Postoperative Hematoma Research Articles

Retrograde puncture for trocar placement for the establishment of the preperitoneal space in laparoscopic totally extraperitoneal repair for groin hernias: 10years of experience.

The aim of this study was to investigate the feasibility and safety of retrograde puncture for trocar placement for the establishment of the preperitoneal space in laparoscopic total extraperitoneal repair (TEP) for groin hernias. A retrospective analysis of the clinical data of 1388 patients who underwent TEP surgery for a groin hernia at the General Hospital of Northern Theater Command of the Chinese People's Liberation Army (hereinafter referred to as the General Hospital of Northern Theater Command) from August 2013 to August 2023 was conducted. The feasibility and safety of retrograde puncture for trocar placement for the establishment of the preperitoneal space were examined. All 1388 operations were successful, with no conversion to open surgery. The mean time for unilateral placement of the Trocars was 6.36 ± 2.32min. The mean time for unilateral hernia surgery was 42.73 ± 10.33min, and the mean time for bilateral hernia surgery was 73.11 ± 20.31min. Peritoneal injuries were observed in 8 patients (0.58%), but there were no abdominal organ injuries. Two patients (0.14%) had inferior epigastric vascular injuries, and 16 patients (1.15%) experienced muscle hemorrhage during retrograde puncture. Twenty-five patients (1.80%) had postoperative local hematomas of the abdominal wall, and 37 patients (2.67%) had subcutaneous emphysema. Sixty-four patients (4.61%) experienced seroma retention, and 13 patients (0.94%) experienced urinary retention. The postoperative follow-up period ranged from 3 to 124months, with a median follow-up time of 66months. None of the patients experienced recurrence, persistent pain, localized foreign body sensation, mesh infection, or incision infection. The retrograde puncture method for placing trocars to establish the preperitoneal space in laparoscopic TEP surgery for groin hernias is feasible and safe.

Lacertus fibrosus release in proximal median nerve entrapment- a systematic review.

The role of lacertus fibrosis as the primary perpetrator behind the illusive pronator teres syndrome is becoming increasingly recognized in recent literature. The aim of this systematic review is to explore the outcomes of lacertus fibrosis release in patients complaining of proximal median nerve entrapment signs and symptoms. In this systematic review, Pubmed, Cochrane Library, Scopus, Ovid databases were reviewed. Studies in which structures, other than the lacertus fibrosus, in the proximal forearm had been concomitantly released were deemed illegible. Various outcome assessment tools were utilized; those were pain, numbness, and satisfaction visual analog scales, return of function and muscle strength, quick DASH, work DASH, and activity DASH scores. Adherence to PRISMA guidelines was maintained. A total of seven studies, three interventional and 4 retrospective observational studies, were included in this review out of 118 articles. These included 446 participants who underwent lacertus fibrosis release with a mean age of 45 years old across a mean duration of postoperative follow-up of 16.1 months. A significant proportion of the patients had a history of unsuccessful conservative or surgical management (prior carpal tunnel release in 10.5%). Minimal access surgery under WALANT was performed in 95%, US-guided release under WALANT in 3.3%, and open exploration was done in 1.5%. A horizontal incision hidden in the elbow flexion creese was done in 74.2%, oblique incision 2cm distal and 2cm radial to the medial epicondyle in 20.8%, and open exploration through a Z-shaped incision over the antecubital fossa in 1.5%. Immediate pain relief and return of function and strength was reported in 99.6%. A significant improvement was reported in postoperative quick DASH (mean = 24 points), work DASH (mean = 28.8 points), and activity DASH (mean = 44.8 points). Further, a significantly lower VAS score was obtained on pain, numbness, and paraesthesia scales. There were two complications, a case of postoperative haematoma and another case of surgical site infection. Seven patients complained of residual symptoms by the end of the follow up duration; carpal tunnel release was done in three and release of superficialis arcade was necessitated in four other cases. Lacertus syndrome can be optimally managed by surgically releasing the lacertus fibrosus. This can be done as a minimally invasive procedure under WALANT. A high index of suspicion is required when encountering patients with signs and symptoms of median nerve entrapment, specifically those who were treated unsuccessfully with the presumption of carpal tunnel syndrome.

A Novel Dual-Catheter Drainage Technique for Prevention of Orbital Hematoma in Blowout Fracture Surgery.

Retrobulbar hematoma after blowout fracture surgery is a devastating complication that can lead to permanent vision loss. When such complications occur, emergency interventions like lateral canthotomy are often required, resulting in additional tissue trauma. This study presents a novel dual-catheter drainage technique designed to prevent postoperative orbital hematoma formation. Eight consecutive patients who underwent orbital wall reconstruction between October 2024 and December 2024 were included in this study. The technique involves placing 2 modified 18-gauge angiocatheters: one positioned above the orbital plate toward the inferior orbital fissure, and another placed horizontally between the lower eyelid musculature and orbital bone. Four to 5 small holes were created around each catheter to enhance drainage efficiency. Initial experience with a single catheter in 1 patient resulted in postoperative lower eyelid hematoma. After modification to a dual-catheter system, 7 subsequent cases demonstrated successful prevention of orbital hematoma formation. Significant drainage was observed during the first 48 hours postoperatively in all cases. No complications, such as infection, ectropion, or permanent diplopia, were observed. The catheter system was maintained for 2 to 3 days postoperatively, with consistent catheter occlusion noted by day 3 due to blood clot formation. This novel dual-catheter drainage technique demonstrates effectiveness in preventing postoperative orbital hematoma after blowout fracture surgery. The method's simplicity, minimal invasiveness, and strategic anatomic coverage make it a valuable approach for reducing postoperative complications and improving surgical outcomes. Further studies with larger patient cohorts are warranted to establish the technique's broader applicability.

Planned iliohypogastric neurectomy for prevention of chronic pain after inguinal hernia repair

PurposeThe present study aimed to investigate the effect of planned ilohypogastric neurectomy (IHPN) in preventing chronic postoperative inguinal pain (CPIP) after anterior herniorrhaphy (AH).Materials and methodsThis prospective, randomized study was conducted between 2016 and 2023. Emergency and incarcerated hernia cases, bilateral inguinal hernias, cases with complications such as postoperative hematoma infection, cases in which the neuroanatomy of the inguinal region was unintentionally damaged, femoral hernias, and paraplegic patients with loss of sensation who underwent anterior inguinal herniorrhaphy with prolene mesh were excluded, and the remaining 1375 patients were included in this study. The patients were randomized into preoperative control and study groups. After further excluding 247 patients (18%) in whom the IHN could not be identified during the operation, 82% of the 1375 patients (n = 1128) were included in this study. In the control group, the RCA segment of the IHN that would remain under the mesh was preserved (control group = G1 = 534). The second group in which this segment of the RCA was excised comprised the study group (G2 = 594). Two groups were prospectively followed and pain scores (PS) were recorded regularly with a 4-point scale. The average follow-up period was 15 months (range 11–19 months) in G1 and 14 months (range 10–18 months) in G2.ResultsThe number of patients with CPIP was 68 in G1 and 19 in G2, this difference was found to be statistically significant (p: < 0.001). There were 19 patients in G1 and 41 patients in G2 with loss of sensation in the operation area, and a significant difference was detected in this respect (p = 0.012).ConclusionThe rate of developing CPIP was significantly lower in patients who underwent IHPN during anterior herniorrhaphy than in those who did not undergo IHPN. The subjective nature of the pain sensation complicates measuring and scoring this sensation and methodologically limits the study.

Optimal timing for decompression in post-operative epidural hematoma: a retrospective analysis and treatment flowchart.

Post-operative epidural hematoma is a rare but devastating complication of spine surgery. The importance of timely decompression for preserving neurologic function has been repeatedly stressed, but the acceptable timescale for decompression remains controversial. The purpose of this study was to propose a diagnosis and treatment flowchart for post-operative epidural hematoma. A retrospective chart review from the registry database of 93 patients who underwent epidural hematoma evacuation from January 2007 to December 2021 was conducted. Statistical analysis was performed to assess the correlation between recovery of neurologic function and time to decompression. Sixty patients were included in the statistical analysis. Time to decompression was significantly associated with recovery of neurologic function in the overall analysis and in subgroup analysis of cases of acute post-operative epidural hematoma. As the time to decompression decreases, there is an improvement in the odds of neurological function recovery. Moreover, a critical threshold for the time to decompression was determined to be < 6h. Timely decompression is strongly suggested for post-operative epidural hematoma. We proposed a flowchart as a tool to guide treatment of post-operative epidural hematoma. For acute post-operative epidural hematoma, decompression within 6h promises better neurologic recovery, and decompression should not be delayed by imaging examination. For delayed post-operative epidural hematoma, decompression should be performed as soon as possible after a definite diagnosis is reached.

Topical Tranexamic Acid and Chest Masculinization Surgeries-Impact on Postoperative Hematoma Incidence.

Topical Tranexamic Acid and Chest Masculinization Surgeries-Impact on Postoperative Hematoma Incidence.

Comparison of Single Port Laparoscopic Ingulinal Hernia Repair versus Open Herniotomy in Term of Recurrence and Postoperative Scrotal Hematoma

Hernia repair is common surgical procedures, with techniques evolving to improve outcomes. Comparing laparoscopic and open approaches is crucial for determining the optimal method to reduce complications such as recurrence and postoperative scrotal hematoma. Objective: To compare the frequency of hematoma and recurrence in laparoscopic assisted inguinal hernian repair versus open herniotomy. Methods: This quasi experimental study was conducted after approval from CPSP (Ref No: CPSP/REU/PSG-2017-068-339, REU 37362) at Pediatric Surgery Department Services Hospital, Lahore, from October 2020 to March 2021 on 254 patients. Patients were divided into two equal groups; Group-A (single port needle assisted laparoscopic repair) and Group-B, (open repair). Patients were assessed after 24 hours to see scrotal hematoma and regular follow up for 3 months to see the recurrence. Data were analyzed using SPSS version 26.0. Independent sample t-test and chi square was applied to compare quantitative and qualitative variables between groups; p-value ≤0.05 as significant. Results: Postoperative hematoma formation was found among 2 patients (1.6%) of Group-A and in 13 patients (10.2%) of Group-B, (p=0.003). Postoperative recurrence between two groups was comparable and statistically insignificant (Group A 6.3% vs Group B 4.0%, p=0.393). (p=0.393). Conclusions: In conclusion, laparoscopic-assisted hernia repair and open herniotomy demonstrate comparable recurrence rates. However, laparoscopic-assisted repair is associated with a significantly lower incidence of postoperative hematoma. These findings indicate that laparoscopic repair may be a safer option with fewer postoperative complications, making it a favorable choice for pediatric inguinal hernia surgery.

Spontaneous uncoupling of microvascular anastomotic coupler device causing post-operative haematoma - salvage with re-coupling of the device: a case report

Spontaneous uncoupling of microvascular anastomotic coupler device causing post-operative haematoma - salvage with re-coupling of the device: a case report

Scalp Defect of Cranioplasty with Titanium Mesh: A Case Report

Abstract: Several implant materials for cranioplasty have been studied, including autologous bone, titanium mesh, polyetheretherketone (PEEK), and polymethyl methacrylate (PMMA). Titanium mesh is believed to have excellent biocompatibility, low cost, and satisfactory cosmetic effects, especially in three-dimensional (3D) custom-made meshes. We reported a 54-year-old man complaining of open wound in his left temporoparietal region since a month. Blood tests showed leukocytosis. Patient was diagnosed as scalp infection with previous cranioplasty using bone cement on temporoparietal region. The patient underwent scalp reconstruction with skin flap, removing skin defect, and split thickness skin graft (STSG) from left thigh. Patient was provided with outpatient medication consisting of analgesics and broad-spectrum antibiotics. Follow-up assessment 14 days after surgery did not reveal any secondary infections on titanium mesh implant and skin flap. The main complications of cranioplasty, in addition to the studied aesthetic results, are represented by the risk of infection, postoperative hematoma, impaired wound healing, as well as prolonged failure due to transplant absorption or infection, as a result of which the prosthesis needs to be removed. In conclusion, titanium mesh is still a better choice of material for cranioplasty in many factors such as price, accessibility, infection rate, and biocompatibility Keywords: scalp; cranioplasty; head injury; prosthesis

Effects of Fluid Gelatin for Lumbar Spinal Stenosis Undergoing Lumbar Endoscopic Bilateral Decompression: A Prospective, Randomized Controlled Trial.

In patients with lumbar spinal stenosis (LSS), prolonged compression of the epidural venous plexus heightens the risk of bleeding and hematoma during minimally invasive surgery. While absorbable fluid gelatin, an animal protein-based hemostatic agent, is available, its effectiveness in lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) remains debated. Our research aims to conduct a prospective randomized controlled trial to investigate the effectiveness and safety of this hemostatic material in patients undergoing LE-ULBD for LSS. From October 2023 to July 2024, a total of 90 patients with LSS who underwent LE-ULBD were enrolled in this study. The 90 patients were randomly divided into two groups: fluid gelatin group (45 cases, using fluid gelatin) and null-fluid gelatin group (45 cases, not using fluid gelatin). Primary outcomes included the success rate of achieving hemostasis within 3 min and symptomatic postoperative epidural hematoma (SPEH). Secondary outcomes encompassed surgical time, intraoperative blood loss, perioperative blood loss, length of stay, and complications. Independent sample t tests were used to compare continuous data. Chi-squared tests and Fisher's exact probability tests were used to analyze the categorical data. The success rate of achieving hemostasis within 3 min (p < 0.05) was significantly higher in fluid gelatin group compared to that in the null-fluid gelatin group, and perioperative blood loss (p < 0.05) and surgical time (p < 0.05) were notably lower in the fluid gelatin group. However, there were no statistically significant differences between the two groups regarding intraoperative blood loss, length of stay, and complications, such as SPEH, allergy, and thrombus. In patients with LSS undergoing LE-ULBD surgery, using fluid gelatin can achieve rapid intraoperative hemostasis, shorten surgical time, and reduce perioperative blood loss without causing complications. Therefore, the conventional use of fluid gelatin in LE-ULBD surgery is an effective and safe strategy.

Use of Fluid Gelatin in Lumbar Spinal Stenosis Undergoing Unilateral Biportal Endoscopic: A Prospective, Randomized Controlled Trial.

In patients with lumbar spinal stenosis (LSS) undergoing unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD), damage to the epidural venous plexus often leads to bleeding, increasing the risk of surgical complications. Surgiflo Hemostatic Matrix (SHM) is a gelatin extracted from porcine skin, used for intraoperative hemostasis. This study aims to evaluate the effectiveness and safety of using SHM during UBE-ULBD surgery. From October 2023 to July 2024, a total of 96 patients with LSS underwent UBE-ULBD surgery. These 96 patients were randomly divided into two groups: the SHM group (48 patients, using flowable gelatin) and the non-SHM group (48 patients, not using flowable gelatin). The primary outcomes included intraoperative blood loss, postoperative drainage volume, and the 3-min hemostasis success rate. Secondary outcomes included symptomatic postoperative epidural hematoma (SPEH), surgical time, postoperative hospital stay, hospitalization costs, and complications. We used independent sample t-tests to compare continuous data, and chi-square tests or Fisher's exact tests to analyze categorical data. The intraoperative blood loss and postoperative drainage volume in the SHM group were significantly less than those in the non-SHM group (p < 0.05), and the 3-min hemostasis success rate in the SHM group was significantly higher than that in the non-SHM group (p < 0.05). There were no statistically significant differences between the two groups regarding SPEH, postoperative hospital stay, hospitalization costs, and complications such as thrombosis formation and allergic reactions. However, the surgical time in the SHM group was significantly shorter than that in the non-SHM group (p < 0.05). When patients with LSS undergo UBE-ULBD, the use of fluid gelatin can effectively reduce intraoperative and postoperative bleeding without introducing additional complications.

Unplanned Excision in Soft Tissue Sarcoma: Current Knowledge and Remaining Gaps.

Soft tissue sarcoma (STS) is a rare and heterogeneous disease, which can result in surgeons not considering STS as a differential diagnosis when they encounter a lump. However, unplanned excision (UE) often occurs in nonspecialized sarcoma centers. Before re-excision (RE) after UE, radiological examinations such as magnetic resonance imaging (MRI) should be performed to determine the surgical margin and conduct a pathological evaluation of the UE. However, differentiating between residual tumor and postsurgical changes remains challenging because of the presence of postoperative edema, hematoma, and seroma on MRI. Propensity score matching analysis showed that patients with STS who underwent RE after UE did not have higher mortality or local recurrence rates than those who underwent planned excision (PE), while RE often requires reconstruction procedures. From the patient's perspective, one operation (PE) is better than two (UE and RE) because it reduces hospital stays and time away from work. Continuous education about STS is necessary for all surgeons to reduce the incidence of UE.

Factors Increasing the Likelihood of Postoperative Hematomas Following Thyroid Surgery.

Neck hematoma following thyroid surgery is a potentially life-threatening complication. This retrospective case-control study reviewed neck hematoma reoperations following thyroid surgery (2009-2024), using 3:1 matching. Univariable analysis identified hematoma and delayed onset (≥ 6 h) risk factors, with odds ratios (ORs) and 95% confidence intervals (CIs). Among 5502 surgeries, the hematoma incidence was 0.55% (n = 30). The mean age was 54 and the female-to-male ratio was 7:3. Key risk factors included pre-induction blood pressure > 160 mmHg (OR = 3.04 [95% CI = 1.25-7.39], p = 0.014) and limited blood pressure change postmedication (OR = 6.25 [95% CI = 1.03-38.08], p = 0.047). The hematoma group had higher rates of smoking, hypertension, diabetes, Graves' disease, and prior thyroid surgery, and, in delayed hematoma cases, larger nodules, total thyroidectomy, and central neck dissection, though not statistically significant. Patients with poorly controlled blood pressure may not be candidates for outpatient thyroidectomy.

A New Dissection Sequence, Based in Mapping Perforators of Pectoralis Major.

Breast augmentation remains a leading cosmetic surgical procedure. Over the past two decades, various benefits and complications of pocket selection techniques have been described for breast augmentations. However, there has been limited evolution in the dissection technique sequence initially described by Tebbetts in his seminal publication. We studied in detail the vascular anatomy of the pectoralis major and breast. We related the findings of anatomical dissections with the conclusions obtained by imaging and developed a systematic dissection sequence for creating a bloodless submuscular pocket. Breast dissection was performed on ten fresh-frozen cadaveric tissues to observe vascular distribution mapping of the dual-plane pocket associated with the subpectoral space, and we replicated it in 727 female patients aged 18-66years undergoing primary breast augmentation with a dual-plane pocket implant placement using a specific dissection sequence. Surgical data, implant information, patient demographics, and complications were systematically collected. The mean patient age was 30 years. Round implants were used exclusively, with 80.05% textured and 19.95% smooth. Implant sizes ranged widely from 150cc to 450cc. We identified the presence of eight perforator vessels within the breast in the cadaver dissections and observed a large retropectoral avascular space. These findings are correlated with the images obtained with indocyanine green (ICG). Consequently, we described four retropectoral zones based on the mapping of the perforators. Importantly, this approach significantly reduced the incidence of possible postoperative hematomas, demonstrating its potential to improve surgical outcomes. This practical dissection sequence of the four retropectoral zones aims to shorten our learning curve for precision, safe, and a bloodless retro-muscular pocket dissection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of Intraoperative Ketorolac in Outpatient Breast Surgery: A Double-blinded Prospective Randomized Controlled Trial.

The use of nonnarcotic analgesics, such as ketorolac, has been shown to reduce postoperative pain and opioid consumption. This double-blinded randomized trial is designed to assess the efficacy of intraoperative ketorolac in reducing postoperative narcotic use in outpatient breast reconstruction and reduction procedures. This study is a prospective double-blinded randomized controlled trial. Adult patients, 18-64 years of age, undergoing breast surgery were randomized to receive 15 mg of ketorolac, 30 mg of ketorolac, or a placebo dose of saline. Patients' opioid requirements in the postoperative anesthesia care unit and postoperative opioid utilization and pain scores were collected through a daily survey. Postoperative hematomas were assessed before discharge and at subsequent follow-up visits for a period of 14 days. Of the 63 patients included in the study, 31 patients underwent delayed reconstruction following mastectomy and 35 patients underwent breast reduction surgery. Patients who received 30 mg of ketorolac had the fastest pain resolution (P < 0.05). The rate of opioid discontinuance was the fastest overall in patients who received 15 mg of ketorolac (rate = -0.072) when compared with the 30-mg ketorolac group (rate = -0.071) and the placebo group (rate = -0.065). Total opioid usage in the postoperative anesthesia care unit was not statistically different across the 3 groups. Only 1 patient developed a hematoma in the 15-mg ketorolac group. This study demonstrates that a single dose of intraoperative ketorolac was associated with reduced opioid usage and postoperative pain. However, due to the study size, the difference in hematoma rate was not statistically significant.

A Retrospective Study on Subgaleal Fluid Collection After Titanium Mesh and Polyetheretherketone Cranioplasty

Cranioplasty is a common neurosurgical procedure aimed at providing structural protection to cerebral tissues and enhancing neurological function. The choice of implant material, particularly polyetheretherketone (PEEK) and titanium mesh, significantly influences postoperative outcomes, including the incidence of subgaleal fluid collections (SFC). This study investigates the incidence of SFC associated with PEEK and titanium mesh in cranioplasty, identifying risk factors and implications for clinical practice. A retrospective analysis was conducted on 70 patients who underwent cranioplasty. The incidence of SFC, postoperative complications, and demographic data were collected and analyzed. Statistical comparisons were made between the 2 implant materials. The incidence of SFC was significantly higher in the PEEK group (46.2%) compared to the titanium mesh group (20.5%) (P= 0.023). PEEK was identified as an independent risk factor for SFC. Additionally, approximately 60% of postoperative epidural hematoma cases presented with SFC, highlighting the importance of meticulous hemostasis during surgery. The overall reoperation rate was 5.7%, consistent with existing literature. Although diabetes mellitus did not show a statistically significant association with SFC (P= 0.064), its potential impact on postoperative complications warrants further investigation. The selection of implant materials in cranioplasty significantly affects postoperative outcomes, with PEEK associated with a higher incidence of SFC. Careful material selection, particularly in patients with comorbidities, and meticulous surgical techniques are essential to improve patient outcomes. Future research should focus on the biological interactions between implant materials and cranial tissues to refine guidelines for clinical practice.

Comparative study between unilateral biportal endoscopic discectomy and percutaneous interlaminar endoscopic discectomy for the treatment of L5/S1 disc herniation

To compare the clinical outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous interlaminar endoscopic discectomy (PIED) for treating L5/S1 disc herniation. Patients with L5/S1 disc herniation treated with UBED (n= 46) and PIED (n= 50) in our hospital during the same period were retrospectively reviewed. Clinical outcome, radiographic parameters, and complications of each group were collected and evaluated. The mean follow-up period was 14.11±3.47 months in the UBED group and 14.52±5.37 months in the PIED group. There was no significant difference in visual analog scale score for the leg (P= 0.836) or lumbar scores (P= 0.335) between PIED and UBED group at preoperative, 1-day postoperative, and last follow-up point. Within the same group, there were significant differences in visual analog scale score for the leg (P < 0.001) and lumbar scores (P < 0.001) compared pairwise at 3 time points. Oswestry Disability Index scores of both groups showed significant improvement at the last follow-up (P < 0.001, P < 0.001), and there was no significant difference in patient satisfaction rates (97.8% vs. 96%) between the 2 groups on the basis of the MacNab criteria. The percentage of facet joint preservation was 96.74±9.10% in the UBED group and 99.22±1.52% in the PIED group. The total blood loss and hospitalization cost was greater in the UBED group. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in the PIED group. UBED indicates similar short-term efficacy compared with PIED for treating L5/S1 disc herniation. No difference was found in facet joint preservation between the 2 groups. We believe the increased cost of UBED as the result of surgical consumables will decrease in the future.

3D Technology-Assisted Minimally Invasive Surgery for the treatment of primary brainstem hemorrhage: A prospective cohort study

PurposeThe objective of this study was to assess the therapeutic efficacy of minimally invasive puncture and drainage (MIPD) facilitated by a three-dimensional (3D)-printed guide plate in the management of primary brainstem hemorrhage (PBH). MethodsThis single-center, prospective cohort study enrolled 30 PBH patients who underwent MIPD guided by 3D printing technology and 30 PBH patients who received conservative treatment, serving as the control cohort. The primary endpoint was the proportion of patients achieving modified Rankin Scale (mRS) scores of 1 and 2 at 30 days post-discharge. Secondary endpoints included hematoma volume at admission and post-treatment, incidence of hospital-acquired pneumonia (HAP) and/or rebleeding, in-hospital mortality rate, and length of hospital stay. ResultsThe treatment cohort demonstrated a significantly higher proportion of patients with mRS scores of 1 and 2 at 30 days post-discharge compared to the control cohort. Conversely, the treatment cohort exhibited significantly lower postoperative hematoma volumes, National Institutes of Health Stroke Scale (NIHSS) scores, HAP incidence, in-hospital mortality, and hospital stay duration than the control cohort. However, no significant difference in rebleeding incidence was observed between the two cohorts. ConclusionMIPD guided by 3D printing technology is more effective than conservative treatment in PBH cases without extensive hemorrhage. This approach can alleviate hematoma pressure earlier, mitigate neurological deficits, reduce HAP incidence, shorten hospital stay, and decrease mortality and disability rates associated with PBH.

Pulse Irrigation Reduces Rate of Postoperative Hematoma Following Breast Reduction.

Breast reduction (BR) involves a large surface area of manipulated tissue, increasing the risk of postoperative hematoma. Pulse irrigation (PI) uses a device to deliver intermittent pressurized irrigant intraoperatively. This study aims to evaluate whether the use of PI is associated with reduced incidence of postoperative hematoma after BR. An IRB-approved, retrospective cohort study was performed on all female patients >18 years old who underwent BR at a single academic medical center from 2019 to 2023. Patients operated on by surgeons who performed BR exclusively with or exclusively without PI were excluded. Demographics, surgical details, and postoperative complications were compared using T-tests for independent samples and Pearson chi-square tests of significance (statistical significance set at p<0.05). A total of 418 patients met inclusion and exclusion criteria: 196 PI patients (46.9%) and 222 (53.1%) non-PI patients. PI patients had differences in race, type of insurance and higher usage of liposuction (all p<0.001). There was a statistically significantly lower hematoma rate in PI patients compared to non-PI patients (0.0% vs. 2.7%, p=0.020). Although not statistically significant, PI patients had lower rates of seroma (1.0% vs. 3.6%, p=0.085) and superficial incisional SSI (1.5% vs. 2.7%, p=0.410) than non-PI patients. Intraoperative use of PI reduces the rate of postoperative hematoma in patients undergoing BR. This finding is hypothesized to be due to provocative disruption of unstable clots which thereby helps to identify sites of tenuous hemostasis so that they can be better cauterized prior to completion of the procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Progress and Outcomes of Intraoperative Nerve Monitoring During Thyroidectomy

Intraoperative nerve monitoring (IONM) is not considered standard of care during thyroidectomy, and guidelines are vague about its use in the absence of strong evidence of superiority over visualization of the recurrent laryngeal nerve (RLN) alone. To characterize patterns of IONM use during thyroidectomy in the US and evaluate the association of IONM with postoperative outcomes. This cohort study used the National Surgical Quality Improvement Program (NSQIP) thyroidectomy data from January 1, 2016, to December 31, 2022. A nationally representative sample included adult patients without poorly differentiated thyroid cancer who underwent thyroidectomy at multiple centers. Data were collected from the time of surgery until 30 postoperative days through January 31, 2023. IONM during thyroidectomy. Prevalence of IONM during thyroidectomy and postoperative outcomes including RLN injury, hypocalcemia, and neck hematoma. A total of 44 265 patients undergoing thyroidectomy were included (77.2% female; mean [SD] age, 51.8 [15.2] years), with 30 633 (69.2%) using IONM. Common indications for surgery in the cohort were goiter (35.3%) and a single nodule or neoplasm (39.2%). The prevalence of IONM increased from 62.5% in 2016 to 75.9% in 2022. RLN injury occurred in 6.0% of cases. On propensity score-matched analyses, IONM was associated with decreased odds of RLN injury overall (adjusted odds ratio [AOR], 0.98; 95% CI, 0.97-0.99) and decreased odds among patients with differentiated thyroid cancer (AOR, 0.96; 95% CI, 0.94-0.99). IONM was not associated with postoperative hypocalcemia (AOR, 0.99; 95% CI, 0.99-1.00) or neck hematoma (AOR, 1.00; 95% CI, 0.99-1.00). This cohort study found that IONM during thyroidectomy has become routine, and use has increased over the last 7 years. IONM was associated with a slightly decreased odds of RLN injury, but no difference in hypocalcemia or neck hematoma. Although IONM use is widespread, further research is needed to identify patients who would benefit the most from this technology.