Patients Developed Wound Complications Research Articles

Risk Factors for Wound Complications Following Conversion TKA after Tibial Plateau Fracture.

The purpose is to investigate the incidence of wound complications for total knee arthroplasty (TKA) following tibial plateau open reduction and internal fixation (ORIF). A prospective arthroplasty registry was queried for patients with CPT codes for primary TKA, tibial plateau ORIF, removal of hardware (ROH), and diagnosis of post-traumatic arthritis. Patients were included if they had undergone tibial plateau ORIF and subsequent TKA. Chart review was performed to obtain demographic, clinical and post-operative information. Twenty-one patients were identified, with average age of 56.23 ± 13.2years at time of tibial plateau ORIF and 62.91 ± 10.8years at time of TKA. Seven (33.3%) patients had a tibial plateau fracture-related infection (FRI). Eight (38.1%) patients underwent ROH prior to TKA. Seven (33.3%) patients' TKA incision incorporated the prior plateau incisions. Eight (36.4%) patients developed wound complications following TKA and 5 (23.8%) developed an acute periprosthetic joint infection (PJI) following TKA and had the plateau incision incorporated into the TKA incision. FRI history did not increase the rate of wound complications but did increase the rate of ROH prior to TKA. Previous FRI involving tibial plateau repair surgery doesn't correlate with PJI after conversion TKA for post traumatic OA. Surgeon-controlled factors such as staged ROH and incision placement can help reduce the rate of wound complications following TKA performed after tibial plateau ORIF. Prognostic Level IV. The online version contains supplementary material available at 10.1007/s43465-022-00709-1.

Open Anterior Component Separation for Complex Incisional and Ventral Hernias—When and How? Case Series Analysis

Abstract Closing the midline in patients with incisional hernias is the cornerstone for a functional reconstruction with low morbidity, low recurrence rates, and good cosmetic results, which is the ideal outcome for every hernia surgeon. However, in patients with large hernias (usually over 10 cm width) or in loss of domain cases, this goal is difficult to achieve. Anterior component separation with or without mesh reinforcement has been the procedure of choice for these patients despite its high rate of wound complications. The goal of our study is to evaluate the opportunity and necessity of the anterior component separation in patients with complex incisional or ventral hernias (defects larger than 10 cm, infected meshes). Data of patients with large incisional/ventral hernia operated using anterior component separation technique in the past 10 years were re-visited and analyzed from hospital records between January 2012 and December 2020. Demographic data (age, gender, body mass index, ASA score) and the main steps of the technique were recorded. Data were reported as mean and standard deviation. We used the anterior component separation in 66 cases, mainly for septic conditions (open abdomen, chronic and extended infections of the abdominal wall, chronic-infected meshes). For large parietal defects with aseptic local condition, we used mesh-reinforced anterior component separation (five patients). Mean age was 68.7 years. Among them, 29 patients developed wound complications (hematoma, seroma, infection). Mean hospital stay was 12.6 days. Recurrence was 18% in patients without mesh and zero in patients with mesh reinforcement after a minimum one-year follow-up. Anterior component separation is still a valid procedure in patients with large abdominal defects especially when a septic wound is to be closed. For large parietal defects, if a wide subcutaneous dissection is required, mesh-reinforced anterior component separation remains a valid alternative in abdominal wall reconstruction in certain cases (mainly aseptic conditions).

Skeletal muscle measurements predict surgical wound complications but not overall survival in patients with soft tissue sarcoma.

It is unknown whether sarcopenia influences treatment outcome in patients with soft tissue sarcoma. Herein, we aimed to elucidate the impact of sarcopenia on sarcoma treatment. A total of 163 soft tissue sarcoma patients were included. Skeletal muscle measures were calculated using computed tomography images. Skeletal muscle area (SMA) and density (SMD) at the L3 level were extracted, and SMA was normalized by height as skeletal muscle index (SMI). The skeletal muscle gauge (SMG) was calculated by multiplying SMD×SMI. The relationship of skeletal muscle measures and clinical factors to wound complications and prognosis was evaluated, and classification and regression tree (CART) analysis was used to develop classification models for risk groups of surgical wound complications. Thirty-three patients developed wound complications. In univariate analysis, age (P=0.0022), tumour location of adductor compartment of the thigh (P=0.0019), operating time (P=0.010), blood loss (P=0.030), SMD (P=0.0004) and SMG (P=0.0001) were significantly correlated with complications. In multivariate analysis, lower SMG was an independent risk factor (P=0.031, OR=3.27). CART analysis classified three risk groups of surgical wound complications by SMG, age, tumour location and operating time, and area under the receiver operating characteristic curve (AUROCC) was 0.75. SMG was not associated with prognosis in univariate analysis (P=0.15). The SMG does not affect overall survival but predicts surgical wound complications.

Timing of Adjuvant Radiation Therapy and Risk of Wound-Related Complications Among Patients With Spinal Metastatic Disease.

Study Design:This was an epidemiological study using national administrative data from the MarketScan database.Objective:To investigate the impact of early versus delayed adjuvant radiotherapy (RT) on wound healing following surgical resection for spinal metastatic disease.Methods:We queried the MarketScan database (2007-2016), identifying patients with a diagnosis of spinal metastasis who also underwent RT within 8 weeks of surgery. Patients were categorized into “Early RT” if they received RT within 4 weeks of surgery and as “Late RT” if they received RT between 4 and 8 weeks after surgery. Descriptive statistics and hypothesis testing were used to compare baseline characteristics and wound complication outcomes.Results:A total of 540 patients met the inclusion criteria: 307 (56.9%) received RT within 4 weeks (Early RT) and 233 (43.1%) received RT within 4 to 8 weeks (Late RT) of surgery. Mean days to RT for the Early RT cohort was 18.5 (SD, 6.9) and 39.7 (SD, 7.6) for the Late RT cohort. In a 90-day surveillance period, n = 9 (2.9%) of Early RT and n = 8 (3.4%) of Late RT patients developed wound complications (P = .574).Conclusions:When comparing patients who received RT early versus delayed following surgery, there were no significant differences in the rates of wound complications. Further prospective studies should aim to identify optimal patient criteria for early postoperative RT for spinal metastases.

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair.

We identified factors that would lead to wound complications after open femoral exposure for endovascular abdominal aortic aneurysm repair (oEVAR). Using the National Surgical Quality Improvement Program dataset (2005-2014), we examined the patients who underwent oEVAR. Patients were stratified on whether they developed postoperative wound complications. Comparisons were made between group with wound complications and those without and adjusted analyses performed to identify variables that independently increased the risk of wound complications. There were 14,868 patients in the study cohort and 2.6% (384 patients) developed wound complications after EVAR. Among those with wound complications, 94% (360 patients) of patients had superficial and deep surgical site infection. Patients who had wound complication were likely to be younger (72.6 vs. 73.7 years old ( p = 0.02), functionally dependent (5.4 vs. 2.5%) ( p < 0.05), smoker (3 vs. 2.4%, p =0.03), female (4 vs. 2.2%), with significantly higher body mass index (31 vs. 28), and more commonly had diabetes (4 vs. 2.4%, p < 0.001) or renal failure (12 vs. 3%, p < 0.001). Although perioperative survival was similar, patients who had wound complications had significantly longer hospital length of stay (LOS) (7.3 ± 12 vs. 3.4 ± 5 days, p < 0.001). Up to 3% patients developed wound complications after open femoral exposure during EVAR with significantly higher LOS and therefore cost utilization.

Waist-Hip Ratio Surrogate Is More Predictive Than Body Mass Index of Wound Complications After Pelvic and Acetabulum Surgery.

To determine whether a novel surrogate of waist-hip ratio (WHR) is more predictive of wound complications after pelvis or acetabulum stabilization than body mass index (BMI) and describe the method of measuring a WHR proxy (WHRp). Retrospective review. One Level 1 Trauma Center. One hundred sixty-one patients after operative repair of pelvis and acetabulum fractures. Operative stabilization of a pelvic ring injury or acetabular fracture. Infection (pin, superficial, and deep) and wound healing complication. We retrospectively reviewed 161 subjects after operative repair of pelvic and acetabular fractures. Primary outcome was any wound complication. BMI was acquired from medical records. WHRp was derived from anteroposterior and lateral computed tomography scout images. BMI and WHRp results were analyzed as continuous and categorical variables. BMI was grouped into high-risk categories of ≥30 and ≥40. WHRp data were grouped utilizing the WHO's high-risk profile for females (>0.85) and males (>0.90). An alternative optimal WHR was also assessed. Covariate analysis included demographic data, Injury Severity Score, mechanism, tobacco use, presence and types of open approach, injury type, associated injuries and comorbidities, failure of fixation, and thromboembolism. The mean follow-up was 15.9 months. Twenty-four (15%) patients developed wound complications. Increasing BMI (P < 0.007) and WHRp (P < 0.001) as continuous variables and female sex (P < 0.009) were associated with wound complications. Applying unadjusted continuous data to a receiver operating characteristic curve revealed a greater area under the curve for WHRp than for BMI (P < 0.001). The optimal predictive WHRp was ≥1.0 (P < 0.001, odds ratio 43.11). The receiver operating characteristic curve from adjusted data demonstrated a greater area under the curve for WHRp ≥1.0 (0.93) compared with BMI ≥30 (0.78) or ≥40 (0.75) and WHO WHRp (0.82). Computed tomography generated WHRp demonstrated excellent interrater reliability (0.99). The WHRp of ≥1.0 was more predictive than BMI of wound complications after operative treatment of pelvis and acetabulum fractures. In our series, WHRp calculated using scout images performed sufficiently well to predict wound complications. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Screws to Plate-and-Screw Constructs for Midfoot Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Arthritis of the midfoot’s 1st, 2nd, and/or 3rd tarsometatarsal joints (TMTJ) are routinely treated with arthrodesis when nonsurgical treatments fail. This surgery is traditionally performed with trans-articular screws, but newer plate- and screw constructs placed across the TMTJs may confer greater rigidity to the midfoot fusion. While in vitro biomechanical studies show advantages to using plate-and-screws over screws to achieve a solid midfoot arthrodesis, there have yet to be clinical comparative investigations about this subject. The purpose of this study is to prospectively evaluate and compare clinical and radiographic outcomes of trans-articular screws versus plate-and screw constructs for arthrodesis of the midfoot’s 1st, 2nd, and/or 3rd TMTJs in a single surgeon’s practice. Methods: Between April 2010 and December 2015, 68 patients presented with arthritis of the 1st, 2nd, and/or 3rd TMTJs that failed nonsurgical management. Of these persons, 50 enrolled in this study to receive a midfoot arthrodesis with either trans- articular screws or plate-and screw constructs. On the day of surgery, 25 patients were randomized to receive 4.0 mm partially- threaded cannulated cancellous screws (Synthes, Paoli, PA) while the remaining 25 were randomized to receive plate-and-screws (ALPS, Biomet, Warsaw, IN) at their involved TMTJs. Preoperative and postoperative function and pain was graded using the Foot and Ankle Ability Measures (FAAM) Scoring System and a Visual Analog Scale (VAS) of pain respectively. Radiographs were assessed for bony healing and hardware stability at the arthrodesis. Postoperative data regarding complications and revision surgeries were also recorded. Patients were routinely followed for 12 months from arthrodesis and then invited for updated longer-term follow-up to collect further data. Results: Of 25 patients with screws for arthrodesis, 21 (84%) achieved fusion within 6 months. Mean FAAM and pain scores changed from 46.4/100 and 8.3/10 preoperatively to 82.7/100 and 2.1/10 respectively at final follow-up. Three (12%) patients developed wound complications. Four patients (16%) experienced delayed union or nonunion of their arthrodesis. Of 25 patients with plate-and-screws for arthrodesis, 23 (92%) achieved fusion within 6 months. Mean FAAM and pain scores changed from 48.2/100 and 8.0/10 preoperatively to 86.3/100 and 1.8/10 respectively at final follow-up, which were not significantly different from patients with screws. Six (24%) patients developed wound complications, which is significantly higher than patients with screws. Two (8%) patients experienced delayed union or nonunion of their arthrodesis, which is less than patients with screws. Conclusion: A comparison of outcomes from performing midfoot arthrodesis with screws or plate-and-screw constructs has not been previously reported in the orthopaedic literature. This study demonstrates that using either screws or plate-and-screw to achieve TMTJ fusion results in a high rate of improving midfoot function and pain. While using just screws generate significantly less wound complications (P&lt;0.05), employing plate-and-screws produce less problems with delayed union or nonunion of the fusion (P=0.30). Studies with a larger patient population may be needed to further confirm these results when using different types of implants for midfoot arthrodesis.

Comparative study of the outcome of pediatric femur diaphyseal fractures treated with titanium elastic nails vs. compression plates

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A variety of methods have been described for the management of femur diaphyseal fractures in children between ages of 5 to 12 years. Some of the techniques include closed reduction and internal fixation (CRIF) with elastic nails, open reduction and internal fixation (ORIF) with compression plates, external fixators and skeletal traction with spica casting. This study was done to compare the outcome and complications of diaphyseal femur fractures in pediatric age treated with CRIF with Titanium elastic nails vs. ORIF with compression plates&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was a prospective, clinical study. A total of 60 patients were studied. 30 patients were treated with CRIF with titanium nails and 30 patients were treated with ORIF with compression plates. Every patient operated was followed up at 3 weeks, 6 weeks, 3 months, 6 months and 3 monthly thereafter until implant removal.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Only 1 wound healing complication was noted in the TENS nail group which was skin irritation at the site of pin insertion. In the compression plating group, 6 patients developed wound complications, including superficial infections, deep infections and keloids. The range of movements at knee joint in the two groups was compared. Only 1 patient had a significant loss of flexion with ROM of less than 100 degrees in the TENS nail group. In the plating group 4 patients had a significant loss of flexion with ROM of less than 100 degrees. Limb length discrepancies were seen in 3 patients in the TENS nail group whereas the compression plating group showed 1 patient. 2 patients in the TENS group developed an angular deformity due to premature weight bearing. 3 patients in the compression plating group developed deformities at the fracture site. The average time for fracture union in the compression plate group was 10.7 weeks and was 14.7 weeks in the patients treated with TENS nail&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; No single fixation method can be considered superior in all types and patterns of pediatric diaphyseal femur fractures. Titanium elastic nails can be considered a better implant for treating pediatric femur fractures when compared to compression plates due to the lesser rates of surgical wound complications, better range of movements at knee joint and overall lesser complication rate as was recorded in this study&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Local perivascular adiponectin associates with lower extremity vascular operative wound complications

Wound complication rates after lower extremity vascular operative procedures stand as high as 40% and represent a major cause of morbidity, mortality, and cost. In view of increasing recognition of adipose tissue involvement in homeostasis and the response to injury, we hypothesized that adipose phenotype is linked to operative wound outcomes. Clinical history, peripheral blood, and subcutaneous and perivascular adipose tissue were prospectively collected at the time of operation in patients undergoing lower extremity revascularization and lower extremity amputations. Nine biologic mediators (adiponectin; interleukin [IL]-1β, IL-6, and IL-8; leptin; monocyte chemoattractant protein-1; plasminogen activator inhibitor-1; resistin; and tumor necrosis factor) were assayed in the adipose tissues and plasma. The 30-day wound complications were captured in real time. Logarithmic transformation of mediator levels was performed based on positively skewed, non-Gaussian distribution, and data were compared using the Student t test. Bonferroni correction was used for multiple comparisons. Sixty-six patients undergoing lower extremity revascularization or lower extremity amputations for severe peripheral arterial disease were enrolled. The 30-day follow-up was 92.4%. In total, 19 (29%) patients developed wound complications. Patients who developed wound complications had elevated perivascular adiponectin levels (mean±standard error, 2,372.45±648.64ng/mL vs 832.53±180.54ng/mL, P=.004). Perivascular IL-1β levels were lower among patients with wound dehiscence (0.41±0.004 pg/mL vs 0.73±0.09 pg/mL, P=.001). Local adipose tissue mediator levels at the time of operation demonstrate a previously undescribed compartment-specific relationship to wound outcomes in patients undergoing lower extremity vascular operative procedures. These associations provide fertile directivesfor defining the mechanisms underlying the pathogenesis of wound complications and their prevention.

Experience with FiberWire for pectus bar attachment

BackgroundMinimally invasive repair of pectus excavatum has become an established method for repair of pectus excavatum. Bar displacement or rotation remains the most common complication of this repair requiring return to the operating room. MethodsRetrospective review of all patients at a single institution who underwent repair of pectus excavatum using FiberWire for bar stabilization between December 2009 and March 2013 was undertaken. Results93 patients underwent minimally invasive pectus repair using FiberWire during the study period. The patients included 73 males and 20 females, with an average age of 14.6years (range 7–21years). Mean operative time was 102minutes (range 56–198minutes). No patients developed wound complications, two patients developed pain because of bar migration and required return to the OR, and no patients had recurrence of their pectus defect because of bar migration during the study period. Median length of follow-up was 17months (range 3–36months). ConclusionStabilization of pectus bars using circumferential rib fixation with FiberWire at multiple points on both sides of the bar appears to be effective in preventing bar rotation and displacement, and requires minimal change to the operation as it has been previously described. Early experience shows a low rate of complications.

Retromuscular Preperitoneal Repair of Flank Hernias

IntroductionFlank hernias represent a challenging problem to reconstructive surgeons. Their anatomic proximity to the bony prominence and major neurovascular structures limits fixation options and restricts mesh overlap. We present our technique and outcomes of a preperitoneal repair with wide mesh overlap. MethodsThis study is a retrospective analysis of patients undergoing open flank hernia repair with a retromuscular preperitoneal approach. ResultsBetween September 2007 and April 2011, 16 patients, mean age 55 years (range 34–80) and BMI 33 kg/m2 (range 26–46), underwent open flank hernia repair. Eight were recurrent hernias; six previously had mesh placed; nine were incarcerated. Mean hernia defect size was 232 cm2 (range 25–800). Mean operative time was 178 min (range 105–245). One intraoperative complication, ureteral injury in a transplant recipient, occurred and was primarily repaired without sequela. Two patients developed wound complications, one requiring superficial debridement and another requiring partial excision (<5 %) of the mesh with secondary healing. With a mean follow-up of 16.8 months (range 2–49), no recurrent hernias were noted. ConclusionOpen retromuscular preperitoneal repair of flank hernias with iliac bone fixation is technically feasible, allowing wide mesh overlap for a durable repair. This approach may offer advantages of treating abdominal wall laxity and repair of larger defects when compared to laparoscopic approaches.

Posterior components separation during retromuscular hernia repair

Retromuscular ventral hernia repair with mesh is a durable technique. In this paper, we describe a novel technique which allows for significant mesh overlap via the retromuscular space in cases of massive ventral hernia. The retromuscular space is developed laterally, to the edge of the rectus sheath. The posterior rectus sheath is incised, dividing the posterior aponeurosis of the internal oblique. The dissection is carried out laterally between the internal oblique and the transversus abdominis muscle, creating space for a large mesh underlay. We have performed this technique successfully in 20 patients with a mean defect area of 223 cm(2) and a mean mesh area of 698 cm(2). Three patients developed wound complications and none complained of long-term pain or abdominal wall deformity. There has been one recurrence due to technical error after a mean 12-month follow-up. This technique of dissection between the internal oblique and transversus abdominis muscles allows for the closure of large hernia defects. The mechanism is two-fold: (1) mobility for closure of the posterior rectus sheath, dorsal to the prosthetic; and (2) increased mobility of the rectus, internal, and external obliques, allowing reconstruction of the linea alba.

Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors

The authors prospectively assessed the value of awake craniotomy used nonselectively in patients undergoing resection of supratentorial tumors. The demographic features, presenting symptoms, tumor location, histological diagnosis, outcomes, and complications were documented for 610 patients who underwent awake craniotomy for supratentorial tumor resection. Intraoperative brain mapping was used in 511 cases (83.8%). Mapping identified eloquent cortex in 115 patients (22.5%) and no eloquent cortex in 396 patients (77.5%). Neurological deficits occurred in 89 patients (14.6%). In the subset of 511 patients in whom brain mapping was performed, 78 (15.3%) experienced postoperative neurological worsening. This phenomenon was more common in patients with preoperative neurological deficits or in those individuals in whom mapping successfully identified eloquent tissue. Twenty-five (4.9%) of the 511 patients suffered intraoperative seizures, and two of these individuals required intubation and induction of general anesthesia after generalized seizures occurred. Four (0.7%) of the 610 patients developed wound complications. Postoperative hematomas developed in seven patients (1.1%), four of whom urgently required a repeated craniotomy to allow evacuation of the clot. Two patients (0.3%) required readmission to the hospital soon after being discharged. There were three deaths (0.5%). Awake craniotomy is safe, practical, and effective during resection of supratentorial lesions of diverse pathological range and location. It allows for intraoperative brain mapping that helps identify and protect functional cortex. It also avoids the complications inherent in the induction of general anesthesia. Awake craniotomy provides an excellent alternative to surgery of supratentorial brain lesions in patients in whom general anesthesia has been induced.

Lateral rhinotomy through nasal aesthetic subunits. Improved cosmetic outcome.

The traditional lateral rhinotomy incision described originally by Moure in 1902 has proved a versatile approach to the mid-facial skeleton. It is not, however, without its complications, particularly poor cosmesis due to depression of the nasofacial groove. In one series 10 per cent of patients developed wound complications. We present our modification of the lateral rhinotomy incision, that takes account of the nasal aesthetic subunits by placing the incision between the dorsal and side wall nasal subunits with extension inferiorly along the alar groove. From November 1994 to February 2001, a retrospective review of case notes showed that 20 patients underwent modified lateral rhinotomy incision for a variety of pathology. Ten cases were for transitional papilloma, nine for malignant disease and one for chronic osteitis of the maxilla and ethmoids post-trauma. Follow up ranged from two weeks to five years. In five cases we were able to preserve the bony piriform aperture without compromising the excision or exposure. We believe that preservation of the bony piriform aperture will further enhance the overall cosmesis and nasal function. No complaints related to the incision were recorded. Our experience with the modified lateral rhinotomy incision has been very satisfactory. It provides good exposure, a low complication rate and excellent cosmetic outcome without undue technical difficulty. It is our preferred incision for all surgery on the mid-facial skeleton and anterior skull base.

Risk of Venous Access Device Wound Complications in Patients Undergoing Paclitaxel Chemotherapy for Gynecologic Malignancies

Objective.To determine if wound complications after placement of a central venous catheter access device are related to the type of postsurgical cytotoxic chemotherapy administered.Methods.All patients in a 10-year period undergoing placement of central venous access device followed by postsurgical chemotherapy for gynecologic malignancies were included in this retrospective case–control study.Results.Sixty-eight patients underwent 78 placement procedures followed by chemotherapy. Six catheters (7.7%) in five patients developed wound complications. Variables evaluated included the type of gynecologic malignancy, previous use of chemotherapy, patient age and weight, preoperative white blood cell count, type of access device and insertion site, use of prophylactic antibiotics, type of chemotherapy and interval to administration, development of wound complication, and catheter removal. Univariate analysis shows an association between subsequent catheter site wound complication and paclitaxel use (P= 0.02) as well as wound complication and combined paclitaxel and cisplatin use (P= 0.005). Multivariate analysis with stepwise linear regression confirms that a paclitaxel containing regimen is associated with an increase in wound breakdown (P= 0.04).Conclusion.The use of a paclitaxel containing chemotherapeutic regimen administered after placement of an indwelling central venous access device in gynecologic oncology patients is associated with wound complications of the catheter site.