Occurrence Of Wound Complications Research Articles

Prevalence and risk factors of wound complications after transtibial amputation in patients with diabetic foot

BACKGROUND Diabetic foot (DMF) complications are common and are increasing in incidence. Risk factors related to wound complications are yet to be established after trans-tibial amputation under the diagnosis of DMF infection. AIM To analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes. METHODS This retrospective cohort study included seventy-two patients with DMF complications who underwent transtibial amputation between April 2014 and March 2023. The groups were categorized based on the occurrence of wound complications, and we compared demographic data between the complication group and the non-complication group to analyze risk factors. Moreover, a multivariate logistic regression analysis was performed to identify risk factors. RESULTS The average follow-up period was 36.2 months. Among the 72 cases, 31 (43.1%) had wound complications. Of these, 12 cases (16.7%) received further treatment, such as debridement, soft tissue stump revision, and re-amputation at the proximal level. In a group that required further management due to wound complications after transtibial amputation, the hemoglobin A1c (HbA1c) level was 9.32, while the other group that did not require any treatment had a 7.54 HbA1c level. The prevalence of a history of kidney transplantation with wound complications after transtibial amputation surgery in DMF patients was significantly greater than in cases without wound complications (P = 0.02). Other factors did not show significant differences. CONCLUSION Approximately 43.1% of the patients with transtibial amputation surgery experienced wound complications, and 16.7% required additional surgical treatment. High HbA1c levels and kidney transplant history are risk factors for postoperative wound complications.

Closed-Incision Negative-Pressure Wound Therapy after Resection of Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized Trial.

Wound healing after resection of large soft-tissue tumors is often impaired by large dead space and fluid collection. Recently, the authors were able to show an association of wound complications with worse oncologic outcome in soft-tissue sarcomas. The aim of the study was to examine the value of closed-incision negative pressure wound therapy on postoperative wound drainage and wound complications after soft-tissue tumor resection. Patients for whom resection is planned of a soft-tissue tumor larger than 10 cm in diameter of the extremities or the trunk were allocated randomly to one of two groups. After wound closure, patients in the study group received closed-incision negative-pressure wound therapy for a duration of 5 days, whereas those in the control group received regular dressings. The amount of drainage fluid, course of wound healing, length of hospital stay, and wound edge perfusion at postoperative day 5 measured by white-light infrared spectroscopy were compared. Sixty patients could be included in the study with even distribution to both study arms, meeting the goal. The postoperative course of wound drainage volume was significantly lower in the study group, and hospital stay was significantly shorter, with 9.1 ± 3.8 days versus 13.9 ± 11.8 days. The occurrence of wound complications was significantly lower in the study group on time-to-event analysis (one versus six). Tissue spectroscopy revealed a significantly higher oxygen saturation increase in the wound edge for the study group versus the control group. Closed-incision negative-pressure wound therapy should be considered for patients undergoing resection of large soft-tissue tumors. Therapeutic, II.

The efficacy and safety of tranexamic acid in the treatment of intertrochanteric fracture: an updated meta-analysis of 11 randomized controlled trials.

This meta-analysis was performed to investigate the efficacy and safety of tranexamic acid (TXA) in the elderly patients undergoing intertrochanteric fracture surgery from the current literatures. The electronic literature database of PubMed, Embase and Cochrane library were searched in October 2019. The intraoperative blood loss, hidden blood loss, postoperative drainage and total blood loss, postoperative hemoglobin, length of stay, transfusion rate, mortality rate, thromboembolic events and wound complications were extracted. Stata 14.0 software was used for our meta-analysis. A total of 11 RCTs (3 new RCTs in 2019) with 1202 patients met our inclusion criteria. This meta-analysis showed that administration of TXA can reduce intraoperative blood loss (P = 0.009), hidden blood loss (P = 0.000), total blood loss (P = 0.000), length of stay (P = 0.003), transfusion rate (P = 0.000) and the occurrence of wound complications (P = 0.006). Furthermore, administration of TXA was associated with an increase in the postoperative Hb level at day 1, 2 and 3 (P = 0.000, P = 0.000 and P = 0.000, respectively) after surgery. However, no significant difference was found between the TXA group and control group regarding the occurrence of thromboembolic events (P = 0.978, including deep vein thrombosis, P = 0.850; pulmonary embolism, P = 0.788; cerebrovascular accident, P = 0.549; myocardial infarction, P = 0.395) and mortality rate (P = 0. 338). Our meta-analysis suggested that administration of TXA is effective in reducing intraoperative blood loss, hidden blood loss, total blood loss, length of stay, transfusion rate, wound complications and enhancing postoperative Hb without increasing the risk of thromboembolic events and mortality rate in intertrochanteric fracture surgery. More large multi-center and high-quality RCTs are required for further research.

Efficacy of platelet-rich plasma injection with lumbar epidural analgesia after total knee arthroplasty

Introduction Lumbar epidural analgesia, one of the most effective methods for postoperative pain relief, was used with autologous platelet-rich plasma (PRP) derived from the patient’s own blood. The effects of application of PRP on pain control, wound healing and occurrence of wound complications were followed. Patients and methods A sum of one hundred sixty patients were allocated into two equal groups. Postoperative analgesia was maintained with patient-controlled epidural analgesia with bupivacaine and fentanyl solution in both groups. Group platelet rich plasma (PRP) received epidural analgesia with analgesic solution of 0.0125% bupivacaine+fentanyl 2 mic/kg of basal infusion rate 4 ml/h with application of PRP, control group received epidural analgesia with analgesic solution of 0.0125% bupivacaine+fentanyl 2 mic/kg of basal infusion rate 4 ml/h by ordinary manner without application of platelet rich plasma. Pain was evaluated at 4, 8, 12, 24 and 48 hours. Both groups received 5ml solution as rescue analgesia whenever visual analog scale score was 5 and above. Heart rate, mean arterial pressure (MAP), sedation scores, and physiotherapy cooperation were also assessed. Results PRP group was associated with good pain control, reduced postoperative infection rates, and good wound healing as compared with the control group. Conclusion Postoperative lumber epidural analgesia with PRP is an appropriate method in post-total knee arthroplasty pain control with possible benefits concerning wound healing and prevention of infection.

Stereotactic Radiotherapy Followed by Surgical Stabilization Within 24 h for Unstable Spinal Metastases; A Stage I/IIa Study According to the IDEAL Framework.

Background: Routine treatment for unstable spinal metastases consists of surgical stabilization followed by external beam radiotherapy (EBRT) or stereotactic body radiotherapy (SBRT) after a minimum of 1–2 weeks to allow for initial wound healing. Although routine treatment, there are several downsides. First, radiotherapy induced pain relief is delayed by the time interval required for wound healing. Second, EBRT often requires multiple hospital visits and only 60% of the patients experience pain relief. Third, spinal implants cause imaging artifacts hindering SBRT treatment planning and delivery. Reversing the order of surgery and radiotherapy, with dose sparing of the surgical area by SBRT, could overcome these disadvantages and by eliminating the interval between the two treatments, recovery, and palliation may occur earlier.Design: The safety of SBRT followed by surgical stabilization within 24 h for the treatment of unstable spinal metastases was investigated. Safety was evaluated using the Common-Toxicity-Criteria-Adverse-Events-4.0, with the occurrence of wound complications within 90-days being the primary concern.Results: Between June-2015 and January-2017, 13 patients underwent SBRT followed by surgical stabilization for unstable spinal metastases. The median time between SBRT and surgery was 17-h (IQR 5–19). None of the patients experienced wound complications. Improvements in pain and quality of life were observed over time for all patients.Conclusion: SBRT followed by surgical stabilization within 24 h for the treatment of unstable spinal metastases is safe. Palliation may be experienced earlier and with both treatments being performed in one hospital admission the treatment burden decreases.

The use of ketamine peri-operatively as part of a multimodal analgesia regimen in dogs

The registered veterinary nurse (RVN) plays a crucial role in managing their patients' level of anaesthesia and analgesia, and must have a sound understanding of the different drugs commonly used in day to day anaesthetic protocols. Ketamine, as part of a low dose or sub-anaesthetic multimodal analgesia regimen, can be useful in facilitating the reduction of the amount of volatile agent needed and reduce the need for ‘rescue’ analgesics peri-operatively. Alleviating pain helps speed the recovery of patients by providing comfort and the relief of stress, helping to minimise the occurrence of wound complications. This article explains the pain process and how ketamine augments the overall analgesia and anaesthesia process, enabling a smoother anaesthetic with reduced side effects and what this means to the RVN.

Cesarean Section Wound Infections and Neonatal Outcomes [8A

INTRODUCTION: Cesarean section wound infections and adverse neonatal outcomes share similar risk factors. This study attempted to evaluate if the two events are correlated. METHODS: Patients undergoing cesarean section deliveries at University Health from 12/2013 to 12/2014 were identified. Common risk factors for wound complication, the occurrence of cesarean section wound complications, and neonatal outcomes were recorded and compared. Fisher’s exact test and two-sample Student's t-test were used to determine if correlations between wound complications and neonatal outcomes were significant, and if the presence of risk factors differed among those with and without wound infections and adverse neonatal outcomes. RESULTS: Included in the study were 490 women with no wound complications, 36 with wound infection, and 54 with wound breakdown without evidence of infection. The occurrence of any wound complication was associated with the occurrence of adverse neonatal outcomes (P=.008, OR 1.89 [95% CI 1.17–3.07]). Wound breakdown was correlated with pregnancy-induced hypertension (P=.01, OR 2.58 [95% CI 1.20–5.29]), while infection was associated with pre-gestational diabetes (P=.02, OR 3.98 [95% CI 1.09–12.04]), and higher BMI (44.8 kg/m2 vs 37.1 kg/m2, P=.0008). Having greater than two risk factors was correlated with having concurrent wound complication and adverse neonatal outcome (P=.001, OR 9.12 [95% CI 2.4–33.3]). CONCLUSION: This study finds that women with a cesarean section wound complication are at a higher risk for complications related to the neonate as well. Counseling of women with multiple risk factors should include the possibility of both maternal and neonatal morbidity.

A modified minimally invasive technique for treatment of intra-articular fractures of the calcaneus. Mid-term results and review of the literature

Background The goal of therapy for calcaneal fractures is elimination of pain and restoration of normal foot shape and walking ability. The occurrence of wound complications is a serious concern in treating calcaneal fractures.

Morbidity and mortality after laparoscopy-assisted and open distal gastrectomy for stage I gastric cancer: Results from a multicenter randomized controlled trial (KLASS-01).

4 Background: Laparoscopy assisted distal gastrectomy (LADG) is widely performed for gastric cancer in Eastern countries, although large scale prospective data are still lacking. We conducted a phase III, multicenter randomized controlled trial (KLASS-01) to compare the short and long term outcomes of LADG versus open distal gastrectomy (ODG) in patients with clinical stage I gastric cancer in Korea. Methods: The primary end point was 5-year overall survival. The morbidity within 30 postoperative days and the surgical mortality were compared to evaluate the safety of LADG as a secondary end point. A total of 1,416 patients were randomly assigned to the LADG group (n = 705) or the ODG group (n = 711) between Feb 1, 2006 and Aug 31, 2010. Results: 1,256 were eligible for per protocol (PP) analysis (644 and 612, respectively). The overall complication rate was significantly lower in the LADG group (LADG vs. ODG; 13.0% vs. 19.9%, P =.001). In detail, the wound complication rate of the LADG group was significantly lower than that of the ODG group (3.1% vs. 7.7%, P <.001). The major intra-abdominal complication (7.6% vs. 10.3%, P =.095) and mortality rates (0.6% vs. 0.3%, P =.450) were similar between groups. Modified intention-to-treat analysis showed similar results with PP analysis. Conclusions: LADG for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complication compared with conventional ODG. Clinical trial information: NCT00452751.

Cholecystectomy and Wound Complications: Smoking Worsens Risk

BackgroundIn the United States, approximately 800,000 cholecystectomies are performed annually. We sought to determine the influence of preoperative smoking on postcholecystectomy wound complication rates. Materials and methodsUsing the National Surgical Quality Improvement Program database (2005–2011), patients aged ≥18 y who underwent elective open or laparoscopic cholecystectomy (LC) for benign gallbladder disease were identified using current procedural terminology codes. Multivariate regression was performed to determine the association between smoking status and wound complications, by surgical approach. ResultsOf 143,753 identified patients, 128,692 (89.5%) underwent LC, 27,788 (19.3%) were active smokers, and 100,710 (70.2%) were females. Active smokers were younger than nonsmokers (mean + standard deviation age: 44.2 (14.9) versus 51.6 (17.9) years); P < 0.001) and had fewer comorbidities. Within 30-d postcholecystectomy, wound complications were reported in 2011 (1.4%) patients. Compared with nonsmokers, active smokers demonstrated increased odds of wound complications after both open cholecystectomy (odds ratio 1.28; P = 0.010) and LC (odds ratio 1.20; P = 0.020) after adjustment for demographic and clinical characteristics. Having wound complications increased the average postoperative length of stay by 2–4 d (P <0.001). ConclusionsActive smokers are more likely to develop wound complications after cholecystectomy, regardless of surgical approach. Occurrence of wound complications consequently increases postoperative length of stay. Smoking abstinence before cholecystectomy may reduce the burden associated with wound complications.

Impact of Current Smoking on the Occurrence of Wound Complications Following Cholecystectomy

Impact of Current Smoking on the Occurrence of Wound Complications Following Cholecystectomy

A new minimally invasive technique for the treatment of intra-articular fractures of the calcaneus preliminary results

Background The goal of therapy for calcaneal fractures is elimination of pain and restoration of normal foot shape and walking ability. The occurrence of wound complications is a serious concern in treating calcaneal fractures. The aim of this study was to evaluate the results of our modified minimally invasive surgical technique for the treatment of intra-articular fractures of the calcaneus. Patients and methods Twenty-one patients with 26 closed, intra-articular fractures of the calcaneus were treated by a minimally invasive technique that we developed by modifying the procedure of Forgon. Results Combining the anatomical and functional results, an overall rating of good, fair, and poor was assigned to each fracture. The results were good in 17 (81%) patients, fair in two (9.5%) patients, and poor in two (9.5%) patients. Conclusion Our results were comparable with the results obtained using other minimally invasive techniques while avoiding the serious soft-tissue complications encountered with open surgery. Thus, we believe that the new technique is an effective and safe alternative for intra-articular calcaneal fracture fixation.

Flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

Extended Lateral Approach for Intra-articular Calcaneal Fractures: An Inverse Relationship between Surgeon Experience and Wound Complications

The current reference standard for the treatment of displaced intra-articular calcaneal fractures is open reduction and internal fixation using an extended lateral approach. In the present retrospective study, we evaluated the results of a consecutive series of patients treated in the same fashion from June 2005 to September 2011 using a subcuticular single-layer closure technique. We also determined the risk factors for the development of wound complications and the rate of wound complications. Also, we assessed which patient, fracture, and surgical characteristics affected these complications. During the 75-month study period, we operated on 53 displaced intra-articular calcaneal fractures in 50 patients using the extended lateral approach. The incision was closed using the subcuticular technique in 49 cases (92.45%). In the subcuticular closure group 2 (4.1%) deep infections and 2 (4.1%) superficial wound complications (1 dehiscence and 1 infection) occurred. Wound edge or flap necrosis was not encountered. The use of bone-void filler and the experience of the surgical team were significantly (p < .001 and p = .026, respectively) associated with the occurrence of wound complications. The subcuticular single-layer suture technique is a suitable closure technique in the treatment of displaced intra-articular calcaneal fractures. It was associated with a low complication rate combined with the extended lateral approach. The effect of bone void fillers on the incidence of complications should receive more attention in future research. The association between wound complications and the experience level of the surgical team supports the need for centralization of this complex injury.

Perioperative Reductions in Circulating Lymphocyte Levels Predict Wound Complications After Excisional Breast Cancer Surgery

Postoperative wound complications after excisional surgery for primary breast cancer can result in patients requiring additional treatments and delay adjuvant therapy and are associated with worse prognoses.We investigated factors that might predispose patients to wound complications. A number of patient characteristics have been associated with wound complications, but there is currently no quantitative measure of the risk of their occurrence. Our hypothesis was that wound complications are related, in part, to the immune status of patients. We recruited patients undergoing surgery for primary breast cancer and determined their circulating levels of various immune cells shortly before and after surgery as a measure of immune status. One hundred seventeen patients were recruited; 16 (13.7%) developed wound complications. The following patient and tumor characteristics were associated with higher wound complication rates: diabetes (P = 0.02); larger tumors (T2/3 vs T1; P = 0.02); metastatic axillary nodes (P = 0.006). With respect to immune status, no significant differences in preoperative levels of circulating immune cells were detected between patients who developed wound complications and those who did not. However, patients who developed complications showed greater reductions in lymphocyte levels 4 hours postoperatively than those who did not (P <0.001). Multivariate analyses demonstrated that falls in lymphocyte levels of greater than 20% or 50% 4 hours postoperatively acted as a significant and independent predictor of wound complications (P < 0.005 and P < 0.0001,respectively). Perioperative changes in lymphocyte levels could provide a practical predictive marker for wound complications on which selective antibiotic prophylaxis could be based.

Risk Factors for Wound Complications Following Abdominoplasty

Problem Statement: Abdominoplasty has become an increasingly popular procedure. Risk factors affecting wound complications of abdominoplasty are not adequately defined in literature. Identification of these risk factors is crucial for better patient’s selection and counseling. The objectives of this study were to determine wound complication rate following abdominoplasty and to examine the relationship of a set of possible risk factors with the incidence of complications. Approach: We studied 116 patients (107 women and 9 men) who underwent abdominoplasty at Jordan University Hospital, between June 1997 and June 2007. Data were collected from patients’ medical records and analyzed to determine types and rates of surgical wound complications. Fourteen possible risk factors were investigated using logistic regression analysis to evaluate their relationship with the occurrence of wound complications. Risk factors examined were: age, sex, body mass index, parity number, smoking history, history of diabetes mellitus, previous gastroplasty for morbid obesity, previous abdominal surgical scars, type of abdominoplasty, plication of recti, hernia repair, operative time and operative blood loss. Results: A total of 29 patients (two males and 27 females) (25%) had wound complications. The most common complication was seroma. It was encountered in 15 cases (12.9%). Six patients (5.2%) had wound infection. Partial skin necrosis was encountered in four cases (3.4 %). Two patients (1.7%) developed wound dehiscence and two patients (1.7%) had hematoma. The only factors significantly increased the complication rate were: increased body mass index (p = 0.002) and history of smoking (p = 0.004). Conclusions and Recommendations: This study confirms the adverse effect of overweight and cigarette smoking on the incidence of wound complication rate following abdominoplasty. We recommend that overweight patients and smokers undergoing abdominoplasty should be adequately counseled and informed about the increased risks. In addition, prophylactic measures should be properly taken to decrease wound complication rate in these groups of patients.

Wound complications at the groin after peripheral arterial surgery sparing the lymphatic tissue: a double-blind randomized clinical trial

Background The groin incision after arterial reconstructive surgery is most likely at risk for infectious or lymphatic wound complications. Theoretically; sparing lymphatic tissue by a lateral approach to the femoral artery should minimize these. The aim of this study was to assess the incidence of wound complications after the lateral versus the direct approach of the common femoral artery. Methods The study population included all patients who underwent an exploration of the common femoral artery between May 2002 and December 2005. Restults After 6 weeks, no statistical differences in the occurrence of wound complications could be shown. A wound infection was present after 6 weeks in 6.1% in the direct group versus 6.0% in the lateral group. Lymphorrhea was persistent in 3.1% in the direct group versus 5.0% in the lateral group. Conclusions Using a lateral vertical incision for the approach of the common femoral artery did not decrease the incidence of postoperative wound complications.

Impact of protein deficiency on venous ulcer healing

The prevalence of protein deficiency and its impact on wound healing is not known for leg ulcers. The aim of this study was to determine the prevalence of protein deficiency in outpatients presenting with leg ulcers and the parameter's prognostic value for wound outcome. Prospective controlled observational study. Ambulatory patients referred for chronic wounds to four university hospitals. Consecutive out-patients with a leg ulcer present for at least 2 months, related to venous insufficiency, associated or not with moderate peripheral arterial disease (ankle-brachial pressure index > 0.7), were included in a prospective study. Wound evaluation (area and occurrence of complications) was performed at baseline and at 12 weeks of follow-up. Biologic nutrition assessment (serum albumin, transthyretin, c-reactive protein) was performed at baseline. The control group consisted of consecutive patients free of leg ulceration and attending the dermatology outpatient clinic for remissive skin cancer or miscellaneous skin disorders. Forty one patients and 43 controls were included. Serum albumin level was under 35 g/L (normal values: 36-44 g/L) in 27% of the patients and 2% of the controls (P < .001). At 12 weeks, 34% of the patients had an increase in wound area. Wound infections occurred in 12% (n = 5) of the patients. Protein deficiency was independently associated with an increase in wound area at 12 weeks (P = .034) and the presence of an inflammatory syndrome was associated with the occurrence of wound complications (wound infection or hospitalization) during follow-up (P < .001). The prevalence of protein deficiency in out-patients with leg ulcers is high and significantly associated with a poor healing prognosis.

Skin Closure After Infrainguinal Bypass Surgery: a Prospective Randomised Study

Background and purpose wound complications after infrainguinal bypass surgery occur frequently and may jeopardise an underlying graft. The purpose of this study was to investigate the role of suture material in the occurrence of wound complications. Methods: prospective randomised trial. 170 consecutive patients underwent femoro-popliteal or femoro–tibial bypass surgery and were randomised between wound closure with continuous polyamide sutures (Ethilon®) or with skin staples. Results ten patients were excluded because of re-intervention or death within 2 weeks after operation. The wound was closed with a continuous polyamide suture (Ethilon®) in 77 patients and with metallic skin staples in 83 patients. The groups were comparable in age, use of corticosteroids, occurrence of diabetes mellitus and operation time. Skin closing time was significantly shorter in the staples group (6.4 min versus 2.7 min, p<0.001). Overall, there were no significant differences between continuous polyamide sutures and metallic skin staples in superficial infections (8% versus 2%), deep infections (1% versus 1%), serous leakage or haematoma. Conclusion we found no significant differences in the incidence of wound complications in infrainguinal bypass surgery comparing continuous polyamide (Ethilon®) and skin staples. The time needed for wound closure was significantly reduced using metallic staples, but this had no effect on the total operation time. Choices of closing materials should be guided by surgeon's preference.

Endoscopic vs. Conventional Vein Harvesting:First Results with a New, Non-Disposable System

Most of the grafts used in coronary bypass surgery are still venous grafts. The preferred vein for bypass surgery is the long saphenous vein. Severe wound complications caused by saphenous vein harvesting occur in 1 % to 3 % of cases. Minor complications that do not need surgical revision occur in up to 43 % of cases. We developed an endoscopic harvesting technique using non-disposable instruments to reduce wound complications caused by vein harvesting. In a retrospective study, the occurrence of wound complications, haematoma, postoperative pain, ambulation, sensory disturbances and patient satisfaction were studied (n = 182). Patients who had either endoscopically harvested (n = 91) or conventionally harvested (n = 91) saphenous vein grafts were reviewed. Results were collected for 173 patients. The overall prevalence of wound complications was 18.7 %. The incidence of wound healing complications could be reduced significantly (p = 0.015) from 15.3 % to 3.4 % using the endoscopic technique. In the endoscopic group, postoperative ambulation was significantly (p = 0.002) easier, patient satisfaction was significantly (p = 0.007) higher, and postoperative leg swelling (p = 0.003) and haematoma (p = 0.004) could be reduced significantly. The occurrence of postoperative pain and sensory disturbances did not differ significantly. We conclude that the used endoscopic vein harvesting is a safe and cost effective method that can significantly reduce wound complications. An ongoing prospective study should establish our demonstrated data.