surgical incision site. The connotation of posts was deemed positive in 78.5% of cases. Of the posts referencing satisfaction, 98.3% depicted patient satisfaction with the surgical outcome. Patient posts in the postoperative phase of care (>1 week after surgery) were more than 2 times as likely to express positive tone (OR = 2.07, P ≤ 0.013) with their clinical course compared with patient posts outside the postoperative period. Overall, social media posts are written in a positive tone, express satisfaction with surgical outcome, typically occur in the postoperative period of care, and depict activities of daily living. These popular mechanisms of communication, such as Instagram, offer spine surgeons unique insights into the true patient experience and may provide an opportunity for surgeons to assess patient feedback, influence patient perceptions, and enhance delivery of lumbar spine care.

Pregnancy Outcomes in Patients with Placenta Previa Due to Site of Placentation

Background: The aim of this research is to evaluate pregnancy outcomes in patients with placenta previa due to the site of placentation. Method: This retrospective study included 105 cases conducted in the OBG department of Al AIN hospital for three years (January 2015 to October 2018). All cases of placenta previa admitted during this period were included in the study. Case records were obtained from the medical record section and carefully analyzed to find out the incidence, various types of placenta previa, its clinical presentation, and its outcome in relation to mode of delivery, birth weight, and maternal and perinatal morbidity. Results: Placental attachment site influenced the outcome of pregnancy. Placental attachment to the anterior wall was associated with shorter gestational age, low birth weight, low Apgar score, higher prenatal bleeding rate, increased postpartum hemorrhage, longer duration of hospitalization, higher blood transfusion and higher hysterectomy rates compared to cases with lateral/posterior wall placenta. Placental attachment at the incision site of previous cesarean section significantly increased the incidence of complete placenta previa compared with placental attachment at a site without incision, but did not significantly influence pregnancy outcomes. Placental attachment to the anterior wall was an independent risk factor for postpartum hemorrhage in patients with placenta previa. Conclusion: The site of placental attachment in patients with placenta previa influences the pregnancy outcome. When the placenta is located on the anterior wall, clinicians should pay attention to the adverse pregnancy outcomes and the possibility of massive postpartum hemorrhage.

Risk of Complications After Breast Surgery in Radiated Patients Using the Closed Incision Negative Pressure Therapy Dressings Compared to Standard-of-Care Dressings

Abstract Goals/Purpose Patients with adjuvant radiotherapy are significantly more likely to have complications such as infections and wound dehiscence following breast surgery.1 Closed incision negative pressure wound therapy (cINPT) holds incision edges together, prevents external contamination and removes exudate, promoting tensile strength and increased collagen recruitment at the incision site compared to the standard of care dressings.2 cINPT is helpful in surgical closures on high-risk patients.3 We evaluated the complication rates following the use of cINPT in implant-based breast reconstruction. Methods/Technique A cohort was collected retrospectively from a single institution, from January 1, 2018 to October 31 2022. The complication rates were then compared between cINPT dressing and standard-of-care dressings on radiated patients following breast surgery. Results/Complications The data collected consist of a total of 83 radiated breasts that underwent implant based reconstruction. cINPT was used in 41 breasts and standard-of-care dressings were used in 42 breasts. Of the cINPT cohort, 2 patients developed seromas that required bedside aspirations (4.8%) and one patient developed an infection (2.4%) with none of the patients requiring re operations. Of the standard of care dressings cohort, 9 patients developed seromas (21.4%), and 3 patients developed infections (7.1%), of which 3 patients required reoperations (7.1%). Conclusion Patients with prior radiation who received cINPT had lower risk of developing complications compared to patients with prior radiation who received standard-of-care dressings.

Local surgery feasibility and safety after carbon ion radiotherapy for primary bone sarcomas

BackgroundIt is known that several complications are caused by local surgery after radiotherapy. Clinical reports that describe the postoperative complications associated with surgery after carbon ion radiotherapy are sparse. This study aimed to elucidate local surgery feasibility after carbon ion radiotherapy specifically for primary bone sarcomas. MethodsThe medical, surgical, and irradiation records of patients who had local surgery at the area irradiated with carbon ion beams between 2004 and 2018 were reviewed retrospectively to evaluate the feasibility and indication of local surgery after CIRT. ResultsThere were eight patients who had 10 local surgeries at the irradiated sites among the 42 carbon ion radiotherapy patients. There were seven males and one female with a median age of 50 years (range 26–73 years). The reasons for surgery were three for skin toxicity and associated infection, five for bone collapse, and associated implant failure, and two for tumor regrowth. All surgical fields included the area of more than 60 Gy (RBE) irradiated dose. All three surgical cases caused by skin toxicity and associated infection had Grade I wound complication after surgery according to the Clavien–Dindo Classification. ConclusionLocal surgery after CIRT appeared feasible in selected patients with primary bone sarcoma, especially for the patients with bone collapse and associated implant failure. However, infection and prescribed irradiation dose at the incision site must be carefully evaluated.

A COMPARISON OF POST-OPERATIVE PAIN RELIEF AFTER ELECTIVE LSCS WITH LOCAL AND INTRAPERITONEAL ROPIVACAINE INSTILLATION AGAINST LOCAL ROPIVACAINE INFILTRATION ALONE

Objectives: For an anesthesiologist, the post-operative phase is just as crucial as the pre-operative and intraoperative periods. Whether a surgery is performed under regional or general anesthesia, the goal should always be to provide patients with a pain-free and comfortable recovery. Spinal anesthesia is frequently used during caesarean sections, but its effects only last for a few hours. As a result, various multidisciplinary analgesia strategies with few side effects have been attempted for postpartum patients to relieve pain because they may also be harmful to the newborn baby’s health. It has already been proven; injecting ropivacaine is a far safer alternative to injecting bupivacaine. We compared local infiltration of injectable ropivacaine alone to both intraperitoneal instillation and local infiltration for post-operative analgesia in individuals who had cesarean surgery. In the present study, intraperitoneal instillation and local infiltration of ropivacaine 0.5% were compared to local infiltration of ropivacaine 0.5% alone for the management of post-operative pain following elective cesarean section under spinal anesthesia. Methods: Pregnant women in ASA Grades I and II who were having a planned caesarean section under spinal anesthesia were divided into two groups at random (R1 and R2 group, each have 30 patients). Patients in Group R1 received a 15 mL injection of 0.5% ropivacaine at the incision site. Patients in Group R2 had intraperitoneal injections of 0.5% ropivacaine in 5 mL before to peritoneal closure and local infiltrations of 10 mL ropivacaine at the site of the incision before skin closure. The duration of the analgesia was calculated by timing the start of the sensory block to a point at which rescue analgesia was sought throughout the post-operative period. Pain intensity was measured using the visual analog scale (VAS). Data on the hemodynamics and side effects of the patients were also gathered. Results: Group R2 analgesia lasted much longer than that of Group R1 (p<0.05). The mean (±SD) analgesic duration in the R1 and R2 groups was 147.17±4.67 and 170.33±3.69 min, respectively. The mean (SD) VAS scores for Group R1 and Group R2 at the moment of the first analgesic demand were 36.7±5.14 and 32.6±6.52, respectively. Conclusion: When combined with intraperitoneal instillation during spinal anesthesia, inj. ropivacaine 0.5% local infiltration enhances post-operative analgesia in cesarean section procedures.

Revaluation of a selected segmental insufflation technique in total thoracoscopic lung segmentectomy.

We report selected insufflation technique using direct bronchial insufflation to visualize the intersegmental plane during total thoracoscopic segmentectomy. Following the transection of the bronchus using a stapler, a small incision was created in the dissected target bronchus, and direct air insufflation was performed at the small incision site. The target segment was inflated, while the preserved segments appeared to collapse, and a demarcating line was visualized between the inflated and deflated lung parenchyma. This technique quickly identifies the anatomic intersegmental plane without warranting special equipment such as jet ventilation or ICG. Furthermore, this method saves time in creating inflation-deflation lines.

Marking the port entries and incision sites.

Marking the port entries and incision sites.

Opioid-Sparing Effects of Flurbiprofen Axetil as an Adjuvant to Ropivacaine in Pre-Emptive Scalp Infiltration for Post-Craniotomy Pain: Study Protocol for a Multicenter, Randomized Controlled Trial.

Pain after craniotomy remains a poorly controlled problem that is mainly caused by the inflammatory reaction at the incision site. Nowadays, systemic opioids use, as first-line analgesics, is often limited because of adverse effects. Flurbiprofen axetil (FA) is a non-steroidal anti-inflammatory drug merged into emulsified lipid microspheres, which represent a strong affinity to inflammatory lesions. Local administration of flurbiprofen into a surgical wound has induced enhanced analgesic efficacy and few systemic or local adverse effects after oral surgery. However, the impact of local FA, as a non-opioid pharmacologic alternative, remains elusive on postoperative pain in craniotomy. In this study, we presume that pre-emptive infiltration of scalp with FA as an adjuvant to ropivacaine can lead to less sufentanil consumption postoperatively in patient controlled intravenous analgesia (PCIA) compared with ropivacaine alone. We design a multicenter, randomized controlled study that will enroll 216 subjects who are planned to receive supratentorial craniotomy. Patients will receive pre-emptive infiltration of scalp either with 50 mg FA and 0.5% ropivacaine, or with 0.5% ropivacaine alone. Primary outcome is total consumption of sufentanil with PCIA device at 48 h postoperatively. This is the first study attempting to explore the analgesic and safety profile of local FA as an adjuvant to ropivacaine for incisional pain in patients undergoing craniotomy. It will provide additional insights into the opioid-sparing analgesia pathways by local administration of NSAIDs for neurosurgery.

V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION

You have accessJournal of UrologyCME1 Apr 2023V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION Rogerio Huang, Akhil Saji, Mubashir Billah, Daniel Bassily, Benjamin Rudnick, Michael Stifelman, and Mutahar Ahmed Rogerio HuangRogerio Huang More articles by this author , Akhil SajiAkhil Saji More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Benjamin RudnickBenjamin Rudnick More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the United States, 80,000 new cases of bladder cancer are diagnosed every year. 30% are muscle invasive at the time of diagnosis, requiring radical cystectomy and ileal conduit being the most common type of urinary diversion. A rare complication is a ureteroileal anastomotic stricture (UIS), which occurs in 2-3% of cases. The gold standard treatment is an open repair. The advent of laparoscopy and robotics has allowed these revisions to be done with improved morbidity. In 2018, the single port robotic system has further enabled advances in minimally invasive surgery. There remains a paucity of educational videos on how to perform single port surgery. We aim to demonstrate a single port ureteroileal conduit revision. METHODS: An IRB approval was obtained at our institution and prospective data was collected on all patients undergoing a single port robotic UIS revision from January 2019 - April 2022. This case demonstration involves a 74 year old male who had a radical cystectomy with ileal conduit in June 2021. He subsequently developed bilateral UIS and elected for a single port UIS revision. RESULTS: The total operative time was 155 minutes and estimated blood loss was 25 mL. The patient’s pain was well controlled and his length of stay was 24 hours. There were no postoperative complications. The patient’s pfannenstiel incision healed with excellent cosmetic results. A renal ultrasound done at 3 months showed resolution of hydronephrosis. In a preliminary review, a single surgeon at our institution performed 6 single port UIS revisions. The mean OR time was 152.4 minutes and the mean estimated blood loss was 30.8 mL. The mean length of stay was 2.2 days. The 30-day postoperative complication rate was 0%. CONCLUSIONS: The single port Da Vinci robotic UIS revision is a novel and effective technique. The single port robot offers a superior platform to access tight spaces and excellent precision for dissection and ureteral anastomotic suturing. A single Pfannenstiel incision site allows easy access to the conduit as well as improved cosmesis. Single site surgery can significantly reduce pain and length of stay. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e510 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rogerio Huang More articles by this author Akhil Saji More articles by this author Mubashir Billah More articles by this author Daniel Bassily More articles by this author Benjamin Rudnick More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors for incisional complications after lumbar internal fixation via posterior midline approach: A case-control study of 455 consecutive cases.

To analyse the clinical data of patients who developed incisional complications and those who did not develop incisional complications after lumbar internal fixation, and investigate the risk factors for incisional complications in patients after lumbar internal fixation with posterior midline incision. A standardised data collection form was used to collect the clinical data of patients who were admitted and underwent lumbar internal fixation in our hospital from July 2018 to July 2021. Patients who experienced any one of the incisional complications, such as incision exudates, swelling, blisters, bruising, superficial/deep incisional infections, poor healing and scarring, after surgery were included in the incisional complication group, and patients who did not develop the above-mentioned incisional complications were included in the control group. Univariate logistic regression analysis was first performed to identify potential risk factors, significant factors from univariate analysis were then included in multivariable logistic regression analysis to identify independent risk factors for incisional complications after lumbar spine surgery. Among 455 patients included in the study, postoperative incision complications occurred in 82 patients, with an incidence rate of 18.02%. Multivariate regression analysis identified seven independent risk factors for incisional complications: age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time and local anaesthetic infiltration at the incision site after surgery. Our findings documented that age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time, and postoperative local anaesthetic infiltration at the incision site were risk factors for incisional complications after lumbar internal fixation with posterior median incision. Awareness of these risk factors can enable surgeons to develop a more appropriate perioperative management plan for patients undergoing lumbar internal fixation, thus helping them recover faster.

Technique and clinical application of free lobed anteromedial thigh perforator flap

To introduce the technique and clinical application of free lobed anteromedial thigh perforator flap. Between October 2017 and December 2021, 65 patients with buccal and oral cancer penetrating defects were planned to treat with free lobed anterolateral thigh flap transplantation, of which 15 cases were found that the sole anterolateral thigh perforator was actually a branch of the anteromedial thigh perforator, and then the free lobed anteromedial thigh perforator flap was harvested for repair. There were 12 males and 3 females with an average age of 34.6 years (range, 29-55 years). According to Union for International Cancer Control (UICC) TNM staging, there were 7 cases of T 4N 0M 0, 4 cases of T 4N 1M 0, 2 cases of T 3N 1M 0, and 2 cases of T 3N 2M 0. The disease duration was 1-10 months (mean, 6.3 months), and the area of secondary soft tissue defect left after radical resection of buccal and oral cancer was from 5 cm×4 cm to 10 cm×6 cm. The anterolateral thigh skin flap ranged from 5 cm×4 cm to 13 cm×6 cm, and the anteromedial thigh skin flap ranged from 5 cm×3 cm to 10 cm×6 cm. The free trilobed anteromedial thigh flap was prepared according to the actual branches of the main trunk of the anteromedial thigh perforator in 4 cases, and the vastus medialis muscle flap was used to fill the cavity defect of the floor of mouth in 7 cases. Among the 15 patients, the vessel pedicles of the anteromedial thigh perforators were derived from the main femoral artery and vein in 8 cases, from the main descending branch of the lateral femoral circumflex artery in 4 cases, and from the main lateral femoral circumflex artery in 3 cases. Hematoma occurred in 2 cases after operation, which was successfully saved after emergency exploration. No vascular crisis occurred, and partial necrosis of anterolateral femoral skin island occurred in 1 case, which was healed with debridement. The remaining flaps survived successfully, and the wounds and donor site incisions healed by first intention. All the patients were followed up 12-36 months (mean, 14.6 months). The appearance of the flap was satisfactory, and no obvious swelling was found; the mouth opening and language function were satisfactory; only linear scar was left in the donor area, and the thigh function was not significantly affected. Local recurrence occurred in 3 cases, and the defect after tumor resection was repaired with pedicled pectoralis major myocutaneous flap. Four patients with neck lymph node metastasis, including ipsilateral side in 3 patients and contralateral side in the other 1 patient, all underwent neck lymph node dissection again. The 3-year survival rate was 86.7% (13/15). The anteromedial thigh perforator vessels distributed in the anterolateral region of the thigh can be used to prepare the anterolateral thigh split lobed flap to repair the buccal and oral cancer penetrating defects.

Fibrin Glue is a Viable Alternative to Fat Graft for Interposition After Tarsal Coalition Resection.

Tarsal coalition is one of the most common foot and ankle pathologies in children, yet there is no consensus regarding what to interpose after resection. Fibrin glue could be considered, but the literature comparing fibrin glue to other interposition types is sparse. The purpose of this study was to evaluate the effectiveness of fibrin glue for interposition compared with fat graft by analyzing the rate of coalition recurrence and wound complications. We hypothesized that fibrin glue would have similar rates of coalition recurrence and fewer wound complications compared with fat graft interposition. A retrospective cohort study was performed examining all patients who underwent a tarsal coalition resection at a free-standing children's hospital in the United States from 2000 to 2021. Only patients undergoing isolated primary tarsal coalition resection with interposition of fibrin glue or fat graft were included. Wound complications were defined as any concern for an incision site that prompted the use of antibiotics. Comparative analyses were conducted using χ 2 and Fisher exact test to examine relationships among interposition type, coalition recurrence, and wound complications. One hundred twenty-two tarsal coalition resections met our inclusion criteria. Fibrin glue was used for interposition in 29 cases and fat graft was used in 93 cases. The difference in the coalition recurrence rate between fibrin glue and fat graft interposition was not statistically significant (6.9% vs. 4.3%, P =0.627). The difference in wound complication rate between fibrin glue and fat graft interposition was not statistically significant (3.4% vs 7.5%, P = 0.679). Fibrin glue interposition after tarsal coalition resection is a viable alternative to fat graft interposition. Fibrin glue has similar rates of coalition recurrence and wound complications when compared with fat grafts. Given our results and the lack of tissue harvesting required with fibrin glue, fibrin glue may be superior to fat grafts for interposition after tarsal coalition resection. Level III, a retrospective comparative study between treatment groups.

An interactive and realistic phantom for cricothyroidotomy simulation of a patient with obesity through a reusable design using 3D-printing and Arduino

Background and objectivesProper airway management during emergencies can prevent serious complications. However, cricothyroidotomy is challenging in patients with obesity. Since this technique is not performed frequently but at a critical time, the opportunity for trainees is rare. Simulators for these procedures are also lacking. Therefore, we proposed a realistic and interactive cricothyroidotomy simulator. MethodsAll anatomical structures were modeled based on computed tomography images of a patient with obesity. To mimic the feeling of incision during cricothyroidotomy, the incision site was modeled to distinguish between the skin and fat. To reinforce the educational purpose, capacitive touch sensors were attached to the artery, vein, and thyroid to generate audio feedback. The tensile strength of the silicone-cast skin was measured to verify the similarity of the mechanical properties between humans and our model. The fabrication and assembly accuracies of the phantom between the Standard Tessellation Language and the fabricated model were evaluated. Audio feedback through sensing the anatomy parts and utilization was evaluated. ResultsThe body, skull, clavicle, artery, vein, and thyroid were fabricated using fused deposition modeling (FDM) with polylactic acid. A skin mold was fabricated using FDM with thermoplastic polyurethane. A fat mold was fabricated using stereolithography apparatus (SLA) with a clear resin. The airway and tongue were fabricated using SLA with an elastic resin. The tensile strength of the skin using silicone with and without polyester mesh was 2.63 ± 0.68 and 2.46 ± 0.21 MPa. The measurement errors for fabricating and assembling parts of the phantom between the STL and the fabricated models were −0.08 ± 0.19 mm and 0.13 ± 0.64 mm. The measurement errors internal anatomy embodied surfaces in fat part were 0.41 ± 0.89 mm. Audio feedback was generated 100% in all the areas tested. The realism, understanding of clinical skills, and intention to retrain were 7.1, 8.8, and 8.3 average points. ConclusionsOur simulator can provide a realistic simulation experience for trainees through a realistic feeling of incision and audio feedback, which can be used for actual clinical education.

Role of the Pfannenstiel Incision in Robotic Hepato-Pancreato-Biliary Surgery

Studies remain limited on the role of the Pfannenstiel incision in minimally invasive hepato-pancreato-biliary (HPB) surgery, especially robotic surgery. The role of various extraction sites in robotic HPB surgery should be understood. Herein, we describe the surgical techniques, outcomes, advantages, and disadvantages of the Pfannenstiel incision in robotic pancreatic surgery. Seventy patients underwent robotic pancreatectomy at our institution between September 2020 and October 2022. The Pfannenstiel incision was used for specimen retrieval in 55 patients. Advantages of the Pfannenstiel incision include less pain, cosmetic benefits, and a lower incidence of complications. Moreover, the specimen could be removed using the robotic system docked. However, all complex reconstructions should be performed intra-abdominally during robotic pancreatoduodenectomies. The incidence of mortality and postoperative pancreatic fistula (grade B) was 0% and 9.1%, respectively. During the median follow-up (11.2 months) after surgery, complications at the Pfannenstiel incision site included surgical site infection (n = 1, 1.8%) and incisional hernia (n = 1, 1.8%). The Pfannenstiel incision can be a useful option for specimen retrieval in minimally invasive HPB surgery, according to the surgeon's preferences and the patient's condition.

Mycobacterium tuberculosis infection of a reverse total shoulder arthroplasty: a case report.

We describe the case of a 78-years-old male with dyspnea, inappetence and weight loss over a period of two weeks. The CT scan suggested disseminated tuberculosis and T5-T6 spondylodiscitis. During hospitalization, he developed a left shoulder pain where a reverse total shoulder arthroplasty was implanted 11 years ago. Open debridement and lavage with retention of the implant was performed first and intraveinous antibiotics were administered. 3 months after surgery the patient developed a painful sinus track at the incision site. Resection of the fistula tract, soft tissue debridement and removal of the implants were performed before restarting chemotherapy. As the incidence of reverse total shoulder arthroplasty continues to increase throughout the world, periprosthetic joint infection (PJI) will probably raise as well. Diagnosing and treatment of shoulder PJI with atypical germs remains a challenge and explantation seems to be the safer surgical option to avoid recurrent surgeries on patient with increasing comorbidities.

Evaluation of Cage Mate-induced Postsurgical Trauma in Mice.

Although mice are social animals, individual housing is sometimes requested after surgery. We questioned whether pair-housing mice after surgery resulted in greater trauma to the surgical site as compared with single housing. We further evaluated the effect of individual housing after surgery on the wellbeing of mice that had previously been pair-housed. Female C57Bl/6 mice (age, 6 to 8 wk) were housed as follows: group A, individually housed before and after surgery (n = 10; all 10 mice underwent surgery); group B, pair-housed before surgery but individually housed after surgery (n = 10; all 10 mice received surgery); group C, pair-housed before and after surgery (n = 20; 10 mice underwent surgery but their cage mates did not); and group D, pair-housed before and after surgery (n = 10; all 10 mice underwent surgery). Dependent variables were body weight, body condition, grimace based on real-time scoring, nest building, time to incorporate into nest test (TINT) score, wound trauma score, and missing wound clips. Weight was significantly different between groups A and C both before and after surgery. Mean nest building scores were significantly higher for pair-housed (groups C and D) than for individually housed mice (groups A and B) after surgery while TINT scores were significantly higher for these same groups both before and after surgery. Mean values for body condition, grimace score, wound score, and number of wound clips missing did not differ significantly between any groups either before or after surgery. Taken together, these results suggest that pair housing mice after surgery benefited their wellbeing but did not increase trauma to the surgical incision site or disturb wound clips as compared with individually housed mice. Furthermore, separating previously pair-housed mice (group B) did not affect these measures as compared with individually housed mice (Group A) either before or after surgery.

Association between the site of clear corneal Phakic intraocular lens implantation incisions and the inflow of ocular surface fluid into the anterior chamber.

Posterior chamber phakic intraocular implantable collamer lens (ICL) implantation is an effective surgical option for the management of myopia. Over the past few years, the number of ICL surgeries has significantly increased. Postoperative inflammation and endophthalmitis are among the most serious complications after successful ICL surgery. Sometimes, when the blepharospasm is removed at the end of surgery, a small amount of the ocular surface fluid will flow into the anterior chamber, which can lead to an increased risk of infection and inflammation. However, little attention has been paid to this phenomenon. We conducted a retrospective study to compare the incidence of extraocular fluid inflow into the eye through the clear corneal incision (CCI) at two different positions (superior and temporal sides). A total of 116 patients with myopia underwent superior CCI ICL implantation (n = 58) or temporal CCI ICL implantation (n = 58) at our hospital from October to December 2021. The incidence of conjunctival sac fluid entering the anterior chamber after eyelid fixative was removed was compared in both groups. Both groups were well matched in all parameters. Ocular surface fluid inflow into the anterior chamber was significantly higher in the superior CCI group (25/58, 47.1%) than in the temporal CCI group (1/58, 1.7%) (p < 0.05). In the patients with ICL implantation, the temporal CCI was better than the superior CCI in avoiding the ocular surface fluid inflow into the anterior chamber, and the potential risk of infection and inflammation was lower.

Outcomes of a Large Series of Laparoscopic Ventral Hernia Repairs after Liver Transplantation.

The hernia defects that develop in liver transplant recipients tend to be complex. Unfortunately, there is a paucity of data to guide post-transplant hernia management. Our goal was to evaluate the outcomes following laparoscopic ventral hernia repair (LVHR) in liver transplant recipients. A retrospective review of a prospectively kept database of liver transplant patients at a single tertiary healthcare facility was completed. All patients between 2007 and 2020 who underwent LVHR for a hernia at their transplant incision site were included. The primary outcome studied was hernia recurrence. Secondary outcomes included time-to-hernia repair, complications, and length of stay (LOS). There were 89 patients who met inclusion criteria. 82% were male, mean age was 60 years, and mean body mass index was 30.2kg/m2. 94.4% were on tacrolimus and 36% on mycophenolate mofetil. Median time-to-hernia repair was 16months with a mean mesh size of 743cm2 and length of stay of 3.7days. None required conversion to an open operation. Postoperative complications included ileus (20.2%), acute kidney injury (11.2%), pneumonia (6.7%), and bleeding requiring re-operation (1.1%). Hernia-related complications included chronic suture site pain (1.1%), seroma requiring intervention (3.3%), surgical site infection (3.3%), nonoperative mesh infection (1.1%), and mesh infection requiring explantation (1.1%). Median follow-up was 23months. Hernia recurrence occurred in 4.5% and no predictive variables for recurrence were identified. Although the hernia defects that develop in liver transplant recipients are complex and their comorbidities significant, LVHR can safely and effectively repair these defects with low rates of recurrence and complications.

Surgical Scar Endometriosis: An Emerging Enigma.

Introduction Surgical scar endometriosis is a subtype of extra-pelvic endometriosis that is characterized by the formation of endometrial tissue near the incision site in patients who have previously undergone surgery. In recent times, with the increasing trend in Caesarean sections, the incidence of surgical scar endometriosishas also emerged. This study aims to describe the clinical characteristics and management of surgical scar endometriosis. Methodology We conducted this cross-sectional, observational study over eight years (2015-2022) in a tertiary care centre in Madurai district, Tamil Nadu, India. We conducted this study after acquiring an ethical certificate from the institutional ethics committee (IEC No. VMCIEC/22/2018). In this study, we sampled all women (n = 32) with a pathological diagnosis of scar endometriosis during the study period from hospital records (universal sampling). We searched the data for both general characteristics and lesion characteristics of the patients. The general characteristics include age, body mass index (BMI), parity, mode of delivery, symptoms, and imaging by ultrasound. We have recorded the lesion characteristics of the patient, including location and size of scar endometriosis, layers involved in scar endometriosis, and surgical technique from surgical notes written in the case sheet. The minimum sample size required for this study was 31 study subjects. We entered the data into Excel (Microsoft, Redmond, WA, USA) and analyzed it in SPSS version 21 (IBM Corp., Armonk, NY, USA). We expressed the quantitative variables in terms of mean and standard deviation and the qualitative variables in terms of frequency and percentage. Results The mean age of the study participants was 34 years (range 23-55 years). In our study, 29 patients (90.6%) were multi-para, and only three (9.4%) were nullipara. Among 29 parous women, the majority (25, or 77.7%) had delivered by Caesarean section, while only four (12.5%) delivered by normal vaginal delivery. The surgical procedures preceding the scar endometriosis were predominantly obstetric procedures (87.4%), out of which 25 patients underwent a Caesarean section and only three underwent an episiotomy.The most common presenting symptom of scar endometriosis in our study was cyclical pain in the scar site (90.4%), followed by swelling (81.25%).In 62.5% of patients, the duration between the presentation of surgical scar endometriosis and surgical intervention was greater than one year. Subcutaneous tissue (90.6%) was the most commonly involved layer in surgical scar endometriosis, followed by the rectus sheath (86.2%). The surgical procedure done for scar endometriosis was wide local excision in 78% of patients, and the remaining 22% of patients had wide local excision with mesh repair. Conclusion Cesarean section is an obvious risk factor for surgical scar endometriosis. Clinicians should have a high index of suspicion for surgical scar endometriosis in women presenting with cyclic pain at the scar site. Ultrasound is accurate in diagnosing scar endometriosis. Surgical management by wide local excision with a clear margin with or without mesh repair is the treatment of choice.