Management Of Wound Complications Research Articles

The rectus femoris muscle flap is an underused tool in the vascular surgeon's armamentarium

Mrs Havercamp aFictitious.aFictitious. presents to clinic at 4:00 pm today for an unscheduled appointment. She is a 67-year-old obese diabetic woman who is 10 days status post right common femoral endarterectomy with Dacron patch angioplasty and retrograde iliac stenting for rest pain. Today, she reports increasing pain and drainage from the groin wound. On examination, there is erythema and dehiscence of the skin edges. Cloudy fluid emanates from the wound. I sigh. “Mrs Havercamp, when was the last time you had anything to eat or drink?” Groin wound complications—alarmingly common, occasionally lethal. Amputation may result, but regardless of the outcome, a significant commitment of time, effort, and cost ensues for the patient and the surgeon. That muscle flaps are a valuable adjunct in the treatment of groin wound complications is incontrovertible. Virtually every vascular surgeon has rotated a sartorius flap, usually with success. But what if the sartorius flap fails? or is unavailable? Most of us will have exhausted our toolbox and require the assistance of a plastic surgeon colleague. Indeed, there are myriad reports of other types of muscle flaps used in the management of groin wounds—tensor fascia lata, gracilis, anterolateral thigh myocutaneous, rectus femoris, rectus abdominis, and others. Common among these reports is that they are performed by plastic surgeons in the majority of cases. This study by Ryer and colleagues1Ryer E.J. Garvin R.P. Kapadia R.N. Jorgensen B.D. Green J.O. Fluck M. et al.Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions.J Vasc Surg. 2020; 71: 905-911Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar describes 24 rectus femoris flaps performed exclusively by vascular surgeons for treatment of complex groin wounds after femoral artery reconstruction. As expected, obesity, diabetes, and chronic real disease were common in this cohort of patients, and more than half of the surgical procedures were performed in fields previously operated on. Outcomes were largely favorable and comparable to other publications for patient survival and limb salvage. There were no instances of flap necrosis, nor were any complications related to flap rotation identified. The technique for creation of these flaps is described and is straightforward. The authors acknowledge a potential disadvantage of the rectus femoris flap: a decrement in knee extension strength. The authors did not attempt to quantify it, and they appear to dismiss its importance among chronically ill patients who engage in little strenuous activity. On the contrary, maintaining all residual strength among these patients whose reserve is marginal may be critically important to maintaining mobility. This study sheds no light on this issue. In addition, harvesting and rotating this flap almost certainly take more time than creating a sartorius flap and do involve a fairly generous counterincision in the thigh. Nevertheless, I suspect that these potential downsides practically have little impact. Will I abandon the sartorius flap? Certainly not, and I suspect the authors will not either. There is clearly a role for this simple flap under the right circumstances. Will I add the rectus femoris flap into my own armamentarium? Absolutely. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructionsJournal of Vascular SurgeryVol. 71Issue 3PreviewGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Full-Text PDF

A 2-year Review of Wound Outcome Following Primary Skin Closure After Laparotomy for Typhoid Ileal Perforation in Bida, Nigeria

Introduction: Laparotomy wound for typhoid ileal perforation is a dirty wound and is usually associated with wound complications and prolonged hospital stay. Delayed primary wound closure which for long has been the most common practice after laparotomy for typhoid peritonitis is now considered to be of little significance in preventing surgical site infection (SSI). We aimed to document the incidence, severity and management of wound complications when primary closure of abdominal wounds was performed following laparotomy for typhoid ileal perforation. Patients and Methods: This was a retrospective study of all patients who had primary abdominal wound closure following laparotomy for typhoid ileal perforation in Federal Medical Centre, Bida from January 2017 to December 2018. Results: There were 71 patients with the age ranges from 2 to 41 years and their median age was 15 years who had laparotomy for typhoid ileal perforation during the study period. All 71 patients had primary closure of their abdominal wounds, however two of them died within 72 hours of operation and were excluded from the study. There were males 38 (55.1%) and females 31 (44.9%) with a male to female ratio of 1.2:1. There was primary wound healing in 23 (33.3%) patients while 44 (63.8%) of them developed incisional surgical site infections (SSI) and 2 (2.9%) developed organ space SSI. Of the 44 patients that had incisional SSI, 33 (75.0%) were superficial and 11 (25.0%) were deep. Other complications noted from the study were faecal fistulae 3 (4.3%) and incisional hernia (4.3%). Conclusion: Though a high incidence of wound morbidity is not unexpected in situation of primary closure of laparotomy wound for bacteria peritonitis, an aggressive wound management may help to reduce the incidence and severity of wound complications in such situations.

Calvarial and Scalp Reconstruction

Scalp reconstruction involves nearly the entire spectrum of reconstructive surgery, including skin grafting, local flaps, and microvascular free flaps. Additionally, tissue expansion can play important role in maximizing outcomes. In recent years, reconstructive algorithms specific to scalp reconstruction have been developed that consider not only the size of the defect, but the quality of local tissues. Many materials have been used for calvarial reconstruction and most modern alloplasts are as reliable as autologous bone, although each as its own advantages and disadvantages. Simultaneous scalp and calvarial reconstruction is now routinely performed. Remaining challenges include management of wound complications over alloplasts and of the infected cranial bone flap following neurosurgical procedures. This review contains 15 figures, 5 tables, and 41 references. Keywords: scalp, calvarium, cranioplasty, free flap, tissue expander, skin graft, bone graft, titanium mesh, methylmethacrylate, polyetheretherketone (PEEK)

Vacuum-Assisted Closure: An Effective Technique to Manage Wound Complications After Metastatic Spine Tumour Surgery (MSTS)-A Case Report.

The management of wound complications following metastatic spine tumor surgery (MSTS) remains a formidable task. Plastic coverage procedures after MSTS are challenging due to unhealthy donor sites following previous radiotherapy and prolonged nonambulation. Negative pressure wound therapy (NPWT) is usually not recommended after MSTS due to fear of tumor seeding and excessive blood loss. However, in certain patients post-MSTS, who may be considered as receiving palliative treatment, NPWT can be effective in managing wound complications. We describe our initial experience with the use of NPWT in a 57-year-old lady diagnosed with multiple lumbar and cervicothoracic vertebral metastases secondary to non-small cell lung carcinoma. She underwent 2 cycles of preoperative radiotherapy followed by decompression and posterior instrumentation of lumbosacral and cervicothoracic regions succeeded by another cycle of radiotherapy. The patient developed wound dehiscence and poly-microbial surgical site infection that was not responsive to regular debridements and antibiotics. Hence, we applied NPWT as an alternative treatment to plastic surgical procedures. The patient clinically improved with a reduced quantity of wound discharge, increased granulation tissue, and a downward trend in the inflammatory markers. Subsequently, wound was secondarily closed after 14 days. The patient was discharged after a total hospital stay of 41 days. The intravenous antibiotics (piperacillin/tazobactam) were changed to oral (ciprofloxacin) after 6 weeks and continued for 4 months. The patient survived for 3 years without any wound complications. Our case report suggests that NPWT can be a potential treatment option for managing wound complications following MSTS.

Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions

ObjectiveGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. MethodsClinical data between 2012 and 2018 were retrospectively analyzed. Data were summarized, and standard statistical analysis was performed. ResultsThere were 23 patients who underwent 24 RFFs for coverage of complex groin wounds after femoral artery reconstructions. One of the 23 patients underwent bilateral RFFs. In this study cohort, patients had a median age of 67.5 years, and 79% (n = 19) were male. Median body mass index was 28.0 kg/m2, and 38% of patients were classified as obese on the basis of body mass index criteria. A history of tobacco use was present in 88%; however, only 29% were current smokers. Diabetes was present in 38% of patients and chronic kidney disease in 29%. Of the 24 RFFs, 14 (58%) were constructed in patients with reoperative groin surgery resulting in the need for muscle flap coverage. Femoral endarterectomy was the most common index procedure (46%), followed by infrainguinal leg bypass surgery (17%) and aortobifemoral bypass (17%). Grafts used during the original reconstruction included 12 bovine pericardial patches (50%), 6 Dacron grafts (25%), 4 PTFE grafts (17%), and 2 autogenous reconstructions (8%). Microbiology data identified 33% of patients (n = 8) to have gram-positive bacterial infections alone, 21% (n = 5) to have gram-negative infections alone, and 29% (n = 7) to have polymicrobial infections; 4 patients (13%) had negative intraoperative culture data. Median hospital stay after RFF was 8 days, and median follow-up time was 29.3 months. Major amputation was avoided in 20 of 24 limbs (83%) undergoing RFF. Eight patients underwent intentional graft or patch explantation (33%) before RFF, whereas 14 of the remaining 15 patients (93%) had successful salvage of the graft or patch after RFF. Two of the patients (13%) who underwent RFF with the intention of salvaging a prosthetic graft or patch required later graft excision. After RFF, 30-day and 1-year survival was 96% and 87%, respectively. ConclusionsRFF coverage of complex groin wounds after femoral artery reconstructions may safely be performed by vascular surgeons with excellent outcomes.

Management of Wound Complications in Spinal Surgery

Learning Objectives After reading this article, the participant should be able to: Explain the causes and sequelae of wound breakdown after spine surgery. Describe preventive steps to minimize the risk of infection during spine surgery. Describe appropriate management of wound complications after spine surgery.

Management of Wound Complications in Spinal Surgery: CME Quiz

Management of Wound Complications in Spinal Surgery: CME Quiz

Management of Wound Complications in Spinal Surgery

Wound complications after spinal surgery are relatively uncommon; however, they can be associated with a significant amount of morbidity. Wound breakdown after spinal surgery is due to a wide variety of causes, ranging from the trivial to life threatening. Prevention and appropriate management of wound complications is of utmost importance. Various studies report rates of wound complications ranging from 1.9% (Weinstein et al, 2000) to 20% (Klink et al, 1994). Sequelae associated with wound infection include prolonged length of hospital stay, multiple operations, meningitis, pseudoarthrosis, osteomyelitis, and loss of hardware. Spinal surgery is unique in its reliance on high-profile hardware for correction of defects. Loss of hardware is equivalent to ultimate failure of the procedure. Incidence of wound complication can be decreased through several preoperative and intraoperative strategies. Salvage of hardware is crucial in the event of wound complication. Important principles in management of wound complication are early detection, adequate debridement, and muscle flap coverage of hardware. In this paper, we address predisposing factors for wound complications, steps that can be taken to minimize risk of infection at time of operation, and management of wound complications once they occur.

Management of Wound Complications From Cesarean Delivery

Multiple factors account for the increasing number of cesarean delivery wound complications in the United States; among them are an increase in cesarean delivery and an increase in the number of overweight and obese patients. This article reviews the pathophysiology of acute wound healing. Risk factors for cesarean delivery wound complications are identified and described. Clinical practices that can reduce the risk of developing wound complications, including Centers for Disease Control and Prevention guidelines, are considered. Treatment guidelines to accelerate wound healing such as secondary closure and negative pressure wound therapy in disrupted wounds are proposed. Older guidelines for management of wounds using secondary intention are critiqued. Historical methods of wound care such as the practice of using certain cleansers and the practice of wet to dry dressings are outdated. Modern wound healing products are described. Obstetricians & Gynecologists, Family Physicians After completion of this article, the reader should be able to describe the effects of obesity on cesarean delivery wound healing, to improve methods of wound healing in the obese patient, and to explain why wet to dry dressing changes are not effective wound management.

The use of sartorius muscle rotation-transfer in the management of wound complications after infrainguinal vein bypass: A report of eight cases and description of the technique

Although rare, major wound breakdown after infrainguinal bypass resulting in vein graft exposure carries the risk of vein graft disruption with threat to both life and limb. The use of sartorius muscle rotation-transfer specifically in the management of exposed autogenous infrainguinal vein grafts has not been previously described. Eight patients were evaluated for major wound disruption resulting in graft exposure after infrainguinal vein bypass. Soft tissue coverage was provided in all eight cases by means of a distally based sartorius muscle rotation flap. There was no instance of postoperative death, graft thrombosis, secondary hemorrhage, or persistent infection. Late follow-up has shown continued satisfactory results. We conclude that effective soft tissue coverage and salvage of exposed infrainguinal vein bypass grafts can be accomplished in selected cases by means of sartorius muscle rotation-transfer.

The use of sartorius muscle rotation-transfer in the management of wound complications after infrainguinal vein bypass: a report of eight cases and description of the technique.

Although rare, major wound breakdown after infrainguinal bypass resulting in vein graft exposure carries the risk of vein graft disruption with threat to both life and limb. The use of sartorius muscle rotation-transfer specifically in the management of exposed autogenous infrainguinal vein grafts has not been previously described. Eight patients were evaluated for major wound disruption resulting in graft exposure after infrainguinal vein bypass. Soft tissue coverage was provided in all eight cases by means of a distally based sartorius muscle rotation flap. There was no instance of postoperative death, graft thrombosis, secondary hemorrhage, or persistent infection. Late follow-up has shown continued satisfactory results. We conclude that effective soft tissue coverage and salvage of exposed infrainguinal vein bypass grafts can be accomplished in selected cases by means of sartorius muscle rotation-transfer.