Postoperative Wound Research Articles

Spondylodiscitis: Understanding pathophysiology, surgical strategies, and postoperative management - A single-center study.

Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center. A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P. Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases. Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.

Analysis of the associated factors in postoperative wound infection following open reduction and internal fixation for elbow fracture.

Postoperative wound infections (PWIs) following open reduction and internal fixation (ORIF) for elbow fractures can significantly affect patient outcomes. Identifying associated risk factors is crucial for improving clinical practices and patient care. A retrospective analysis (June 2020-June 2023) at our institution involved 90 patients who underwent elbow ORIF. Thirty patients developed PWIs (case group), compared to 60 who did not (control group). Variables like anaemia, operation duration, hospital stay, blood loss, body mass index (BMI), age, hypoalbuminemia, smoking status, diabetes mellitus and open fractures were examined. Univariate and multivariate analyses determined the impact of these variables on PWI incidence, with statistical significance set at p < 0.05. The main pathogens identified were Escherichia coli among Gram-negative bacteria (59.46%) and Staphylococcus aureus among Gram-positive bacteria (40.54%). In the univariate analysis, hypoalbuminemia, anaemia, and lifestyle factors such as smoking showed higher prevalence in patients with PWIs. However, age and length of hospital stay did not significantly influence infection rates. The multivariate analysis further elucidated that anaemia, smoking, diabetes mellitus and open fractures were independent, significant predictors of PWIs. These findings highlight the complexity of factors influencing infection risk post-ORIF, underscoring the importance of both individual health conditions and surgical complications in patient outcomes. Anaemia, smoking, diabetes mellitus and open fractures significantly increase the risk of PWI after elbow ORIF. Early identification and management of these risk factors are imperative to reduce infection rates and improve postoperative recovery.

Purulent Complications after Planned Operations in a Multidisciplinary Hospital

The study included 326 patients who are visiting the surgical department of the Belgorod Regional Clinical Hospital of St. Joasaph with purulent postoperative wounds in the period from 2018 to 2022 after elective surgeries. The largest number of patients hospitalized by us with suppuration of the postoperative wound, previously operated on for hernias – 116 (35,58 %), in second place in terms of number was the group of patients after operations on the abdominal organs (Laparotomy) – 50 (15,34 %), patients with infection of the skin and soft tissues after operations on bone tissue (metal osteosynthesis) were 32 (9,82 %), after (total arthroplasty of large joints) – 48 (14,72 %) patients, operations on the peripheral vessels of the lower extremities were performed in 50 (15,34 %) patients, in 30 (9,2 %) patients have previously undergone surgery on the organs of the mediastinum (Sternotomy). From the general list of possible causes of the development of purulent wound complications after elective surgical interventions described in the literature, we identified the frequency of their occurrence, and the correlation analysis made it possible to identify those that had the closest relationship with the resulting indicator (the fact of wound suppuration after surgery with ranking the severity of the purulent-inflammatory process according to the ASEPSIS scale). The regression models built on the basis of the identified parameters were characterized by high coefficients of determination (&gt; 0.8), were significant (reliable) and made it possible to predict the expected value of the patient's postoperative wound assessment. It has been established that the dynamics of changes in the state of the postoperative wound was most strongly affected by such indicators as the use of synthetic and metal implants, temperature in the operating room &lt; 210C or &gt; 240C, wound area in cm2, air temperature in the ward &gt; 240C, and the presence of soft tissue hematoma in the area of the postoperative wound.

A clinical case of surgical treatment of appendiceal stump abscess

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur. The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed. The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.

Three-dimensional printed pure-titanium implantation for chest wall reconstruction involving the sternum and ribs: a novel approach.

Chest wall reconstruction is challenging due to the complex shape and large defect size. The three-dimensional printing technology enables the fabrication of customized implants, and 3D-printed pure-titanium could provide superior mechanical properties to conventional materials. The aim of this study was to evaluate long-term outcomes of patients undergoing chest wall reconstruction with a 3D-printed pure-titanium implant. Between August 2018 and May 2021, 5 patients underwent surgery due to sternal metastasis (n = 3), postoperative sternal wound infection (n = 1) and deformity (n = 1). The customized implant was designed and constructed based on the size and shape of the chest wall defect measured on computed tomography. All patients demonstrated uneventful recovery without complications during the hospital course. During the median follow-up of 20 months, 1 patient underwent revision surgery due to implant breakage, and 1 removed the implant due to trauma-related chest wall infection. One patient died from cancer progression, while 3 patients are alive without any implant-related complications. Chest wall reconstruction using a 3D-printed pure-titanium implant could be a novel alternative for patients with various conditions affecting the sternum and ribs.

Effect of two different peritoneal dialysis modalities on wound infection in peritoneal dialysis patients: A meta-analysis.

Peritoneal dialysis(PD) is one of the most efficient methods in end-stage kidney disease, and it is very important for PD to perform well. No research has been conducted to evaluate the effect of various types of PD catheters on the prognosis of post-operative wound complications. While recent meta-analyses are in favour of straight tubing, there is still uncertainty as to whether direct or coiled PD is beneficial. The purpose of this meta-analysis was to compare the efficacy of direct and coiled PD catheters on the incidence of post-operative wound infection, bleeding and peritonitis. A comprehensive search was carried out on three databases, including PubMed and Embase, and a manual search was carried out on the links in the paper. The results showed that the incidence rate of bleeding after operation and the degree of infection among the straight and coiled pipes were compared. The results showed that there were no statistically significant differences in the incidence of post-operative wound infection among straight PD patients with coiled PD (OR, 0.79; 95% CI, 0.58-1.08 p = 0.13). No statistical significance was found in the case of PD with coiled tubing compared with that of straight PD group in wound leakage (OR, 1.17; 95% CI, 0.71-1.93 p = 0.55). No statistically significantly different rates of post-operative peritonitis were observed for coiled tubing compared with straight ones in PD patients (OR, 1.06; 95% CI, 0.78-1.45 p = 0.7). There is no statistical significance on the rate of wound infection, wound leakage and peritonitis among coiled and straight tube in PD.

THE USE OF A POLYVALENT KLEBSIELLA BACTERIOPHAGE IN INFECTION AFTER RECONSTRUCTIVE PLASTIC SURGERY ON THE SPINE IN A CHILD (A CLINICAL CASE)

The incidence of infection after reconstructive plastic surgery on the spine (in particular, spondylodesis) in children remains at a fairly high level and ranges from 0.4% to 8.7%. These complications are often caused by polyresistant bacterial pathogens; this accentuates the need for new effective therapeutic approaches. Bacteriophage preparations in combination with antibiotics can optimize existing strategies for the treatment of infectious diseases, since they are able to selectively destroy bacteria, including biofilm-forming ones. The aim of the study was to draw the attention of practitioners to modern problems of treating polyresistant infections on the example of a case of purulent complication after spinal surgery in a child. Materials and methods. On the basis of the FSBI "Federal Center for Traumatology, Orthopedics and Endoprosthetics" under the Health Ministry of the Russian Federation (the town of Cheboksary) a retrospective analysis of a clinical case of treating early infection after reconstructive plastic surgery on the spine caused by a polyresistant strain of Klebsiella pneumoniae was conducted. Research results. Patient P., 2.2 years old, with congenital pathology of the musculoskeletal system, who repeatedly received medical care in various medical organizations, underwent surgical spine stabilization. In the early postoperative period, an infectious complication developed caused by a polyresistant strain of Klebsiella pneumoniae (a producer of extended-spectrum beta-lactamases and carbapenemases). Along with surgical debridement of the postoperative wound, a combined etiotropic antibacterial therapy was performed (12 weeks). However, complete healing of the postoperative wound was achieved in combination with the administration of a polyvalent klebsiella bacteriophage (10 weeks). Conclusions. This clinical case demonstrates that the use of a polyvalent klebsiella bacteriophage can increase the effectiveness of antibacterial pharmacotherapy in surgical treatment with preservation of metal structures.

The impact of long-term antihypertensive treatment on wound healing after major non-cardiac surgery in patients with cardiovascular diseases: A meta-analysis.

Hypertension is a prevalent condition that poses significant challenges in the perioperative management of patients undergoing major non-cardiac surgery, particularly concerning wound healing and scar formation. This meta-analysis assesses the impact of long-term antihypertensive treatment on postoperative wound healing, examining data from seven studies involving patients who received such treatments compared to untreated controls. Our findings reveal that long-term antihypertensive therapy is associated with significantly improved wound healing outcomes, as indicated by lower REEDA scores (I2 = 96%, SMD = -25.71, 95% CI: [-33.71, -17.70], p < 0.01) 1 week post-surgery and reduced scar formation, demonstrated by lower Manchester Scar Scale scores (I2 = 93%, SMD = -37.29, 95% CI: [-44.93, -29.64], p < 0.01) 2 months post-surgery. These results underscore the potential benefits of antihypertensive treatment in enhancing surgical recovery and offer insights into optimising perioperative care for hypertensive patients.

Analysis of the Relationship between Patient Family Knowledge about Infections in Post-Operative Wounds in Supporting the Post-Operative Patient Wound Healing Process: Study at dr. Soekardjo Regional General Hospital, Tasikmalaya, Indonesia

Introduction: Post-operative wound infection is a serious complication that can hinder the healing process. The patient's family's knowledge about post-operative wound infections can play an important role in supporting the healing process. This study aims to analyze the relationship between the patient's family's knowledge about infections in post-operative wounds and the process of wound healing in post-operative patients at dr. Soekardjo Regional General Hospital Tasikmalaya.&#x0D; Methods: This research used a cross-sectional design with a total of 52 respondents selected by purposive sampling. Data was collected using a questionnaire to measure the patient's family's knowledge about post-operative wound infections and observation sheets to assess the wound healing process. Data analysis was carried out using the Chi-square test.&#x0D; Results: The majority of respondents were 32 years or older. Respondents' education was dominated by secondary level. The majority of respondents have incomes greater than or equal to the UMR. The majority of respondents had sufficient knowledge about post-operative wound infections, but there were still 17.31% of respondents who had insufficient knowledge. The results of the study showed that there was a significant relationship between the patient's family's knowledge about post-operative wound infections and the wound healing process (p-value &lt; 0.05).&#x0D; Conclusion: The patient's family's knowledge about post-operative wound infections can support the patient's post-operative wound healing process.

The effect of primary closure versus secondary closure techniques on postoperative wound pain in patients undergoing mandibular surgery: A meta-analysis.

This research is intended to explore the influence of second and first degree closure methods on the degree of wound pain and swelling of the face following the removal of the mandible. For the purpose of this study, three data sets, including PubMed and Embase, were selected. A separate statistical analysis was conducted on the choice of the trial, the collection of data and the risk of bias. Differences between trials were analysed with a chi-square approach, with data analyses dependent on I2. A sensitivity analysis was conducted, and a possible publication bias was evaluated. Ultimately, nine qualifying trials were chosen out of an original pool of 1922 related trials following an in-depth evaluation under the eligibility and exclusion criteria, as well as a follow-up screening. The results indicated that there was no statistically significant change in the degree of post-operation pain after 1 day operation between one or secondary closures of treatment (MD, -0.46; 95% CI, -0.93, 0.01, p = 0.06); the results showed that there were no statistically significant differences in post-operation wound pain after 3 days in two group (MD, -0.15; 95% CI, -0.68, 0.37, p = 0.56); the results showed that there were no statistically different effects on the post-operation wound pain after the 7th day in two groups (MD, -0.14; 95% CI, -0.31, 0.03, p = 0.1). The results showed that there were no statistically different effects on the post-operation wound pain after the 1 day in two groups (MD, -0.26; 95% CI, -0.38, -0.13, p < 0.0001); on the 3rd day after surgery, the face was significantly smaller swelling in the secondary closure of closure compared with the first-stage closure group (MD, -0.70; 95% CI, -1.40, -0.00, p = 0.05). While there is no obvious effect on post-operation wound pain in patients with mandibular surgery, there is significant difference in post-operation face swelling. The findings do not support a preference for any of these methods.

Effect of platelet-rich plasma on healing of lower extremity diabetic skin ulcers: A meta-analysis.

The aim of this research is to explore the therapeutic efficacy of platelet-rich plasma (PRP) on the cutaneous ulceration of diabetes mellitus (DM). From the beginning of the database until January 2024, we looked through several databases to obtain randomised, controlled PRP studies to treat the wound healing of DM in adult patients. The Cochrane Collaboration's Risk-Of-Bias Instrument was used to evaluate the risk of bias in randomised, controlled studies. Funnel plots, sensitivity analyses and Egger regression tests were employed to determine the reliability and effectiveness of the meta-analyses. Depending on the degree of heterogeneity, a fixed or random effect model has been used. The statistical significance was determined to be below 0.05. Altogether 281 trials were collected from the database and entered into Endnote Software for screening, and 15 trials were analysed. It was found that PRP was associated with a higher rate of wound healing (OR, 3.23; 95% CI, 2.42, 4.31 p < 0.0001). PRP was associated with a reduction in the risk of post-operative wound infection (OR, 0.46; 95% CI, 0.21, 0.99 p = 0.05). PRP was associated with a reduction in the risk of amputations amongst those with DM (OR, 0.50; 95% CI, 0.30, 0.84 p = 0.009). Overall, PRP treatment for DM is expected to improve the rate of wound healing, decrease the risk of wound infection and decrease the risk of amputations.

Comprehensive assessment of risk factors and pathogenic characteristics of wound infections following thoracoscopic radical resection for lung cancer.

Lung cancer remains a leading cause of cancer-related mortality, with surgical resection as a primary treatment modality. However, postoperative wound infections (PWIs) pose significant risks following thoracoscopic radical resection. This study aims to identify the risk factors and pathogenetic characteristics associated with PWIs in lung cancer surgery. A comprehensive retrospective study was conducted from August 2021 to June 2023 at our institution. The study included 30 patients who developed PWIs and 60 controls who did not, following thoracoscopic radical resection for lung cancer. We evaluated various factors including age, hospital stay, intraoperative blood loss, body mass index (BMI), operation time, prophylactic antibiotic use, diabetes mellitus and tumour staging. Diagnostic criteria for PWIs were based on clinical signs and microbiological confirmation. Statistical analysis was performed using SPSS software, utilizing chi-square tests, and univariate and multivariate logistic regression analyses. The predominant pathogens identified in PWIs were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Univariate analysis revealed operation time (≥4 h) and diabetes mellitus as significant risk factors for PWIs, while prophylactic antibiotic use was associated with a lower incidence of PWIs. Multivariate analysis further confirmed these findings, highlighting prolonged operation time and diabetes as significant predictors of PWIs, and antibiotic use as a protective factor. Prolonged operation time and diabetes mellitus significantly increase the risk of PWIs following thoracoscopic radical resection for lung cancer, whereas prophylactic antibiotics play a protective role. These findings underscore the importance of tailored preventive strategies in clinical practice to minimize the occurrence of postoperative infections and improve surgical outcomes in lung cancer patients.

Mucocele Treatment in Pediatric Patient at RSGM UMY

Background : Mucoceles is minor salivary gland lession. The extravasation mucocele, commonly referred to as a "mucous retention cyst," does not have an epithelial lining or a well-defined boundary. An extravasation mucocele is believed to be caused by damage to a tiny salivary gland excretory duct. Saliva accumulates in the adjacent submucosal tissue due to a tear in the duct, leading to swelling. Retention type mucocele occurs when a small salivary gland duct is blocked, often by a sialolith, periductal scarring, or tumor. Salivary flow blockage leads to the accumulation of saliva and the enlargement of the duct. Objective : To provide treatment for mucocele in a pediatric patient at RSGM UMY Case Report : A 9-year-old patient came to RSGM UMY accompanied by his mother, complain he has swelling on lower lip. He often bite the lower lip for a long time. It is painless and sometimes increases in size. His experiencing discomfort due to the bump. Method : The mucocele was excised using infiltration anesthetic and a blade no. 15. Surgical sutured silk braided was utilized for postoperative wound closure. The patient was provided with post-operative instructions and prescribed antibiotics and analgesics. The patient was scheduled for a follow-up appointment after one week to have the sutures removed. Result : No complaints after control 1 month and 3 months after treatment Conclusion : Surgical removal remains the optimal choice for treating mucoceles due to its simplicity and cost-effectiveness compared to laser ablation, cryosurgery, and electrocautery

Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow

Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF). To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF. This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used. Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4-1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA. Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to highelectricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgerycandiminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.

Effect of prophylactic use of cefazolin in caesarean section on postoperative infection: A meta-analysis.

Caesarean section rate is increasing and postoperative wound infection is a major health-threatening complication after caesarean section (CS). The aim of this study was to evaluate the efficacy of Cefazolin at different time for post-caesarean delivery. The aim of this study was to compare the use of Cefazolin at different times on infections after CS. The time of antibiotic use in CS can be divided into two groups: before skin incision (SI) and after cord clamping (CC). In this study, 268 relevant articles were found in the database, and finally, 10 articles were analysed. This study included a total of 5256 cases of caesarean section. The data on wound infections, endometritis, urinary tract infections and fever were analysed. Perform an analysis of the data using RevMan 5.3. The results showed that cefazolin before SI reduced wound infection compared to after CC (odds ratio [OR], 0.51; 95% CI: 0.37-0.69; p < 0.0001). Cefazolin prophylactically used before SI reduce endometritis after CS compared to after CC (OR, 0.52; 95% CI: 0.35-0.77; p = 0.001). There was no significant difference in urinary tract infections after CS between cefazolin prophylactically used before SI and after CC (OR, 0.80; 95% CI: 0.50-11.28; p = 0.35). There was no significant difference in fever after CS between the prophylactic use of cefazolin before SI and after CC (OR, 0.60; 95% CI: 0.26-11.43; p = 0.225). Cefazolin before SI reduces wound infection and endometritis after CS.

Does local fat thickness correlate with post-operative infection in open reduction and internal fixation of acetabulum fractures?

Obesity is an epidemic which increases risk of many surgical procedures. Previous studies in spine and hip arthroplasty have shown that fat thickness measured on preoperative imaging may be as or more reliable in assessment of risk of post-operative infection and/or wound complications than body mass index (BMI). We hypothesized that, similarly, increased local fat thickness at the surgical site is a predictor of wound complication in acetabulum fracture surgery. Patients who underwent open reduction and internal fixation (ORIF) of an acetabulum fracture through a Kocher-Langenbeck (K-L) approach at a single institution from 2013 to 2020 were identified. Pre-operative CT scans were used to measure fat thickness from the skin to the greater trochanter in line with the surgical approach. Post-operative infections and wound complications were recorded and associated with fat thickness and BMI. 238 patients met inclusion criteria. 12 patients had either infection or a wound complication (5.0%). There was no significant association with BMI or preoperative fat thickness on post-operative infection or wound complication (p-value 0.73 and 0.86). There is no statistically significant association of post-operative infection or wound complications in patients with increased soft tissue thickness or increased BMI. ORIF of acetabulum fractures through a K-L approach can be performed safely in patients with large subcutaneous fat thickness and high BMI with low risk of infection or wound complications.

Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. The use of barbed sutures decreased closure time by 6min (30.1 vs. 36.1min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. I.

Prevention of purulent and inflammatory complications of the soft tissues of the abdominal wall in patients with peritonitis

Objective. To learn about measures to prevent purulent and inflammatory complications of the soft tissues of the abdominal wall in patients with peritonitis.&#x0D; Materials and methods. Based on the purpose of the study, 2 groups of patients were formed. The main group included 23 patients in whom a variable–height polyurethane wound dilator in combination with an application sorbent was used intraoperatively to prevent surgical wound suppuration. The control group included 27 patients who were treated with polyurethane wound dilator alone.&#x0D; Results. Suppuration of the surgical wound occurred in 2 (8.7%) patients of the main and 6 (22.2%) patients of the control group, seroma – in 1 (4.3%) and 2 (7.4%) patients, respectively, haematoma – in 1 (3.7%) patient of the control group, inflammatory infiltration – in 2 (8.7%) patients of the main and 3 (11.1%) patients of the control group.&#x0D; Conclusions. The use of a polyurethane wound dilator in combination with an application sorbent for the prevention of postoperative wound suppuration in patients with spilled and general peritonitis in the toxic and terminal stages allowed to reduce the number of purulent and inflammatory complications of the soft tissues of the abdominal wall in the main group by 2 times compared to the corresponding indicator in the control group.

The choice of surgical correction method depending on the etiology of decompensated chronic venous insufficiency

Aim. To evaluate the immediate and distant results of treatment depending on the etiology of chronic venous insufficiency in the stage of decompensation. Materials and methods. This work presents an analysis of the results of treatment of 342 patients of CEAP 6 with manifestations of chronic vein insufficiency on the background of varicose disease (VD) and post-thrombotic syndrome (PTS) in the surgical clinic of the Transcarpathian Regional Clinical Hospital named after A. Novak (Uzhhorod) for the last 10 years. At least 169 patients had VD (CEAP 6). Post-thrombotic syndrome (occlusive form) was observed in 173 patients (CEAP 6). The ratio of women to men in VD was 3:1, and in PTS was 3:2. Results. In patients of group I (crossectomy + short stripping + distal scleroobliteration), postoperative complications developed in only 2 (4.3 %) patients in the form of suppuration of the operative wound on the thigh and lymphorrhea. With extended venectomy + SEPS, early postoperative complications were observed in 5 (6 %) patients: three patients had suppuration of the postoperative wound on the thigh, and two patients had lymphorrhea. In classical venectomy + Linton’s operation, inguinal wound suppuration occurred in 2 (5.3 %), lymphorrhea in 3 (7.9 %) patients. Suppuration of the postoperative wound on the lower leg was observed in another 3 (7.9 %) patients. The long-term outcomes in the patients of the group I were: 9 (19.1 %) patients had partial recanalization of the perforated veins of the group of great saphenous vein (GSV) on the lower leg, and one (2.1 %) had complete recanalization. Trophic ulcer (TU) did not heal in one patient after conservative treatment, relapse of TU occurred in 7 (4.1 %) patients. In patients of the group II thrombosis of the cross autovenous shunt (during Palma’s operation) in the early postoperative period was observed in 5 (8.5 %) patients, during autovenous shunting and Husni’s operation (transposition of the GSV into the popliteal vein) in no case. During Linton’s operation, suppuration of the postoperative wound was observed in 7 (15.9 %) cases. TU did not heal with conservative treatment in 5 (56 %) patients. Conclusions. In the stage of decompensation of VD, pathogenetically justified treatment is crossectomy, venectomy with elimination of horizontal reflux in the zone of trophic ulcer. Trophic ulcers &lt;5 cm and &gt;2 cm deep I–II degrees are treated conservatively after surgery and heal independently within a year. Phlebectomy and CE of the affected limb are contraindicated in PTS. Pathogenetically justified method of treatment is reconstructive and restorative surgery to restore main blood flow with elimination of horizontal reflux in the zone of trophic ulcer.

The Effect of Preoperative Chlorhexidine Gluconate Cleanse on Lower Extremity Surgical Site Infections: A Retrospective Cohort Study.

Lower extremity surgical sites are at an increased risk of wound infection following Mohs micrographic surgery. To evaluate the rate of lower extremity surgical site infections following a 14-day regimen of preoperative 4% chlorhexidine gluconate (CHG) rinses and postoperative wound occlusion for 14 days. Retrospective data were collected from procedures performed by the senior author from January 2022 through June 2023. To meet inclusion, patients must have completed waist-down CHG soak and rinse for 14 days before surgery, including the day before surgery. In addition, the patient must have kept the dressing clean, dry, and intact until the postoperative appointment at 14 days. A total of 100 Mohs cases met inclusion criteria. Zero patients developed a surgical site infection. Chlorhexidine gluconate preoperative rinsing and postoperative occlusion for 14 days may minimize the risk of wound infection. Although further research is indicated, an opportunity exists for the adoption of CHG into routine clinical practice in the outpatient dermatology setting.