Lower Incidence Of Wound Complications Research Articles

Robotic natural orifice specimen extraction surgery versus robotic transabdominal specimen extraction surgery for early-stage rectal cancer: a multicenter propensity score-matched analysis (in China).

Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition. This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer. Multicenter retrospective cohort trial. Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers. The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique. After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140min (125-170min) vs. 140min (120-160min), P = 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48h (41-56h) vs. 48h (44-62h), P = 0.049 and 77h (72-94h) vs. 82h (72-96h), P = 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7-9 day) vs. 8 day (7-9 day), P = 0.005]. The overall postoperative complication rates were similar between the groups (10.7% in the R-NOSES group vs. 11.9% in the R-TSES group, P = 0.617). However, the R-NOSES group had a lower incidence of wound complications compared to the R-TSES group (0.0% vs. 2.2%, P = 0.015). Regarding surgical stress response, the R-NOSES group showed superior outcomes. Additionally, patients in the R-NOSES group required fewer additional analgesics on postoperative days 1, 3, and 5 and reported lower pain scores compared to the R-TSES group. The body image scale (BIS) and cosmetic scale (CS) scores were also significantly higher in the R-NOSES group. Furthermore, the R-NOSES group demonstrated significantly better outcomes in functional dimensions such as physical, role, emotional, social, and cognitive functioning, and in symptoms like fatigue and pain, when compared to the R-TSES group. It is imperative to ensure the safe and standardized implementation of R-NOSES through the establishment of a uniform training protocol. These results affirm that R-NOSES is a safe and effective treatment for early-stage rectal cancer when meticulously executed by skilled surgeons.

Improvement of Russian clinical guidelines and reduction of mortality in perforated ulcers

To analyze the results of laparoscopic surgery in patients with perforated ulcers using evidence-based medicine approaches. We compared the efficacy and effectiveness of laparoscopic and open surgeries in patients with perforated ulcers. Meta-analysis of mortality after laparoscopic surgeries (randomized controlled trials) and trial sequential analysis were carried out. We clarified the differences between the efficacy and effectiveness of laparoscopic surgeries regarding postoperative mortality. In the Russian Federation, mortality after laparoscopic surgery is 9-11 times lower compared to open procedures. According to evidence-based researches (efficacy of laparoscopic interventions in 10 meta-analyses), these differences are less obvious (1.4-3.0 times) and not significant. The diversity-adjusted required information size to draw reasonable conclusions about differences in mortality in trial sequential analysis was 68 181 participants. Meta-analyses of RCTs also demonstrate lower incidence of wound complications (1.8-5.0% after laparoscopic surgery and 6.3-13.3% after laparotomy), shorter hospital-stay (mean difference from -0.13 to -2.84) and less severe pain syndrome (mean difference in VAS score from -2.08 to -2.45) after laparoscopic technologies. The obvious advantage of laparoscopic surgery in patients with perforated ulcers is fast-truck recovery following shorter hospital-stay, mild pain and rarer wound complications. Comparison of postoperative mortality regarding efficacy and effectiveness is difficult due to insufficient introduction of laparoscopic technologies in clinical practice and diversity-adjusted required information size.

Comparison between achilles tendon reinsertion and dorsal closing wedge calcaneal osteotomy for the treatment of insertional achilles tendinopathy: A meta-analysis

BackgroundThe debridement and Achilles tendon reinsertion (DATR) have been the most common surgical approach for the treatment of Insertional Achilles Tendinopathy (IAT), while dorsal closing wedge calcaneal osteotomy (DCWCO) has recently gained popularity as an alternative surgical option. This study aimed to systematically review the published literature on both surgical techniques and compare their clinical outcomes and complication rates. MethodsA systematic review was performed according to the PRISMA guidelines using Medline, Embase, and Scopus databases. The inclusion criteria encompassed clinical studies reporting functional outcomes and complications, with a minimum of 10 patients and at least 12 months of follow-up. ResultsSeven studies (n = 169) were included for the analysis of DATR, and eight studies (n = 227) were included for the analysis of open DCWCO. Both groups showed a similar improvement in AOFAS score. The overall complication rates were 16.6% in the DATR group and 9.2% in the DCWCO group, but the difference was not statistically significant. However, there was a significantly higher incidence of wound complications in the DATR group (10.1%, 95% C.I.: 4.7–15.6) compared to the DCWCO group (2.5%, 95% C.I.: 0.6–4.4) as the confidence intervals did not overlap. ConclusionsClinical outcomes and overall complication rates of both techniques were comparable, although DCWCO had a lower incidence of wound complications. Further research should be focused on prospective studies comparing the two techniques to corroborate the current findings. Level of evidenceLevel IV; meta-analysis

Percutaneous cruciate repair of ruptured Achilles tendon

Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to open techniques. We describe a novel percutaneous cruciate suture performed through 5 stab skin incisions, four of which are longitudinal and parallel to the course of the sural nerve to minimize the risk of injury and one transverse incision at the site of rupture, with a total of 16 suture threads and the knot outside the tendon body, increasing the tensile strength of the suture and minimizing the risk of re-rupture. Clinical studies are necessary to ascertain whether the theoretical advantages of the cruciate suture technique translate into better clinical outcomes compared to established percutaneous techniques.

Safety and feasibility of a novel chest tube placement in uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer.

The type and placement of chest tube for patients undergoing uniportal video-assisted thoracoscopic lobectomy remains controversial. The aim of this study was to assess the efficacy and safety of a novel technique in which a pigtail catheter was used alone as the chest tube and placed near the incision for chest drainage after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy. A total of 217 patients undergoing uniportal video-assisted thoracoscopic lobectomy were retrospectively reviewed and divided into two groups. In group A, a 12-Fr pigtail catheter with several side ports was placed next to the uniportal wound. In group B, a conventional 20-Fr chest tube was placed through the uniportal wound itself. Postoperative complications related to chest tube placement and patients' subjective satisfaction were compared between the two groups. Postoperative pain management effect and other clinical outcomes such as duration of chest drainage and postoperative stay were also compared. There were 112 patients in group A and 105 patients in group B. A significantly lower incidence of wound complications was found in group A postoperatively (p = 0.034). The pain score on coughing in group A was significantly lower than that in group B on postoperative day two (POD2) (p = 0.021). There was no significant difference of other clinical outcomes such as duration of chest drainage and postoperative stay as well as major complications between the two groups. Placing a 12-Fr pigtail catheter alone next to the uniportal wound for chest drainage might be effective and safe after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy.

The effect of subcutaneous drain insertion after median sternotomy on surgical site infection in obese patients

Background: Sternal wound infection after cardiac surgery is associated with high morbidity and mortality. This study aimed to assess the effect of subcutaneous wound drainage on surgical site infection in overweight patients undergoing cardiac surgery via median sternotomy.
 Methods: This prospective study was conducted on 100 obese patients undergoing sternotomy as a part of cardiac surgery from March 2021 to June 2022. The study included two groups. Group 1 (n= 45) had prophylactic subcutaneous drainage after surgery, and Group 2 (n= 55) did not have prophylactic subcutaneous drainage.
 Results: Hospital stay (7.8±1.9 vs. 8.65±1.38 days; P= 0.013) were higher in patients without drains. Deep sternal wound infection [2 (4.44%) vs. 9 (16.4%); P= 0.105], superficial wound infection [2 (4.44%) vs. 7 (12.7%); P= 0.18] and debridement with secondary suture [1 (2.2%) vs. 6 (10.9%); P= 0.125] were non-significantly lower in patients with subcutaneous drains.
 Conclusion: Obese cases who received prophylactic subcutaneous wound drainage after sternotomy wound closure could have a lower incidence of wound complications. A larger randomized trial is recommended.

90-Day Reoperation and Wound Complication Rates in Lateral Approach to Total Ankle Replacement for Post-Traumatic Arthritis

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle replacement (TAR) has achieved relatively successful outcomes with respect to postoperative complications; however, mixed evidence exists regarding early complication rates, reoperation, and infection1-5. The largest study of TAR to date indicates a statistically significant risk of postoperative infection in tobacco users and diabetic patients6. Unlike currently established anterior approaches to arthroplasty, the lateral transfibular approach potentially avoids disruption of perfusion to the skin, possibly decreasing postoperative complications7. The lateral ankle allows surgeons to correct malunion of the fibula in post-traumatic arthritis deformity cases and achieve appropriate coronal and sagittal implant alignment to achieve similar physiological joint orientation8,9. The purpose of this study was to report 90-day reoperation and wound complication rates in lateral approach to total ankle replacement for post-traumatic arthritis (PTA). Methods: A retrospective chart review of lateral TAR cases from 2016-2022 was conducted at a single institution. Only patients undergoing TAR for post-traumatic arthritis were included in this review. A total of 49 patients (22 females and 27 males) underwent total ankle replacement with the Zimmer Biomet Trabecular MetalTM Total Ankle by a single surgeon. Patient demographics, operative data, complications, and adverse events requiring corrective surgery were recorded within 90 days of arthroplasty. Results: The patient sample included 6 active smokers, 11 diabetics, and 32 patients with hypertension with an average age of 60.7 and average BMI of 34.3 (Table 1). Three of the 49 (6.1%) patients required secondary surgery within 3 months of surgery (Table 2). Revision surgery indications included: 1 (2.0%) for removing painful hardware, 2 (4.1%) due to infection, and 1 (2.0%) for tarsal tunnel syndrome after surgery. There were 0 nonunions of the fibula at 90 days and through 1 year follow up. Of the patients requiring secondary surgery for infection, 1 was a smoker and 1 had a history of ankle fusion nonunion and avascular necrosis which was converted to a TAR (Table 4). Conclusion: This retrospective study demonstrates a comparable rate of secondary surgeries following TAR via lateral approach in the early postoperative period (6.1%) while having a slightly higher rate of infection than those previously reported (4.1%)7,8. Notwithstanding, we observed a 100% healing rate of fibula osteotomies; however, we failed to demonstrate a lower incidence of wound complications than previously reported. Surgeons should counsel patients of these risks in those with PTA undergoing lateral TAR, especially in smokers and diabetics.

Enhanced recovery after surgery pathway: association with lower incidence of wound complications and severe hypoalbuminemia in patients undergoing posterior lumbar fusion surgery

BackgroundWound complications are associated with worse satisfaction and additional costs in patients undergoing posterior lumbar fusion (PLF) surgery, and the relationship between enhanced recovery after surgery (ERAS) pathway and wound complications remains poorly characterized.MethodsIn this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between the ERAS program and the incidence of postoperative wound-related complications and other complications following PLF surgery; other outcomes included the length of stay (LOS), 90-day hospital and rehabilitation center readmission.ResultsThe average patient age was 65 yr. More patients with old cerebral infarction were in ERAS group (p < 0.01), and other demographics and comorbidities were similar between groups. Patients in the ERAS group had a lower incidence of postoperative wound-related complications than the non-ERAS group (12.4 vs. 17.8%, p = 0.02). The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing (6% vs. 3%, p = 0.02). ERAS group had a lower incidence of severe postoperative hypoalbuminemia (serum albumin less than 30 g/L) (15.8% vs. 9.0% p < 0.01). Additionally, ERAS patients had shorter postoperative LOS (8.0 ± 1.5 vs. 9.5 ± 1.7, p < 0.01), lower rate of readmission within 90 days (1.9% vs. 6.4%, p < 0.01) and discharge to rehabilitation center (4.2% vs. 1.0%, p < 0.01).ConclusionERAS pathway might help decrease the rates of postoperative wound complications and severe hypoalbuminemia following PLF surgery; additionally, it demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90 days.

Reduction and functional outcome of open reduction plate fixation versus minimally invasive reduction with percutaneous screw fixation for displaced calcaneus fracture: a retrospective study

BackgroundMinimally invasive surgery has become popular because of the lower incidence of wound complications. However, achieving an anatomic reduction that provides a satisfactory outcome is difficult using minimally invasive surgery. Our study aimed to evaluate the reduction and clinical outcomes of closed reduction and percutaneous fixation treatment using a closed reduction traction device for displaced intra-articular calcaneal fractures compared with traditional open reduction plate fixation using an extended lateral approach.MethodsA total of 40 patients and 45 feet with calcaneus fractures from 2012 to 2016 were studied. The open reduction plate fixation group (24 feet) was compared to the closed reduction percutaneous fixation group (21 feet) with a traction device. The reduction assessments included length, width, height, Bohler’s angle, Gissane’s angle, and varus or valgus angle before and after surgery. The clinical outcomes included the American Orthopaedic Foot and Ankle Society hindfoot score and the visual analog score for pain, length of stay, and complication rate.ResultsThe patients were followed up for an average of 16.53 ± 3.95 months. No significant differences in reduction were observed between the open and closed groups (P > 0.05). The American Orthopaedic Foot and Ankle Society scores of the two groups were 80.29 ± 6.15 and 83.62 ± 6.95 (open versus closed) (P = 0.0957). The visual analog scores of the open and closed groups were 1.50 ± 1.22 and 0.81 ± 0.87 (P = 0.0364). The lengths of stay in the open and closed groups were 9.63 ± 2.72 days and 6.71 ± 1.85 days (P = 0.0002). The complication rates of the open and closed groups were 20.8% (5/24) and 4.8% (1/21) (P < 0.0001).ConclusionsThe closed reduction percutaneous fixation with traction device method may provide equivalent reduction results and superior outcomes for the length of stay, VAS score, and complication rate for displaced intra-articular calcaneal fractures.

A modified tarsal sinus approach for intra-articular calcaneal fractures.

Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed. This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. Twenty-nine patients with average follow-up time of 18 (range 13-29) months were included. The radiographs demonstrated significant corrections of the Bohler's angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70-98) and the good and excellent rate was 89.7%. The modified tarsal sinus approach in the treatment of Sander's type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.

Continuous epidural infusion in gynecologic oncology patients undergoing exploratory laparotomy: The new standard for decreased postoperative pain and opioid use

ObjectiveTo compare the incidence of postoperative complications and opioid pain medication usage in gynecologic oncology patients who did and did not receive an epidural prior to undergoing exploratory laparotomy. MethodsRetrospective cohort study of all patients undergoing exploratory laparotomy with the gynecologic oncology division at Washington University in St Louis between January 2012 and October 2015. Data on demographics, pathology, postoperative pain and opioid use, and incidence of postoperative complications were collected. ResultsFive hundred and sixty-one patients underwent laparotomy, 305 with an epidural and 256 without. Patients with an epidural used significantly less hydromorphone in the post-anesthesia care unit (PACU) (p = 0.003) and on postoperative day (POD)#1 (p = 0.05), less total opioids on POD#0 (p < 0.01), and more non-opioid pain medication on POD#1–3 (p < 0.01). Patients with an epidural had lower pain scores in the PACU (p = 0.01), on POD#0 (p < 0.01), POD#1 (p < 0.01), and POD#3 (p = 0.03). Patients with epidurals had shorter hospital length of stay (p < 0.01), no difference in hospital readmission or incidence of venous thromboembolism up to 90 days postoperatively, longer duration of Foley catheter (20.4 vs 10.3 h, p = 0.02) with no difference in postoperative urinary tract infection, higher incidence of postoperative hypotension (63% vs 36.3%, p < 0.01), and lower incidence of wound complications (5% vs 14.1%, p < 0.01). ConclusionsPerioperative epidurals used in patients undergoing major abdominal surgery correlate with decreased postoperative opioid use, increased use of non-opioid pain medications, and improved pain relief postoperatively with acceptable postoperative risks and should be standard of care for these patients.

Idiopathic Early-onset Scoliosis: Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-year Follow-up.

Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression. Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05. In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18% (4 of 22) of VEPTR and 16% (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50%) than VEPTR patients (27%) (P<0.001) and achieved a greater percentage of thoracic height gain (24%) than VEPTR patients (12%) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15% greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14%) than VEPTR patients (41%) (P=0.011). In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR. Level III.

Posterior Components Separation With Transversus Abdominis Release (TAR) Versus Alternative Techniques of Components Separation: Systematic Review

The aim of this study is to assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernias. Ventral abdominal hernias complicate up to 11% of laparotomy wounds. Surgical management includes primary repair, hernioplasty, flaps, and components separation. A technique has been described to close large abdominal defects by releasing bilateral myofascial flaps of rectus abdominis from external oblique and advancing these flaps to the midline. Minimally invasive and endoscopic techniques were subsequently developed to reduce complications. A recently described method is PCS-TAR. The hypothesis is that PCS-TAR for abdominal wall reconstruction is associated with lower rates of wound complications and hernia recurrence than other components separation techniques. A comprehensive search of databases including Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus was conducted in accordance with PRISMA guidelines, looking for the primary outcomes of hernia recurrence and wound complications following different techniques of components separation. Inclusion and exclusion criteria were defined. The quality of studies was examined independently by 2 assessors. A total of 363 studies were identified. Three retrospective comparative studies met the inclusion criteria. No randomized control trial comparing different techniques of abdominal wall components separation was identified. No technique could be identified as superior to others, due to a paucity of the literature. However, based on a few retrospective cohort studies, PCS-TAR emerges as a well-tolerated new technique, with a low incidence of wound complications and hernia recurrence.

Comparison of functional outcome of calcaneal fractures after plate or screw osteosynthesis

The purpose of our investigation was to prospectively review and compare the early outcomes of Sanders II and III closed displaced intra-articular calcaneal fractures (DIACFs) in a group of patients treated by open reduction and internal fixation with plate and screws using the extended lateral approach or the sinus tarsi approach (STA). Thirty-eight patients with DIACFs were prospectively enrolled and operatively treated using either the extended lateral approach or the STA. Patients underwent a careful clinical and radiographic examination and were evaluated according to the American Orthopaedic Foot and Ankle Society score, visual analog scale, and the Foot Function Index. The results from our study showed similar clinical and radiographic outcomes between the 2 groups. In our series, Sanders II and III DIACFs were sufficiently exposed using the STA to achieve anatomic reduction and stable fixation. The STA group had a lower incidence of wound complications (p ≥ .05), the surgical procedure was faster, and the waiting time to surgery was shorter (p ≤ .05). Despite the limited number of patients and the short follow-up period, our results suggest that the STA is a useful method for the treatment of DIACFs, with a low incidence of complications and results comparable to those for patients treated using the extended lateral approach.

Endoscopic versus open radial artery harvesting: A meta-analysis of randomized controlled and propensity matched studies.

We sought to investigate the impact of radial artery harvesting techniques on clinical outcomes using a meta-analytic approach limited to randomized controlled trials and propensity-matched studies for clinical outcomes, in which graft patency was analyzed. A systematic literature review was conducted using PubMed and MEDLINE to identify publications containing comparisons between endoscopic radial artery harvesting (ERAH) and open harvesting (ORAH). Only randomized controlled trials and propensity-matched series were included. Data were extracted and analyzed with RevMan. The primary endpoint was wound complication rate, while secondary endpoints were patency rate, early mortality, and long-term cardiac mortality. Six studies comprising 743 patients were included in the meta-analysis. Of them 324 (43.6%) underwent ERAH and 419 (56.4%) ORAH. ERAH was associated with a lower incidence of wound complications (odds ratio: 0.33, confidence interval 0.14-0.77; p = 0.01). There were no differences in graft patency, and early and long-term cardiac mortality between the two techniques. ERAH reduces wound complications and does not affect graft patency, or short- and long-term mortality compared to ORAH.

Effects of Unilateral Tourniquet Used in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty.

To assess the benefits of use of a tourniquet in one limb in patients undergoing simultaneous bilateral total knee arthroplasty (TKA). A prospective randomized trial was designed to evaluate the outcomes of unilateral tourniquet use during simultaneous bilateral TKA. A total of 52 (36 women and 16 men) patients with osteoarthritis who underwent simultaneous bilateral primary TKA between January 2010 and January 2015 were assigned randomly to tourniquet (TG) or non-tourniquet (NG) groups prior to surgery. Operating time, pain score, range of motion, first active straight-leg raise time, swelling, wound healing, deep vein thrombosis, and Knee Society score were observed. Mean operating time in the TG group was shorter than that in the NG group (P < 0.05). Postoperative pain was measured by a visual analog scale (VAS) and straight-leg raise time, which was lower and shorter in limbs operated without the use of a tourniquet (P < 0.05). In addition, this group had less postoperative swelling and lower incidence of wound complications in the early postoperative period (P < 0.05). There was no significant difference in the range of motion (ROM), deep venous thrombosis incidence, and Knee Society scores between the two groups. Tourniquet use in bilateral TKA can reduce intraoperative time but was associated with a higher incidence of wound complications and larger postoperative knee swelling.

Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

BackgroundThe extensile lateral approach (ELA) has been widely performed for displaced intra-articular calcaneal fractures (DIACFs), and wound complications remain a significant problem. As a minimal incision technique, the sinus tarsi approach (STA) was designed to overcome this disadvantage. There were already many reports about this approach but the conclusions were not completely consistent. Based on the current evidence, we performed this meta-analysis to compare the STA with ELA in the management of DIACF and expected to draw a certain and meaningful conclusion.MethodsAll potentially relevant randomized controlled trials (RCTs) and cohort studies (CSs) were searched in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrial.gov. The desirable outcomes including wound complications, excellent and good rate, secondary surgery rate and Böhler’s angle were extracted. RCT studies were assessed using the Risk of Bias Tool recommended by the Cochrane Collaboration, and cohort studies were evaluated using the Newcastle–Ottawa Scale. The data of RCTs and cohorts were pooled respectively using the fixed-effect model or random-effect model. Mean differences with 95% confidence intervals (CIs) were calculated for continuous data, and relative risks (RRs) with 95% CIs were calculated for dichotomous data. Statistical heterogeneity was assessed with the Q test and I2. Sensitivity analysis was developed to assess the reliability of pooled results.ResultsSeven studies including two RCTs and five CSs were eligible for the meta-analysis. No matter RCTs or CSs, the pooled data all showed that STA group had a lower incidence of wound complications than that in the ELA group and no significant difference was found in excellent and good rate and the recovery of Böhler’s angle between the two groups. The CSs also showed that the STA group had a lower incidence of secondary surgeries than that in the ELA group.ConclusionsThrough a STA, we not only can reduce the problems in wound healing but also achieve nearly the same adequate restoration of DIACF along with the similar functional outcomes compared with through an ELA.

Early versus Delayed Postoperative Oral Feeding after Gastrointestinal Anastomosis

Background: There is no evidence that bowel rest and a period of starvation are beneficial for healing of gastrointestinal anastomosis. Aim of work: This study assesses the outcomes of early oral feeding compared with the 5 days delay after small and large bowel anastomosis. Patients and methods: This study included 40 patients with either small intestinal or colonic anastomosis randomly divided into two groups (20 patients each). Group I patients were managed traditionally with 5 day delay before oral feeding, while those of group II were allowed oral fluids once there was audible intestinal sounds or passage of flatus. Results: There was no significant difference comparing both groups as regards gender and age distribution, cause and type of surgery and occurrence of intestinal fistula. There was a significant lower incidence of wound complications in group II with shorter hospital stay. Conclusion: Early oral feeding after gastrointestinal anastomosis is safe, effective, well tolerated and beneficial to all patients.

Comparison Between Sinus Tarsi Approach and Extensile Lateral Approach for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures: A Multicenter Prospective Study

The purpose of our investigation was to prospectively review and compare the early outcomes of Sanders II and III closed displaced intra-articular calcaneal fractures (DIACFs) in a group of patients treated by open reduction and internal fixation with plate and screws using the extended lateral approach or the sinus tarsi approach (STA). Thirty-eight patients with DIACFs were prospectively enrolled and operatively treated using either the extended lateral approach or the STA. Patients underwent a careful clinical and radiographic examination and were evaluated according to the American Orthopaedic Foot and Ankle Society score, visual analog scale, and the Foot Function Index. The results from our study showed similar clinical and radiographic outcomes between the 2 groups. In our series, Sanders II and III DIACFs were sufficiently exposed using the STA to achieve anatomic reduction and stable fixation. The STA group had a lower incidence of wound complications (p ≥ .05), the surgical procedure was faster, and the waiting time to surgery was shorter (p ≤ .05). Despite the limited number of patients and the short follow-up period, our results suggest that the STA is a useful method for the treatment of DIACFs, with a low incidence of complications and results comparable to those for patients treated using the extended lateral approach.

Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach

INTRODUCTION: The wound complication rate for open reduction and internal fixation of calcaneus fractures through the extensile approach is 30%. Due to this high rate of wound complications, many surgeons prefer conservative management. If post-traumatic arthritis develops, the clinical results of a subtalar fusion are better if the posterior facet is reduced and the shape of the calcaneus restored. The sinus tarsi approach utilises a much smaller incision and indirect reduction techniques limiting the need for a large incision while still providing good exposure of the posterior facet for anatomic reduction The purpose of this study is to present the technique for open reduction and internal fixation through a sinus tarsi approach, to assess the adequacy of reduction and the complication rate. METHODS: A retrospective chart and X-ray review was performed of all patients who had an open reduction and internal fixation of the calcaneus performed since 2013. We report on the interim results of the adequacy of reduction and maintenance thereof and the incidence of wound complications. Follow-up was for a minimum of 6 weeks RESULTS: Twelve procedures were performed in this time. The Bohler's angle improved from a median of 12° pre-operatively to 28.5° (p=0.002) post-operatively. The angle of Gissane improved from a median of 125° to 110° (p=0.0001). Two patients had minor wound complications, both of which were managed without surgery, using dressings for 10 to 12 days CONCLUSION: Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with a low incidence of wound complications