Incision Site Research Articles

Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine closure technique in cesarean delivery: a systematic review and meta-analysis of randomized trials

BackgroundA cesarean scar defect is a structural abnormality in the myometrium at the site of a prior cesarean incision, primarily influenced by the closure technique. Purse-string uterine suturing (PSUS) may reduce the incidence of cesarean scar defects and improve uterine integrity. However, the literature presents inconsistent findings, necessitating a systematic evaluation. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of PSUS on ultrasound outcomes and surgical parameters related to cesarean scars.MethodsThis systematic review and meta-analysis involved a search for relevant publications in English and Persian across multiple databases, including PubMed, the Cochrane Library, Google Scholar, Scopus, Web of Science, and SID. The search was unrestricted by date and included all available publications up to August 8, 2024. The risk of bias in the included studies was evaluated using the Risk of Bias 2 (ROB2) tool, while the certainty of the evidence was assessed through the GRADE approach. Meta-regression was employed to investigate potential risk factors for cesarean scar defects, and trial sequential analysis was conducted to mitigate Type I and Type II errors.ResultsA total of 353 studies were identified through the search strategy, with 8 studies included in the analysis. The meta-analysis demonstrated a significant reduction in the rate of cesarean scar defects in the PSUS group compared to the control group (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.36 to 0.58; 8 trials, 751 participants, I² = 0%, indicating no heterogeneity). Additionally, a shorter uterine incision length was observed in the PSUS group compared to the control group (MD -3.84, 95% CI -4.97 to -2.71; 4 trials, 438 participants, I² = 80%, suggesting substantial heterogeneity). The PSUS group also exhibited greater residual myometrium thickness (RMT) than the control group (MD 1.33, 95% CI 0.72 to 1.94; 5 trials, 417 participants, I² = 92%, indicating considerable heterogeneity). However, no statistically significant differences were found between the PSUS and control groups regarding operation time (p = 0.10, I² = 67%, suggesting moderate heterogeneity), length (p = 0.14, I² = 98%, indicating considerable heterogeneity), height (p = 0.10, I² = 76%, suggesting substantial heterogeneity) of incision defects, or blood loss during the procedure (p = 0.94, I² = 0%, indicating no heterogeneity).ConclusionsThe use of PSUS during cesarean sections significantly reduces the occurrence of cesarean scar defects, indicating a clear clinical benefit with moderate certainty. However, the evidence for other ultrasound evaluation outcomes and surgical parameters remains of low to very low certainty. Therefore, further research is essential to validate these findings and assess the long-term clinical implications of integrating PSUS into cesarean procedures.

Clinical benefits of the 5th intercostal incision in uniportal VATS for female patients.

To assess the clinical benefits of a 5th versus 4th intercostal incision in female patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomy and lymphadenectomy, focusing on breast tissue preservation, pain, cosmetic outcomes, recovery, and surgical maneuverability. A retrospective analysis of 150 female lung cancer patients was conducted, divided into 4 and 5th intercostal incision groups (n = 75 each). Propensity score matching balanced baseline characteristics. Primary outcomes included breast tissue involvement, postoperative pain (VAS), cosmetic satisfaction (Likert scale), recovery time, surgical maneuverability, and complication rates. Statistical analysis used Mann-Whitney U and Chi-square tests for group comparisons and multivariable regression to adjust for confounders. The 5th intercostal incision significantly reduced breast tissue involvement (10.7 vs. 65.3%, p < 0.01), postoperative pain (VAS: 4.8 vs. 7.2, p < 0.01), and recovery time (5.9 vs. 8.4 days, p < 0.05), while enhancing cosmetic satisfaction (p < 0.01) and improving access to upper pulmonary veins. Incision site infections were notably lower in the 5th intercostal group (2.7 vs. 10.7%, p < 0.05). The 5th intercostal incision provides substantial clinical advantages in uniportal VATS for female patients, including reduced breast tissue involvement, minimized pain, enhanced cosmetic outcomes, and faster recovery. These findings support the 5th intercostal incision as a preferred approach in this patient population, aligning with precision surgery principles to optimize outcomes.

The effect of local anaesthetic agents on opioid use and recovery in patients undergoing open heart surgery: a randomized controlled study.

After open heart surgery, patients experience high levels of pain at the sternotomy incision site and around the chest tube(s), affecting their recovery. This study was conducted to determine the effects of local anesthetic application around the sternotomy incision site and chest tube(s) on the amount of opioids used and recovery after surgery in patients undergoing open heart surgery. This randomized controlled experimental study was conducted with a total of 60 patients, with 30 patients in the experimental group and 30 patients in the control group. In the experimental group, LIDOFAST 40mg/2ml + 0.025mg/2ml, a local anesthetic agent, was applied to the postoperative sternotomy incision site and around the chest tube(s) in addition to routine treatment. Patients in the control group received only routine treatment. Data were collected using the "Descriptive Characteristics Form" and the "Postoperative Recovery Index". It was observed that postoperative pain started later, opioid consumption decreased, and postoperative recovery was faster in the experimental group. As the number of chest tubes increased, recovery was delayed in all groups, and as the number of opioids used increased, postoperative recovery was negatively affected in the control group. In this study, local anesthetic application to the sternotomy incision site and around the chest tubes after open heart surgery was found to reduce postoperative opioid consumption and positively affect recovery. Current Controlled Trials NCT06642077 (Retrospectively registered).

The Determining of the New IMF and Incision Location in Breast Augmentation Using Ergonomix Model Implants

This study presents a geometric formula to optimize the location of the Inframammary Fold (IMF) and incision site in breast augmentation with Ergonomix model implants. Traditional volumetric planning can lead to complications, including poor implant positioning and visible scars. By applying a semicircular arc length formula, 30 patients undergoing primary breast augmentation were evaluated between 2018 and 2021. Results showed accurate IMF and incision placement for 29 patients, achieving the desired 45% upper pole and 55% lower pole ratio. The proposed method simplifies surgical planning, improves outcomes, and enhances long-term stability, offering a practical, effective alternative to subjective techniques.

Mixed Reality (Holography)-Guided Minimally Invasive Cardiac Surgery—A Novel Comparative Feasibility Study

The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient’s computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon’s mental reconstructed image from the patient’s preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety.

Use of peri-incisional liposomal bupivacaine was not different than placebo regarding pain score or rescue analgesia in a randomized clinical trial of 83 dogs.

To evaluate the impact of peri-incisional liposomal bupivacaine (LB) on postoperative pain scores, opioid use after soft tissue surgeries, and incidence of incision site complications in dogs. Client-owned dogs (n = 83) were enrolled in a randomized, blinded, placebo-controlled clinical study for dogs undergoing a variety of soft tissue surgical procedures between March 31, 2021, and August 18, 2022. After incision closure, an injection of a placebo (0.9% NaCl) or LB was administered into the peri-incisional subcutaneous tissues. Pain was assessed via the Glasgow Composite Measure Pain Scale (CMPS-SF) preoperatively, at extubation, and at 2, 4, 8, 12, 24, 30, 36, 48, 54, 60, and 72 hours postoperatively or until time of discharge. The need for rescue analgesia was assessed based on CMPS-SF guidelines. The effect of LB on pain scores was analyzed with mixed-model linear regression, and the χ2 test was used to examine effects on incision complications and need for rescue analgesia. 83 dogs were enrolled. There was no significant difference in CMPS-SF scores between LB and placebo groups at any time period. Rescue analgesia was administered to 21 dogs in each group and was not significantly different. There was no significant difference in incision site complications. The incidence of surgical site infections was 6.0% for all procedures. Peri-incisional LB did not significantly decrease the use of rescue analgesia for postoperative soft tissue surgeries in a clinical setting with the use of multimodal analgesia. This is consistent with findings in human literature. Clinicians should not rely on LB used in the peri-incisional subcutaneous tissue to improve analgesia in patients undergoing soft tissue surgery.

Hospital Fear Points and Fear Levels of Children 5-10 Years Old.

Aim: This study aimed to determine hospital fear points, specific aspects of the hospital experience that are particularly frightening for children, and fear levels of children 5-10 years old who are admitted to the hospital. Methods: This descriptive cross-sectional study of 210 children in eastern Turkey aged 5-10 years used a Demographic Findings and Hospital Fears Form and the Child Fear Scale to collect data about the children's demographics, the opinions of the mothers about their children's fears, and the children's fears about the hospital. Results: Children in the outpatient treatment services and emergency department were afraid of blood drawing, intravenous insertion, injections (shots), and separation from their mothers. In the surgical department, in addition to painful procedures, children were most afraid of being forced to undergo the procedure, insertion of medications, being in the operating room, being awakened after surgery, and seeing the incision site. In the inpatient ward, children were most afraid of nurses and doctors entering the room. Conclusions: Children feared painful procedures, separation from their mothers, and the unknown in the hospital setting.

Optimized Two-Port Laparoscopic-Assisted Ovariohysterectomy for Hydrometra and Pyometra in Small-Sized Dogs.

The clinical outcomes of laparoscopic-assisted ovariohysterectomy for the treatment of hydrometra or pyometra in small-sized dogs have not been reported. This study aimed to retrospectively investigate the clinical outcomes of two-port laparoscopic-assisted ovariohysterectomy in small-sized dogs weighing < 6 kg with mild to moderate hydrometra or pyometra. Laparoscopic ports were placed at the umbilicus on the midline, as well as at the midpoint between the umbilicus and pelvic brim. While the uterine horn was externally retracted, the cervical region was ligated and transected. A total of 77 dogs were included, with a median age of 8.8 years (range: 10 months to 16.1 years) and a median weight of 3 (range: 1.26-6.0) kg. Clinical signs included lethargy, anorexia, polydipsia, and polyuria; 51 dogs (66%) were asymptomatic, with an enlarged uterus incidentally detected during health checkups. Histopathological analysis revealed hydrometra and pyometra in 51 and 26 dogs, respectively. The median operative time was 32 (range: 15-83) minutes, and the median hospital stay was 0 (range: 0-3) days. No intraoperative complications occurred, although 18 dogs experienced anorexia postoperatively, and 3 showed signs of incision site infection. All sutures were removed 7-10 days postoperatively, and all dogs were clinically healthy at the two-week follow-up. The findings indicate that two-port laparoscopic-assisted ovariohysterectomy is a safe and effective treatment option for managing mild to moderate hydrometra and pyometra in small-sized dogs.

Understanding the Impacts of Surgical Drains on Postoperative Pain and Quality of Life.

Surgical drains are commonly used in breast surgery and breast reconstruction for seroma prevention. Although many surgeons are aware that surgical drains can cause considerable discomfort to patients, less is understood about the specific impacts of drains on postoperative pain and quality of life (QOL). A cross-sectional survey was conducted among patients at our institution who had previously undergone mastectomy or breast reconstruction procedures to better understand patients' experiences with surgical drains. Patients were asked to report their attitudes toward a series of QOL statements and rate postoperative pain using numeric pain scales. Pair-wise analysis was used to identify predictors of responses. A total of 203 complete responses were recorded. Increased pain scale ratings for pain at the body wall, incision site, and drain entry site were significantly associated with drain duration at 2-3 weeks or longer (P < 0.05). Notably, 84.7% of patients reported that drains increased the difficulty of completing daily tasks. Most patients (66.0%) reported negative impacts on mood, and 37.0% reported apprehension toward undergoing future procedures that may require drains. Most patients (65.0%) also expressed that they would prefer to receive care from institutions that utilize improved alternatives to standard drains. Surgical drains cause substantial discomfort to most patients and exert several negative impacts on QOL. In addition to limiting drain use wherever possible, innovations in technique and the development of alternatives to existing drains may offer patients a less painful, improved postoperative recovery experience.

A Comparison of 90-Day Complication Rates Between Intra-incisional and Extra-incisional Pin Sites in Robotic Total Knee Arthroplasty.

Robotic-assisted total knee arthroplasty (TKA) platforms require tibial and femoral pins to support rigidly fixed navigation arrays. These pins can be placed inside or outside the primary incision. We sought to compare 90-day complication rates between three different pin configurations: all-outside, intra-incisional femur/extra-incisional tibia, and all-inside. A retrospective cohort study of 2,880 patients undergoing robotic primary TKA was performed, including 1,004 patients (35%) with all-outside pins, 1,056 patients (37%) with intra-incisional femur/extra-incisional tibia pins, and 820 patients (29%) with all-inside pins. The primary outcomes were primary wound complications and pin site wound complications within 90 days. Secondary outcomes were manipulations under anesthesia (MUAs) and complex regional pain syndrome (CRPS). There were 41 (2.0%) tibial pin site wound complications and three (0.3%) femoral pin site wound complications. There were 109 (3.8%) wound complications involving the primary incision. There was no difference in primary wound complication rates between the all-outside, intra-incisional femur/extra-incisional tibia, and all-inside groups (3.3 versus 3.9 versus 4.3%, P = 0.54). There were 18 major wound complications requiring reoperation or readmission; 13 of these involved the primary incision only, three involved the primary incision and tibial pin sites, and two involved the tibial pin sites only. There were no differences between the three groups in the rates of MUAs (4.1 versus 2.4 versus 3.4%, P = 0.09) or CRPS (0.1 versus 0.1 versus 0.6%, P = 0.06), respectively. There were no intraoperative or postoperative periprosthetic pin-related fractures in the study sample. Primary wound complication rates were similar in patients who had pins placed outside or within the primary incision during robotic TKA. However, among patients who had extra-incisional tibial pins, there was an additional 2.0% risk of tibial pin site-related wound complications. All-inside pin placement did not lead to an increased risk of CRPS or MUAs compared to extra-incisional tibial pins.

Survival outcomes comparing minimally invasive versus open cytoreductive surgery in recurrent adult-type granulosa cell tumors.

Adult-type granulosa cell tumors are a rare form of ovarian cancer, 30% of which will recur. Cytoreductive surgery is often performed at the time of a first recurrence, but little is known about the impact of open versus minimally invasive surgical approaches on survival outcomes. To examine associations between surgical approach, clinical variables, and survival outcomes among patients with adult-type granulosa cell tumors who underwent cytoreductive surgery at the time of first recurrence. This is a retrospective cohort study of patients with adult-type granulosa cell tumors enrolled in the MD Anderson Rare Gynecologic Malignancy Registry as of April 2024. Included patients had at least one documented recurrence and underwent secondary cytoreductive surgery as part of their treatment plan. Patients were excluded if surgery was performed prior to January 1, 2000, or if surgery was not intra-abdominal. Demographics and clinical variables were compared using descriptive statistics. Surgical complexity was classified as either low, intermediate, or high based on procedures performed. Progression-free and overall survival outcomes were stratified by surgical approach and estimated using Kaplan-Meier curves. A multivariable Cox proportional hazards model was used to adjust progression-free survival at time of first recurrence for age, year of surgery, and extent of disease. 485 patients with adult granulosa cell tumors were identified, 108 met inclusion criteria. Seventy-eight (72%) had open and 30 (28%) had minimally invasive secondary cytoreductive surgery. Baseline characteristics, including initial stage, self-identified race, or age at diagnosis, did not differ between open and minimally invasive surgery groups. Patients undergoing minimally invasive surgery were significantly younger at the time of surgery than the open group, with a median age of 42 vs 49, respectively (p=0.03). For the open group, 33% of surgeries were considered intermediate complexity and 4% high complexity, compared to 7% and 0% in the MIS group, respectively (p=0.004). There was no difference in achieving optimal cytoreduction, 85% in the open group and 88% in the MIS group (p=0.68). Following secondary cytoreductive surgery, there was no difference in overall survival, median overall survival of 166 months in the open group and 94 months in the minimally invasive group (p=0.27), or progression-free survival after first recurrence, 26 months in the open group compared to 21 months in the minimally invasive group (p=0.42). The difference in progression-free survival after the first recurrence remained non-significant after adjustment for key potential variables, including age, surgical approach, year of surgery, and extent of disease. There was no difference in incisional or port site recurrences at the time of second recurrence among those undergoing open (8.3%) compared to minimally invasive surgery (7.4%) at time of first recurrence (p=0.89). In patients with a first recurrence of adult-type granulosa cell tumors, open secondary cytoreductive surgery did not achieve superior outcomes compared to surgery via a minimally invasive approach. Minimally invasive surgery should be considered for carefully selected patients with recurrent adult-type granulosa cell tumors. Future research is needed on patient factors important to the selection of surgical approach in this setting.

Effects of Rosmarinus officinalis extract on wound healing, colon anastomosis, and postoperative adhesion in colon anastomosis rats.

Intraabdominal adhesions increase the incidence and length of surgical complications. Many anti-adhesive agents have been used for this purpose, but no definitive solution has yet been found. Studies on the prevention and reduction of anastomotic leakage, therefore, remain up to date. This study aimed to determine the effects of Rosmarinus Officinalis extract on colon anastomosis as a surgical model, its antiadhesive activity, and its impact on wound healing in the laparotomy site simultaneously to facilitate the clinical application of Rosmarinus Officinalis extract. The rats were divided into two groups of seven rats each. Group C (Control): Laparotomy with colon anastomosis + 2 mL isotonic solution. Group R (Rosmarinus officinalis): Laparotomy + colon anastomosis, + 2 mL of 2% rosmarinus officinalis. Macroscopic adhesion scoring was performed and recorded. The tensile strength of the wound was assessed using tissue samples obtained from the incision line. From the incision line, tissue samples were obtained for histopathological investigation and tissue hydroxyproline levels. Anastomotic burst pressure was measured from the segment of colon anastomosis. In terms of Macroscopic adhesion score, there was no statistically significant difference between Group C and Group R (p=1.000). The mean Wound tensile strength value of Group R was significantly lower than that of Group C (p=0.003). In terms of mean Anastomotic burst pressure, there was no statistically significant difference between Group C and Group R (p=0.078). According to the findings of our investigation, peritoneal administration of Rosmarinus Officinalis extract in the early postoperative period may increase the risk of evisceration in the abdominal incision site.

Challenges in Diagnosis and Management of Non- Tuberculous Mycobacterial infection: Report of three cases

Non-tuberculous mycobacteria (NTM) can cause a wide range of infections, from affecting the lungs (pulmonary) to the other parts of the body (extrapulmonary) like skin, soft tissue, surgical wounds, and areas around catheters and implants. A significant challenge is that NTM infections are often misdiagnosed as tuberculosis. This case series highlights these difficulties by exploring three patient experiences. The first case involves a 48-year-old man who developed a prolonged fever following coronary artery bypass grafting (CABG) surgery. He also presented with enlarged liver and spleen (hepatosplenomegaly). Imaging studies revealed a large saccular aortic ascending aneurysm. While surgery (ascending aortic and proximal arch replacement) addressed the aneurysm, the definitive diagnosis came later. Histopathological and microbiological examinations ultimately revealed the culprit to be NTM. In second case, a 56-year-old male underwent a laparoscopic bilateral total extraperitoneal inguinal hernia repair. However, he experienced persistent serous drainage from the incision site post-surgery. To investigate the cause, discharge was collected and subjected to various tests. Therefore, a PCR test for Non-tuberculous Mycobacteria (NTM) was performed. This test returned positive, confirming the diagnosis of NTM infection rather than tuberculosis. And our third case was post operative endophthalmitis following cataract surgery due to NMT. Through these case reports, our Aim is to raise awareness among healthcare professionals. Bangladesh J Medicine 2025; 36: 66-70

New technique for incision site selection in laparoscopic-assisted minilaparotomy for canine fistula

New technique for incision site selection in laparoscopic-assisted minilaparotomy for canine fistula

Comparison of two strategies estimating surgically induced astigmatism in position prediction of toric IOLs in 2.2mm cataract surgery.

To compare the precision of the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) in estimating SIA when predicting the power and axis of toric IOLs under different circumstances. 120 eyes of 99 patients undergoing toric IOL replacement in a simple cataract surgery were included in the retrospective study. The predicted position of toric IOL was calculated by Z Calc online calculator and Barrett Toric Calculator with M-SIA (0.4D) or C-SIA (0.1D). Position prediction error (PPE, the difference between the predicted position of toric IOL and the ideal position of toric IOL), its absolute value (PPE-Abs) and △PPE (the difference between absolute value of PPE calculated by C-SIA and by M-SIA using the same toric calculator) were used to evaluate the precision in estimate of SIA. Statistical significance in mean PPE and mean PPE-Abs was found in the group M-Barrett. The orientation of corneal astigmatism and eye laterality were influential to mean PPE while gender was not. △PPE was below 0 in both toric calculators. Significant difference in △PPE was seen between groups with different corneal astigmatism when all eyes were OS, as well as between groups with different eye laterality when all eyes were with WTR astigmatism. We did not find a significant difference between M-SIA and C-SIA in estimating the SIA of the patients undergoing small-incision cataract surgery combined with toric IOL implantation. M-SIA was not recommended in Barrett Toric Calculator. The orientation of corneal astigmatism and the incision on the cornea should be considered when choosing between M-SIA and C-SIA. WHAT IS KNOWN? : Either the arithmetic mean of surgically induced astigmatism (M-SIA) or the centroid of surgically induced astigmatism (C-SIA) of a cohort was used to estimate the position of toric IOLs before the surgery. The size and site of corneal incision could influence the orientation and the magnitude of SIA. WHAT IS NEW? : When calculating the axis of toric IOLs with Barrett Toric Calculator, arithmetic mean of SIA (M-SIA) was not recommended for estimate. The orientation of corneal astigmatism could influence the estimate of SIA. We created several novel variables that could be used to indirectly evaluate the stability of toric IOLs and the prognosis of patients.

Peritoneal Closure at Caesarean Section; A Comparative Cross-Sectional Study

Background: Cesarean section rates have been growing consistently on a worldwide scale. Peritoneal closure is important because it can help provide the best possible surgical results and recuperation after surgery. The surgical incision site could not receive enough support and protection if the peritoneal layer is not closed. Objective: To compared the mean pain score following peritoneal closure with non-closure during Caesarean procedure. Materials and Methods: Comparative cross-sectional study, conducted at department of obstetrics and gynecology of Hayatabad Medical Complex Peshawar. The research comprised 276 pregnant women with primigravida, who were having an elective caesarian section, categorized into two groups (Closure &amp; Non-closure) of 138 participants in each. To prevent surgical skill bias, senior obstetricians with over three years of experience conducted Caesarean sections on both groups. SPSS (version 22) was used to enter and analyze all the data. Results: A total of 138 with closure patients were observed in which 38(60%), 48(35%), and 7(5%) patients had mild, moderate, and sever pain respectively. While in closure group, a total 138 patients were observed in which 64(46%) had mild, 62(45%) moderate, and 12(9%) patients had severe pain. The p-values for mild, moderate, and severe pain across age groups were 0.571 and 0.681 for the non-closure and closure groups, respectively. Conclusion: Our study highlights that peritoneum non-closure discomfort is less severe than peritoneum closure during a cesarean section. It is advised that during an emergency cesarean section, both visceral and parietal peritoneal closure can be safely skipped because the surgical result is better.

Leiomyoma mimicking hypertrophic scar/keloid over the surgical incision site

Following surgery, hypertrophic scars/keloid is a frequent consequence, especially in people with a hereditary propensity for scar development. Although the precise cause of hypertrophic scar development is unknown, it is believed to be caused by an excess of collagen being produced at the site of damage. There are several ways to treat hypertrophic scars, including cryotherapy, laser therapy, intralesional steroids (ILS), and surgical excision. Recurrence rates are significant, and treatment results might be uncertain. In this case report, we describe a 43-year-old male patient who had spinal decompression and fixation surgery and thereafter acquired a hypertrophic scar/keloid-like lesion that was resistant to ILS. Following a biopsy, it was discovered that the tumor was a leiomyoma, which is quite rare in this situation.

Effectiveness of stepwise progressive ultra-tension-reducing suture method in treatment of high-tension wounds on chest, back, and limbs

To investigate effectiveness of a novel suture method-stepwise progressive ultra-tension-reducing suture method in closing high-tension wounds on the chest, back, and limbs. A retrospective analysis was conducted on 25 patients with high-tension wounds on the chest, back, and limbs who were treated with stepwise progressive ultra-tension-reducing suture method between January 2022 and December 2022. Among the patients, there were 8 males and 17 females, with an average age of 30.5 years (range, 18-56 years). All wounds after scar or tumor resection were located on the chest, back, upper limbs, and lower limbs in 8, 6, 9, and 2 cases, respectively. The size of wounds ranged from 3.5 cm×2.8 cm to 40.0 cm×15.0 cm. All patients were advised to use topical silicone-based treatments postoperatively. The protrusion of the incision, the height of the protrusion, and the duration of the tension reduction effect were observed. The scar formation at the incision site at 6 months after operation was observed, the scar appearance was evaluated by Vancouver Scar Scale (VSS) score, and the scar width was measured. The patient's satisfaction and adverse reactions to incisions were also evaluated. The incisions significantly elevated, with a height of 0.3-2.5 cm, and the tension reducing effect lasted for 8.5-18.0 weeks after operation, with an average of 13.6 weeks. All incisons healed by first intention. One patient experienced transient hyperpigmentation, which resolved spontaneously. Three keloid patients showed localized redness postoperatively, and 2 experienced local recurrence, which improved significantly after treatment with triamcinolone, 5-fluorouracil injections, and laser therapy. All patients were followed up 6.0-13.5 months, with an average of 10.1 months. At 6 months after operation, all patients had linear scars, with VSS scores ranging from 1.0 to 3.5 (mean, 2.0). The width of the scars ranged from 0.5 to 3.0 mm (mean, 1.4 mm). The patients expressed satisfaction with the effectiveness. The stepwise progressive ultra-tension-reducing suture method for high-tension wounds can effectively reduce the tension at the wound edges, providing a prolonged tension-reducing effect and satisfactory effectiveness.

Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.

Tissue Reaction Elicited by Neosealer Flo, AH 26, and CC Sealer in Rats

Background: Since root canal sealers are in contact with periradicular tissues, biocompatibility is one of their most important features .There is no available study about the biocompatibility of NSF and CC Sealer that are newly made bioceramic-based sealers. This study aimed to compare the tissue reaction elicited by NeoSealer Flo (NSF), AH26, and ColdCeramic Sealer (CC sealer) in rats. Material and Methods: The sealers were mixed and applied in molds to fabricate sealer discs, which were then implanted in the subcutaneous tissue of the backs of 30 healthy adult Albino Wistar rats. Each rat received three sealer discs and the fourth incision site remained empty as a control group. After 7, 30, and 90 days, the rats were sacrificed. Biopsy samples were evaluated regarding the extent and severity of inflammation, angiogenesis, fibroplasia, and infiltration. Data were analyzed in SPSS software using Kruskal-Wallis and Mann-Whitney U tests. Results: Tissue reaction to NSF was generally severe and increased up to day 30, but slightly decreased at three months, although it was still severe, and significantly greater than the tissue reaction to other sealer types. After one month, all rats in the NSF group showed foreign body reaction and giant cells around sealer particles; while, foreign body reaction was not seen in other groups. Tissue reaction to CC Sealer and AH26 was not significantly different at any point in time (P&gt;0.05) and was the highest on day seven and then decreased up to month three. Conclusion: According to the present results, the CC Sealer appears to be a biocompatible material; however, NSF showed higher severity and extent of inflammation and triggered higher tissue reaction.