Large joint arthroplasty is among the most frequently performed procedures in orthopaedic surgery. One of the most common and challenging causes of prosthetic failure is periprosthetic joint infection (PJI). Periprosthetic soft tissue damage is often a critical yet underestimated factor influencing surgical outcomes. The aim of our meta-analysis is to evaluate the clinical efficacy, complications, failure rates, and the overall reliability of free flaps as a reconstructive solution. PubMed, Embase, and Google Scholar were searched, according to PRISMA guidelines. Studies were included if they reported healing rate, complications, type of free flaps, and pathogen characteristics. A quality evaluation was performed. The overall effect size was reported as survival rate of the free flaps, and the secondary effect sizes were determined as the rate of reinfection or persistent infection after coverage with free flaps and the amputation rate because of non-controlled infection. The statistical analysis was carried out using the software 'R', version 4.5.0 (2025-04-11). Fourteen papers were included, with a total of 185 observations and 161 events (free flap survived). All papers were retrospective studies. The pooled survival rate was 93% (I 2 = 66.7%). The pooled rate of reinfection or persistent infection after the index surgery was 16% (I 2 = 77.6%). The amputation rate was 8%. Free flaps are a reliable solution to manage tissue loss in patients with periprosthetic infection, but the results could be affected by technical errors and non-skilled intra- and post-operative management. Orthoplastic and microsurgical skills are mandatory to be successful.

Skin infections are a common concern in the treatment of atopic dermatitis (AD) with topical medications including topical corticosteroids (TCS), tacrolimus, delgocitinib, and difamilast. However, real-world evidence regarding the incidence of these infections across different topical medications remains limited. This study aimed to evaluate patient characteristics and the incidence rates of skin infections associated with topical medications using Japanese claims data. We conducted a retrospective cohort study using health insurance claims data from June 2022 to June 2023. Patients with AD were classified into three treatment groups: difamilast, TCS, and non-TCS (tacrolimus and delgocitinib). Incidence rates of skin infections were calculated using the person-year method (1000 person-years). Propensity score matching was used to compare treatment groups. Among 107,854 eligible patients, 1,844,45,988, and 8256 received difamilast, TCS, and non-TCS monotherapy, respectively. Before matching, the proportions of female patients were 59.8%, 51.7%, and 66.8% in the difamilast, TCS, and non-TCS groups, and the median ages were 19.0, 13.0, and 38.0years, respectively. After matching, the incidence rate of skin infections was 362.880/1000 person-years in the difamilast group, compared with 306.336/1000 person-years in the TCS group (risk ratio: 1.185; 95% confidence interval [CI] 0.934, 1.503). Compared with the non-TCS group, the risk ratio was 1.302 (95% CI 1.005, 1.686). No major differences were observed in the incidence of individual skin infections, except for acne. Among patients who received difamilast monotherapy, the incidence rate of skin infections (340.341/1000 person-years; 95% CI 285.209, 406.129) was consistent with the overall patients prescribed difamilast (349.819/1000 person-years; 95% CI 326.257, 375.084). Difamilast demonstrated a comparable safety profile to other topical treatments regarding skin infections in patients with AD. These findings highlight the importance of monitoring infection risk and ensuring appropriate clinical management when prescribing topical medications for AD.

Lean and Green Hand Surgery in the Office: Does It Work?

Background: Bovine anaplasmosis is a communicable disease transmitted via ticks, which carries significant veterinary and economic implications. Data from western Iraq remains scarce despite high cattle exposure to vector-borne infections. Objective: To determine the incidence of Anaplasma marginale in cattle in Anbar Province, compare the diagnostic performance of microscopy, ELISA, and PCR, and assess associated haematological changes. Methodology: Between January and December 2024, three hundred blood samples were drawn from cattle (1–10 years, both sexes) across 20 farms in Haditha, Heet, Al-Qaim, and Rutba districts; Giemsa-stained smears, a commercial ELISA, and PCR targeting the msp5 gene were used for diagnosis. Haematological parameters (RBC, Hb, PCV, WBC) were measured using an automated analyser. Prevalence was determined by sex, age, and season, while haematological data were compared by t-tests (α = 0.05). Results: Prevalence was 28.0% by microscopy, 36.3% by ELISA, and 41.3% by PCR, with PCR being most sensitive. Infection rate was higher among females (46.9%) compared to males (33.6%), and in older cattle than in younger ones; Peak rates occurred in the summer (62.6%), with the lowest rates in winter (17.3%). Infected cattle had reduced Hb, PCV, RBC, and elevated WBC counts. Conclusion: This study provides the first detailed epidemiological report on bovine anaplasmosis in western Iraq. The results confirm that PCR is the most sensitive tool, underlining host and seasonal influences on infection and revealing distinct haematological alterations. These findings provide a surveillance baseline and support control strategies against A. marginale in endemic regions.

To improve the rates of central line-associated bloodstream infections in an intensive care and non-intensive care setting in a large Australian health service. Evidence-based care bundles targeting central line practices were developed and implemented using a pragmatic action research-approach. Wards recruited change facilitators to implement the bundles. Compliance and ward engagement were measured, and pre-intervention and intervention central line-related infection rates were compared. Wards showed a reduction in central line-related infections by 90% during the intervention for up to 2 years. Adherence to bundles was high in both settings. Improvements in insertion practices were observed after baseline and were sustained, with the largest improvement seen in documentation. Maintenance and removal practices showed less variation than insertion practices. Care bundles are an effective intervention to reduce central-line-related infections over a sustained period when clinician adherence is high. Care bundles can be effective in high-risk settings beyond intensive care units, including haemodialysis. Central lines were identified from local hospital data as a major contributor to health care-associated infection rates. Care bundles were implemented in high-risk settings and demonstrated sustained reductions in central-line-related infections. Care bundles are an effective intervention for health care organisations to reduce and sustain preventable infections in high-risk patient cohorts. We adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework. No patient or public contribution.

Periprosthetic joint infection (PJI) remains a serious complication of arthroplasty, associated with increased morbidity, mortality, and healthcare costs. While patient-related and procedural risk factors are well established, the effect of surgical gown type on infection risk is unclear. Single-use surgical gowns are often used due to their perceived superior sterility in the absence of clear evidence. The purpose of this study was to determine the effect of single-use compared with reusable gown use on the incidence of PJI in the 12 months following primary hip and knee arthroplasty. Between January 2015 and September 2023, 9,239 consecutive primary elective hip and knee arthroplasties were performed at our institution. Data were obtained from a prospectively maintained local registry aligned with the UK Health Security Agency Surgical Site Infection database and National Joint Registry, and combined with surgeon gown preference data. A retrospective logistic regression was undertaken to evaluate the association between gown type and PJI in the 12 months after surgery, adjusting for age, sex, BMI, diabetes, and chronic obstructive pulmonary disease (COPD). A total of 76 infections (0.82%) were identified, comprising 49/5,024 knees (0.98%) and 27/4,215 hips (0.64%). Infection occurred more frequently in the single-use gown group (n = 4,314; 1.0%) than in the reusable gown group (n = 4,925; 0.6%; p = 0.017). Single-use gowns were associated with higher odds of infection (adjusted odds ratio (OR) 1.73 (95% CI 1.09 to 2.76); p = 0.020). Use of single-use surgical gowns was independently associated with an increased odds of PJI following primary hip and knee arthroplasty in the 12 months after surgery in our institution. This finding highlights the need for further studies exploring the causal factors contributing to this outcome.

Percutaneous Endoscopic Gastrostomy Tubes Do Not Increase the Rate of Left Ventricular Assist Device Postoperative Infections

Virus-induced epithelial lesions during fingolimod: HPV-related genital warts and molluscum contagiosum-case series and literature review.

In 2023, our emergency department, serving a region with one of the highest rates of new HIV infection, implemented Centers for Disease Control and Prevention-recommended universal, opt-out HIV screening for adolescents. However, few patients admitted to the pediatric hospital medicine service (PHM) were tested. To address this gap, we aimed to expand universal, opt-out HIV testing to PHM and evaluate screening implementation. In this pre-postintervention study, we compared HIV testing rates for patients admitted to PHM aged 13years or older during 5months preimplementation and postimplementation (February to June 2024 and July to November 2024). Clinicians received regular education on HIV screening guidelines and opt-out language and were encouraged to incorporate screening in confidential psychosocial assessments. If the inpatient team did not offer testing, HIV navigators counseled adolescents, regardless of parental presence. Testing rates were compared with chi-square and Welch's t-test. There was a 38% increase in HIV screening from the preimplementation to postimplementation periods (preimplementation, 12.4%; postimplementation, 17.1%; P = .04). Postimplementation, 533 adolescents were eligible for HIV screening; 148 were approached, and 91 HIV tests were ordered (17.1% of eligible; 64% girls; mean age 16 ± 1.8years), identifying one adolescent with HIV (>1% seroprevalence; 3% for boys). Adolescents were significantly more likely to be tested when approached by an HIV navigator than during a confidential interview (P = .004). Parental presence did not negatively impact adolescent participation. Adopting universal, opt-out HIV screening with HIV navigators in the inpatient setting significantly increased testing rates. Further studies on the most effective and sustainable approach to screening are needed.

Although some children with B-cell acute lymphoblastic leukemia (B-ALL) receive intravenous immunoglobulin (IVIG) during conventional therapy, supplementation practices vary, and data describing the indications and their impact are lacking. In this single-institution cohort of children with B-ALL receiving conventional chemotherapy, we evaluate associations of patient and disease characteristics with IVIG supplementation, describe infection-related outcomes by IVIG receipt, and describe outcomes after IVIG supplementation. Multivariable logistic regression models identified factors associated with IVIG receipt. Of 373 eligible patients with B-ALL who did not receive immune therapy, 251 (67.3%) had an IgG level checked, and 114 (30.6%) received IVIG. The median IgG nadir was lower in IVIG recipients versus nonrecipients (404 vs. 675mg/dL, P<0.01). IVIG recipients were younger at diagnosis (4 vs. 6y, P<0.01) and had a larger number of severe infections per 1000 leukemia treatment days (4.2 vs. 2.5, P<0.01). In adjusted models, the odds of IVIG administration were lower for non-white patients (OR=0.43, 95% CI=0.22-0.83), higher for patients with >2 severe infections during treatment (OR=2.57, 95% CI=1.28-5.18), and higher for National Cancer Institute standard risk patients with IgG nadir <500mg/dL (OR=7.45, 95% CI=3.54-15.70). For IVIG recipients, the rate of emergency department visits, severe infections, and febrile neutropenia episodes was 5.4, 1.9, and 1.1 per 1000 treatment days, respectively, during IVIG supplementation. Among children with B-ALL receiving conventional chemotherapy, clinical characteristics differ between IVIG recipients and nonrecipients. Uniform IgG measurements during therapy may guide supplementation decisions, especially in the era of frontline immunotherapy.

Acute urinary tract infections (UTIs) are common after prolapse and anti-incontinence surgery, with incidence rates varying from 14% to 64%. The objective was to decrease rates of symptomatic urinary tract infections in patients undergoing pelvic organ prolapse repair and/or anti-incontinence surgery using an intraoperative bundle. This change in practice was implemented on January 19, 2024, for all patients undergoing prolapse and/or anti-incontinence surgery within our division, with data collected until July 18, 2024. A similar cohort from 1 year before the implementation was used as a comparison. The regimen consisted of re-prepping the urethral meatus with 4% chlorhexidine swab before any instrumentation, including placement of the transurethral catheter or cystoscope. Any time the urethral catheter was temporarily removed, it was placed in a solution of 80mg gentamicin/500mL normal saline in the operative field. The number of times urethral instrumentation occurred was recorded. No changes were made to our standard of care for prophylactic intraoperative antibiotics. Patients discharged with a Foley catheter received methenamine hippurate and cranberry tablets per our standard practice. The primary outcome, incidence of symptomatic UTIs within 30 days postoperatively, was determined for pre-bundle and post-bundle implementation participants. Secondary analyses included the association between UTI rates and urethral instrumentation, specific surgeon, and procedure type. We also sought to determine if these interventions were associated with increasing resistance in bacterial isolates from urine cultures. The total of 461 patients in pre-bundle and post-bundle groups were similar in age, body mass index, and race distribution, with similar rates of baseline comorbidities of interest: diabetes, recurrent UTIs, and current smoking status. For the primary outcome of symptomatic UTI within 30 days of index surgery, there was a significant decrease from 18.1% to 10.9% ( P =0.034). When analyzing the number of urethral instrumentations per case, the median number was 3, with no difference between those who developed UTI and those who did not. There was no difference in rates of failed voiding trial and no increase in resistant bacterial strains after the bundle implementation. An almost 50% decrease in secondary postoperative urinary retention was demonstrated in the post-bundle group, postulated to be related to the lower rate of UTIs. An intraoperative bundle that includes urethral re-prepping before all intraoperative instrumentation and keeping the Foley catheter in a gentamicin/saline solution when not in use demonstrated a 40% decrease in symptomatic UTIs within 30 days of surgery. Given the low cost and ease of implementation of these interventions, surgeons should consider incorporating these measures to help minimize postoperative UTIs after prolapse and anti-incontinence surgery.

Healthcare-associated infections (HAIs) are a major global patient safety concern, yet comprehensive national surveillance data remain limited in many regions, including the Middle East. In the United Arab Emirates (UAE), prior efforts were restricted to selected surgical site infections (SSIs), with no unified framework capturing the full spectrum of HAIs. We aimed to establish the first national benchmark for HAIs across multiple healthcare sectors and infection types. We conducted a cross-sectional analysis of national HAI surveillance data from 92 hospitals with ≥ 20 beds across the UAE in 2023. Data were reported through a standardized electronic reporting system using Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) definitions. Outcomes included rates of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated events (VAE), and SSIs, alongside causative organisms, multidrug-resistant organisms (MDROs), and hand hygiene compliance. Device-associated infection rates were expressed per 1,000 device-days and SSI rates per 100 procedures. Comparisons with NHSN pooled mean rates were descriptive. Across participating hospitals, 236 CLABSI, 225 CAUTI, 247 VAE, and 488 SSI events were identified. National rates were 0.95 per 1,000 central line-days for CLABSI and 0.84 per 1,000 catheter-days for CAUTI, both exceeding NHSN pooled mean rates (0.74 and 0.73, respectively). The VAE rate (2.85 per 1,000 ventilator-days) was lower than NHSN (8.04). SSI rates exceeded NHSN pooled mean rates for cesarean section (emergency 1.17%, elective 1.77%), appendectomy (0.37%), coronary artery bypass grafting (1.83%), laminectomy (2.02%), and craniotomy (2.11%), while rates were lower for knee (0.39%) and hip arthroplasty (0.20%). Among 464 causative isolates reported from Dubai and the Northern Emirates, 31.3% were multidrug-resistant, predominantly carbapenem-resistant Enterobacterales, methicillin-resistant Staphylococcus aureus, and Candida auris. Hand hygiene compliance was 91.3%. This first national HAI surveillance report in the UAE demonstrates the feasibility of multisector data integration and establishes a baseline for benchmarking. Elevated device-associated infection rates and substantial MDRO burden highlight priorities for prevention and antimicrobial stewardship. Comparisons with NHSN pooled mean rates should be interpreted cautiously due to differences in risk adjustment. Expansion of standardized surveillance and incorporation of patient-level data will be essential to refine benchmarking and guide targeted interventions.

Diabetic foot ulcers (DFUs) remain one of the most devastating complications of diabetes, accounting for over 80% of nontraumatic amputations and contributing to a 5-year mortality rate exceeding 30%. Despite significant clinical advances, profound disparities persist. Racial and ethnic minoritized populations, rural communities, and people with low socioeconomic resources experience disproportionate rates of severe ulceration, infection, delayed healing, and amputation. Traditional research approaches, often developed in academic settings without community input, have insufficiently addressed the contextual, cultural, and structural factors shaping DFU risk and outcomes. Community-engaged research (CEnR) offers a promising pathway to address these inequities; yet, DFU-specific evidence remains limited and heterogeneous. In response, the Diabetic Foot Consortium (DFC), a national research network funded by the National Institute of Diabetes and Digestive and Kidney Diseases, has initiated multisite efforts to embed community advisory boards, faith-based partnerships, mobile outreach, and culturally aligned engagement into DFU research. We propose the DFC-CEnR Model, a conceptual framework for integrating community-engaged approaches to DFU prevention, early detection, treatment, and research participation. The model distinguishes CEnR from related approaches (community-based participatory research, patient and public involvement, cultural humility, and equity-focused system interventions), outlining hypothesized mechanisms and evaluation domains. Illustrative consortium examples demonstrate how engagement domains may be operationalized and inform future testing of validated outcome measures. This article positions community engagement as a hypothesis-generating strategy that requires rigorous empirical testing to determine its impact on DFU outcomes and disparities.

Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and is responsible for anogenital warts and several cancers. Although the effectiveness of female HPV vaccination has been well established since its introduction in 2006, no systematic review has specifically evaluated the impact of male vaccination programs introduced in 2011. We synthesised real-world evidence on gender-neutral vaccination (GNV), identifying 17 studies reporting rates of HPV infection, anogenital warts, and HPV-related cancers during the pre- and post-GNV periods among males in high-income countries. Overall, we found limited but consistent evidence of benefit in males, although some of the observed reductions may also reflect herd immunity effects from earlier female-only HPV vaccination programs. Only two studies evaluated temporal trends in HPV infection, both demonstrating reductions in vaccine-targeted genotypes, although important methodological limitations restrict generalisability. Eight studies reported consistent declines in anogenital warts among adolescents and young adults, supporting a beneficial population-level impact of GNV. Analyses of HPV-related cancers showed an overall increasing incidence, likely reflecting long latency periods. However, some studies reported encouraging declines in cancer incidence among younger age groups. Oropharyngeal incidence decreased by 11%-19% among U.S. males aged 20-44years, and penile cancer incidence decreased by 6%-38% among those aged 15-34years. In Texas, penile and anal cancer incidence decreased by 35% and 16%, respectively, among males 20years or older, while in Austria, anal cancer incidence decreased by 38% among men aged 30-39years. Given the relatively recent introduction of male vaccination programs, longer follow-up is required to fully assess their impact. Studies in low- and middle-income countries are urgently needed.

Antimicrobial resistance (AMR) is a significant health problem, especially in low- and middle-income countries. This study aimed to investigate the prevalence and trends of antimicrobial resistance (AMR) and multidrug resistance (MDR) in bacterial infections at a tertiary-care hospital in Dhaka, Bangladesh, and the prevalent pathogens and their resistance profiles. A cross-sectional study was conducted on clinical specimens from patients admitted to tertiary-care hospitals, processed at Ibn Sina Diagnostic and Imaging Center in Dhaka, Bangladesh. A total of 3,996 clinical specimens were sampled by patients, with inclusion and exclusion criteria. The samples were blood, urine and wound swabs. Data regarding culture positivity, pathogen distribution and antimicrobial susceptibility were summarized using descriptive statistics. Out of the 3,996 specimens, 72.5% were positive in terms of significant bacterial growth. The gram-negative bacteria were the dominant ones, with Escherichia coli (25.4%) and Klebsiella spp. (20.4%). The most common pathogens are Pseudomonas aeruginosa (15.8%), Acinetobacter spp. (11.9%), Staphylococcus aureus (10%), and Coagulase-negative Staphylococci (8.1%) were the most common gram-positive. In E. coli, the resistance was significantly high with a 42.5% ciprofloxacin resistance and a 47.0% ceftriaxone resistance. MDR was identified in 53.0% of E. coli isolates, and similar MDR patterns were observed in Klebsiella spp. and Pseudomonas aeruginosa. The study shows that there is high-AMR, especially amongst gram-negative pathogens, at a tertiary-care hospital. There is an urgent need to enhance antibiotic stewardship and infection control to deal with the increasing rate of MDR bacterial infections.

Induced abortion can impair endometrial repair, increasing risks for infertility. This study directly compared three hormonal regimens for enhancing post-abortion uterine recovery. This study aimed to compare the efficacy and safety of different hormonal regimens on uterine recovery following surgically induced abortion. In this randomized controlled trial, 320 patients undergoing induced abortion at Leshan People's Hospital (May 2021 to January 2023) were allocated a computer-generated random number sequence into four groups (n=80 each): Group A received estradiol tablets/estradiol and dydrogesterone tablets, Group B received estradiol gel, Group C received drospirenone and ethiny lestradiol tablets (II) and Group D was a blank control. Primary outcomes included duration of vaginal bleeding, postoperative endometrial thickness, time to first menstruation and incidence of intrauterine adhesions and adverse events. The duration of vaginal bleeding was significantly shorter in the treatment groups (Group A: 4 days [IQR 2-6]; Group B: 4 days [IQR 2-7]; Group C: 3 days [IQR 2-6.5]) compared to the control group (6 days [IQR 4-7]; P<0.05). Endometrial thickness was significantly greater in Group B (0.6 cm [IQR 0.5-0.8]) than in Groups A (0.5 cm [IQR 0.4-0.7]), C (0.4 cm [IQR 0.3-0.5]) and D (0.4 cm [IQR 0.4-0.6]; P<0.05). The time to menstrual resumption was shorter in Groups A (33 days [IQR 31-37]) and C (32 days [IQR 29-35]) compared to Groups B (36 days [IQR 33.5-42]) and D (38 days [IQR 35-44]; P<0.05). No significant differences were observed in postoperative infection or adhesion rates. The incidence of irregular bleeding was higher in Group C (44.4%) than in Group D (13.0%; P<0.05), but all adverse events were self-limiting. This study provides direct comparative evidence that specific hormonal regimens offer distinct benefits for post-abortion recovery. For women seeking contraception through drospirenone and ethinyl estradiol tablets are valuable for shortening bleeding and promoting menstrual regularity. For those with future fertility goals, estradiol gel is valuable for significantly enhancing endometrial regeneration. All regimens demonstrated good safety, enabling personalized clinical decision-making to improve patient outcomes after induced abortion.

Lyme disease is a growing public health concern in the United States. Despite higher rates of infection among children and disseminated disease among racial minorities, few studies have investigated the role of health care inequities on tick-borne disease knowledge among parents. We conducted a single-center, cross-sectional, anonymous survey of tick-borne disease recognition and prevention strategies among English- and Spanish-speaking parents/caregivers in a region of high Lyme disease incidence (Long Island, New York). Survey questions consisted of demographics, knowledge assessment, and tick bite prevention practices. Survey responses were analyzed with descriptive statistics and a multivariable logistic regression model to identify associations between participant characteristics and a calculated knowledge score. In total, 120 participants completed the survey, including 95 (79.2%) English speakers and 25 (20.8%) Spanish speakers. Of these, 72 participants (60%) answered all 4 knowledge questions correctly, and 94 (78.3%) answered 75% of the knowledge questions correctly. English language preference was associated with higher knowledge scores on univariate but not multivariable analysis. Multivariable analysis identified Hispanic or Latino race/ethnicity, lower household income, and fewer years of residence on Long Island as predictors of lower Lyme disease knowledge scores. Our findings highlight the role of adverse social determinants of health on Lyme disease risk, underscoring the need for focused educational interventions on high-risk populations.

The optimal method of wound closure after ileostomy reversal remains uncertain. Purse-string approximation reduces surgical site infections but requires prolonged wound care. Combining negative pressure wound therapy with primary linear closure may offer a more convenient approach while maintaining acceptable infection rates. To determine whether primary linear closure with negative pressure wound therapy is noninferior to purse-string approximation in preventing surgical site infection after ileostomy reversal. Prospective, nonblinded, multi-institutional, noninferiority randomized controlled trial. Community tertiary hospital and academic medical center. Adults undergoing elective ileostomy reversal between October 2018 and March 2024. Participants were randomly assigned to undergo either primary linear closure with negative pressure wound therapy or purse-string approximation for skin closure after ileostomy reversal. The primary outcome was the occurrence of surgical site infection, with a noninferiority margin set at 16%. Secondary outcomes included time to wound healing and scar appearance using the validated Patient and Observer Scar Assessment Scale. One hundred twelve patients completed the study, with 61 in the negative pressure wound therapy arm and 51 in the purse-string approximation arm. Primary linear closure negative pressure wound therapy was noninferior to the purse-string approximation arm in terms of surgical site infection: 7% and 2%, respectively, with an absolute risk difference of 5% (95% CI, 2.5%-12.5%). Early wound healing at 2 weeks was achieved in 77% vs 23.5% of patients, respectively ( p < 0.001, generalized estimating equation analysis). All wounds healed by 6 weeks in both groups. No negative pressure wound therapy device malfunctions occurred. Nonblinded study limited to 2 institutions. Ileostomy reversal by primary linear closure negative pressure wound therapy is noninferior to purse-string approximation in terms of the occurrence of surgical site infections while achieving significantly faster wound healing. The method is safe, convenient, and cosmetically acceptable. See Video Abstract . Advocate Aurora Health IRB, IRB# 22.034 (7082). ANTECEDENTES:El método óptimo para el cierre de heridas tras la reversión de una ileostomía sigue siendo incierto. La aproximación en jareta reduce las infecciones del sitio quirúrgico, pero requiere un cuidado prolongado de la herida. La combinación de la terapia de presión negativa para heridas con el cierre lineal primario podría ofrecer un enfoque más conveniente, manteniendo al mismo tiempo tasas de infección aceptables.OBJETIVO:Determinar si el cierre lineal primario con terapia de presión negativa para heridas es no inferior a la aproximación en jareta en la prevención de infecciones del sitio quirúrgico tras la reversión de una ileostomía.DISEÑO:Ensayo controlado aleatorizado, prospectivo, no enmascarado, multiinstitucional y de no inferioridad.ESCENARIOS:Un hospital terciario comunitario y un centro médico académico.PACIENTES:Adultos sometidos a una reversión electiva de ileostomía entre octubre de 2018 y marzo de 2024.INTERVENCIÓN:Los participantes fueron aleatorizados para recibir, como cierre cutáneo tras la reversión de la ileostomía, bien un cierre lineal primario con terapia de presión negativa para heridas, bien una aproximación en jareta.MEDIDAS DE RESULTADO PRINCIPALES:El resultado primario fue la aparición de infecciones del sitio quirúrgico, con un margen de no inferioridad establecido en el 16%. Los resultados secundarios incluyeron el tiempo hasta la cicatrización de la herida y el aspecto de la cicatriz, evaluados mediante la Escala de Evaluación de Cicatrices por el Paciente y el Observador (Patient and Observer Scar Assessment Scale), la cual está validada.RESULTADOS:Ciento doce pacientes completaron el estudio: 61 en el brazo de terapia de presión negativa para heridas y 51 en el brazo de aproximación en jareta. El cierre lineal primario con terapia de presión negativa para heridas resultó no inferior a la aproximación en jareta en términos de infecciones del sitio quirúrgico (ISQ): 7% y 2%, respectivamente, con una diferencia de riesgo absoluta del 5% (IC del 95%: -2,5% a 12,5%). Se logró una cicatrización temprana de la herida a las 2 semanas en el 77% de los pacientes del primer grupo frente al 23,5% del segundo (p < 0,001; análisis GEE). Todas las heridas habían cicatrizado a las 6 semanas en ambos grupos. No se produjeron fallos de funcionamiento en los dispositivos de terapia de presión negativa para heridas.LIMITACIONES:Estudio no enmascarado, limitado a dos instituciones.CONCLUSIONES:La reversión de la ileostomía mediante cierre lineal primario con terapia de presión negativa para heridas es no inferior a la aproximación en jareta en términos de la aparición de infecciones del sitio quirúrgico, logrando al mismo tiempo una cicatrización de la herida significativamente más rápida. Este método es seguro, conveniente y estéticamente aceptable. (AI-generated translation )Registro del ensayo:IRB de Advocate Aurora Health, N.º de IRB 22.034 (7082).

Evolution of the Lower Extremity Reconstruction: From Limb Salvage to Functional Reconstruction.

Efficacy and Safety of Endovascular Therapy with Stent Implantation Versus Endarterectomy in Common Femoral Artery Atherosclerosis: A Systematic Review and Meta-Analysis.