Prevention Of Wound Complications Research Articles

Prophylactic antibiotics for excision of premalignant vulvar lesions: A pilot randomized controlled trial

No prospective data have been described to inform guidelines on antibiotic prophylaxis for partial vulvectomies. Thus, we conducted a single-center, pilot, double-blind randomized controlled trial to assess the effectiveness of prophylactic antibiotics to prevent wound complications after partial vulvectomies. Patients were randomly assigned 1:1 to preoperative antibiotics or no preoperative antibiotics. The primary outcome of 30-day postoperative wound complications occurred in 31 (62 %) of all patients, with no differences between groups. The most common wound complications were superficial separation (54.2 % antibiotic prophylaxis vs. 65.3 % no prophylaxis, p = 0.37) and surgical site infection (0 % antibiotic prophylaxis vs 7.7 % no prophylaxis, p = 0.49). However, this study was limited by differences in patient characteristics between the groups. This study provides data to perform power calculations for a trial examining the effect of preoperative antibiotics on surgical site infection.

Topical Negative Pressure Wound Therapy to Prevent Wound Complications Following Cesarean Delivery in High-Risk Obstetric Patients: A Randomized Controlled Trial

(Aust N Z J Obstet Gynaecol. 2023;63:516–520) The prevalence of cesarean deliveries (CD) has surged in recent decades, paralleling an uptick in medical complications during pregnancy linked to delayed childbearing and rising obesity rates. Consequently, post-CD wound complications have become a significant health concern. Mitigating these complications is a priority, with various wound vacuum systems available. While concerns persist about their effectiveness compared to standard treatments, some evidence suggests modest benefits, particularly in nonobstetric settings. The PICO wound vacuum system has shown promise for clean, noninfected surgical wounds, including cesarean incisions, though data is mainly from small trials or retrospective cohorts. Our study explores the use of PICO in preventing wound infections and breakdown in women with risk factors for complications postcesarean delivery.

Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial

BackgroundThe recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed.MethodsWe propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery.DiscussionThis trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates.Trial registrationUMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205

Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review.

Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure.

Unveiling the role of artificial intelligence for wound assessment and wound healing prediction

Wound healing is a very dynamic and complex process as it involves the patient, wound-level parameters, as well as biological, environmental, and socioeconomic factors. Its process includes hemostasis, inflammation, proliferation, and remodeling. Evaluation of wound components such as angiogenesis, inflammation, restoration of connective tissue matrix, wound contraction, remodeling, and re-epithelization would detail the healing process. Understanding key mechanisms in the healing process is critical to wound research. Elucidating its healing complexity would enable control and optimize the processes for achieving faster healing, preventing wound complications, and undesired outcomes such as infection, periwound dermatitis and edema, hematomas, dehiscence, maceration, or scarring. Wound assessment is an essential step for selecting an appropriate treatment and evaluating the wound healing process. The use of artificial intelligence (AI) as advanced computer-assisted methods is promising for gaining insights into wound assessment and healing. As AI-based approaches have been explored for various applications in wound care and research, this paper provides an overview of recent studies exploring the application of AI and its technical developments and suitability for accurate wound assessment and prediction of wound healing. Several studies have been done across the globe, especially in North America, Europe, Oceania, and Asia. The results of these studies have shown that AI-based approaches are promising for wound assessment and prediction of wound healing. However, there are still some limitations and challenges that need to be addressed. This paper also discusses the challenges and limitations of AI-based approaches for wound assessment and prediction of wound healing. The paper concludes with a discussion of future research directions and recommendations for the use of AI-based approaches for wound assessment and prediction of wound healing.

How to Prevent Wound Complications After Total Ankle Arthroplasty Through Anterior Approach: A Systematic Review on Current Treatment Options.

Total ankle arthroplasty (TAA) through anterior approaches is a common treatment for end-stage tibiotalar arthritis. The occurrence of wound healing problems can lead to severe consequences. The aim of this systematic review is to summarize the available methods to minimize postoperative wound complications after TAA through standard anterior approaches. Three databases were searched for original articles concerning methods to reduce anterior wound complications after TAA. Eligible articles were examined to extract studies' characteristics, population data, type of intervention, and related wound complications. Study risk of bias assessment was conducted through the Newcastle-Ottawa Scale. Thirteen articles were included for analysis, investigating 8 types of intervention, which were grouped into 3 classes: biological, mechanical, and pharmacological methods. A significant decrease in wound complications was reported for negative pressure wound therapy (3% vs 24%, P = .014), soft tissue expansion strips (2% vs 12%, P = .04), and tranexamic acid (TXA) administration (9% vs 22%, P = .002). Despite the limitations of the included studies, this review showed encouraging results for TXA administration. Good results were found for mechanical methods, despite each intervention being supported by only 1 comparative study. Careful selection of patients is recommended to identify potential benefits or contraindications to such interventions. Further prospective randomized studies would be helpful to confirm these results.Levels of Evidence: 3.

Wound complications after prosthetics of hernial defects of the anterior
 abdominal wall: causes and methods of prevention (literature review).

Goal. To review the literature data on wound complications after prosthetic repair of hernial defects of the anterior abdominal wall, causes and methods of prevention.Results. An analysis of the literature has shown that the problem of wound complications during endoprosthetics for external abdominal hernias has not been completely solved. Among all postoperative complications after such hernias, seroma, infiltration and prolonged exudation are most common, less often ligature fistula, subcutaneous fat infarction, postoperative wound suppuration, cyst, granuloma, rejection of the prosthesis. The effectiveness of various methods of preventing wound complications during abdominal wall prosthetics is ambiguous. Conclusions. It is necessary to improve the known and develop new endoprostheses that would cause a minimal reaction of the body with good integration into tissues and high strength (to exclude relapses).

Effectiveness of 3-Day Prophylactic Negative Pressure Wound Therapy on Closed Abdominal Incisions in the Prevention of Wound Complications: A Randomized Controlled Trial

ObjectiveTo determine the impact of negative pressure wound therapy of closed abdominal incisions on wound complications. BackgroundSurgical wound complications including surgical site infection complicating open abdominal operations are a burden on the economy. The outcomes of SSI include prolonged hospital stays, adjuvant treatment delay, and incisional hernias leading to a decrease in the quality of life. Prophylactic negative pressure wound therapy has recently been tried with promising results. MethodsA randomized controlled trial involving 140 patients post-laparotomy with primary wound closure was divided into 2 groups (70 patients each). For the first group, NPWT dressings were applied for the first 3 days and then conventional dressings for 4 days after. For the second group, conventional dressings were applied for 7 days. Patients were followed up for SSI, seroma, wound dehiscence, and hospital stay. ResultspNPWT was associated with a significantly lower rate of SSI development compared with gauze dressings (3/70 vs. 17/70) (p = 0.001). It also had a significant effect on lowering the incidence of seroma (0/70 vs. 7/70) (p = 0.007) and delayed wound healing (0/70 vs. 8/70) (p = 0.006) and on decreasing days of hospital stay (2.2±0.6 vs. 3.5 ± 1.8) (p <0.00001). No significant difference was observed with regard to hematoma (0/70 vs. 1/70) (p = 0.5) or wound dehiscence (0/70 vs. 2/70) (p = 0.5). No burst abdomens or NPWT complications were recorded in our study. ConclusionThree-day NPWT applied to primarily closed incisions is effective in reducing the incidence of SSI, seroma, and delayed wound healing in abdominal operations compared to conventional gauze dressings.

Development and validation of a survey designed to measure patient experience of and preference for surgical wound care discharge education: A pilot study

Aim of the studyTo develop and undertake validation testing of a survey designed to measure patients’ experiences of and preferences for surgical wound care discharge education. Materials and methodsA literature review and content analysis was undertaken on patients' experiences of and preferences for surgical wound care discharge education. Four themes were uncovered in the literature (wound care discharge education, preferences for discharge education delivery, participation in wound care decisions and patient ability to manage their surgical wound to prevent wound complications), which guided item generation. Three types of validity testing occurred including: 1) face validity testing by the research team; 2) content validity testing (using Delphi study) with an international panel of experts including patients, clinicians and researchers; and 3) content validity (using pilot-testing) of the survey with seven patients from the target population. ResultsInitially 106 items were generated from the literature, and of these, 55 items were subjected to content validity testing by an international panel of 41 experts. After two Delphi rounds, 18 items were retained. Most patients provided limited and very minor feedback during pilot-testing. However, pilot-testing resulted in a revised survey administration plan to deliver the survey via telephone, including adding prompts and preambles to items. ConclusionAn 18-item survey comprised of three groups of items and an individual item was rigorously developed. The survey requires further testing among a larger sample of patients to confirm the items reflect important aspects of patients’ experiences of and preferences for surgical wound care discharge education.

Factors Associated with Intention in Performing Foot Care Using the Theory Of Planned Behavior in Type 2 Diabetes Mellitus Patients

One of the efforts to prevent complications of diabetic neuropathy in diabetic patients is foot care such as washing the feet every day, drying and oiling them, examining the feet for foot ulcers and signs of pre-ulceration, and wearing well-closed footwear at home. or outside the house. In performing foot care, DM sufferers must have strong intentions and beliefs so that they can run it well. This study aimed to determine the factors related to the intention to perform foot care using the theory of planned behavior at the UPTD of the Poasia Health Center, Kendari City. This study used a correlation design with a cross-sectional study approach involving 32 samples. The sampling technique used was accidental sampling. The instrument used is a questionnaire. Data analysis using Spearman correlation test. The results showed that there was no relationship between attitudes (direct = 0.9, indirect = 0.11), subjective norms (direct = 0.058 and indirect = 0.165) and behavioral control (direct = 0.022 and indirect = 0.037) on the intention to perform foot care in Type 2 DM patients. Further research should examine respondents who have understood or understood the importance of DM foot care. It is recommended that respondents and families still need foot care daily to prevent wound complications.

Polyphenol in olive oil: A promising adjuvant therapeutic agent in wound healing management and wound complication prevention

Wound is one of the most common findings in medical problems. Tissue repairment would return tissue integrity normally in morphology and function, but in certain cases, tissue repairment could be disrupted or uncontrolled. Disrupted tissue repair by infection agents, inadequate treatment, or other risk factors would lead to complications such as ulcers, gangrene, tissue death, or hypertrophic scar. These complications could lead to physical, mental, social, aesthetic, and financial burdens. Olive oil is a substance extracted from whole olive fruits widely used in the culinary world. Olive oil in skin treatment has been used since ancient times, and current research has developed in olive oil as an adjuvant treatment. Several researches have resulted in a positive result for olive oil as a promising agent for wound treatment to emulate tissue regeneration and prevent wound complications. According to several studies, flavonoids, oleuropein, phenolic acids, phenolic alcohols, lignans, and other compounds contribute as antioxidant and anti-inflammatory compounds. Certain substances in olive oil contribute as a cell protector, antimicrobial, and anticarcinogenic, which are important aspects of wound management, tissue recovery and complication prevention. These substances are found in eliminating oxidative species, lowering inflammatory responses, and inducing protein synthesis in tissue regeneration.

Optimal Method of Skin Wound Management for Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Skin closure for total knee arthroplasty (TKA) typically focuses on promoting optimal healing, while preventing wound complications and infection, allowing for functionality and immediate ambulation, and providing for excellent cosmesis. In this systematic review and meta-analysis of the literature, we will focus on closure of the skin. Specifically, we assessed: (1) wound complication risk of different techniques and (2) closing time of different sutures/techniques. There were 20 reports on infection risk and closing time. Meta-analyses focused on the qualifying studies for closing time and wound complication risk reports were also performed. These studies (378 patients) demonstrated overall lower wound complication risks with the use of barbed compared with traditional sutures (3% vs. 6%, p < 0.05). The subsequent meta-analysis included 749 patients demonstrating overall significant closing time reductions of a mean of 7 minutes with the use of barbed sutures (p < 0.05). Therefore, multiple recent reports suggest superior outcomes and faster results when using barbed sutures for TKA skin closure.

Role of Subcutaneous Suction Drain in Prevention of Wound Complications after Elective Abdominal Surgery

Role of Subcutaneous Suction Drain in Prevention of Wound Complications after Elective Abdominal Surgery

Stopping prehospital chlorhexidine skin wash does not increase wound morbidity after incisional hernia repair: results of a 4-year quality improvement initiative.

Prehospital chlorhexidine gluconate (CHG) skin washes are used to prevent wound complications, but little evidence supports this practice in hernia surgery. A propensity-matched retrospective review published by our group in 2016 found that prehospital CHG was associated with an increased risk of surgical site occurrences (SSO) and surgical site infections (SSI) after ventral hernia repair. Prehospital CHG was, therefore, abandoned by three of five surgeons at the Cleveland Clinic Foundation (CCF) by April 2017. We aimed to determine if discontinuation of prehospital CHG affected wound morbidity rates after incisional hernia repair. The Abdominal Core Health Quality Collaborative was queried for all patients who underwent open, clean incisional hernia repairs with 30-day follow-up from 2014 to 2019. Using an interrupted time series (ITS) analysis model adjusted for group and mean propensity score, wound morbidity before and after April 1, 2017 (start of Q2) was compared between three groups: CCF surgeons who abandoned prehospital CHG (Group 1), CCF surgeons who continued using prehospital CHG (Group 2), and non-CCF surgeons using prehospital CHG (Group 3). Outcomes included rates of SSOs, SSIs, and surgical site occurrences requiring procedural intervention (SSOPI) at 30days. In total, 4276 patients were included in the analysis (Group 1: 339 before Q2 vs 673 after Q2; Group 2: 211 before Q2 vs 175 after Q2; Group 3: 1312 before Q2 vs 1566 after Q2). Rates of SSO, SSIs, and SSOPIs at 30days were similar across all three groups before and after prehospital CHG discontinuation. Stopping prehospital CHG wash did not result in increased wound morbidity after open, clean, incisional hernia repair. We have abandoned CHG use in this context.

Impact of peripartum antibiotics on wound complications in women with obstetric anal sphincter injury.

To evaluate the role of antibiotics on preventing wound complications following obstetric anal sphincter injuries (OASI). This is a cohort study with retrospective and prospective components of women who sustained an OASI at vaginal delivery. The primary objective of this study was to assess the impact of prophylactic antibiotics at the time of delivery on perineal wound complications. Women were grouped based on peripartum antibiotic administration: no antibiotics (NABX), antibiotics for OASI wound complication prophylaxis (PABX), antibiotics for therapeutic indications (TABX), and antibiotics for any indication (AABX, PABX + TABX). Four hundred and twenty-five women with OASI were included in this analysis. Most women experienced a third-degree perineal laceration (358, 84.2%). One hundred and sixteen (27.3%) women received NABX, 195 (45.9%) women received PABX, and 114 (26.8%) women received TABX. Cefazolin was the most common antibiotic in the PABX group. Perineal wound complications occurred in 51 (12.0%) women: 14 (12.4%) in NABX, 26 (13.3%) in PABX, 11 (9.6%) in TABX, and 37 (12.0%) in AABX. The incidence of perineal wound complications did not differ between groups. In this cohort study, peripartum antibiotics did not reduce wound complication incidence following OASI. It is likely that a first-generation cephalosporin is not the ideal antibiotic in this clinical setting.

Mechanical simulation study of reapproximated sternum rigidity comparing sternal fixation devices.

A reliable sternal fixation is one of the most basic parts of cardiac surgery requiring sternotomy for preventing wound complications and promoting early recovery. Although various products have been released to the markets, the characteristics of each device are still unclear. A simulation study was conducted to compare the properties of two sternal fixation device: a commonly used monofilament stainless-steel wire and a newly designed cable comprised of several titanium alloys strands. Sternum models made of monomer casting nylon were tied with each material and displaced in longitudinal, antero-posterior, and horizontal directions. Resistance against each directional external force was measured and compared. The titanium cable showed a higher resistance to every directional displacement since slight deviations and a twofold higher maximum strength than the stainless wire. An in vitro simulation study revealed the titanium cable system provide stronger sternum fixation than stainless-steel wire.

O044 The risk of surgical site infection and other wound complications following surgery to the lymph nodes for staging or treatment of malignancy: a systematic review and meta-analysis of 45,415 cases

Abstract Introduction For completion of staging of malignant melanoma, sentinel lymph node biopsy (SLNB) may be offered to patients with stage 1B disease or greater, and in some positive cases, completion lymphadenectomy is offered. However, there is little evidence that either procedure are beneficial to patients, and both procedures carry a risk of wound complications. The aim of this study was to assess the current prevalence of wound complications in these procedures and quantify the change over time of this risk. Methods This was a subgroup analysis of a larger systematic review (Prospero CRD42021239530). A systematic search was undertaken to identify all published material relating to surgery on the lymph nodes. The primary outcome was the proportion of surgical site infection and/or seroma. Studies relating to malignant melanoma were selected from the overall results, and random effects meta-analysis of proportions and meta-regression were undertaken. Results Seventy studies were suitable for inclusion in meta-analysis, constituting 7,585 patients. The proportion of patients developing infection following SLNB was 3.5% (95% CI 2.0–6.0%) and seroma 7.8% (4.0–14.3%). For completion lymphadenectomy, the risk of SSI was 17.4% (13.4– 22.2%) and seroma 24.7% (23.4–26.0%). Neither SSI nor seroma incidence have changed significantly in 30 years. Conclusion The risk of complications in these procedures remains high and has not changed in 30 years. Given a potential lack of benefit of these procedures, this data should be used as part of the decision-making process when counselling patients, and to guide future research into prevention of wound complications. Take-home message The risk of SSI following block dissection for melanoma is almost 20%, and the risk of seroma almost 25%. This unacceptably high risk has not improved in the last 30 years.

Complex Wound Closure in Adult Spinal Deformity Surgery Reduces Complications in High-Risk Patients

Adult spinal deformity (ASD) surgery is becoming increasingly prevalent. Soft tissue defects arising from revision closure and impaired healing can predispose to wound complications including dehiscence and infection. Soft tissue coverage with local muscle flaps has been shown to minimize wound complications in high-risk patients. In this study we evaluate the role of complex wound closure in preventing wound complications in high-risk spinal deformity patients. The authors retrospectively reviewed charts of patients who underwent ASD surgery. Patients were stratified into muscle flap advancement (by neurosurgery or plastic surgery) closure versus primary approximation by neurosurgery. Relevant patient and operative factors were collected and summarized using descriptive statistics. Outcomes of interest included wound complication and revision surgery. Ninety-four cases met inclusion criteria including 56 wounds closed by neurosurgery and 38 wounds closed by plastic surgery (PRS). Of the neurosurgery wounds, 31 and 25 were closed by primary approximation and muscular flap advancement, respectively. Patients operated on by PRS were higher risk than all patients operated on only by neurosurgery (P= 0.0037) but were not significantly higher risk than the neurosurgery performed flap cohort (P= 0.4914). In subgroup analysis, despite similar levels of risk, the PRS population experienced lower rates of any wound complication (P= 0.028) and specifically dehiscence (P= 0.029) compared with the neurosurgery performed flap closure cohort. Prophylactic involvement of plastic surgery in ASD surgery wound closure may improve wound outcomes in higher risk patients. A multidisciplinary approach with plastic and spine surgeons may lessen the risk of wound complications in high-risk spine surgeries.

Can prophylactic negative pressure wound therapy improve clinical outcomes in spinal fusion surgery? A meta-analysis.

Recently negative pressure wound therapy (NPWT) is increasingly being prophylactically used to prevent wound complications in various types of surgeries, but its role in spinal fusion surgery was less well established. This study aimed to evaluate the efficacy of prophylactic NPWT (PNPWT) usage in spinal fusion surgery. Following PRISMA guidelines, databases PubMed, Embase and Web of Science were searched for relevant studies. Studies comparing PNPWT with standard wound dressing (SWD) were included and analyzed. The primary outcome was the incidence of surgical site infection, and secondary outcomes were incidence of wound dehiscence, overall wound complication, readmission and reoperation. A total of five studies were included; there were 279 patients in PNPWT group and 715 patients in SWD group. Four studies investigated surgical site infection; the pooled analysis showed a significantly lower incidence of surgical site infection in PNPWT group (OR: 0.399; 95% CI: 0.198, 0.802). Two studies explored wound dehiscence, three studies reported overall wound complication, and there were no significant differences between the two groups ((OR: 0.448; 95% CI: 0.144, 1.389) and (OR: 0.562; 95% CI: 0.296, 1.065), respectively). Two studies evaluated readmission, three studies compared reoperation rate, and the pooled results demonstrated no significant difference between the two groups ((OR: 1.045; 95% CI: 0.536, 2.038) and (OR: 0.979; 95% CI: 0.442, 2.169), respectively). The current evidence suggested PNPWT could effectively reduce postoperative surgical site infection, but it had no significant benefit on reducing the incidence of wound dehiscence, overall wound complication, readmission and reoperation.

Safety and Feasibility of Autologous and Allogeneic Cell Therapy in Preventing Wound Complications After Below-the-knee Amputation

Ischemic wound complications of below-the-knee amputation (BKA) will necessitate conversion to above-the-knee amputation (AKA) in ≤36% of cases. Loss of the knee joint has deleterious effects on patient rehabilitation. Cell therapy has demonstrated proangiogenic benefits in patients with peripheral arterial disease, which might allow for improved wound healing after BKA. We assessed the use of cell therapy in BKA wound healing through a safety and feasibility study.