Postoperative Wound Dehiscence Research Articles

Diagnosis and Treatment of Skin Lesions in Renal Transplant Recipients: A Retrospective Review.

Immunosuppressive therapy is essential for to prevent graft rejection in renal transplant patients; however, it is associated with elevating the risk of several pathologies in these patients particularly infectious and neoplastic conditions. In this study, we explore the diagnosis and treatment of skin lesions in renal transplant patients. A retrospective chart review of 12 renal transplant recipients referred to plastic and reconstructive surgery with skin lesions from 2000 to 2020 was performed. The mean age of the 12 patients was 49.6 years. Time to plastic surgery after renal transplantation ranged between 1 and 16 years. Nine cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, and 1 case of skin and soft tissue infection of the lower extremity and cutaneous extranodal NK/T-cell lymphoma, nasal type was observed. Flaps, skin grafts, and artificial dermis grafts constitute the main reconstructive methods. There were no postoperative infections or wound dehiscence. Cutaneous infections and skin malignancy account for most of the skin lesions developing after renal transplantation. Posttransplant lymphoproliferative disorder warrants equal attention and should not be disregarded. Early diagnosis and treatment significantly improve prognosis as patients with longer duration of transplant were found to have more aggressive tumors. Plastic and reconstructive surgery offers a safe therapeutic method of treatment in these cases.

Optimizing treatment strategies for pediatric phimosis and redundant prepuce: a comparative study of traditional circumcision and disposable circumcision stapler.

To investigate the surgical outcomes and complication rates of traditional circumcision and disposable circumcision stapler in the treatment of pediatric patients with phimosis and redundant prepuce. A retrospective analysis was conducted on pediatric patients with phimosis or preputial redundancy treated at our pediatric surgery department from January 2022 to December 2023. The patients were divided into two groups: treated with traditional circumcision (control group) and treated with a disposable circumcision stapler (experimental group). Surgical parameters (operation time, intraoperative bleeding), postoperative outcomes (postoperative pain scores, wound healing time, severe edge swelling, wound dehiscence, postoperative rebleeding, postoperative infection, aesthetic satisfaction), were compared between the two groups. A total of 301 pediatric patients were included in our study, with 146 in the traditional group and 155 in the stapler group. The stapler group showed significantly lower values in operation time, intraoperative bleeding, and postoperative rebleeding compared to the traditional group (P < 0.05). However, the traditional group had a significant advantage in postoperative wound healing time and the occurrence of severe edge swelling (P < 0.05). There were no significant differences between the two groups in terms of anesthetic drug dosage, postoperative pain level, postoperative infection rate, wound dehiscence, and aesthetic satisfaction (P > 0.05). In the treatment of pediatric phimosis and redundant prepuce, the advantage of traditional circumcision lies in faster postoperative recovery and less severe edge swelling. The disposable circumcision stapler excels in thorough hemostasis, easy and safe operation, suitable for primary medical use, but lags behind in postoperative recovery compared to the traditional method. Each treatment approach has its own advantages, and the choice should be based on the actual condition and circumstances of the patient. Personalized treatment decisions should be made collaboratively to achieve the best therapeutic outcomes.

Global utilization of biportal spinal endoscopy: Case series on management of lumbar pathology in Soddo, Ethiopia

IntroductionBiportal spinal endoscopy is a safe and cost-effective methodology for the management of lumbar pathology in rural underserved hospitals that have standard orthopaedic arthroscopic equipment, but lack access to microscopy. MethodsThis is a case series noting 1-year outcomes from 5 patients managed with biportal spinal endoscopy during an 11-day mission trip to Soddo, Ethiopia in November 2022. Surgical complications, postoperative assessments, and patient-reported outcomes (PROs) were retrospectively collected and analyzed. Surgical techniques and equipment utilized were shared with residents and faculty at the hospital. ResultsFive Ethiopian patients (4:1, female:male) with no prior spine surgery history elected to undergo biportal surgery for the diagnoses of lumbar stenosis and disc herniation, averaging 31 years of age with Body-Mass-Indices (BMI) <35. Two patients underwent endoscopic discectomy, and three patients underwent endoscopic unilateral laminotomy and bilateral decompression (ULBD). There were no complications. No postoperative functional deficits, infections, readmissions, revisions, or wound dehiscences were noted at 12 months follow-up. VAS-back and VAS-leg scores improved to <2/10 for 80 % of patients. All patients returned to work/activities of daily living. No patients required postoperative pain management beyond the 2-week post-operative follow-up. ConclusionWith these five patients, we found that biportal spinal endoscopy can be safely applied in rural hospital settings with limited resources. This supports biportal spinal endoscopy as a viable minimally invasive modality for the management of lumbar pathology. For hospitals with limited resources, but access to arthroscopic equipment, biportal spinal endoscopy is a feasible option. Level of evidenceIV.

Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes.

Complex surgical back wounds represent significant morbidity in patients who have undergone spinal procedures requiring closure or revision by plastic surgeons. This study aimed to assess the utility of bacterial wound culture data for predicting surgical outcomes of wound management. This study is a single-institution retrospective review of consecutive patients who required plastic surgery intervention for wound infection following spinal procedures between the years 2010 and 2021 (n = 70). Statistical analysis was performed for demographics, comorbidities, perioperative laboratory studies, and treatment methods. The primary outcomes of interest were rate of postoperative complications after soft tissue reconstruction and reconstructive failure. The secondary outcome of interest was time to healing in number of days. The overall complication rate after wound closure was 31.4%, with wound infection in 12.9%, seroma in 10%, dehiscence in 12.9%, and hematoma in 1.4%. Increasing number of debridements before wound closure increased the likelihood of a surgical complication of any kind (odds ratio [OR], 1.772; 95% confidence interval [CI], 1.045-3.002). Positive wound cultures before reconstruction were associated with development of seroma only (OR, 0.265; 95% CI, 0.078-0.893). Use of incisional vacuum-assisted closure devices significantly decreased the odds of postoperative wound dehiscence (OR, 0.179; 95% CI, 0.034-0.904) and increased odds of healing (hazard ratio, 3.638; 95% CI, 1.547-8.613). Positive wound cultures were not significantly associated with negative outcomes after complex closure or reconstruction of infected spinal surgical wounds. This finding emphasizes the importance of clinical judgment with a multidisciplinary approach to complex surgical back wounds over culture data for wound closure timing.

Comparison of Surgical Outcomes of Two New Techniques Complementing Robotic Single-Site Myomectomy: Coaxial Robotic Single-Site Myomectomy vs. Hybrid Robotic Single-Site Myomectomy.

This study aimed to compare surgical outcomes between two new robotic single-site myomectomy (RSSM)-complementary techniques: coaxial robotic single-site myomectomy (Coaxial-RSSM) and hybrid robotic single-site myomectomy (Hybrid-RSSM). Medical records for 132 women undergoing Coaxial-RSSM and 150 undergoing Hybrid-RSSM, consecutively, were retrospectively reviewed. Patient characteristics and surgical outcomes were assessed and compared after propensity score matching (PSM). In the outcomes of PSM, the Coaxial-RSSM group showed significantly reduced blood loss (79.71 vs. 163.75 mL, p < 0.001) and reduced hospital duration (4.18 ± 0.62 vs. 4.63 ± 0.90) relative to the Hybrid-RSSM group. Conversely, Hybrid-RSSM allowed for a shorter operative time compared with Coaxial-RSSM (119.19 vs. 156.01 min, p = 0.007). No conversions to conventional laparoscopy or laparotomy or any need for the multi-site robotic approach occurred in either group. Postoperative complications, including ileus, fever, and wound dehiscence, showed no statistically significant differences between the two groups. Blood loss was lower with Coaxial-RSSM, and operative time was shorter for Hybrid-RSSM. A follow-up prospective study is warranted for more comprehensive comparison of surgical outcomes between the two techniques.

Is topical antibiotic use necessary to prevent surgical site infection following oculoplastic surgery?

To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a "100% antibiotic free" fashion. We conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). The relationship between the use of local antibiotics and the occurrence of SSI was assessed using Fisher's exact test. The alpha risk was set to 5% and two-tailed tests were used. Among the 947 procedures included, 617 were included in the LATB group and 330 in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). SSI occured in four (4/617; 0.65%) and five (5/330; 1.52%) procedures in the LATB and LATB free group respectively, without any statistical difference between the groups (p = 0.290). A subgroup analysis was carried out by excluding the procedures performed under prophylactic intraoperative intravenous antibiotics and did not reveal any statistical difference between the two groups (p = 0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI (p = 0.002). This study suggests that performing a "100% antibiotic free" oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.

Marijuana Use in Aesthetic Surgery Patients: A Retrospective Review of 441 Cases

Abstract Goals/Purpose Marijuana use is increasing in Canada following its legalization in 2018. 27% of Canadians were reported to have consumed marijuana in 2022. Marijuana use in surgical patients is a topic that has had exponential growth in the literature recently. The drug has many therapeutic effects such as analgesia, muscle relaxation, sedation and mood improvement. However, it is also associated with deleterious cardiovascular, respiratory and coagulopathic effects that can significantly impact the care of surgical patients in the peri-operative period. Literature from other surgical specialities has shown similar recovery and ultimate surgical outcome between marijuana users and non-marijuana users despite increased pain and poorer quality of life associated with marijuana use. There is a paucity of information about the effects of marijuana on aesthetic plastic surgery outcomes. The prevalence of marijuana use in aesthetic plastic surgery patients is currently unknown and there is a need for more evidence to develop clinical practice guidelines regarding the use of marijuana in the perioperative period. The purpose of this study is to describe the effects of marijuana consumption on aesthetic plastic surgery outcomes. Methods/Technique A single-center retrospective review was completed including all patients who underwent abdominoplasty, mastopexy and/or other body contouring surgery (such as brachioplasty, thigh lift or lower body lift) between January 2021 and August 2023. Other procedures such as liposuction, fat grafting, implant insertion or removal were also reviewed if they took place during the same general anesthetic. Marijuana use was defined as use within 4 weeks pre- and/or post-operatively. Data collection included patient demographics, body mass index (BMI), marijuana use, smoking status, comorbidities, surgical procedure(s) performed, operative time, resection weight and/or liposuction volume (if applicable), complications and follow up. Results/Complications A total of 1000 procedures in 441 patients were reviewed during the 32-month study period. Average patient age was 43 years old and average patient BMI was 27.3 kg/m2. 20.4% of patients were marijuana users. The average number of procedures completed per patient was 2.3 and average operative time was 167 minutes (2 hours and 47 minutes). 79% of cases involved more than one surgical procedure. 63% of the 441 cases involved an abdominoplasty, 49% involved a mastopexy, 5% involved a brachioplasty and 4% involved a thigh lift procedure. 33% of cases included breast implants and 47% liposuction. Average follow up time was 5.2 months. Overall surgical complications consisted of a 5% superficial infection rate, 1% deep infection rate, 9% seroma rate, 1% hematoma and lymphocele rates, 3% rate of wound dehiscence requiring surgical intervention and 11% rate of superficial delayed wound healing. There were no cases of nipple necrosis or full thickness skin necrosis. A comparison of patient demographics between marijuana and non-marijuana user groups revealed that marijuana users were significantly younger than non-marijuana users (average age 39 and 44 years old respectively). Surgical data, outcomes and complications were not found to be significantly different between the 2 groups for all variables. Conclusion Marijuana consumption in the perioperative period does not appear to affect aesthetic surgery outcomes such as post-operative infections, seroma, lymphocele, wound dehiscence, or fat necrosis based on the results of this study. There is a need for prospective work on this topic to produce better quality evidence and ultimately to create evidence-based guidelines on the perioperative use of marijuana for aesthetic surgery patients.

The Association of Body Mass Index and Early Outcomes Following Orthognathic Surgery

The existing data on the link between body mass index (BMI), operative characteristics, and surgical outcomes across orthognathic surgery are limited. The purpose was to measure the association between BMI and early postoperative outcomes in orthognathic surgery. This is a retrospective cohort study of patients (n=118) aged > 14years undergoing bimaxillary orthognathic surgery between 2015 and 2018 by a single surgeon within the Kaiser Permanente Northern California-integrated healthcare system. Patients undergoing unilateral or additional procedures, history of prior orthognathic surgery, or pre-existing pain conditions were excluded. The predictor variable was BMI measured as a continuous (kg/m2) and categorical variable (underweight/normal, overweight, obese). The primary outcome variables were additional postoperative antibiotics, increased postoperative visits, wound dehiscence, and wound infection. The secondary outcome variables were total operative and anesthesia time. The demographic covariates included age, sex, and race/ethnicity. The clinical covariates included history of obstructive sleep apnea, Mallampati score, tobacco use, American Society of Anesthesia classification, thyromental distance, history of difficult intubation, and Angle's classification. Bivariate and multivariate analyses were performed to measure the associations between BMI and the primary and secondary outcomes. Multivariable logistic regression analyses were used to measure associations between BMI and the postoperative outcomes. Statistical significance was defined as P<.05. The study sample was composed of 118 subjects with a mean age of 26.91years (standard deviation 9.43). Forty-seven percent (n=55) were male, and the mean BMI was 25.13 (standard deviation 5.19). BMI category was significantly associated with age, with increasing age associated with higher BMI category (P=.02). According to the bivariate and multivariable logistic regression analyses, controlling for age, race/ethnicity, BMI, and total operative time, increased total operative time was associated with additional postoperative antibiotics (odds ratio=1.03, 95% confidence interval: 1.01, 1.05), and increased postoperative appointments (odds ratio=1.02, 95% confidence interval: 1.01, 1.04). No significant association between BMI and other clinical or operative characteristics was seen aside from American Society of Anesthesia classification. Elevated BMI was not associated with worsened operative characteristics or postoperative outcomes. This supports the suitability of orthognathic surgery in a BMI-diverse population.

Open Biceps Tenodesis and Tenotomy Have Low 30-Day Postoperative Complication Rates

PurposeTo compare 30-day postoperative rates of adverse events, particularly infection rates, between open biceps tenodesis and biceps tenotomy. MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) was filtered using current procedural terminology (CPT) codes to identify patients undergoing open biceps tenodesis and tenotomy from 2010-2021. Patients were divided into cohorts based on procedure type. Propensity score matching was used to account for confounding variables. Statistical analyses were conducted to compare 30-day postoperative outcomes between cohorts, as well as to evaluate secondary risk factors for complications. ResultsOverall, 12,367 patients were included in the study with 11,417 undergoing open biceps tenodesis and 950 undergoing biceps tenotomy. After matching, 1,900 patients were included in the final analysis. The rate of outpatient procedures in the tenodesis cohort was significantly higher than in the tenotomy cohort. Rates of any adverse event (AAE), sepsis, pneumonia, reoperation, and extended length of stay (LOS) were significantly higher in the tenotomy cohort compared to the tenodesis cohort. There was no difference in infection rates or wound dehiscence between the two groups. After multivariable analysis, increasing age, longer operative time, and history of bleeding disorders were associated with significantly higher odds of developing any adverse event (AAE). ConclusionsIn this study we found that tenotomy and open tenodesis are both safe options for treatment of biceps pathology. The overall rate of developing any adverse event and the rate of postoperative sepsis were higher in the tenotomy cohort. In addition, rates of postoperative infection and wound dehiscence did not vary between the two groups. Small differences were additionally observed in rates of pneumonia, return to OR, and extended LOS, and these rates were higher in the tenotomy cohort. Level of EvidenceLevel III, retrospective comparative study.

Thermosensitive/thermochromic silicone and infrared thermography mapping in 60 consecutive cases of epilepsy surgery.

Epilepsy surgery represents a therapeutic opportunity for those patients who do not respond to drug therapy. However, an important challenge is the precise identification of the epileptogenic area during surgery. Since it can be hard to delineate, it makes it necessary to use auxiliary tools as a guide during the surgical procedure. Electrocorticography (ECoG), despite having shown favorable results in terms of reducing post-surgical seizures, have certain limitations. Brain mapping using infrared thermography mapping and a new thermosensitive/thermochromic silicone (TTS) in epilepsy surgery has introduced a new resource of noninvasive and real-time devices that allow the localization of irritative zones. Sixty consecutive patients with drug-resistant epilepsy with surgical indications who decided to participate voluntarily in the study were included in the study. We measured brain temperature using two quantitative methods and a qualitative method: the TTS sheet. In all cases, we used ECoG as the gold standard to identify irritative areas, and all brain tissue samples obtained were sent to pathology for diagnosis. In the subgroup in which the ECoG detected irritative areas (n = 51), adding the results in which there was a correlation with the different methods, the efficiency obtained to detect irritative areas is 94.11% (n = 48/51, P ≤ 0.0001) while the infrared thermography mapping method independently has an efficiency of 91.66% (P ≤ 0.0001). The TTS has a sensitivity of 95.71% and a specificity of 97.9% (P ≤ 0.0001) to detect hypothermic areas that correlate with the irritative zones detected by ECoG. No postoperative infections or wound dehiscence were documented, so the different methodologies used do not represent an additional risk for the surgical proceedings. We consider that the infrared thermography mapping using high-resolution infrared thermography cameras and the TTS are both accurate and safe methods to identify irritative areas in epilepsy surgeries.

Effectiveness of Concurrent Ankle Arthroscopy During Open Reduction and Internal Fixation of Malleolar Fractures in Prevention of Common Short-Term Complications

Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system.

Laparoscopic value in the management of acute abdomen during pregnancy

Background Acute abdominal pain during pregnancy represents a challenging pathology in diagnosis and treatment. This study aimed to evaluate the value of laparoscopy in managing pregnant patients presented with acute abdomen. Materials and methods From June 2022 to June 2023, 45 pregnant females presented with acute abdominal pain were prospectively analyzed. These patients were treated laparoscopically, aiming for diagnostic and treatment purposes. Intra- and Postoperative evaluations for the laparoscopic value were assessed for all possible complications early, during the hospital stay and until the first postoperative 30 days. Results Inflammation 82.2%, including acute appendicitis 89.7%, and cholecystitis 10.3%, were found to be the most common causes of acute abdomen. No intraoperative or postoperative morbidity, including infection, sepsis, or wound dehiscence, was reported until the first 30 days. Similarly, no postoperative mortality was detected. Moreover, no cases had abortions during their conception time. Conclusion Laparoscopic value exceeds the treatment advantages but has a significant role in diagnosing the etiologies of acute abdomen during pregnancy. Laparoscopy could successfully treat different pathologies during pregnancy. No restriction for the time of conception regarding the use of laparoscopy was reported. Further comparative studies regarding laparoscopic use during pregnancy should be conducted.

Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation

BackgroundRisk-adjustment (RA) models are used to account for severity of illness in comparing patient outcomes across hospitals. Researchers specify covariates as main effects, but they often ignore interactions or use stratification to account for effect modification, despite limitations due to rare events and sparse data. Three Agency for Healthcare Research and Quality (AHRQ) hospital-level Quality Indicators currently use stratified models, but their variable performance and limited interpretability motivated the design of better models.MethodsWe analysed patient discharge de-identified data from 14 State Inpatient Databases, AHRQ Healthcare Cost and Utilization Project, California Department of Health Care Access and Information, and New York State Department of Health. We used hierarchical group lasso regularisation (HGLR) to identify first-order interactions in several AHRQ inpatient quality indicators (IQI) - IQI 09 (Pancreatic Resection Mortality Rate), IQI 11 (Abdominal Aortic Aneurysm Repair Mortality Rate), and Patient Safety Indicator 14 (Postoperative Wound Dehiscence Rate). These models were compared with stratum-specific and composite main effects models with covariates selected by least absolute shrinkage and selection operator (LASSO).ResultsHGLR identified clinically meaningful interactions for all models. Synergistic IQI 11 interactions, such as between hypertension and respiratory failure, suggest patients who merit special attention in perioperative care. Antagonistic IQI 11 interactions, such as between shock and chronic comorbidities, illustrate that naïve main effects models overestimate risk in key subpopulations. Interactions for PSI 14 suggest key subpopulations for whom the risk of wound dehiscence is similar between open and laparoscopic approaches, whereas laparoscopic approach is safer for other groups. Model performance was similar or superior for composite models with HGLR-selected features, compared to those with LASSO-selected features.ConclusionsIn this application to high-profile, high-stakes risk-adjustment models, HGLR selected interactions that maintained or improved model performance in populations with heterogeneous risk, while identifying clinically important interactions. The HGLR package is scalable to handle a large number of covariates and their interactions and is customisable to use multiple CPU cores to reduce analysis time. The HGLR method will allow scholars to avoid creating stratified models on sparse data, improve model calibration, and reduce bias. Future work involves testing using other combinations of risk factors, such as vital signs and laboratory values. Our study focuses on a real-world problem of considerable importance to hospitals and policy-makers who must use RA models for statutorily mandated public reporting and payment programmes.

Effectiveness of Specific Single-Use Incisional Negative Pressure Wound Therapy (PICO System) After Major Lower Extremity Amputation

Lower extremity amputation (LEA), particularly in patients with diabetes or peripheral vascular disease, often results in complications such as surgical site infections (SSIs) and wound dehiscence. This study examined whether utilizing the portable and user-friendly PICO system (Smith and Nephew Medical Ltd, Hull, UK) as incisional negative-pressure wound therapy can reduce post-LEA complications. This study was conducted at a Japanese tertiary medical center and involved a retrospective analysis of LEA cases (n = 32) between January 2021 and December 2022. The PICO dressing group (n = 16) was compared to the conventional dressing group (n = 16) for post-LEA wound management. The primary outcome was the incidence of postoperative wound complications, including SSI and wound dehiscence, within 15 days of LEA. Superficial/deep SSI and wound dehiscence occurred less frequently in the PICO dressing group than in the conventional dressing group (12.5% vs 43.8%; p = .054). There were no cases of deep SSIs in the PICO dressing group. Although this study has limitations owing to its retrospective design and small sample size, the results suggest the potential of the PICO system for improving outcomes in post-LEA wound management.

Obesity Increases Risk for Wound Complications After Pediatric Foot Surgery: A Retrospective Cohort Review Using the NSQIP-Pediatric Database.

As the incidence of childhood obesity continues to rise, so too does the number of obese children who undergo foot surgery. As the childhood obesity epidemic rolls on, pediatric orthopaedic surgeons will encounter obese patients with even greater frequency. Therefore, a comprehensive understanding of the risks associated with obesity is valuable to maximize patient safety. The purpose of this study is to retrospectively evaluate the relationship between obesity and postoperative outcomes in patients undergoing pediatric foot surgery across multiple institutions using a large national database. Pediatric patients who had undergone foot surgery were retrospectively identified using the American College of Surgeons 2012-2017 Pediatric National Surgical Quality Improvement (ACS-NSQIP-Pediatric) database by cross-referencing reconstructive foot-specific CPT codes with ICD-9/ICD-10 diagnosis codes. Center for Disease Control BMI-to-age growth charts were used to stratify patients into normal-weight and obese cohorts. Univariate and multivariate analyses were performed to describe and assess outcomes in obese compared with normal-weight patients. Of the 3924 patients identified, 1063 (27.1%) were obese. Compared with normal-weight patients, obese patients were more often male (64.7% vs. 58.7%; P =0.001) and taller (56.3 vs. 51.3 inches; P <0.001). Obese patients had significantly higher rates of overall postoperative complications (3.01% vs. 1.32%; P =0.001) and wound dehiscence (1.41% vs. 0.59%; P =0.039). Multivariate analysis found that obesity was an independent predictor of both wound dehiscence [adjusted odds ratio (OR)=2.16; 95% CI=1.05-4.50; P =0.037] and surgical site infection (adjusted OR=3.03; 95% CI=1.39-6.61; P =0.005). Subgroup analysis of patients undergoing clubfoot capsular release procedures identified that obese patients had a higher rate of wound dehiscence (3.39% vs. 0.51%; P =0.039) compared with normal-weight patients. In multivariate analysis, obesity was an independent predictor of dehiscence (adjusted OR=5.71; 95% CI=1.46-22.31; P =0.012) in this procedure group. There were no differences in complication rates between obese and normal-weight patients in a subgroup analysis of tarsal coalition procedures or clubfoot tibialis anterior tendon transfer procedures. Obese children undergoing foot surgery had higher overall complication rates, wound complications, and surgical site infections compared with children of normal weight. As the incidence of childhood obesity continues to rise, this information may be useful in assessing and discussing surgical risks with patients and their families. III.

Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders.

Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms ofblood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include aprolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation ratesandhigher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties anddevelop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.

Meningosel ve miyelomeningosel nedeni ile opere edilen 0-1 yaş çocuklarda sentetik dura ile otolog dura kullanımının komplikasyon gelişimi açısından karşılaştırılması

Abstract: Aim: The aim of this study is to compare the usage of synthetic and autologous dura mater in terms of complication risk in 0-1-year-old children who were operated for meningocele and myelomeningocele. Material and Methods: This cross-sectional observational study was conducted with 44 children aged 0-1 years who were operated for meningocele and myelomeningocele in a university hospital neurosurgery clinic between November 2010 and December 2016. Patient data were extracted retrospectively from hospital records. The demographics and gestational and clinical features of the mothers and babies, and the need for secondary surgery and the presence of postoperative infection, necrosis, wound dehiscence, and/or neurological deficit were compared between the cases who synthetic dura mater was used in their surgery and those autologous dura was used in their surgery. Results: In total, 86.4% of the 44 infants were preterm, and the predominant neurological problem was plegia in the vast majority. While the defect was located in the lumbar region in more than half of them, myelomeningocele was detected in 77.3% of all cases. The median defect size detected in the patients was 20.0 cm2, primary closure was performed in 30 patients, Limberg flap procedure in 14 patients, however, autologous dura mater and synthetic dura mater were used equally in the patients. The defect size was larger in patients using synthetic dura, furthermore hydrocephalus was found more frequently in these patients. While primary closure was applied in all patients using autologous dura and in one third of the patients using synthetic dura, Limberg flap procedure was applied in two thirds of synthetic dura group. The need for secondary surgery developed more frequently in synthetic dura group, and all postoperative complications were observed more frequently in these patients. In addition, the need for secondary surgery and postoperative necrosis, wound dehiscence, and neurologic deficit are more frequent in patients who underwent Limber flap compared to primary closure. However, the need for secondary surgery and the risk of postoperative complications were similar between primary closure and Limberg flap procedures in synthetic dura group. Conclusion: Although the synthetic dura mater was used in more severe patients, it had a higher need for secondary surgery and a higher risk of complications compared to autologous dura. In patients using synthetic dura, on the other hand, primary closure and Limberg flap had similar efficacy and safety.

A Case Series for Immediate Dental Implant Placements by means of Osteotome Technique

Purpose: To overcome the limitations of implant placement in Knife edge ridges, Summer introduced Osteotome technique in 1994. It has been claimed that bone condensing for preparation of the implant site in soft bone avoids the risk of heat generation and also implants can be placed precisely with increased primary stability. The purpose of this study was to analyze the use of the osteotome technique, followed by immediate implant placement, using cases presenting different conditions as dento-alveolar bony defects and to define management solutions in the event of existing bone resorption. Material and Methods: A group of twenty patients treated with bone expansion by means of osteotome technique, followed by single immediate implant placement were placed either in the maxillary or mandibular regions. Clinical findings have been recorded (complications, infection, and wound dehiscence) during the whole follow up period. The amount of bone expansion at the alveolar ridge after implant placement was measured clinically, gingival margin was evaluated clinically, and the marginal bone resorption (crestal bone loss) were evaluated radiographically for the restored implant oneyear after implant’s functional loading. Results: The surgical sites for the implant areas showed no post-operative complications, infection nor wound dehiscence during the whole follow up period. No prosthetic complications were recorded at follow up visits. The amount of bone expansion at the alveolar ridge were ranged 2.6-4.2 mm. The amount of marginal bone resorption from time of implant placement to one-year’s after implant’s functional loading were ranged 0.8-1.9 mm. The contour, height, and width of gingival at the implant site was corresponded to the soft tissues that surround the adjacent natural teeth) The gingival margin as esthetic outcome were achieved for most of the restored implants one-years after implant’s functional loading. Conclusion: Based on the results of this study, the Osteotome technique is a good technique for the purpose it was introduced i.e. for Knife edge ridges and the advantages for this technique for patients include less surgical trauma and a shorter treatment time.

Paddle Lead Spinal Cord Stimulation in the Morbidly Obese Patient Population: Outcomes and Complications in a Single-Surgeon Cohort

Paddle lead spinal cord stimulation (SCS) is used to treat refractory chronic pain. Morbidly-obese patients seek SCS to reduce chronic pain. However, these patients face worse surgical outcomes, and the SCS literature has not evaluated safety and efficacy in this patient population. This study is the largest single-surgeon case series to date on morbidly obese patients with paddle lead SCS implantations. The primary objective is to report post-operative complication rates in morbidly-obese patients receiving SCS implants. The secondary objective is to report patient-reported pain scores and PROMIS Pain Interference and Physical Function scores in these patients. A retrospective chart review was conducted. The patient charts were reviewed from the day of procedure consent to 6 months post-op. Demographic information, pain scores, PROMIS scores, neurological complications, infections, and wound complications were documented. 67 patients were included. The mean pre-operative BMI was 44.47±4.02 kg/m2. The mean age was 58.9±11.4 years old. There were no neurological complications. 3/67 (4%) developed culture-positive infections. 9/67 (13%) patients developed superficial wound dehiscence without underlying infection. The mean post-op PROMIS PF score was 31.6±6.2 (n=16) and the mean post-op PROMIS PI score was 64.0±6.4 (n=16). There was a reduction in pain scores, from 7.9±1.7 pre-op to 5.7±2.5 post-op (n=22, p=0.004). Paddle lead SCS implantation is safe for morbidly-obese patients. The only minimal-risk complications present were post-operative infections and wound dehiscence. Surgical care can be modified to further reduce the rates of infection and dehiscence.

Comparison of Simple Penile Dressings following Hypospadias Repair: does it really matter?

Background: Hypospadias repair requires an appropriate wound dressing to prevent complications, but there is a lack of studies comparing the efficacy of different dressings. Aim: To compare the clinical outcomes of occlusive hydrocolloid dressing and petroleum-impregnated gauze with zinc oxide adhesive plaster, and recommend an appropriate dressing based on efficacy, availability, and cost-effectiveness. Methods: We performed a retrospective cohort study on paediatric patients who had undergone hypospadias repair between August 2017 and November 2020 at Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. All the patients receiving one of the two wound dressings, occlusive hydrocolloid dressing (group A) or petroleum-impregnated gauze with zinc oxide adhesive plaster (group B) during primary or secondary hypospadias repair, operated by the same paediatric surgeon were included in this study. Patients with missing data were excluded. There was only one patient lost to follow up in this study. Results: A total of 64 male hypospadias patients with a mean age of 6.0 ± 3.4 years were included in this study. Group A patients (n=37) received a thick 10 x 10 cm occlusive hydrocolloid dressing whereas, in Group B patients (n=27), a 2.5 x 10 cm petroleum-impregnated gauze with zinc oxide adhesive plaster was applied over the wound. In group A, five patients (13.5%) suffered post-operative fistula and wound dehiscence. Whereas, in group B, the post-operative fistula was seen in three patients (11.1%). This study provides evidence-based information to clinicians and healthcare providers regarding the use of wound dressings for hypospadias repair. By demonstrating the efficacy of a cheaper and more accessible dressing, this study could help improve access to care and reduce costs for patients, especially in resource-limited settings. Conclusion: Occlusive hydrocolloid dressing and petroleum-impregnated gauze are equally effective in the healing of hypospadias repair wounds. The simpler and cheaper petroleum-impregnated gauze may be preferable in resource-limited settings. Keywords: Hydrocolloid dressing; Petroleum impregnated gauze; Paraffin gauze; Hypospadias