Occurrence Of Wound Infection Research Articles

The role of TENS therapy in reducing the incidence of post-Caesarean section wound infection.

The occurrence of wound infection following a Caesarean section procedure poses a substantial clinical obstacle. Transcutaneous Electrical Nerve Stimulation (TENS) has been identified as a promising supplementary treatment option for improving the healing process and decreasing the incidence of infections. This study assessed the efficacy of TENS therapy in the postoperative care of patients who have had Caesarean section. We randomly assigned a total of 108 women who had Caesarean sections to either a TENS group (n = 54) or control (n = 54). The TENS therapy was provided twice daily for a duration of 30 min for the period of 14 days following the surgery. The main measure of interest in this study was the occurrence of wound infection during 30-day period. Additionally, secondary measures included the rate of wound healing, levels of pain experienced and level of patient satisfaction. In comparison to the control (22.2%, p < 0.05), the TENS group had notably reduced occurrence of wound infection, with the rate of 7.4%. TENS group had superior wound healing results, as measured by REEDA scale, at 7 days (2.1 ± 0.8 vs. 2.5 ± 1.0, p < 0.04), 14 days (1.2 ± 0.5 vs. 1.9 ± 0.7, p < 0.05) and 30 days (0.3 ± 0.5 vs. 0.7 ± 0.6, p < 0.05). Furthermore, TENS group had reduced pain levels on the Visual Analog Scale (VAS) at all evaluation intervals (p < 0.05). TENS group exhibited significantly higher levels of patient satisfaction, as evidenced by 64.8% of participants rating high satisfaction, in contrast to 40.7% in the control group (p < 0.05). The incidence of adverse effects was found to be minor, as indicated by a skin irritation rate of 3.7% and reported discomfort rate of 1.9% at the electrode location. TENS therapy effectively decreased the occurrence of post-Caesarean wound infections, expedited the healing process and enhanced pain control. This treatment was well-received by patients and had little negative consequences. The aforementioned results provided evidence in favour of incorporating TENS into post-Caesarean care regimens, which may have significant consequences for improving patient outcomes and maximizing healthcare resources.

Effect of body mass index on the wound infection and complications in patients with liver cancer: A meta‐analysis

AbstractThis study systematically evaluates the effect of body mass index on the occurrence of wound infections and complications in patients undergoing liver cancer surgery through a meta‐analysis. A computerized search was conducted, from database inception to October 2023, in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for studies related to the impact of body mass index on patients undergoing liver cancer surgery. Two researchers independently selected studies based on inclusion and exclusion criteria, extracted data, and assessed the quality. Data analysis was performed using Stata 17.0 software. A total of 8 studies, encompassing 21 030 liver cancer surgery patients, were included. The analysis revealed that patients with a higher body mass index had a significantly higher incidence of wound infection (odds ratio [OR] = 2.36, 95% confidence interval [CI]: 1.21–4.60, p = 0.012) and complications (OR = 1.58, 95% CI: 1.11–2.24, p = 0.011) compared to the control group. Additionally, the hospital stay for higher body mass index patients was longer than that for the control group (standard mean difference [SMD] = −1.09, 95% CI: −4.71 to 2.53, p = 0.556), although this difference was not statistically significant. The study indicates that liver cancer surgery patients with higher body mass index were at an increased risk of postoperative wound infection and complications. This finding highlights the importance of considering body mass index as a factor in the management and care of patients undergoing liver cancer surgery.

Primary Closure Versus Delayed Primary Closure of Class III and IV Surgical Wounds Following Emergency Laparotomy: A Prospective Comparative Study.

Introduction Emergency surgery has a high risk of complications due to the detrimental effect of perioperative sepsis and the relative lack of preoperative optimization of patients. Despite advances in critical care for the management of sepsis, its prevention is dependent on various patient and surgeon factors. Surgical site infection continues to be a major determinant of morbidity and mortality following emergency abdominal surgery, especially in contaminated or dirty wounds. This study aims to compare two techniques of abdominal wall closure, primary closure with subcutaneous suction drains and delayed primary closure following negative pressure wound therapy, in terms of incidence of surgical site infection and morbidity. Materials and methods The study was a prospective comparative study including 50 patients with an acute surgical abdomen requiring laparotomy. The patients were randomized into two groups, Group A (n=25) who underwent primary closure, and Group B (n=25) who underwent delayed primary closure. In Group B patients, a vacuum-assisted closure device was applied in the subcutaneous space for five days prior to the closure of the skin. Outcomes were compared in terms of the incidence of superficial and deep surgical site infection, its association with diabetes mellitus, and the total duration of hospital stay. A chi-square test and an unpaired t-test were used for the test of significance. Results A total of 50 patients, comparable in age, were included in the study. The overall incidence of surgical site infection was significantly higher in patients of Group A as compared to Group B (p=0.0046). There was a positive correlation between diabetes mellitus and the occurrence of wound infection in both groups with the odds ratio being 2.67 and 2.38 respectively. The incidence of superficial wound infection was significantly higher in Group A when compared to Group B (52% versus 24%; p=0.04). Deep surgical site infection was higher in patients of Group A (20% versus 8%) but was not statistically significant (p=0.22). The average duration of hospital stay was 41.56 ± 6.96 and 37.86 ± 6.68 days for patients who developed complications fromGroups A and B respectively, while it was nearly two and a half times lower in uncomplicated cases of Groups A and B (11.71± 1.70 days and 16.58± 1.06 days respectively). The one-tailed unpaired t-test showed a significant difference in means of hospital stay between patients with and without complications (T: 17.06, critical value: 1.677). Conclusion Delayed primary closure is an effective method of managing contaminated and dirty wounds following emergency laparotomy. Negative pressure wound therapy is one technique for preventing wound bed infection and accelerating wound healing in such cases. By combining the above in emergency surgeries, the incidence of surgical site infection and duration of hospital stay can be significantly reduced.

Comparison of Outcome after Open Pilonidal Sinus Treatment Versus Endoscopic Pilonidal Sinus Treatment (EPSIT)

Objective: To compare the complications among open pilonidal sinus treatment versus endoscopic pilonidal sinus treatment (EPSIT). Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Rawalpindi Pakistan, form Feb to Nov 2021. Methodology: The study was conducted on 150 patients who underwent pilonidal sinus treatment at our surgical unit. Patients were randomly divided into two groups. Group-A underwent open pilonidal sinus surgery, while Group-B underwent endoscopic pilonidal sinus treatment (EPSIT). Recurrence, bleeding, seroma formation and occurrence of wound infection were compared in both groups. Results: All of the 150 patients included in the final analysis were males. The mean age of patients who underwent surgery for pilonidal sinus in our study was 41.22±9.34 years. 79(43%) patients underwent the open surgical method, while 71(57%) underwent the endoscopic one. All the complications were found statistically significant (p-value&lt;0.05) in patients who underwent open surgical procedures for pilonidal sinuses compared to those who underwent endoscopic surgical methods. Conclusion: Endoscopic pilonidal surgery emerged as a better option than open pilonidal surgery. Patients undergoing open pilonidal surgery were more at risk of bleeding, recurrence, developing seroma and wound infections.

Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study

BackgroundPatients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA). MethodsThis retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS. ResultsThe study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0–77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01–1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335–8.073; P = 0.01), development of wound infection (2.653 1.285–5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388–2.116, P < 0.001) were significant predictors. ConclusionsIncreased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients’ LOS provides a reliable reference for clinical treatment.

Risk Factors and Role of Antibiotic Prophylaxis for Wound Infections after Percutaneous Endoscopic Gastrostomy.

The incidence of wound infections after percutaneous endoscopic gastrostomy (PEG) varies widely in recent studies. The present study systematically investigates the underlying risk factors for the development of wound infections in a large cohort of patients over a long-term follow-up period. A retrospective cohort study of patients undergoing PEG insertion using either the pull or push technique was conducted and patients followed up for 3 years. Tube-related wound infections were identified, and pathogens regularly cultured from wound swabs. Adjusted analysis was performed via univariate and multivariate logistic regression analysis. 616 patients were included in this study. A total of 25% percent of patients developed wound infections upon PEG tube insertion and 6.5% showed recurrent infections. Nicotine abuse (p = 0.01), previous ischemic stroke (p = 0.01) and head and neck cancer (p < 0.001) showed an increased risk for wound infection after PEG placement. Moreover, radio-chemotherapy was associated with the occurrence of wound infections (p < 0.001). Infection rates were similar between pull and push cohorts. The most common bacterial pathogen detected was Enterobacterales (19.2%). Staphylococcus aureus, Pseudomonas aeruginosa and enterococci were frequently detected in recurrent infection (14.2%, 11.4% and 9.6%, respectively). Antibiotic prophylaxis showed no effect on infection rates. Wound infections after PEG placement are common and occasionally occur as recurrent infections. There is potential for improvement in everyday clinical practice, particularly regarding antibiotic prophylaxis in accordance with guidelines.

Delayed vs. early enteral feeding after repair of congenital recto-vestibular fistula: The effect on perineal wound healing.

congenital Recto vestibular fistula represents the commonest type of anorectal malformation in females. The treatment of this anomaly is mainly approached either through anterior or posterior sagittal ano-rectoplasty approach. Several perioperative factors may affect the outcome. One of major postoperative complications is the occurrence of wound infection. We aimed to study the effect of delayed vs. early enteral feeding on the occurrence of perineal wound infection (PWI) after repair of congenital recto vestibular fistula. Fifty-five infants with recto-vestibular fistula were included. They were managed by single stage anterior sagittal anorectoplasty (ASARP) at an age ≥3 months. Groups A and B included infants who started oral intake on the 6th and 2nd postoperative days respectively. Group A infants were kept on peripheral parenteral nutrition (PPN) during the fasting period. Superficial wound infection occurred in three cases in group A while it developed in seven cases in group B. Deep perineal infection occurred in two and five cases in group A and group B respectively. The mean hospital stay was 8 days in group A vs. 13 days in group B when PWI developed. Delayed enteral feeding with PPN keeps the perineal wound less contaminated with stool. This promoted proper and fast healing with lower incidence of PWI. Also, PPN compensates the catabolic effects of both surgical trauma and fasting during the postoperative period and ensures maintenance of normal levels of essential nutrients that allow for proper healing.

Outcomes After Primary Closure of Animal Bite Wounds

Introduction: Most animal bites heal without difficulty. However, some animal bite wounds lead to infection, and whether animal bite wounds should be left open or sutured remains controversial. This study aimed to evaluate the risk factors for bite-wound infection, and whether primary closure interfered with wound infection.Methods: This was a single-center, retrospective cohort study. The following information was extracted: date of treatment, age, sex, location of the injury, severity of injuries, surgical procedure, the interval between injuries, and primary treatment.Results: A total of 535 patients presented with dog- or cat-bite wounds. Primary closure was performed in 89 patients (17.0%); 73 patients had wound infections (14%). There were no significant differences between infection and age, sex, animal species, wound location, or severity (P = 0.46, 0.35, and 0.30, respectively). However, occurrence of wound infections after primary wound closure increased significantly (P < 0.05). More infections in the head, neck, and lower extremities occurred particularly in the primary closure group than in the open wound group (P < 0.05).Head and neck bite wounds generally exhibit low infection rates owing to the rich blood supply to the area. However, our study showed that the infection rates of head and neck bite injuries were similar to those of the upper and lower extremities.Conclusion: There were many cases of infection after primary suturing, even in the head and neck regions. Therefore, careful follow-up after primary care of bite wounds is required.

A Comparative Study on the Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal.

BackgroundHypospadias is the most common penile malformation affecting up to one in 300 live male births. In general, a urinary diversion (urethral stent or bladder catheter) is maintained in situ for two to seven days or more after hypospadias repair. Because of the low level of evidence, the latest guidelines of the European Association of Urology and the European Society of Paediatric Urology provide no recommendations concerning the timing of catheter removal after hypospadias surgery. In this study, we aimed to compare the outcomes of hypospadias surgery (tubularized incised plate urethroplasty, TIPU) following early versus late bladder catheter removal.MethodologyIn total, 62 patients were included in this study. All patients underwent TIPU by the same team of surgeons. All patients were divided into the following two groups: group A (32 patients) had their catheter removed on or before the fifth postoperative day, and group B (30 patients) had their catheter removed after the fifth postoperative day. All patients were scheduled for an outpatient assessment after two weeks, at one month, after three months, and at six months if necessary.ResultsThe mean age of patients in group A was five years (three to seven years) and in group B was five years (four to 7.25 years) with a p-value of 0.378. Among the early complications of the surgery, the occurrence of wound infections, urinary tract infections, and urinary retention was comparable among the two groups. The rate of bladder spasms (0% versus 13.3%, p = 0.033) was significantly higher in group B than in group A. The rate of urinary retention (12.5% versus 0%, p = 0.045) was significantly higher in group A than in group B. Superficial wound infection occurred in two out of 32 patients in group A (6.3%) and two out of 30 patients in group B (6.7%) (p = 0.94). Both groups had similar incidences of wound complications. Urinary tract infections also had a similar incidence in both early and late catheter removal groups, i.e., one out of 32 patients in group A (3.1%) and three out of 30 patients (10%) in group B (p = 0.271). Urinary extravasation following hypospadias repair occurred in two out of 32 patients (6.3%). No extravasation was noted in the late catheter removal group. However, the difference was not clinically significant (p = 0.164). Two patients in both groups developed urethrocutaneous fistula (6.3% in group A versus 6.7% in group B). However, the difference was not clinically significant. Meatal stenosis developed in three out of 32 patients in group A and two out of 30 patients in group B (9.4% versus 6.7%; p = 0.696). One patient in the early catheter removal group developed urethral stricture as a late complication. None of the patients in the late catheter removal group developed this complication.ConclusionsThe occurrence of long-term complications of TIP hypospadias repair was not affected by the early removal of the bladder catheter. The shortcomings of our study were its descriptive nature and the small sample size. Further prospective randomized controlled trials are needed to ascertain the safety of early catheter removal and improvement in quality of life in the immediate postoperative period.

FATORES DE RISCO PARA INFECÇÃO DE FERIDA OPERATÓRIA APÓS COLECISTECTOMIA LAPAROSCÓPICA ELETIVA

ABSTRACTBACKGROUND:One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors.AIMS:This study aims to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures.METHODS:This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection.RESULTS:There were seven cases of wound infection (1.59%). No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection.CONCLUSIONS:The nonuse of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

FATORES DE RISCO PARA INFECÇÃO DE FERIDA OPERATÓRIA APÓS COLECISTECTOMIA LAPAROSCÓPICA ELETIVA.

ABSTRACT - BACKGROUND:One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors.AIM: This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures.METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection.RESULTS: There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection.CONCLUSIONS: The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

Wound infection in elbow fractures: Incidence and new management protocol.

Wound infection in elbow fractures: Incidence and new management protocol.

Is Prophylactic Antibiotic Therapy Needed in Thyroidectomy?

Antibiotics have been traditionally prescribed for any open head and neck surgery. With classification of wound and wound contamination and various published guidelines the practice is still widely prevalent. Thyroidectomy being a clean surgery does not warrant the use of antibiotics at all. We performed an interventional prospective study to see the occurrence of wound infection in patients who received antibiotic prophylaxis as compared to those who did not. A total of 71 patients were recruited in the study who were randomly divided into two groups, one received antibiotic prophylaxis and other did not. Both the groups did not show any marked change in the incidence of wound infection hence highlighting the unnecessary use of prophylactic antibiotics in thyroid surgeries.

Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children: A Randomised Controlled Trial.

Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co-amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children. In this prospective, randomised, double-blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co-amoxiclav versus placebo and the rate of local and systemic infections were assessed. Of the 106 patients considered for inclusion, 49 patients were randomized. In the per-protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P = 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02-1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P = 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%-1.80%]. Similar results were obtained in intention-to-treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P = 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P = 0.02). The number-needed-to-treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients. A preoperative dose of co-amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.

Study of gentamicin deposition in cellulose with albumin

Methods of binding antibacterial drugs to the surface of cellulose without the use of oxidizing agents to prevent the occurrence of wound infections have been studied. The immobilization of gentamicin in the complex of partially denatured albumin in the composition with bacterial cellulose has been analyzed. The study was carried out on samples of cellulose synthesized by Gluconacetobacter hansenii. Albumin served as a binding agent, which was used to impregnate cellulose samples, which were then denatured. Using PCR amplifi cation CFX (BioRad), the optimal denaturation temperature was selected. The effectiveness of the immobilization of albumin in the thickness of the cellulose was assessed by staining it with the luminescent dye SYPRO® Ruby Protein Gel Stain, followed by transilluminator detection. Bacterial cellulose impregnated with undenatured albumin was used as a control. Albumin immobilization in bacterial cellulose was observed at temperatures of 65– 95 °C. The antibacterial activity of the complex “cellulose + albumin + gentamicin” was evaluated using a test strain of bacteria Staphylococcus aureus ATCC 25923. The growth inhibition of the test strain of bacteria was observed in all tests with bacterial cellulose in combination with partially denatured albumin and gentamicin. In control samples, in which gentamicin was not immobilized as part of partially denatured albumin, growth inhibition zones of Staphylococcus aureus ATCC 25923 were not noted. It was concluded that by partial denaturation of albumin it is possible to delay antibacterial drugs in the thickness of bacterial cellulose for their further release. A new version of the material suitable for the production of implants and bandages based on bacterial cellulose gel with antibacterial properties is proposed. Dressings based on a composite of bacterial cellulose, albumin and gentamicin are most relevant for the treatment of burns. The presence of gentamicin in their composition is also relevant for the prevention of bacterial infections.

Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach

BackgroundPericardiectomy is the final treatment for constrictive pericarditis. However, this greatest surgical approach is still very controversial. This study pursued to assess the outcomes in patients with recurrent chronic constrictive pericarditis undergoing reoperated pericardiectomy via median sternotomy versus left anterolateral thoracotomy and to explain which surgical approaches might be better for recurrent chronic constrictive pericarditis.MethodsA total of 24 patients were identified with recurrent chronic constrictive pericarditis and underwent reoperation with pericardiectomy between July 2003 and July 2015. The decision for this surgical approach was mainly dependent on the operating surgeon’s preference. Out of 20 patients, 16 patients underwent pericardiectomy via median sternotomy and 8 patients via left anterolateral thoracotomy pericardiectomy. Their data were obtained retrospectively from the case notes.ResultsBoth groups of patients were similar in age, gender between two operations, and also in peripheral venous pressure, cardiac rhythm and New York Heart Association (NYHA) class distribution. The mortality rates were similar in both groups with one death (12.5%) due to low cardiac output syndrome in the left anterolateral thoracotomy group and two deaths (12.5%) in the median sternotomy group. All the deaths were associated with cardiac complications and happened in the perioperative period. NYHA functional class status enhanced in most of the patients. Patients in both groups had a similar and significant improvement in their NYHA status that improved from 3.4 ± 0.7 to 1.8 ± 0.1 (P = 0.001) in the left anterolateral thoracotomy group and reduced from 3.3 ± 0.6 to 1.9 ± 0.4 (P = 0.001) in the median sternotomy group. There was a significantly greater rate of pulmonary infection in the thoracotomy group than in the median sternotomy group (50% versus 25%, P = 0.02). Nevertheless, there was a significantly greater occurrence of wound infections in the median sternotomy group in 3 patients versus in one patient of the left anterolateral thoracotomy group (18.8% versus 12.5%, P = 0.02).ConclusionsLeft thoracotomy incision was preferred to sternotomy in the current setting of this situation and was done safely without CPB. It avoided life-threatening sternal infection and it also has showed an equal as well las significant enhancement of NYHA status of the patients.

Subcuticular interrupted versus continuous skin suturing in elective cesarean section in obese women: a randomized controlled trial

Objective: To compare the interrupted subcuticular skin closure with continuous one in obese women undergoing cesarean delivery. Materials and methods: A randomized controlled study conducted on 169 obese women with term uncomplicated singleton pregnancy who underwent elective cesarean delivery. They were randomized to either skin closure through continuous subcuticular sutures using vicryl 3/0 or interrupted subcuticular suturing using vicryl 3/0. The primary outcome parameter was occurrence of wound infection. Secondary outcomes included other skin complications, postoperative pain, operative duration and hospital stay Results: There was a statistically higher number of cases with wound hematoma (20 vs. 10, p = .04), infection (30 vs. 15, p = .008) and those who needed reclosure of wound (8 vs. 0, p = .004) in the continuous when compared to women in the interrupted subcuticular group, respectively. Healing with secondary intension was significantly higher in women in the continuous subcuticular group (52 vs. 26, respectively, p < .001). The number of cases with wound seroma and keloid formation was not statistically different between the two groups (25 vs. 19, p = .272 and 12 vs. 5, p = .069 in the continuous vs. interrupted groups, respectively). The duration of CS was longer in those who underwent interrupted closure when compared to continuous ones. However, that was statistically insignificant (40.95 + 6.376 vs. 37.05 + 6.455, p = 0.14). Conclusions: Most surgical wound complications were reduced if skin closure with continuous subcuticular sutures is replaced with interrupted one.

Cell salvage for postpartum haemorrhage during vaginal delivery: a case series.

The safety and effectiveness of cell salvage for vaginal delivery is unknown. This case series aimed to assess the utility and adverse events related to the use of cell salvage for maternal haemorrhage during vaginal delivery. A cohort study design was chosen, focused on postpartum haemorrhages that occurred after vaginal delivery for which cell salvage equipment was requested to be set up in the labour and delivery room outside of a sterile operating room environment. Variables recorded included duration of stay in hospital, occurrence of wound infections, sepsis, thromboembolic events, and amniotic fluid embolism. Of 28 cases of postpartum haemorrhage during vaginal deliveries involving the setup or use of cell salvage equipment, ten were associated with successful re-infusion of salvaged shed blood. These ten cases were compared to the 18 cases in which cell salvage equipment was set up, but insufficient shed blood was salvaged for re-infusion. There were no instances of postpartum sepsis, wound infection, or thromboembolism associated with the use of cell salvage for vaginal delivery. Although one case of suspected amniotic fluid embolism occurred, severe symptoms began prior to the infusion of salvaged blood. Infusion of salvaged shed blood collected from a vaginal delivery field is feasible. The outcomes of these cases do not exclude an unacceptably high risk of infection or embolic events. Trials evaluating the safety and effectiveness associated with the use of cell salvage in vaginal deliveries are justified.

Influence of deep neuromuscular block on the surgeonś assessment of surgical conditions during laparotomy: a randomized controlled double blinded trial with rocuronium and sugammadex

BackgroundDuring laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB. MethodsThis was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml−1) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection. ResultsDeep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3–5) compared with 4.00 (range 1–5) (P<0.001), respectively. Deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure (P<0.001), fewer episodes of need to optimize surgical conditions (P<0.001), and fewer incidents with sudden movements (P<0.001). No differences in operating time, occurrence of wound infection, and wound dehiscence were found. ConclusionsDeep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy. Clinical trial registrationNCT02140593.

Blood transfusion and postoperative complications: a cautionary comment.

In the recent issue of JAMA Surg , Ecker and coworkers (1) reported a large study aimed to evaluate trends in transfusion rates for major abdominal oncologic resections. This retrospective population-based study was using the American College of Surgeons National Surgical Quality Improvement Project database. Another study by Ferraris et al. (2) aimed to determine the role of transfusion for patients’ postoperative outcomes. This study was based on the same database. Ecker et al. (1) found transfusion was associated with occurrence of wound infection, renal insufficiency, and myocardial infarction. Ferraris et al (2) revealed that transfusion has a dose-dependent adverse effect on postoperative outcomes. Though some of these findings were confirmed by another population based study (3), we believe that some issues of these two articles require consideration.