Local Postoperative Complications Research Articles

Safety of thyroidectomy and cervical neck dissection without drains

Many studies have reported that drainage after thyroidectomy does not decrease the rate of local postoperative complications. We sought to review the safety of thyroidectomy combined with cervical neck dissection (CND) without drainage. The medical records of consecutive patients who underwent thyroidectomy without drainage were retrospectively reviewed. Two groups were defined depending on whether CND was or was not performed. The main outcome was identification of patients with cervical bleeding, hematoma or seroma. We included 1127 patients (139 who had CND and 988 who did not). Of these, 207 patients (18%) had transient postoperative hypocalcemia, 9 (0.8%) had permanent postoperative hypoparathyroidism, 56 (5%) had transient postoperative hoarseness and 7 (0.6%) had permanent vocal cord paralysis. A total of 44 patients (4%) experienced postoperative hematoma and/or seroma: 8 patients (6%) who had CND and 36 (4%) who did not. There was no major bleeding in the 2 groups; all patients had minor bleeding or seroma not requiring surgical intervention. The postoperative stay in hospital for both groups was 1 day in 92% of patients. Wound infection occurred in 0.8% of all patients: 1 (0.7%) who had CND and 8 (0.8%) who did not. There was no significant difference between the groups in overall perioperative complications or in time of hospital discharge. Thyroidectomy without drains is safe and effective, even in combination with CND.

Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center

In this double-blind prospective randomized trial, our objective was to investigate the effect of antibiotic prophylaxis in patients undergoing elective inguinal hernia surgery with mesh repair in a large-volume tertiary referral trauma center. Eligible patients were assigned randomly to either an antibiotic prophylaxis group or a control group. Patients in the prophylaxis group were given 1 g cefazolin by IV bolus injection whereas the placebo control group received an equal volume of sterile saline preoperatively. A Lichtenstein repair was done in all cases. The patients were examined for surgical site infection (SSI) and other postoperative local complications before discharge, and reexamined 3, 5, 7, and 30 days after discharge. Groups were well matched for age, sex, coexisting diseases, ASA scores, type of hernia, type of anesthesia, duration of surgery. Incidence of infection was 7% in the control group (7/100) and 5% in the prophylaxis group (5/100) (P = 0.38). All the infections were superficial and responded well to drainage and proper antibiotic therapy. All other postoperative complications were similar in the two groups. In our settings antibiotic prophylaxis has no significant effect on the incidence of SSI in elective repair of inguinal hernias with mesh. The most effective way to reduce the incidence of infection in prosthetic repair may be a specific center for treatment of abdominal wall hernias.

The Proximal Femur Nail Antirotation: An Identifiable Improvement in the Treatment of Unstable Pertrochanteric Fractures?

The optimal surgical treatment of patients with an unstable extracapsular proximal femoral fracture is yet to be found. From the biomechanical point of view, the use of an intramedullary device in combination with a dynamic femoral head/neck stabilization implant seems an optimal technique. One of these intramedullary devices, the Proximal Femoral Nail (PFN), has several drawbacks in practice. The Proximal Femur Nail Antirotation (PFNA) has been designed to address these. We hypothesized that the placement of one femoral head/neck fixation device in the PFNA would improve positioning of the implant in the femoral head compared with the PFN and reduce the number of reoperations in both short and long term. We followed 157 consecutive patients with unstable trochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.2 and A.3) treated with a PFN or a PFNA for 1 year. The radiologic position of the implant was evaluated, and the postoperative local and systemic complications were registered. The position of the femoral head/neck stabilization implant was "good" in 39 (44.8%) patients in the PFN group and 23 (32.9%) patients in the PFNA group; the position was "acceptable" in 30 (34.5%) versus 33 (47.1%) patients, and in 18 (20.7%) versus 14 (20%) patients, the position was "poor" (p = 0.277). Because of implant-related complications, three patients in the PFN group and four patients in the PFNA group needed an early reoperation (p = 0.136). A late reoperation because of implant-related complications was performed in 13 patients in the PFN group and in three in the PFNA group (p = 0.016). This study shows that osteosynthesis with the PFNA does not improve the position of the implant in the femoral head compared with the PFN. However, the risk of a secondary complication and the necessity of a late reoperation are significantly higher in patients treated with a PFN compared with patients treated with a PFNA.

Complications of total laryngectomy in the era of chemoradiation

As more total laryngectomies (TLE) are nowadays performed as salvage procedures, the rate of postoperative complications increases. The primary aim was to report the rates of postoperative local complications for total laryngectomy in patients with previous radiotherapy or chemoradiotherapy (RT/CRT) in comparison with primary TLE data. We attempted to identify patient- and tumor-related factors predictive of postoperative pharyngocutaneous fistula (PCF) formation. The secondary aims were to analyze the survival rate in relation to postoperative complications and to study prognostic factors of survival in TLE patients. A retrospective study was conducted in 208 patients. Logistic regression was used to determine the most significant risk factors for fistula formation. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. PCF developed in 20.7% of cases. In the group of patients with previous RT/CRT, the fistula rate was significantly higher (34%). In multivariate analysis, significant risk factors for fistula formation were previous radiotherapy or chemoradiotherapy (p = 0.02), higher N classification (p = 0.03), and procedure performed by a less experienced surgeon (p = 0.003). The survival and recurrence rates were not influenced by PCF formation. The overall survival rates were lower in patients with previous RT/CRT and in patients with lymph node involvement.

Oral piercing and oral diseases: a short time retrospective study.

Body piercing indicates the puncturing of a part of the body in which jewelry may be worn. In recent years, oral piercing is increasingly popular especially among young people. Body piercing has to be considered as a surgical procedure to all intents and purposes and, as such, has to be performed only by qualified personnel able to assure high standards of professionalism in facilities subject to sanitary inspections.The aim of the present work is to verify what risks patients may be exposed to and what complications may occur after a healthcare professional performs oral piercing.Our retrospective study includes 108 patients (74 males and 34 females) aged between 14 and 39 years, who had oral piercing done 12±4 months earlier. All the patients underwent clinical examination to reveal the possible presence of late complications. After piercing, none of the 108 patients developed widespread complications.Although all patients said they had followed the piercers' instructions, 96% of them reported postoperative local complications such as bleeding within 12 hours of piercing (90%), perilesional edema for 3±2 days after piercing surgery (80%), and persistent mucosal atrophy (70%).

The phlebological surgery in elderly patients

The pathogenesis of the lower limbs varicose veins in the elderly patients is the same one as in the juvenile and adult age. What changes is the severity of the clinical picture, because the disease is a chronic pathology and it is aggravated with the passing of the years in absence of prophylaxis and missed or inadequate therapy. Equally the surgical operations on the superficial venous system of the elderly patients from a technical point of view are the same that are practiced in other ages of life. What changes is the anaesthesiological risk, which is increased, because other chronic pathologies are frequently associated with the old ones. Currently both the use of techniques of peripheral anesthesia, as the blocks of the lower limbs nervous trunks, and the introduction of poor toxic anesthetics for the heart in therapeutical practice allow in an incisive way to submit elderly people to surgical procedures. Above all the out-patient hemodynamic surgery of the superficial chronic venous insufficiency, which requires a careful and meticulous instrumental investigation aimed surgical gestures, but simple, effective, of brief duration, has convinced many surgeons of the possibility to operate on the varicose patients of a more and more advance age. On the other hand the rapid postoperative mobilization of those sick, in absence of immediate complications, means that they can be discharged from the hospital on the same day of the operation. This undoubtedly involves positive reflexes on the sanitary expense and it increases at the same time the compliance in terms of motivation and acceptance of the proposed procedure. The elderly patient, perhaps more than the younger adult, once informed of the new anaesthesiological and surgical techniques, gladly gives his consent to the intervention, pleased to return to his own house and tquickly return to his daily occupations. How much I dictate you is translated in our experience, that is carried out near the Phlebological Center of the Siena University, in a progressive increase in the last 5 years both in absolute terms (223) and percentages (12%) of the number of subjects older than sixty-five years old that have been submitted to surgical operations for the venous disease. Of all 223 patients, males are 68 and females are 155; 144of them have an age between 66 and 70 years, 73 belonging to the eighty years of life and 6 subject to the ninty. All patients have been operated in Day Hospital admission. No mortality has been found. Local postoperative complications was encountered in 1,8% of the cases.

Population-based trend analysis of 2813 patients undergoing laparoscopic sigmoid resection

The use of laparoscopic sigmoid resection for diverticular disease has become increasingly popular. The objective of this trend analysis was to assess whether clinical outcomes following laparoscopic sigmoid resection for diverticular disease have improved over the past 10 years. The analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. Some 2813 patients undergoing elective laparoscopic sigmoid resection for diverticular disease from 1995 to 2006 were included. Unadjusted and risk-adjusted analyses were performed. Over time, there was a significant reduction in the conversion rate (from 27.3 to 8.6 per cent; P(trend) < 0.001), local postoperative complication rate (23.6 to 6.2 per cent; P(trend) = 0.004), general postoperative complication rate (14.6 to 4.9 per cent; P(trend) = 0.024) and reoperation rate (5.5 to 0.6 per cent; P(trend) = 0.015). Postoperative median length of hospital stay significantly decreased from 11 to 7 days (P(trend) < 0.001). This first trend analysis in the literature of clinical outcomes after laparoscopic sigmoid resection, based on almost 3000 patients, has provided compelling evidence that rates of postoperative complications, conversion and reoperation, and length of hospital stay have decreased significantly over the past 10 years.

頭頸部癌再建術後局所合併症に対する対応

The goals of head and neck reconstruction after malignant tumor resection include obtaining good postoperative function and appearance and minimizing operative invasiveness. However, the most important goals are reducing local postoperative complications and discharging the patient early, because patients requiring head and neck reconstruction tend to have poorer prognoses. Local complications delay wound healing, postoperative treatment, and postoperative recovery of eating and speech functions. Thus, when shown to be necessary by clinical observation and imaging findings, we open the wound area promptly and attempt to diagnose the complication. In this way, we can discover cervical infections and minimize wound contamination before more serious complications, such as total flap necrosis, develop. We review measures for preventing local complications in patients undergoing head and neck reconstruction at our institution and divide them into preoperative, intraoperative, and postoperative measures.

Prophylactic use of the silver-acetate–coated graft in arterial occlusive disease: A retrospective, comparative study

Silver-coated vascular polyester prostheses were developed not only for the treatment of prosthetic graft infections, but also for use as prophylaxes. Although some studies describe the use of these prostheses in cases of infection, there are few data on their prophylactic use. This study compares the performance of the InterGard Silver polyester graft (Intervascular, Datascope, Inc, La Ciotat, France) with that of standard prostheses in routine use. This retrospective study included all patients who received alloplastic bypass for treatment of arterial occlusive disease at the University Hospital in Würzburg from January 1996 to December 2006. The courses of disease were analyzed by examining the medical records. Follow-up research documented long-term results. The cases of 913 patients were analyzed (430 silver grafts, 483 standard grafts). Indications for the operations were claudication (silver: 136, nonsilver: 212), rest pain (49/65), tissue loss (135/148), and acute occlusion (110/58). Prosthetic implantation was performed in the aorto-iliaco-femoral position (silver: 93, nonsilver: 146), in the femorodistal position (309/304), and as multilevel reconstruction (28/33). With regard to perioperative complications, the two groups did not differ significantly. There were no silver release-related complications, such as colored exudation or wound staining. Mean follow-up time was 56.7 +/- 1.6 (SEM) months. When corrected for redo procedures, stage of disease, and type of reconstruction, both materials performed equally well: 5-year patency for claudication: silver 91%, nonsilver 95%, femorodistal 47%/41%; 5-year patency for critical ischemia: aortofemoral 88%/93%, femorodistal 31%/35%; 5-year limb salvage (critical ischemia): aortofemoral: 78%/79%; femorodistal: 59%/67%. Graft infections (Szilagyi grade III) were detected in 59 patients (6.4%; silver: n = 32, 7.4% vs control: n = 27, 5.5%; P = .28) after an average of 321 +/- 96 days. One infection occurred out of 93 aortofemoral operations with the silver prosthesis (1.1%) compared to 4.1% (6/146) in the control group (P = .17). For patients with femorodistal grafts, silver exhibited an infection rate of 9.4% compared to 5.9% (P = .11). In the multiple regression analysis, two factors influenced the rate of a graft infection significantly: wound healing impairment and revision after bypass implantation. Silver did not prevent a subsequent bypass infection in these cases (silver: 18.1% vs 12.5%, P = .27). The silver-coated prosthesis did not differ from standard materials. Silver had no significant effect on the risk of graft infection. Our study showed good results with the silver prosthesis in the aorto-iliaco-femoral position, but in cases of femorodistal grafting, a reduction of prosthetic infections was not achieved. The silver grafts did not prevent subsequent infections in cases of tissue loss or postoperative local complications.

Postbariatric Patients Undergoing Body-Contouring Abdominoplasty

Postbariatric patients undergoing abdominoplasties were retrospectively analyzed to correlate postoperative local complications with the 2 most commonly used techniques of raising the abdominal flap: diathermocoagulation versus scalpel. All patients undergoing body-contouring abdominoplasties were included. Excluded were patients with ongoing clinical infections, those that received a complete course of antibiotic in the 6 months before operation, those requesting steroid therapy, those with systemic diseases that could impair wound repair (arteriosclerosis, diabetes mellitus), and those who had undergone apronectomy. One hundred thirty-seven patients were divided into 2 groups (diathermocoagulation = 90 vs. scalpel = 47). Overall, 7 seromas (5.1%), 7 hematomas (5.1%), and 28 wound infections (20.4%) were detected. A higher occurrence of postoperative hematomas was found after the flap raised using a scalpel (12.8% vs. 1.1%, Fisher exact test, P < 0.05), with a relative risk of 11.6. A significant association existed between postoperative hematomas and wound infections with delayed healing (n = 10, 7.3%): 43% of patients with a hematoma also experienced a wound infection with delayed healing versus 5.4% of those that did not develop hematomas (Fisher exact test; P < 0.01). In patients for whom a scalpel had been used to raise the flap, this correlation persisted (50% of patients with a hematoma had developed a wound infection with delayed healing vs. 7.3% of those that did not develop hematomas; Fisher exact test; P < 0.05).In postbariatric patients, diathermocoagulation reduces the occurrence of postoperative hematomas and wound infections with delayed healing compared with the cold knife.

Suppression of the postoperative neutrophil leucocytosis following neoadjuvant chemoradiotherapy for rectal cancer and implications for surgical morbidity

The extent to which neoadjuvant chemoradiotherapy for rectal cancer influences postoperative morbidity is controversial. This study investigated whether this treatment suppresses the normal perioperative inflammatory response and explored the clinical implications. Prospective databases were queried to identify 37 consecutive study patients undergoing definitive surgery following 5-FU/capecitabine-based chemoradiotherapy and 34 consecutive untreated control patients operated upon for rectal or rectosigmoid cancer. Preoperative (< 10 days) and postoperative (< 24 h) neutrophil counts, along with morbidity data, were confirmed retrospectively. Univariate and multivariate analyses assessed the apparent effect of chemoradiotherapy on change in neutrophil count. The latter's association with postoperative morbidity was then examined. Sufficient data were available for 34 study and 27 control patients. Repeated-measures ANCOVA revealed significant differences between their perioperative neutrophil counts (P = 0.02). Of the other characteristics which differed between the groups, only age and tumour location were prognostically significant regarding perioperative change in neutrophil count. Accounting for relevant covariates, chemoradiotherapy was significantly associated with a suppressed perioperative neutrophil leucocytosis. Local postoperative complications affected 25 of 61 patients, who had lower perioperative neutrophil increases than their counterparts (P = 0.016). Chemoradiotherapy appears to suppress the perioperative inflammatory response, thereby increasing susceptibility to local postoperative complications.

Mannheim Peritoneal Index in the Prediction of Postoperative Complications in Patients with Peritonitis

Objective: to study the diagnostic and prognostic values of the Mannheim peritoneal index (MPI) in the development of postoperative local and systemic complications in patients with peritonitis. Materials and methods. The case histories of 92 patients with generalized peritonitis of varying etiology (other than pancreatogenic one) were analyzed. The patients were retrospectively divided into 3 groups according to the outcomes and occurrence of postoperative local complications. The postoperative complications were classified by the procedure developed by A. L. Kostyuchenko et al. as local and systemic ones. When the patients had two signs or more of the systemic inflammatory response syndrome, they were stated to have systemic complications and to be diagnosed as having abdominal sepsis with the pattern of organ dysfunctions being described in accordance with the sepsis classification proposed by R. S. Bone et al. (1992). The number of organ dysfunctions was daily counted in each patient over time in the postoperative period. On the first postoperative day, MPI was calculated in scores for each patient; the mean MPI was estimated for all patient groups. The predictable mortality was calculated using the MPI plot. Results. All the patients with generalized peritonitis in the development of local postoperative complications were observed to have sepsis in the postoperative period, without developing local complication in 84.6% of the patients. A direct correlation was found between the MPI and the quantity of organ dysfunctions (r=0.6; p=0.001). In patients with local postoperative complications being developed, the MPI values were higher (p&lt;0.05) than in those without them. The mortality rates that have been predicted by means of MPI (16.3%) and actual (15.2%) are actually in agreement. Conclusion. There is evidence for the diagnostic and prognostic values of MPI in the development of local and systemic postoperative complications in patients with peritonitis. MPI calculation from postoperative day 1 along with later dynamic estimation of the number of organ dysfunctions makes it to objectively assess not only prognosis, but also the pattern of postoperative peritonitis. The major advantage of MPI is the simplicity of calculation, which permits its use in clinics. Key words: peritonitis, prognosis, complications, sepsis, Mannheim peritoneal index.

The Impact of Comorbidity on Surgical Outcomes in Laparoscopy-Assisted Distal Gastrectomy

The purpose of this study was to evaluate the impact of comorbidities on the surgical outcomes in laparoscopy-assisted distal gastrectomy (LADG). Although laparoscopic gastrectomy is less invasive than conventional open surgery, surgeons are still concerned with surgical outcomes associated with comorbidity. We retrospectively collected data on 1324 patients who underwent LADG between April 1998 and December 2005 by 10 surgeons in 10 hospitals. After excluding 87 patients who had an unusual medical history or surgical methods, 1237 patients were enrolled for analysis to evaluate the effect of comorbidities on the surgical outcomes. Seven patients (0.6%) died during their hospitalization, and postoperative complications occurred in 162 (13.1%) of 1237 patients. According to univariate analysis, gender, number of comorbidities, reconstruction type, and the surgeon's experience in laparoscopy-assisted gastrectomy (LAG) were related to postoperative local complications; age and comorbidity were related to systemic complications; and comorbidity was the only variable related to hospital mortality. Comorbidity was a predictive risk factor for local complications (odds ratio (OR): 1.79) and systemic complications (OR: 2.89) in multivariate analysis. The patients with pulmonary comorbidity were related to most types of immediate postoperative complications compared with other comorbidities. Our study suggests that comorbidities of patients could be a predictive risk factor for surgical complication after LADG. Therefore, patients with early gastric cancer having comorbidity should be considered for one of the limited surgeries. In addition, surgeons should carefully assess patients with comorbidities with full perioperative attention.

Postoperative Komplikationen elektiver Kolonresektionen bei Divertikulitis

Data on 142 patients (57 men, 85 women; mean age 64.2 [37-91] years) who had elective colon resection for diverticulitis were retrospectively analysed with respect to postoperative morbidity and mortality. Associated systemic disease was present in 47.9% of patients; intraabdominal complications were found preoperatively in 55.6%. Resection with primary anastomosis was performed in 97.9% of patients. Local postoperative complications were noted in 14.1%, general complications in 31.7%. Two patients died postoperatively of the consequences of local complications. In both cases diverticulitis had been complicated by fistulas (mortality rate 1.4%). With careful preparation, standardized operative technique and intensive perioperative supervision the risk of elective colon resection for diverticulitis is low. It can thus be undertaken, even after the first severe attack of diverticulitis, in patients without associated disease.

Duodenum-preserving total pancreatic head resection for cystic neoplastic lesions in the head of the pancreas

Cystic neoplastic lesions of the pancreas are now found with increasing frequency. Duodenum-preserving pancreatic head resection with segmental resection of the duodenum has been introduced for the surgical treatment of inflammatory and neoplastic lesions. We report the following data from 15 patients treated surgically for cystic neoplastic lesions of the pancreas head. Duodenum-preserving total pancreatic head resection (DPPHRt) with segmental resection of the duodenum (SD) was performed in eight patients, five with intraductal papillary mucinous neoplasm (IPMN), two with mucinous cystic neoplasm (MCN), and one with cystic endocrine neoplasm (EN). In four patients, a subtotal pancreatic head resection was performed, but recurrence of the IPMN lesion was observed in two patients. Ten patients suffered cystadenoma, three patients had a borderline lesion, and two patients had an in-situ carcinoma. Eight patients had a DPPHRt with SD resection, two patients had a resection of the uncinate process including segmental resection of the inferior duodenal segment, and one patient had a duodenum-and spleen-preserving total pancreatectomy. In four patients a DPPHR with subtotal pancreatic head resection was carried out. Postoperative local complications occurred in eight patients: there was a recurrence of the IPMN lesion in the remnant pancreatic head in two patients; and there was intraabdominal bleeding in one patient, pancreatic fistula in one patient, and delay of gastric emptying in four patients. Seven patients showed signs of acute pancreatitis. Hospital mortality was 0%, and postoperative length of hospital stay was 10. 4 days (range, 8-18 days). Duodenum-preserving total pancreatic head resection for IPMN, MCN, serous cystadenoma (SCA), and cystic EN lesions is a safe and beneficial surgical procedure. Segmental resection of the duodenum was applied for an oncologically complete resection. In regard to long-term outcome, the procedure is, additionally, a pancreatic cancer preventive strategy.

Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results

The aim of this review was to evaluate surgical outcomes of laparoscopic cholecystectomy for gangrenous and empyematous acute cholecystitis defined as severe acute cholecystitis. It is not known to what extent surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis differ from those for the nonsevere acute form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases. Literature searches were conducted to identify: (1) comparative studies which reported laparoscopic surgical outcomes separately for severe acute and nonsevere acute cholecystitis; (2) studies comparing such an approach with open cholecystectomy, subtotal laparoscopic cholecystectomy or cholecystostomy in severe acute cholecystitis. Results were pooled by standard meta-analytic techniques. Seven studies with a total of 1,408 patients undergoing laparoscopic cholecystectomy were found. The risks of conversion (RR 3.2, 95% CI 2.5 to 4.2) and overall postoperative complications (RR 1.6, 95% CI 1.2-2.2) were significantly higher in severe acute cholecystitis with respect to the nonsevere acute forms. However, no difference was detected as regards to local postoperative complications. No studies comparing open cholecystectomy or cholecystostomy with urgent laparoscopy were found. A lower feasibility of laparoscopic cholecystectomy has been found for severe cholecystitis. A lower threshold of conversion is recommended since this may allow to reduce local postoperative complications. Literature data lack valuable comparative studies with other treatment modalities, which therefore need to be investigated.

Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications.

Primary shoulder hemiarthroplasty is an established treatment modality for complex fractures of the proximal humerus. Long-term functional outcome is often disappointing. However, little is known about social implications particularly in the elderly. A single-institution case series of consecutive geriatric patients (age > 70 years) treated with shoulder hemiarthroplasty for complex fractures of the proximal humerus between 1994 and 1997 was analysed. Postoperative morbidity, long-term function, radiological outcome and social implications were evaluated. Seventy-seven patients fulfilled the study criteria. Median age at the time of operation was 80 years (range 70-93 years). Systemic and local postoperative complications were observed in 8% including 2 patients (3%) with revision surgery. Postoperative mortality was 1%. Forty-eight patients (62%) were available for follow-up (median 49 months, range 25-80 months), 22 (29%) died from causes unrelated to hemiarthroplasty before follow-up and 7 patients (9%) did not attend follow-up examination. Median Constant-Murley score was 41 points (range 17-77 points). Long-term results concerning pain were satisfying. The Oxford shoulder score ranged from 14 to 40 (median 30). Forty-one patients (85%) still lived in their original environment and managed their daily life independently despite poor shoulder function. Four patients (8%) lived in a retirement home and 3 (6%) in a nursery home. Eighty percent of our patients were still able to use public transportation, do the daily shopping and wash their whole body by themselves. Most patients managed their daily life independently despite poor shoulder function.

Complicações pós-operatórias em tireoidectomias com ou sem dreno

OBJETIVO: Analisar a ocorrência de complicações pós-operatórias locais (hematoma, seroma e infecção de ferida) e tempo de hospitalização em pacientes submetidos à tireoidectomia com ou sem dreno. MÉTODO: Quatrocentos e noventa e oito pacientes submetidos à tireoidectomia foram classificados de acordo com o uso ou não de dreno. Os pacientes foram agrupados para facilitar a descrição em: grupo não drenado; grupo drenado com Penrose e grupo drenado com Hemovac. Cada grupo era composto por 166 pacientes. RESULTADOS: A taxa de complicação foi 7,4% (37/498). O tempo de hospitalização variou de 1 a 5 dias (mediana, um dia), com 85,6% dos pacientes no grupo não drenado ficando um dia, enquanto o mesmo ocorreu em 51,8% dos pacientes do grupo drenado com Hemovac e em apenas 26,9% dos pacientes do grupo drenado com Penrose. Com isso, o tempo médio de hospitalização foi significativamente maior nos pacientes do grupo drenados com Penrose comparado com os outros grupos (p=0,0001). Hematoma foi uma complicação encontrada em 1,4% dos pacientes (7/498). Complicações como seroma e infecção de ferida cirúrgica foram encontradas em 4,4% e 1,8% dos pacientes, respectivamente. Nenhuma correlação estatisticamente significativa foi observada quanto à ocorrência de tais complicações e a presença ou não de dreno. CONCLUSÕES: O uso rotineiro de dreno em pacientes submetidos à tireoidectomia não apresenta benefícios. A seleção criteriosa dos pacientes e uso de medidas meticulosas de hemostasia são importantes para reduzir o risco de complicações pós-operatórias como hematoma e seroma.

Management of Periocular Basal and Squamous Cell Carcinoma: A Series of 485 Cases

To analyze the outcome of management of patients with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) in a tertiary referral eye center in Sydney, Australia. Retrospective case series. Review of medical records of 485 consecutive cases (469 patients) with confirmed eyelid cancer. Intervention procedures: Surgical excision with 3- to 5-mm clinically clear margins and histologic confirmation of the surgical margins. Frozen section histology or Mohs' micrographic surgery (MMS) was used for incompletely excised cases, and those located in the medial canthus or close to the lacrimal drainage system. Standard reconstruction techniques were employed. Survival period free of tumor, incomplete excision, recurrences, type of closure, and complications. Excision was initially incomplete in 25.4% of all tumors. Morpheaform type of BCC (chi(2)P < .001), and medial canthus location BCCs (chi(2)P < .05) were associated with a higher incomplete resection rate. A 35.9% incomplete excision rate was associated with a significantly higher recurrence rate compared with complete excision (8.4% and 4.6%, respectively, chi(2)P < .05). Twenty-seven patients (5.6%) had a recurrent tumor. After incomplete excision, there was no recurrence with MMS, but 4.7% recurrence rate when frozen section technique was used (P < .05). Local postoperative complications occurred in 41 patients (8.5%). In the setting of a tertiary referral center, incomplete primary resection of an eyelid skin cancer is the main risk factor for recurrence. Incomplete resection is significantly associated with medial canthus location and morpheaform type of BCC and with moderately differentiated SCC. MMS is the safer technique after incomplete tumor excision.

Heterotopic Ossification Revisited: A 21-Year Surgical Experience

Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55% and 37%, respectively. The elbow was the most frequent site (>90%), and 44% were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90% of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75% of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.