Rate Of Wound Dehiscence Research Articles

Do Antibacterial Skin Sutures Reduce Surgical Site Infections After Elective Open Abdominal Surgery?—A Prospective, Randomized Controlled Single-Center Trial

Background/Objectives: The general use of triclosan-coated suture material (TCSM) for wound closure to prevent surgical site infections (SSIs) remains controversial. There is no conclusive evidence in the literature to support this and recommendations by professional organizations are contradictory. Therefore, the main objective of the study was to evaluate the 30-day rate of surgical site infections (SSIs) after elective open abdominal surgery using triclosan-coated versus uncoated running sutures (NCSM) for skin closure. Methods: This prospective, randomized, double-blinded study enrolled patients scheduled for open elective abdominal surgery, intraoperatively assigned to either the use of triclosan-coated or non-coated sutures for skin closure. The follow up was 30 days after surgery to detect SSIs. Secondary endpoints were wound dehiscence and reoperation rate due to wound dehiscence within 30 days, all-cause 30-day mortality and length of hospital stay. Potential risk factors for poor wound healing were evaluated in multivariate analysis. Data were analyzed in an intention to treat analysis. Results: In total, 364 patients (171 males [47%]) were randomized, 182 in either group. Six underwent urgent reoperation prior to first visit and were excluded from analysis. In the full analysis set (FAS), 358 were analyzed. SSI within 30 days occurred in 22 [12.2%] patients in the control group compared to 32 [18%] in the study group. The risk difference was not statistically significant (5.8%; 95% confidence interval (CI) −1.6–13.2%; p = 0.128). The wound dehiscence rate within 30 days was 14 of 179 [7.8%] in the NCSM group vs. 19 of 178 [10.7%] in the TCSM group. The difference in re-operation rates due to wound dehiscence was 0 of 179 [2.8%] vs. 5 of 178 [2.8%] in either group and not statistically significant (p = 0.0706). Among all patients recruited, 8 died within 30 days after surgery. Three of them died before the first assessment of the primary endpoint on day 3 and were therefore excluded from the FAS. The 30-day mortality rate was 2 of 180 [1.1%] in the NCSM group vs. 3 of 178 [1.7%] in the TCSM group. The majority of SSIs occurred in the superficial layer of the wound in both study groups (8.9% vs. 9.6%). The median [inter quartile range (IQR)] length of hospital stay was 13 [9.0, 19.2] days in the NCSM group vs. 11 [9.0, 16.8] days in the TCSM group There was a tendency towards shorter hospitalization in the study group (0.72 days [6%]). Conclusions: Our prospective randomized controlled trial could not confirm the superiority of TCSM for skin closure after elective open abdominal surgery in terms of SSI rates in a 30-day follow up period. Therefore, based on our results, a general recommendation for its use in all surgical fields cannot be justified.

EXTH-84. A DURABLE RECURRENT INTRACEREBROVENTRICULAR INFUSION METHOD IN MICE FOR PRECLINICAL ASSESSMENT OF CELLULAR THERAPEUTICS

Abstract BACKGROUND Significant advancement in cellular treatments for glioblastoma has been made in recent years. The administration route has shifted from intravenous access to local delivery, namely intracerebroventricular (ICV) delivery, in order to prevent the injected cellular products from becoming trapped in peripheral organs such as liver and spleen. There is currently no reliable preclinical system available to accurately examine new cellular treatments that involve long-term recurrent infusion into the cerebral ventricles. METHOD We optimized the surgical device and technique by modifying a commercially available ICV device with a predetermined needle length, eliminating the requirement for spacers hence relieving the tension of the surgical wounds. To avoid skin puncture, we substituted the tunneled catheter with a silicon catheter. The surgical incisions were secured with autoclips in replacement of sutures. We administered periodic infusions of engineered monocytes on a weekly basis using the tunneled catheter for a duration of 8 weeks. The rate of wound dehiscence was monitored. RESULTS The delivery of the engineered monocytes to the cerebral ventricle via the ICV device has been confirmed using a bioluminescence-based imaging. The device and the tunneled catheter demonstrate a long-lasting durability for a minimum of 8 weeks. The optimized device and method effectively reduce the occurrence of post-operative wound dehiscence. Using a silicon catheter minimizes skin punctures. CONCLUSION Our optimized ICV device, material, and surgical approach offer a dependable preclinical instrument for the long-term and recurrent delivery of cellular therapies that reflect patients’ clinical treatment schedules and provide a more accurate evaluation of their translational potential.

Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction

BackgroundPressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps.MethodsA retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics.ResultsIn this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate.ConclusionClosed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care.Trial registration.The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20–2023–25, Date: Mar. 24 2023).

Computer-Aided Design and Manufacturing in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes with the Conventional Technique.

Pre-operative computer-aided design and manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. We aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps. Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, past medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method. A total of 215 patients (n=79 conventional, n=136 CAD/CAM) were included. Both cohorts had similar demographics except the CAD/CAM cohort was younger (p=0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM (p=0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence (p=0.037). Median [interquartile range] follow-up duration was similar (931 [1854] days in conventional vs 728 [841] days in CAD/CAM, p=0.084). After excluding patients with major surgical complications in the first 30-days, CAD/CAM cohort had a lower hardware removal rate (28.8% vs 13.9%, p=0.011). The significance persisted after including only the patients with more than 2 years of follow-up. The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates due to complications.

Comparison of continuous versus modified continuous SMEAD jones “far-near-near-far” suturing technique for abdominal wall closure in emergency midline laparotomy wound in terms of wound dehiscence.

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method.

National Trends and In-Hospital Outcomes for Immediate Implant-Based Versus Autologous-Based Breast Reconstruction: A Propensity Score-Matched Analysis.

Breast reconstruction consists primarily of two methods: autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR). Each of these methods has its advantages and disadvantages. The current study used the National Inpatient Sample (NIS), the largest inpatient database in the United States, to explore the trends, complications, and disparities in the use of IBR and ABR. The current study used the NIS database from 2016 to 2020, including the International Classification of Diseases, 10th version (ICD-10) codes. A propensity score-matching (1:1) analysis was used to match the IBR and ABR groups. The percentage of breast reconstruction increased from 58.8% in 2016 to 63.4% by 2020. The trend of ABR was upward, and the trend of IBR was downward. In addition, the ABR group had significantly higher rates of cardiovascular complications (odds ratio [OR], 1.29), respiratory complications (OR, 4.26), vascular complications requiring surgery (OR, 7.82), blood transfusions (OR, 3.44), vasopressor need (OR, 1.409), and acute kidney injury (OR, 1.68). However, the ABR group had significantly lower rates of wound infection (OR, 0.430), wound dehiscence (OR, 0.213), wound seroma (OR, 0.602), and sepsis (OR, 0.252). A significant disparity was found in using ABR for different subgroups based on age, hospital teaching status, racial background, socioeconomic status, and hospital bed size. The current study showed an upward trend in the utilization of ABR and a downward trend for IBR. Although ABR had a higher rate of pulmonary, cardiovascular, vascular, and bleeding complications, it had a lower rate of wound-related complications.

A single-centre, retrospective study of incisional hernia repair outcomes post kidney transplantation.

Incisional hernias (IH) after kidney transplantation (KTx) can cause significant morbidity in kidney transplant recipients (KTR). We aimed to report the outcomes of surgical repair of IH in KTR from our centre. We retrospectively analysed all the IH repairs in KTR from May 2018 to May 2023. We documented pre-transplant baseline characteristics, peri- and post-KTx events and outcomes and post-IH repair complications. We also documented length of stay, survival, and hernia recurrence post-IH repair. We performed 35 incisional hernia repairs in 34 KTR from May 2018 to May 2023 with an overall incidence of 1.63% symptomatic IH. Mean patient age was 56.7 ± 10.1 years and mean body mass index (BMI) 29.7 ± 6.49kg/m2. A history of previous hernia operation and open abdominal operations was present in 11.4% and 22.9% of the population, respectively. The types of repairs performed were primary (5.7%), onlay (62.9%), inlay (2.9%) and retromuscular sublay (28.6%). Mean hernia neck size was 8.9 ± 5.6cm. After IH repair, there was no perioperative mortality with an average 5.5 ± 3.9 days of length of stay. There were seven episodes (20%) of IH recurrence. There was a 6% of superficial wound dehiscence rate and a 3% of surgical site infection. Pearson's correlation test revealed that post-operative hernia recurrence was not related with neck size, post-transplant complications or pre- and post-transplant characteristics, as well as post-transplant outcome. The recurrence rate in our cohort was 20%. Known risk factors for IH in KTR as well as post-KTx events were not correlated with hernia recurrence or other post-hernia repair complications.

Pressure makes diamonds? The impact of closed incision negative pressure wound therapy on complications following abdominoplasty in patients with massive weight loss—results from a case controlled trial

BackgroundThe effectiveness of closed incision negative pressure wound therapy (ciNPWT) has been shown across various studies. However, studies with large patient cohorts comprising post-bariatric patient populations are missing. The objective of this research was to assess the influence of ciNPWT on post-operative wound complications in this demanding patient collective. MethodsWe conducted a retrospective case-control study. Between 1 January 2013 and 31 December 2023, a total of 251 abdominoplasty procedures following massive weight loss were identified. Patients were matched based on resection weights. We matched 118 patients separated into two groups depending on post-surgical wound management (conventional wound dressings vs ciNPWT). The primary outcomes were wound-related disorders and secondary outcomes were the number of readmissions or reoperations within 30 days after the initial surgery. ResultsThe study revealed equal incidence of seroma formation (15 vs 15, p = 1.0), rates of wound dehiscence (23 vs 20, p = 0.56), surgical site infection (11 vs 6, p = 0.18), hematoma (17 vs 9, p = 0.07), complete removal of all drainages (6.7 vs 6.1 days, p = 0.34) and total number of readmission (12 vs 11, p = 0.77) or reoperations (12 vs 10, p = 0.63) within 30 days. The second hospital stay caused by revision was significantly shorter in the ciNPWT group (5.8 days vs 12.0 days, p = 0.02). ConclusionConsequently, we did not find evidence to support the hypothesis that ciNPWT reduces complications after abdominoplasty in patients with massive weight loss.

Complications after benign gynecologic surgery-How are they captured in register-based research? A national register study in Sweden.

The evidence on complication rates after gynecological surgery is based on multiple types of studies, and the level of evidence is generally low. We aimed to validate the registration of complications in the Swedish National Quality Register of Gynecological Surgery (GynOp), by cross-linkage to multiple national registers. A national register-based study using prospectively collected data was conducted, including women who had surgery on the uterus or adnexa for benign indications from January 1, 2017, to December 31, 2020. In Sweden, complications after gynecological surgery are registered in GynOp, and if the complication has rendered any interaction with healthcare, it is also in national health registers. The GynOp register, the National Patient Register, the Prescribed Drugs Register, and the Cause of Death Register were cross-linked. Complications in GynOp and complications according to ICD10 were analyzed, as well as the cause of death if occurring within 3 months of surgery and prescription of antibiotics ≤30 days. Comparisons between the registries were descriptive. During the study period 32 537 surgeries were performed, of which 26 214 (80.6%) were minimally invasive. Complications were reported in GynOp for 569 women (1.7%) at surgery, 1045 (3.2%) while admitted, and 3868 (13.7%) from discharge to 3 months after surgery. In comparison, according to the Patient Register, 2254 women (6.9%) had postoperative complications within 3 months of discharge (difference of 6.8 percentage points [95% confidence interval 6.2-7.2]). Furthermore, 4117 individuals (12.7%) had a prescription of antibiotics ≤30 days which could indicate a postoperative infection. The rates of hemorrhage, wound dehiscence, and thrombosis were comparable between GynOp and the Patient Register while diagnoses not leading to contact with specialized care had higher rates in the quality register. The coverage of complications was 79.1% in GynOp and 46.1% in the Patient Register, using the total number of complications from both registers as the denominator. A higher frequency of complications is captured in GynOp than in the National Patient Register. Patient-reported outcomes assessed by a physician are beneficial in identifying complications indicating the importance of structured pre-defined follow-up over a set period.

Early enteral nutrition (EEN) following intestinal anastomosis in pediatric patients – what’s new?

Abstract Introduction Abdominal surgery in children may disrupt normal gut function, necessitating prolonged fasting, which can lead to complications such as dehydration and nutritional deficits. Early enteral nutrition (EEN) after surgical procedures can enhance wound healing, prevent malnutrition, and expedite recovery. Although concerns exist regarding the risk of complications associated with EEN, current evidence suggests that it is not linked to increased perioperative complications. Content This scoping review provides an overview of the role of EEN in pediatric abdominal surgery, exploring its benefits and risks within the context of recent literature from 2021 to 2024. A systematic literature search was conducted using the PubMed database in April 2024 and the identified studies were compared. The search revealed 586 results, wherefrom eight studies (three systematic reviews and five clinical studies) fulfilled the inclusion criteria. Five studies were added since 2021. Overall, EEN may reduce the length of hospital stay, time to full oral intake, and return of bowel function. It does not seem to increase the rate of anastomotic leakage. EEN is associated with lower rates of surgical site infections and wound dehiscence as well as fewer septic complications. One study showed an increase in nausea/vomiting and abdominal distension in the EEN group, which did not lead to further complications. Summary and Outlook Current evidence suggests that EEN after abdominal surgery in pediatric patients is not associated with a higher rate of complications. In fact, EEN seems to be beneficial and lead to improved patient outcomes and shorter hospital stays. Emphasis on patient and parent comfort, individualized feeding initiation based on clinical factors, and standardized postoperative feeding protocols are recommended to optimize outcomes in pediatric abdominal surgery.

A Sustainable Solution for Reducing Draping Waste in Cleft Surgeries.

This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair. A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques. All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists. The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison. Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards. Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence. The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group. Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes.

Impact of dual procedures: How combining VP shunt placement for hydrocephalus and myelomeningocele repair in newborns affects complication rates?

To discern the efficacy of simultaneous versus delayed VPS surgery in managing hydrocephalus linked with MMC repair: The debate over the concurrent or deferred placement of ventriculoperitoneal shunts (VPS) during myelomeningocele (MMC) repair in hydrocephalic neonates necessitates a nuanced evaluation of associated risks and benefits. While VPS placement can mitigate cerebrospinal fluid (CSF) leaks and minimize wound dehiscence post-MMC repair, it concurrently introduces potential hazards such as infections and shunt-related malfunctions. This prospective cohort study focused on144 newborns with spinal myelomeningocele and hydrocephalus. Divided into two groups based on the timing of dysraphism repair and VPS placement, 101 children underwent concurrent procedures, while 43 received deferred VPS insertion post-MMC closure. Female patients constituted 60% of the cohort, with lumbar lesions being predominant. The median age for MMC closure was three days. Analysis revealed that the deferred insertion group exhibited higher rates of shunt malfunctions, CSF leaks, and wound dehiscence compared to the concurrent insertion group. Although indications hinted at a potential increase in shunt infections in the immediate insertion group, statistical significance was lacking. The study established a statistically significant association between the timing of shunt insertion during MMC repair and specific outcomes, such as CSF leaks and wound dehiscence. The findings suggest that concurrent shunt insertion during MMC repair may reduce the incidence of these complications compared to deferred insertion. However, no substantial differences emerged in terms of shunt infection and malfunction, emphasizing the persistent challenges associated with these major complications.

Effect of Chronic Steroid Use on Postoperative Wound Complications in Patients Undergoing Arterial Bypass Surgery for Lower Extremity Peripheral Arterial Disease

ObjectiveWhile existing literature reports adverse effects of chronic steroid use on surgical wound outcomes, there remains lack of data exploring the effect of steroids on postoperative outcomes following lower extremity arterial bypass surgery. This study aims to explore the effect of chronic steroid use on surgical outcomes in patients undergoing open revascularization for lower extremity arterial occlusive disease. MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) files between 2005 and 2020, all patients receiving aortoiliac or infrainguinal arterial bypass for peripheral arterial disease (PAD) were identified by Current Procedural Terminology (CPT) codes. Patient characteristics and 30-day outcomes were compared using χ2 test and independent t-test, and association of chronic steroid use with wound complications was studied using multivariable logistic regression analysis. ResultsA total of 44,675 patients undergoing open lower extremity revascularization were identified, of which 1,807 patients were on chronic steroids and 42,868 patients were not on chronic steroids. On multivariable logistic regression analysis, being on chronic steroids was associated with higher rates of deep SSI (OR 1.37, 95% CI 1.03-1.83), any SSI (OR 1.22, 95% CI 1.04-1.43) and wound dehiscence (OR 1.42, 95% CI 1.03-1.96). Chronic steroid users also had significantly increased odds of developing sepsis (OR 1.56, 95% CI 1.19-2.04), pneumonia (OR 1.44, 95% CI 1.08-1.91), UTI (OR 1.54, 95% CI 11.13-2.09), DVT (OR 1.60, 95% CI 1.01-2.53), and 30-day readmission (OR 1.30, 95% CI 1.12-1.50), reoperation (OR 1.17, 95% CI 1.01-1.37) and mortality (OR 1.33, 95% CI 1.01-1.76) compared to non-chronic steroid users. ConclusionThis study confirms that chronic corticosteroid use is associated with higher risk of surgical site infections (SSIs) in patients undergoing lower extremity arterial bypass surgery. These patients typically have various underlying health issues, emphasizing the need for personalized treatment and management to reduce steroid-related postoperative complications and improve survival.

Endoscopic Versus Open Treatment of Carpal Tunnel Syndrome: Postoperative Complications in Patients With Diabetes Mellitus

Patients with type 2 diabetes mellitus (T2DM) often face higher postoperative complication rates. Limited data exist regarding outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study compares complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM. The TriNetX database was used to perform a retrospective cohort study of 67,225 patients with T2DM who underwent ECTR (n= 17,792) or OCTR (n= 49,433). Demographic data, medical comorbidities, and complication rates were analyzed. A 1:1 propensity score match was performed to calculate risk ratios and 95% confidence intervals of postoperative median nerve injury, 6-week wound dehiscence, and 6-week wound infection. After matching, a significantly greater number of ECTR patients had liver disease (P= <.001) and a body mass index > 40 (P= .001) compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders (P= .003). Patients with T2DM who underwent ECTR had a significantly lower relative risk of 6-week wound infection, 6-week wound dehiscence, and median nerve injury (all P < .001) compared to patients who underwent OCTR. In our analysis of T2DM patients undergoing CTR, ECTR yielded significantly lower rates of wound infection, wound dehiscence, and nerve injury within 6-weeks post-surgery, reducing the risk by 43%, 52%, and 58%, respectively. These findings suggest that ECTR may result in a lower complication rate in this patient population. III.

Effects of subcutaneous drain on wound dehiscence and infection in gynecological midline laparotomy: Secondary analysis of a Korean Gynecologic Oncology Group study (KGOG 4001)

ObjectiveTo identify the effects of subcutaneous drain insertion on wound dehiscence and infection in patients who underwent gynecological midline laparotomy. MethodsThis analysis identified the secondary endpoints of the KGOG 4001 study, a prospective, multicenter, non-blind, randomized controlled trial. Patients scheduled to undergo midline laparotomy for gynecological diseases and, with body mass index<35 kg/m2, were randomized (1:1) to treatment (with subcutaneous drain) and control (without subcutaneous drain) groups from February 2021 to December 2021. We compared the incidence rate of wound dehiscence 4 weeks post-surgery and the cumulative incidence rate of wound dehiscence and infection up to 4 weeks post-surgery between the two groups. ResultsOf 174 patients randomized to the treatment (n = 84) and control (n = 90) groups, 12 were excluded owing to loss to follow-up; finally, 162 patients (treatment, n = 79; control, n = 83) were included in intention-to-treat analysis. The frequency of cancer surgery (79.7 % vs. 77.1 %, p = 0.683), mean surgery time (227.7 vs. 226.7 min, p = 0.960), and mean wound length (24.2 vs. 24.3 cm, p = 0.933) were comparable between two groups. No significant differences were observed in the incidence rate of wound dehiscence 4 weeks post-surgery (1.3 % vs. 2.4 %, p > 0.999), cumulative incidence rate of wound dehiscence (8.9 % vs. 6.0 %, p = 0.491), and cumulative incidence rate of wound infection (1.3 % vs. 0.0 %, p = 0.488) up to 4 weeks post-surgery between the two groups. ConclusionSubcutaneous drain insertion is not associated with a significant improvement in the incidence of wound dehiscence and infection in patients who undergo gynecological midline laparotomy. Clinical trial registrationClinicalTrials.gov, NCT04643197.

Incision Closure for Direct Anterior Total Hip Arthroplasty: Is There a Difference in the Rate of Superficial Wound Complications With Suture Versus Staples?

Background Direct anterior total hip arthroplasty (DA-THA) has increased in popularity over recent decades. However, DA-THA has been reported to have a higher incidence of superficial wound complications, including infection and incisional dehiscence, compared to other surgical approaches to hip arthroplasty. While this indicates a need for optimal wound closure, little research exists on the preferred method of skin closure following DA-THA. This study aimed to determine if there was any difference in rates of superficial infection, wound dehiscence, or overall wound complications with skin closure using a running subcuticular 3-0 Monocryl® suture compared to surgical staples following DA-THA. Methods Records of patients who underwent DA-THA at our institution between July 2017 to July 2022 were retrospectively reviewed. Data were abstracted on patient demographics, comorbidities, skin closure method, and wound complications from the electronic medical record. Superficial infection and wound dehiscence were classified based on explicit diagnosis in post-operative records and incision photographs taken during follow-up visits. Overall wound complications were classified in patients who experienced either superficial infection, incisional dehiscence, or both complications following surgery. Descriptive statistics and chi-squared measures were obtained from post-operative patient data, and significance was set at p[Formula: see text] 0.05. Results A total of 365 DA-THAs were completed in 349 patients. A running subcuticular 3-0 Monocryl® suture closed 207 surgeries (56.7%), while surgical staples closed 158 surgeries (43.3%). There was no significant difference in independent rates of superficial infection (p = 0.076) or wound dehiscence (p = 0.118) between suture and staple cohorts; however, suture closure (10, 2.7%) was associated with a significantly higher rate of overall wound complications compared to staple closure (1, 0.3%) (p = 0.020). Conclusion DA-THA carries the risk of overall wound complications, including superficial infection and wound dehiscence. Our findings suggest superficial skin closure with staples may be preferred over sutures due to lower rates of overall wound complications. Further studies are needed to determine the optimal method of skin closure following DA-THA.

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction.

Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is the current gold-standard autologous option. The profunda artery perforator (PAP) and lumbar artery perforator (LAP) flaps have more recently been described as alternatives for patients who are not candidates for a DIEP flap. The aim of this study was to review the survival and complication rates of PAP and LAP flaps, using the DIEP flap as a benchmark. A literature search was conducted using PubMed, MEDLINE, Embase, BIOSIS, Web of Science, and Cochrane databases. Papers were screened by title and abstract, and full texts reviewed by three independent blinded reviewers. Quality was assessed using MINORS criteria. Sixty-three studies were included, for a total of 745 PAP, 62 stacked PAP, 187 LAP, and 23,748 DIEP flap breast reconstructions. The PAP (98.3%) had comparable success rate to DIEP (98.4%), and the stacked PAP (88.7%) and LAP (92.5%) success rate was significantly lower (P < 0.0001). The PAP and LAP groups both had a low incidence of fat necrosis. However, the revision rate for the LAP group was 16.1% whereas the PAP group was 3.3%. Donor site wound dehiscence rate was 2.9 in the LAP group and 9.1% in the PAP group. Profunda artery perforator and DIEP flaps demonstrate very high rates of overall survival. The LAP flap has a lower survival rate. This review highlights the survival and complication rates of these alternative flaps, which may help clinicians in guiding autologous reconstruction technique when a DIEP flap is unavailable.

The Influence of Patient Characteristics and Social Determinants of Health on Postoperative Complications Following Achilles Tendon Rupture.

The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair. A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables (P < .05) were included in a multivariate regression. Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, P = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, P < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, P = .03) and VTE (OR = 0.32, P = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, P < .01) and shorter TTS with reruptures (OR = 0.02, P = .02). Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications.

Donor Site Outcomes Following Autologous Breast Reconstruction with DIEP Flap: A Retrospective and Prospective Study in a Single Institution

Background: The deep inferior epigastric perforator artery (DIEP) free flap is the most commonly performed autologous breast reconstruction. Despite the relative reduction in donor site complications compared to nonmuscle-sparing options, there is still high morbidity associated with this surgery. The purpose of this study is to compare outcomes and complications at our institution and to discuss potential quality improvement initiatives. Methods: A retrospective cohort study was performed looking at patients who underwent delayed or immediate autologous breast reconstruction with a DIEP flap over a 6-year period (2015-2021) at our institution. Complication rates for abdominal infection, seroma, hematoma, wound dehiscence, delayed wound healing, umbilical necrosis, subjective abdominal weakness, abdominal bulge, and hernia were calculated. Additionally, a prospective cohort study was conducted using a portable ultrasound device to detect postoperative changes in the abdominal donor site, including fluid collections and postoperative edema. Results: One hundred seventeen patients underwent autologous breast reconstruction with a DIEP-free flap. Forty-one percent of patients experienced 1 or more donor site complications. Complication rates were 16.2%, 12.8%, 1.7%, 15.4%, 8.5%, 4.3%, 0%, 10.3%, and 2.6%, respectively, for the list above. There was a higher proportion of complications in patients who smoked within the past 3 months and those who had a body mass index (BMI) between 35 and 39.9, although this was not statistically significant. Bilateral reconstructions had higher rates of umbilical necrosis (24.5% vs 7.8%) and wound dehiscence (9.4% vs 0%) compared to unilateral. Twenty-one patients were included in the prospective analysis. No significant changes in abdominal wall edema were found. Twenty-four percent of the patients had detectible collections on ultrasound, and these were associated with wound dehiscence and the need for debridement. Discussion: Our institutional abdominal donor site complication rates in DIEP reconstruction patients are higher than those published in the literature. Similar complication rates were identified regardless of smoking status, BMI, and unilateral/bilateral surgery. Quality improvement initiatives could be considered and implemented to reduce future complications.

Incidence of port site complications in relation to timing of bevacizumab infusion.

Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor, with a serious complication of wound healing complications. The package insert currently does not have recommendations on the management of bevacizumab administration around minor procedures, including port placements. Currently, there are only two trials that have examined the optimal timing of bevacizumab after port placement. This is a single-center retrospective trial aiming to evaluate the rate of wound dehiscence and other port site complications depending on the time between port placement and bevacizumab infusion. Eligible patients who have had at least one port place and have received bevacizumab for an oncologic indication were identified in a study period of 1/1/2016-3/31/2021. The primary outcome of this study was the incidence of wound dehiscence in relation to the timing of bevacizumab infusion. A total of 243 patients met the inclusion criteria, and 116 port placements had a port site complication. For wound dehiscence, 6% was observed 0 days from port placement, 10% was observed 1 day from port placement, 0% was observed 2 days from port placement, 0% was observed 3-7 days from port placement, 3% was observed 8-14 days from port placement, and 3% was observed 15-30 days from port placement. The results of this study show an inverse relationship between the risk of wound dehiscence and port site complication and the timing of bevacizumab infusion to port placement, with an increase in absolute risk of wound dehiscence when bevacizumab is given within 2 days of port placement.