Late Wound Complications Research Articles

A Randomized, Single-Blind Study Comparing the Clinical Equivalence of Truglyde Fast® and Safil Quick® Polyglycolic Acid Fast-Absorbing Sutures for Episiotomy Repair Following Vaginal Delivery.

Episiotomy, the deliberate surgical incision on the vaginal orifice during vaginal delivery, requires prompt repairing of the incised tissue. It may be associated with bleeding, infection, dehiscence, dyspareunia, short-term pain, and prolonged hospital stay. The outcome of surgery depends on the suture material and technique to repair the episiotomy. We aim to subjectively assess perineal pain and maternal morbidity following episiotomy repair with Truglyde Fast®(Healthium Medtech Limited, Bengaluru, India) and Safil Quick® (B. Braun Medical Private Limited, Mumbai, India)polyglycolic acid fast-absorbing suture. This multicentric, prospective, randomized (1:1), two-arm, parallel-group, single-blind study was started in August 2020 and completed in March 2021. Ninety-nine primiparous or multiparous eligible women requiring episiotomy were recruited to Truglyde Fast® (n=51) and Safil Quick® (n=48) groups. The primary outcome measure was post-episiotomy perineal pain to be assessed using a visual analog scale (VAS). Secondary endpoints included evaluation of local anesthesia (quantity), intraoperative suture handling, number of sutures utilized, time spent for episiotomy repair and complete healing, analgesic number and dosage, early and late wound complications, presence of residual suture and frequency of re-suturing, resumption of sexual activity and dyspareunia, and adverse events. The threshold to discriminate significant from non-significant outcomes was p<0.05. At all visits, a non-significant change in perineal pain was noted between Truglyde Fast® and Safil Quick® groups. A significant difference (p<0.05) in the number of sutures used and intraoperative handling characteristics was observed between thegroups. Results of other secondary endpoints showed non-significant differences. Truglyde Fast® and Safil Quick® polyglycolic acid fast-absorbing sutures are clinically equivalent. Both sutures are safe and effective for episiotomy repair following vaginal delivery with minimal perineal pain and risk of maternal morbidity.

Comparing morphologic features and complications of main clear corneal incision between junior and senior residents observed using anterior segment optical coherence tomography.

Wound construction is a critical step in phacoemulsification. Using anterior segment optical coherence tomography (AS-OCT), we compared the morphological features and complications of main incisions made by junior or senior residents during phacoemulsification. This cross-sectional comparative study included eyes with senile cataracts that underwent uneventful phacoemulsification with a clear corneal incision made by seven senior and eight junior ophthalmology residents. All eyes underwent postoperative image acquisition using AS-OCT on day one and at three months, examining for morphological features and potential complications of the main incision. We included 50 eyes of 50 patients with a male-to-female ratio of 22 (44%) to 28 (56%); 26 (52%) were operated on by junior residents and 24 (48%) by seniors. The mean geometric features of the main incisions and the frequency of early and late wound complications were comparable between the two groups (all P > 0.05). A significant correlation was found between the incision length and angle with the superior (r = + 0.80; P < 0.001 and r = - 0.63; P < 0.001, respectively) and inferior (r = + 0.84; P < 0.001 and r = - 0.68; P < 0.001, respectively) areas of the incision, as well as between the length and angle of incision (r = - 0.74; P < 0.001). The number of planes in the wound architecture was not significantly different according to senior or junior resident status (P > 0.05). Although the number of eyes with stromal hydration was significantly greater for junior residents than for seniors (P < 0.001), the corneal thickness at the entrance to the cornea or the anterior chamber, presence of endothelial wound gaping, and Descemet's membrane detachment were comparable between eyes with and without stromal hydration (all P > 0.05). At three months, 29 (58%) patients returned for examination, in whom seven (24%) had late wound complications. This study found no significant differences in the performances of junior and senior residents in terms of wound construction or its associated complications. However, considering the overall rate of some observed wound-related complications, we recommended revision of the resident educational curriculum concerning the structure and complications of the main incision.

Clinical equivalence of Trusynth fast® and Vicryl rapide® polyglactin 910 fast absorbing sutures on maternal morbidity experienced by women following episiotomy repair: a single-blind, randomized study

Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast® and Vicryl Rapide® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18—40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast® (n=47) or Vicryl Rapide® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p&lt;0.05) in total score of episiotomy healing scale on day 2 (0.13±0.34 versus 0.35±0.56) and swelling on day 2 (8.51 versusversus 28.57%) was noted between Trusynth Fast® and Vicryl Rapide® group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. Conclusion: Trusynth Fast® suture is clinically equivalent to Vicryl Rapide® suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020

Late seroma and infection in patients with cranioplasty implants after lateral suboccipital craniectomy

Late wound complications, such as dehiscence or infection, are rare following the retrosigmoid approach, especially when the cranial opening is small. Here, we report two cases of late wound complications after lateral suboccipital craniectomy and cranioplasty with polymethyl methacrylate. Sudden neck rotation was the cause of complications in both cases, and seroma formation, wound dehiscence, and infection developed subsequently 4 and 19 years after surgeries, respectively.

MP23-11 PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: AN INTERNATIONAL MULTICENTER COLLABORATION

MP23-11 PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: AN INTERNATIONAL MULTICENTER COLLABORATION

Meta-analysis of biological mesh reconstruction versus primary perineal closure after abdominoperineal excision of rectal cancer.

Extralevator abdominoperineal excision (ELAPE) of rectal cancer has been proposed to achieve better oncological outcomes. The resultant wide perineal wound, however, presents a challenge for primary closure and subsequent wound healing. This meta-analysis compared the outcomes of primary perineal closure with those of biological mesh reconstruction. The Medline and Embase search was performed for the publications comparing primary perineal closure to biological mesh reconstruction. Early perineal wound complications (seroma, infection, dehiscence) and late perineal wound complications (perineal hernia, chronic pain, and chronic sinus) were analyzed as primary endpoints. Intraoperative blood loss, operation time, and hospital stay were compared as secondary endpoints. There was no significant difference in the overall early wound complications after primary closure or biological mesh reconstruction (odds ratio (OR) of 0.575 with 95% confidence interval (CI) of 0.241 to 1.373 and a P value of 0.213). The incidence of perineal hernia after 1year was significantly high after primary closure of the perineal wounds (OR of 0.400 with 95% CI of 0.240 to 0.665 and a P value of 0.001). No significant differences were observed among other early and late perineal wound complications. The operation time and hospital stay were shorter after primary perineal closure (p 0.001). A lower incidence of perineal hernia and comparable early perineal wound complications after biological mesh reconstruction show a relative superiority over primary closure. More randomized studies are required before a routine biological mesh reconstruction can be recommended for closure of perineal wounds after ELAPE.

Comparison of "onlay" and "sublay" methods of mesh repair of incisional hernia in terms of early and late period wound complications

Comparison of "onlay" and "sublay" methods of mesh repair of incisional hernia in terms of early and late period wound complications

A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of &lt;0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature.

To analyse the incidence of additional soft tissue releases with the lateral parapatellar approach, and the clinical and radiological outcomes of total knee arthroplasties performed using the lateral parapatellar approach for valgus arthritic knees. A review of the existing literature on valgus arthritic knees undergoing knee replacement was performed and our results compared. This is a prospective cohort study of 50 patients operated by this approach. Operation and clinical records were assessed to determine the number and sequence of soft tissue releases. Functional outcome was measured using the Oxford Knee Score. Radiological assessment included measurement of alignment and implant positioning. 46 patients included. Mean follow-up of 4years. Additional lateral releases were performed in 11 (24%) cases. Mean valgus alignment corrected from 13.1 degrees pre-operatively to 5.7 degrees post-operatively. Oxford Knee Score improved from a mean pre-operative score of 11.9 to a mean post-operative score of 38.3 at final follow-up. Radiographs revealed lateralisation of the tibial component in 4 patients. No immediate or late post-operative wound complications, late instabilities or revisions were observed. Lateral parapatellar approach is highly effective in correcting the valgus deformity with a low incidence of additional soft tissue releases. Medium-term results indicate an excellent functional outcome with no complications.

Tissue Oximetry Readings Accurately Predict Late Complications in Patients Undergoing Free Flap Breast Reconstruction: Exploring the Optimal Cut Point Value.

The use of tissue oximetry for monitoring following free tissue transfer has become a common practice across the United States to facilitate early detection of poor flap perfusion in the postoperative setting. There is no consensus on the optimal value, below which there is a higher chance of wound complications in patients undergoing free flap breast reconstruction. Patients undergoing free flap breast reconstruction from 2015 to 2018 were retrospectively reviewed. Patients who returned to the operating room for a revision of the anastomosis were excluded from analysis. Patients were divided in two groups based on the development of late complications. Those were defined as fat necrosis, wound dehiscence, or distal flap ischemia/necrosis that developed after discharge from the hospital. Mean percutaneous oximetry readings of the first 24 hours were recorded and the mean change from the initial reading was calculated. The correlation between tissue oximetry change and development of complications was explored. A total of 120 patients were identified. The mean age was 53, while the mean body mass index was 33. A total of 38 patients developed late wound complication. History of smoking, diabetes mellitus, neoadjuvant radiation therapy, and the mean change of the tissue oximetry reading were identified as independent predictors of wound complications. The absolute number of the tissue oximetry reading did not predict late complications. A multivariate analysis revealed that patients who experienced a mean decrease < 15% from the initial reading during the first 24 hours were significantly more likely to develop late flap-related wound complications. In patients undergoing free tissue breast reconstruction, tissue oximetry readings do not predict late wound complications. However, the mean change at 24 hours from the initial reading does. A decrease of <15% in tissue perfusion was associated with a significant increase in the probability of developing flap-related wound complications.

Outcomes of Layered versus Mass Closure in Transverse Incision during Emergency Laparotomy in Children

Background: The value of laparotomy closure technique may be measured by the incidence of early and late wound complications. The best laparotomy closure technique should be less time consuming, easy and cost-effective, while preventing both early and late complications. Objective: To compare the outcomes of layered versus mass closure in transverse incision during emergency laparotomy in children. Methods: This prospective comparative study was conducted at Department of Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2016 to June 2018. A total of 60 pediatric age cases that underwent laparotomy were included in this study. Cases were randomly allocated into two groups; 30 patients were in Group A (Layered closure) and 30 patients were in Group B (Mass closure). The outcome variables were time required for wound closure, wound infection, wound dehiscence and incisional hernia. Data were analyzed and compared by statistical tests. Results: The mean age of Group A and Group B patients were 31.08 ± 30.25 months and 34.70 ± 42.73 months respectively (p = 0.706). The ratio between male and female subject was 1.1:1 in Group A and 3.3:1 in Group B. The common diseases of the study patients who underwent laparotomy were intussusceptions, intestinal obstruction due to bands and adhesion, perforated appendix and perforation of small intestine due to blunt trauma respectively. Mean wound closure time was significantly less in mass closure group [28.20 ± 2.17 minutes in layered closure group and 18.80 ± 1.67 minutes in mass closure group, (p ≤ 0.001)]. Wound infection rate, incidence of superficial wound dehiscence, and incisional hernia were relatively less in mass closure group, however, the differences were not statistically significant (p = 0.053, p = 0.095 and p = 0.301 respectively). There was no complete wound dehiscence in Group A, but that was in 1 (3.3%) patient in Group B (p = 0.313). Conclusion: Mass closure technique is comparatively better than layered closure technique.

A prospective study of single layer abdominal wall closure in the tertiary care hospital

Background: Despite advances in surgical techniques and material, abdominal wound closure remains challenging. Most abdominal wall incisions are either midline or paramedian. The value of a particular method of closing is determined by the incidence of early and late wound complications. The best abdominal wound closure technique should be, fast, easy, safe and cost effective. It should also prevent or minimize the early and late complications. This study addresses the midline single-layer closure of the abdominal wound.Methods: The purpose of this study is to evaluate the single layer midline abdominal wound closure. The early and late complications associated with this method are studied, and relevant literature reviewed. The study period is from May 2016 to May 2018, i.e. 24 months. The study group comprises of 52 patients, admitted in the department of surgery SBRKM Government medical college Jagdalpur. In all of them, the midline incisions closed in a single layer by a non-absorbable continuous suture. The skin closed separately. The mean age of the patient is 46.5 years. The male to female ratio is 3:1. Emergency laparotomy done in 35 cases and 17 (38.4%) underwent elective surgeries.Results: In this series 20 (38.4%) patients had wound infection. 10 (19.2%) patients had wound gaping. There was no incisional hernia in six months follow-up.Conclusions: Single layer abdominal wall closure has a definite advantage. It is fast, easy and cost-effective. Continuous running suture with non-absorbable material provides enough strength during healing and is better than interrupted sutures. The incidence of early and late complications is also significantly less. The results are comparable to many meta-analyses and RCT did in this field.

Outcome analysis of surgery for symptomatic spinal metastases in long-term cancer survivors.

As patients with metastatic cancer live longer, an increased emphasis is placed on long-term therapeutic outcomes. The current study evaluates outcomes of long-term cancer survivors following surgery for spinal metastases. The study population included patients surgically treated at a tertiary cancer center between January 2010 and December 2015 who survived at least 24 months postoperatively. A retrospective chart and imaging review was performed to collect data regarding patient demographics; tumor histology; type and extent of spinal intervention; radiation data, including treatment dose and field; long-term sequelae, including local tumor control; and reoperations, repeat irradiation, or postoperative kyphoplasty at a previously treated level. Eighty-eight patients were identified, of whom 44 were male, with a mean age of 61 years. The mean clinical follow-up for the cohort was 44.6 months (range 24.2-88.3 months). Open posterolateral decompression and stabilization was performed in 67 patients and percutaneous minimally invasive surgery in 21. In the total cohort, 84% received postoperative adjuvant radiation and 27% were operated on for progression following radiation. Posttreatment local tumor progression was identified in 10 patients (11%) at the index treatment level and 5 additional patients had a marginal failure; all of these patients were treated with repeat irradiation with 5 patients requiring a reoperation. In total, at least 1 additional surgical intervention was performed at the index level in 20 (23%) of the 88 patients: 11 for hardware failure, 5 for progression of disease, 3 for wound complications, and 1 for postoperative hematoma. Most reoperations (85%) were delayed at more than 3 months from the index surgery. Wound infections or dehiscence requiring additional surgical intervention occurred in 3 patients, all of which occurred more than a year postoperatively. Kyphoplasty at a previously operated level was performed in 3 cases due to progressive fractures. Durable tumor control can be achieved in long-term cancer survivors surgically treated for symptomatic spinal metastases with limited complications. Complications observed after long-term follow-up include local tumor recurrence/progression, marginal tumor control failures, early or late hardware complications, late wound complications, and progressive spinal instability or deformity.

Syndesmotic fixation in unstable ankle fractures: Does early post-operative weight bearing affect radiographic outcomes?

ObjectiveTo analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis. DesignRetrospective comparative cohort study over a two year period. SettingLevel 1 trauma centre Patients/Participants152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation without syndesmosis screws, one patient who had concomitant ankle and talar fracture. Five patients were lost to follow up and eleven patients were followed up in other centres. A total of 86 patients were analysed InterventionProtected or full weight bearing. Main Outcome MeasurementThe primary outcome measure was early diastasis. The secondary outcomes were late diastasis, wound complications and re-operation. Analysis of variance was used for the predictor variable of weight bearing status. We assumed a priori that p values of less than 0.05 were significant. ResultsMedian age was 36 (IQR 30), with 54 males and 32 females. Median follow up was 12 weeks (IQR 6). There was no significant difference when comparing weight bearing status and change in radiographic measurements intra-operatively compared to 6 and 12 week follow up radiographs (tibiofibular clear space p = 0.799, tibiofibular overlap p = 0.733 and medial clear space p = 0.261). ConclusionAfter surgical stabilization of an unstable syndesmotic injury, full weight bearing did not lead to syndesmotic diastasis in the early post-operative period. Full weight bearing is recommended following ankle fixation which includes syndesmotic fixation.

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Introduction: The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were documented. Results: We found early (Day 1 - Day 3) infection rate of 5.6%, intermediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for fracture reduction of calcaneal fractures with acceptable wound related complication rate. Minimally invasive techniques and the sinus tarsi approach are being used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.

Post-operative wound complications following emergency and elective abdominal surgeries

Background: The post-operative wound complications can be defined as any negative outcome as perceived either by the surgeon or by the patient. Objectives were to study the early and late post-operative wound complication of patients undergoing emergency and elective abdominal surgery, to find out and compare the incidence of post-operative wound complications following emergency and elective abdominal surgery and to find out and compare the factors associated with wound complications following elective and emergency abdominal surgery.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 years (from July 2015-September 2017) and is a prospective type of study using 100 cases (Group A: Elective and Group B: Emergency abdominal surgeries –50 each). The study was approved by the Institute’s Ethics Committee.Results: 100 patients were operated in our study. The type of collection from surgical site was seropurulent in 4 (8%) patients and purulent in 1 (2%) patient of Group A whereas it was seropurulent in 5 (10%) patients and purulent in 1 (2%) patient of Group B. The type of collection in Closed Suction Drain was Serous in 12 (24%) patients, Serosanguineous in 10 (20%) patients and Seropurulent in 1 (2%) patient of Group A whereas it was Serous in 13 (26%) patients, Serosanguineous in 10 (20%) patients and Seropurulent in 1 (2%) patient of Group B. The post-operative hospital stay for majority of the patients in Group A was ≤10 days (82%) while it was 11-14 days for Group B (54%).Conclusions: Possible complications following elective surgery and those following urgent/emergency surgery, a debatable issue was the possibility of significant differences between them. The emergency laparotomies are also more common than elective laparotomies especially at peripheral centers. These findings suggest that wound complications do occur in elective abdominal surgeries. These can be reduced to a certain extent by careful case selection, improving Hb levels prior to surgery, using adequate prophylaxis and better surgical practices.

Late Dacron Patch Inflammatory Reaction after Carotid Endarterectomy

The aim was to analyse the incidence and presentation of carotid patch inflammatory reactions following carotid endarterectomy (CEA). This was a cohort study using a prospectively maintained database. All patients who underwent elective CEA at a tertiary vascular centre between 2002 and 2016 were included. Computed tomography scan angiogram, duplex scan, and leucocyte scintigraphy were used to assess patients with suspected inflammatory patch complications. Re-intervention procedures and outcomes were noted. Histopathology and organisms cultured from the harvested material during re-intervention were assessed. During the study period, 633 patients underwent elective CEA. Fifty-one underwent eversion endarterectomy: 111 did not require a patch, whereas 471 patients had a patch repair. Four hundred and twenty eight had a Dacron patch repair and 43 a biological patch. Eight patients returned with late Dacron patch inflammatory complications (1.3% of all CEA and 1.9% of Dacron patch closures) after a period ranging from 18 months to 7 years (mean 4.1±2.1 years). Seven of the eight patients underwent surgical re-intervention, and the eighth patient was deemed high surgical risk. One patient underwent a vein bypass, three had vein patch repair, one required internal carotid artery (ICA) ligation after patch excision, and two were managed by debridement, with omohyoid and sternomastoid muscle covering of the patch. The patient who required ICA ligation suffered a fatal stroke. The remaining patients had a satisfactory outcome. All patients showed evidence of foreign body reaction in pathological examination with no pathological organism cultured from swabs or tissue harvested during surgery. Late wound complications after CEA may be related to inflammatory reaction of the Dacron patch rather than infection. Infection should be excluded first. Reconstruction with vein is effective. However, debridement with sternomastoid and omohyoid muscle covering of the patch may be considered in high risk patients after exclusion of infection with regular follow-up.

A prospective study of proton reirradiation for recurrent and secondary soft tissue sarcoma

Background and purposeProton reirradiation for sarcoma has not been previously described. We hypothesized that this strategy would provide favorable toxicity and survival outcomes. Material and methodsPatients with soft tissue sarcoma in a previously-irradiated field were enrolled on a prospective trial of proton reirradiation. The primary endpoint was provider-reported acute toxicity. Secondary endpoints included late toxicities, local control, and overall survival. Results23 patients underwent proton reirradiation. Median time between radiation courses was 40.7months (range 10–272). No grade 4–5 toxicities were observed. One patient (4%) experienced acute grade 3 dysphagia. Common grade 2 acute toxicities were fatigue (26%), anorexia (17%), and urinary incontinence (13%). There were two grade 3 late wound infections (10%) and one grade 3 late wound complication (5%). Grade 2 late complications included lymphedema (10%), fracture (5%), and fibrosis (5%). At a median follow-up of 36months, the 3-year cumulative incidence of local failure was 41% (95% CI [20–63%]). Median overall survival and progression-free survival were 44 and 29months, respectively. In extremity patients, amputation was spared in 7/10 (70%). ConclusionsProton reirradiation of recurrent/secondary soft tissue sarcomas is well tolerated. While longer follow-up is needed, early survival outcomes in this high-risk population are encouraging.

Wound Complications Due to Obesity in the Patients Undergoing Abdominal Surgery

&lt;p&gt;Various factors may affect the outcome of patients in perioperative period. Obesity is considered as one of these factors which increases the risk of perioperative complications. The wound complications in obese and non-obese are different.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The objective of the study was to compare wound complications in obese and non-obese patients undergoing abdominal surgery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This comparative study was conducted from 01- 05-2012 to 30-04-2015 on 140 patients in the department of surgery, Mayo Hospital Lahore. All these patients were divided into two groups of 70 patients each. Group A (obese) and B (nonobese) on the basis of body mass index. The patients of age less than 12 years, peritonitis, diabetes mellitus, jaundice, renal failure, coagulation disorder were excluded in both groups. All the patients had open and laparoscopic surgery by the consultant on elective list. The operative and postoperative findings and outcome in term of wound complications like wound infection, dehiscence, seroma, hernia, were noted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the140 patients were divided into group A (obese) and B (non obese) of 70 patients each. The age ranged from 17 to 58 years and males were common (50.8%) than females (49.2%). In group A, body mass index varied from 31.9kg m&lt;sup&gt;-2&lt;/sup&gt; to 39.08kg m&lt;sup&gt;-2&lt;/sup&gt; and in group B from 19.3kg m&lt;sup&gt;-2&lt;/sup&gt; to 23.2kg m&lt;sup&gt;-2&lt;/sup&gt;. The complications in group A were wound infection in 18, dehiscence in 5, seroma in 13, and hernia 4 patients. While in group B, the complications were wound infection in 3, seroma in 5, no dehiscence and incisional hernia in one patient. The results showed that early and late wound complications are more in obese patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The wound complications are significantly associated with obesity in patients undergoing abdominal surgery and are more in obese than in non obese patients.&lt;/p&gt;

Delayed Introduction of Everolimus in De Novo Renal Transplanted Patients: A Single-Center Experience

IntroductionImmunosuppressive protocols containing everolimus (EVR) preserve good renal function in kidney transplantation (KT), although they are often complicated by several adverse events. We have evaluated the efficacy and safety of a protocol with late (1 month after KT) EVR introduction. Material and MethodsThis study randomized 49 de novo patients undergoing KT between September 2012 and June 2014 into 2 groups: group A (n = 24) with late EVR introduction and tacrolimus reduction, and group B (control group; n = 25) with a standard immunosuppressive regimen. Primary aims were 1-year patient and graft survivals and acute rejection rates. Secondary aims were related to wound, metabolic, and hematologic complications. ResultsPatient and graft survivals were similar in both groups. One year after KT, median serum creatinine was inferior in group A (1.4 vs 1.8 mg/dL; P = .004). Late acute rejection (8.3 vs 12.0%; P = 1.0) and wound complication (4.2 vs 4.0%; P = 1.0) rates were similar. Higher cholesterol and triglycerides and lower platelets and hemoglobin levels were observed in group A. ConclusionsIn our experience, delayed introduction of EVR shows similar results with respect to its early introduction, contemporaneously presenting fewer wound complications and lymphoceles. A higher rate of metabolic and hematologic complications are, however, observed in patients under EVR therapy. Further multicenter studies should be performed to confirm these preliminary results.