Redon Drain Research Articles

Acute Intestinal Obstruction Due to a Foreign Body Migrated into the Abdomen after a Clandestine Abortion Almost 20 Years Ago

Acute intestinal obstruction caused by a foreign body is no longer a rare phenomenon, especially if the latter is found in the digestive tract. However, the migration of an extradigestive foreign body as a cause of obstruction is extremely rare. We report the case of a 60-year-old female patient seen urgently on September 5, 2023 at 3:00 p.m. at the District Hospital of Commune IV of Bamako with the diagnosis of acute intestinal obstruction. Intraoperatively we noted grélo-uterine, grélo-sigmoid adhesions and bands tying the terminal ileum with significant intestinal dilatation upstream without signs of necrosis. Also a foreign body (tubing of a serum infuser) rigid curved of approximately 40 cm was located between the loop. The procedures performed were: adhesiolysis, sectioning of the flanges, extraction of the foreign body, toileting and installation of a Redon drain in the Douglas cul de sac. The in-depth postoperative questioning revealed a notion clandestine abortion in 2003 by a nurse in a country in the sub-region, leaving an infusion tube in place for a few hours. And she was supposed to go in the next day for a check-up, but she didn't show up. Our medical team reviewed the ASP image where we noted in addition to the central hydroaeric levels, an inverted U-shaped image of a foreign body (infuser tubing) going from the left hypochondrium to the left iliac fossa. confirming the diagnosis intraoperatively. The postoperative course was simple. The patient returned home on postoperative day 5.

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering

PurposeTo report on our experience with a simplified, suction-bottle-drain technique of thoracic drain (Redon-like) combined with fully thoracoscopic vertebral body tethering (VBT) and a limited pleural approach, with particular focus on the rate of pulmonary complications.MethodsA retrospective study was performed on all consecutive patients who underwent VBT for adolescent idiopathic scoliosis. For all subjects, a 10G Redon drain, an active drain system consisting of a perforated tube and a suction bottle, was placed intrathoracically and tunneled under the skin. All drains were removed on the first postoperative day. Perioperative and postoperative data such as type of access, length of surgery, amount of fluid collection in the drain, and length of hospital stay were collected. The type and number of pulmonary complications occurring in the first 3 months after surgery, along with their symptoms and management, were recorded.ResultsOne Hundred eighty-two patients were included in the analysis. The mean length of surgery was 97 min (75–120). The average fluid collection in the drain was 30 ml (5–50), the mean length of hospital stay was 3 days (2–4). During the observation period, pulmonary complications occurred in five patients (2%). Two patients presented an aseptic right pleural effusion; for two patients, a residual pneumothorax was diagnosed on the X-rays in the recovery room and one patient developed a chylothorax. All patients recovered without sequelae.ConclusionThe simplified, Redon-like drain combined with a fully thoracoscopic VBT and limited pleural approach seems a safe and effective alternative to the chest drain. This technique allows to remove the drain on the first postoperative day, thus simplifying the management of the patients and improving their comfort.

Incidence of postoperative complications in patients with breast cancer depending on the type of drain.

Postoperative complications in patients with breast cancer delay the initiation of adjuvant therapy, prolong the length of hospitalization and reduce the patients' quality of life. Although their incidence can be influenced by many factors, the connection with the type of drain is insufficiently studied in the literature. The aim of this study was to assess whether there is an association between the use of a different drainage system and the occurrence of postoperative complications. The data of 183 patients included in this retrospective study were collected from the information system of the Silesian Hospital in Opava and then statistically analyzed. These patients were divided into two groups according to the type of drain used - a Redon drain (active drainage) was used in 96 patients, and a capillary drain (passive drainage) was used in 87 patients. The incidence of seromas and hematomas, the duration of drainage and the amount of wound drainage were compared between the individual groups. The incidence of postoperative hematomas was 22.92% in the group of patients with the Redon drain, and 10.34% in patients with the capillary drain (p=0.024). The incidence of postoperative seromas was comparable for the Redon drain (39.6%) or the capillary drain (35.6%) (p=0.945). No statistically significant differences were found in the drainage time or the amount of wound drainage. A statistically significantly lower incidence of postoperative hematomas was observed when using a capillary drain compared to the use of a Redon drain in patients after breast cancer surgery. The drains were comparable with respect to seroma formation. None of the studied drains was significantly more beneficial in terms of the total drainage time and the total amount of wound drainage. breast cancer, postoperative complications, drain, hematoma.

Surgical drain induced subgaleal hematomas and skin necrosis in pediatrics: a case report.

Subgaleal drainage is often being used in craniotomy procedures. It's not only offers advantages but also carries a risk of life-threatening complications. Here, we present a rare case of subgaleal hematoma and skin necrosis caused by placement of subgaleal drainage in a pediatric patient after a craniotomy procedure. We reported a 6-months-old child who came to our institution complaining of uncontrolled eye movements which occurred 4months earlier. From the CT scan and MRI, it was found that the patient had a mass in his suprasellar region, which suggested a suprasellar tumor. She underwent a mass resection procedure, but unfortunately, 3days after the surgical procedure, the wound appeared necrotic, with a blackish color around the drain. The necrotic wound was suspected due to vacuum subgaleal drain placement. The wound was cleaned and the suture removed, but the necrotic area was still there. Four days after the surgery, the patient clinical condition got worse. After 17days of treatment with no significant improvement, unfortunately, the patient died. The mechanism of subgaleal hematoma and skin necrosis induced by the Redon drain possibly related to mechanical compression by the drain, which damage perforating vessels and subsequently disrupt skin vascularization, combined with vascular stasis as given by negative pressure of the drain. This induced skin ischemia lesion which later contributes the necrotic formation. The subgaleal hematoma and skin necrosis as a complication of subgaleal redon drain in pediatric are rare phenomenon and likely under reported. The possible underlying mechanism was that drain's negative pressure disrupt subgaleal tissue and induce necrotic formation. Even the complication is rare compared to older children, yet it has been linked to an increased risk for infection, morbidity, and mortality.

A minimally invasive cerclage of the tibia in a modified Goetze technique: operative technique and first clinical results

IntroductionIn spiral fractures of the tibia, the stability of an osteosynthesis may be significantly increased by additive cerclages and, according to biomechanical studies, be brought into a state that allows immediate full weight bearing. As early as 1933, Goetze described a minimally invasive technique for classic steel cerclages. This technique was modified, so that it can be used for modern cable cerclages in a soft part saving way.MethodAfter closed reduction, an 8 Fr redon drain is first inserted in a minimally invasive manner, strictly along the bone and placed around the tibia via 1 cm incisions on the anterolateral and dorsomedial tibial edges using a curette and a tissue protection sleeve.Via this drain, a 1.7 mm cable cerclage can be inserted. The fracture is then anatomically reduced while simultaneously tightening the cerclage. Subsequently, a nail or a minimally invasive plate osteosynthesis is executed using the standard technique.Using the hospital documentation system, data of patients that were treated with additional cerclages for tibial fractures between 01/01/2014 and 06/30/2020 were subjected to a retrospective analysis for postoperative complications (wound-healing problems, infections and neurovascular injury). Inclusion criteria were: operatively treated tibial fractures, at least one minimally invasive additive cerclage, and age of 18 years or older. Exclusion criteria were: periprosthetic or pathological fractures and the primary need of reconstructive plastic surgery. SPSS was used for statistical analysis.Results96 tibial shaft spiral fractures were treated with a total of 113 additive cerclages. The foregoing resulted in 10 (10.4%) postoperative wound infections, 7 of which did not involve the cerclage. One lesion of the profundal peroneal nerve was detected, which largely declined after cerclage removal. In 3 cases, local irritation from the cerclage occurred and required removal of material.ConclusionIn the described technique, cerclages may be inserted additively at the tibia in a minimally invasive manner and with a few complications, thus significantly increasing the stability of an osteosynthesis. How this ultimately affects fracture healing is the subject of an ongoing study.

Neskorý vznik tenzného pneumoperitonea cez brušnú stenu po zavedení PEG-J

A 71-year-old woman with Parkinson’s disease underwent elective percutaneous endoscopic gastrojejunostomy due to levodopa-carbidopa intestinal gel treatment. Less than one week after the procedure, the patient developed abdominal distension. X-ray and computed tomography revealed massive pneumoperitoneum. An external binder was dislocated above the abdominal wall. After replacing the binder and fixating it onto the skin, imaging showed no regression of free air. Drainage was performed using a Redon drain, and a gush of free air and ascites leaked out of the abdominal wall. Ventilatory air leakage beside the gastric tube caused permanent massive pneumoperitoneum. After the removal of the PEG tube, the patient fully recovered. In this article, we present a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma. This complication is rarer than air leakage from the visceral wall stoma.

Biological Glue as an Alternative to Suction Drainage in Tissue-Expanded Flaps in Children

Biological glue is already used as a hemostatic agent and tissue adhesive in plastic surgery. This study evaluates the use of this glue as an alternative to suction drainage for the adhesion of tissue-expanded flaps in pediatric patients. This is a retrospective, multicenter case-control study on 48 flap procedures conducted on 42 children (5 months-12 years of age) between 2004 and 2017, comparing a "glue" group (n = 24) with a control group (n = 24), in which a classic redon drain was used. The control patients were matched according to age, etiology, location of the lesion, and the size of the expander. The primary end point was the duration of hospital stay. The conditions were 24 cases of congenital nevus, 14 of cicatricial alopecia, and 10 of sebaceous hamartoma. Twenty-nine lesions were located on the scalp, 15 on the back, 2 on the thigh, and 2 on the buttocks.The average surgical durations (48 ± 24 vs 63 ± 32 minutes, P = 0.13) and average room occupancy time (126 ± 21 vs 139 ± 44 minutes, P = 0.29) were similar between the glue group and the control group. However, the average duration of hospital stay was lower in the glue group (1.5 ± 1.5 days) than in the control group (3.6 ± 1.3 days, P < 0.0001). The complication rates between the groups were similar. The application of glue on expanded flaps is as reliable as suction drainage with the advantage of reducing the duration of hospital stay and potentially enabling outpatient treatment for certain patients.

Use of topical tranexamic acid in primary total hip arthroplasty. Efficiency and safety. Our experience

Background and aimIntravenous tranexamic acid has been shown to reduce bleeding and the need for transfusions in total hip arthroplasty, although it has a theoretical risk of producing thromboembolic phenomena. Recently some papers have been published using the topical application of tranexamic acid, but the ideal administration protocol has not yet been clearly defined. The aim of this paper was to demonstrate that our protocol of topical tranexamic acid is effective and safe. MethodsProspective data collection from a case series of 80 primary hip arthroplasties, in which the following topical tranexamic acid protocol is used: 1.5 g diluted to a total volume of 60 ml were administered, applying 20 ml in the acetabular bed, 20 ml in the femoral canal and 20 ml through the Redon drain, keeping it closed for 20 min. ResultsEighty patients were operated. Preoperative haemoglobin 14.26 g/dL; preoperative haematocrit 42.39%. An average loss of 2.74 g/dL of haemoglobin and 8% of haematocrit was obtained. Eleven percent of the patients required transfusion, of whom 67% had known previous anaemia; only 3 patients without prior anaemia required transfusion (4%). There were no thromboembolic complications in our series. ConclusionThe use of topical tranexamic acid was safe and effective in primary total hip arthroplasty, reducing the need for blood transfusion compared to that described in the literature in untreated patients.

Endoscopic vacuum therapy with instillation (iEVT) - a novel endoscopic concept for colorectal anastomotic leak and perianal complications.

IntroductionAnastomotic leaks remain the most fearful complications.AimWe present a novel endoscopic salvage therapy known as endoscopic vacuum therapy with instillation (iEVT) as a combination of standard endoscopic vacuum therapy (EVT) and negative pressure wound therapy with instillation (iNPWT).Material and methodsA case series of 6 consecutive patients treated with iEVT is presented. A Redon drain and a central venous catheter were introduced within polyurethane foam used as a self- made device for iEVT and antimicrobial solution was instilled.ResultsA total of 6 patients with the mean age of 29.5 ±8.9 were treated with iEVT. The mean number of iEVT sessions was 5.8 ±2.3. The mean time of iEVT management was 20.7 ±8.8 days. Locally, a reduction in purulent discharge and defect’s dimension with contraction were revealed confirmed with imaging studies.ConclusionsiEVT is a very encouraging, novel method for complicated perianal diseases and anastomotic leak.

Utilización del ácido tranexámico tópico en la artroplastia total primaria de cadera. Eficacia y seguridad. Nuestra experiencia

Background and aimIntravenous tranexamic acid has been shown to reduce bleeding and the need for transfusions in total hip arthroplasty, although it has a theoretical risk of producing thromboembolic phenomena. Recently some papers have been published using the topical application of tranexamic acid, but the ideal administration protocol has not yet been clearly defined. The aim of this paper was to demonstrate that our protocol of topical tranexamic acid is effective and safe. Materials and methodsProspective data collection from a case series of 80 primary hip arthroplasties, in which the following topical tranexamic acid protocol is used: 1.5 grams diluted to a total volume of 60ml were administered, applying 20ml in the acetabular bed, 20ml in the femoral canal and 20ml through the Redon drain, keeping it closed for 20minutes. ResultsEighty patients were operated. Preoperative haemoglobin 14.26g / dL; preoperative haematocrit 42.39%. An average loss of 2.74g / dL of haemoglobin and 8% of haematocrit was obtained. Eleven percent of the patients required transfusion, of whom 67% had known previous anaemia; only 3 patients without prior anaemia required transfusion (4%). There were no thromboembolic complications in our series. ConclusionsThe use of topical tranexamic acid was safe and effective in primary total hip arthroplasty, reducing the need for blood transfusion compared to that described in the literature in untreated patients.

Efficacy and safety of two post-operative drains: results of a prospectively randomized clinical study in breast cancer patients after breast conserving surgery

To compare the efficacy and safety of two post-operative drains in breast cancer patients after breast conserving surgery. This was a prospectively randomized comparative study of two drains investigated in breast cancer patients after breast conserving therapy. The Redon drain ends in a tip with 28 double perforations while the Quadrain drain features 4 flexible flaps of about 0.15m length. The drains cost 0.28 € and 3.54 €, respectively. Primary target parameter was the duration of the drains staying in the surgical site. Secondary target parameters were pain post-surgery, seroma volume, final cosmetic result and surgical site infections. A total of 88 patients were randomized, 47 and 41 received the Redon drain and the Quadrain drain, respectively. The mean duration of the drains staying in the surgical site was not different between the Redon and the Quadrain drain, 42.6h (± 25.8h) and 50.1h (± 28.5h), respectively (p = 0.1959). The post-operative pain score, seroma size, cosmetic result and surgical site infections were not different for both systems. The Redon drain and the new Quadrain drain were not significantly different with respect to duration in the surgical site, post-operative pain, seroma volume and cosmetic result.

Revision surgery in acute periprosthetic knee joint infections

Reduction of pathogens in the knee joint by removal of infected periprosthetic soft tissue, irrigation and modular implant exchange of the total knee arthroplasty (TKA) to eliminate the infection and long-term preservation of the TKA. Early infection of TKA (<4weeks postoperatively); acute hematogenous TKA infection (symptom duration <3weeks). Delayed (>4weeks postoperatively) or chronic TKA infection; TKA loosening; difficult-to-treat pathogens; critical soft tissue with draining sinus tract. Excision of the wound or old surgical scar (=primary approach to the knee joint). Preparation of subcutaneous tissue. Opening the joint capsule. Removal of the old suture in tissue layers. Five tissue samples taken for microbiological and 1tissue sample for histopathological examination using an unused instrument from the knee joint. Debridement of the upper recesses with complete synovectomy. Partial resection of Hoffa's fat body. Eversion of the patella. Resection of peripatellar soft tissue and infection membranes from the medial and lateral part of the capsule. Removal of the polyethylene inlay. Débridement of the posterior joint capsule with protection of vessels and nerve. Systematic removal of avital and infected periprosthetic tissue. Checking for correct fit of the femoral and tibial part of TKA. Antiseptic rinsing of the joint cavity with mechanical cleaning of the TKA. Extensive irrigation of the joint cavity by jet lavage (3-5l saline solution). Glove change of the surgical team and new operation coverage. Inserting new polyethylene. Layerwise wound closure. Removal of redon drain on postoperative day2. Physiotherapy and CPM. Removal of cutaneous suture about 2weeks postoperatively. Antibiotic treatment for 12weeks postoperatively (2weeks intravenous, 10weeks per oral). Checking of inflammatory markers. Using correct indications and therapy, up to 90% of patients with acute periprosthetic TKA infection can be successfully treated with infection elimination and TKA preservation.

No benefit of autologous transfusion drains in total knee arthroplasty.

Autologous blood transfusion drains are commonly used to reduce allogeneic blood transfusion rate after total knee arthroplasty. There is conflicting evidence as to whether autologous transfusion drains (ABT drains) were effective when restrictive transfusion triggers were used. The aim of our study was to ascertain where, as a part of a blood management protocol, autologous blood transfusion drains reduce the allogeneic blood transfusion rate after total knee arthroplasty. Two-hundred total knee arthroplasty patients were included in the prospective randomized controlled study. After implantation, a Redon drain without vacuum assistance (control, n=100) or an autologous blood transfusion drain (ABT group, n=100) was used. Demographic and operative data were collected. The blood loss, total blood loss, blood values and transfusion rate were documented. The blood loss in the drains was significantly increased for the ABT group (409 vs. 297ml, p<0.001). There was a non-significant trend towards a higher total blood loss for ABT patients (1844 vs. 1685ml, n.s.). The allogeneic blood transfusion rate was similar for both groups (8 vs. 9%, n.s.). Similarly, the number of transfused blood units was comparable between both groups (0.2U/patient vs. 0.17U/patient n.s.). In combination with restrictive blood transfusion triggers, ABT drains had no positive effect on the allogeneic blood transfusion rate. The blood loss in ABT drains was higher. As a consequence, the use of ABT drains was discontinued. I.

Detection of disseminated tumor cells in aspirative drains after neck dissection.

The dissemination of individual tumor cells is a common phenomenon in solid cancers. Detection of tumor cells in bone marrow disseminated tumor cells (DTC) and in peripheral blood circulating tumor cells (CTC) in nonmetastatic situation is of high prognostic significance. Compared to breast, colon and prostate cancers, the studies on CTC and DTC in head and neck cancers are sparse. The objective of our study was to detect DTC in drains after neck dissection. Fourteen patients undergoing surgery for stages III and IV head and neck cancers were enrolled in this study--twelve presenting with squamous cell carcinoma and two with adenocarcinoma. Redon drain analysis was performed by the Cellsearch method using immunomagnetic and fluorescence approaches. A positivity threshold value was set at 2DTC/7.5 ml of the sample. Tumor cells were detected in drains of 69 % of patients a few days after surgery. The range of quantification was 3-2,094 DTC/5 ml and we showed morphological differences between the two types of carcinoma cells. DTC were detected after neck dissection both in squamous cell carcinoma and in adenocarcinoma. Potential clinical significance of tumor cells needs to be further investigated as their presence could affect pre-surgical and post-operative treatments.

Editorial Comment on: Andrzej Smereczyński, Teresa Starzyńska, Katarzyna Kołaczyk and Józef Kładny Role of sonography in assessing complications after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) was introduced to the arsenal of surgical techniques in 1987 and has become the gold standard in treating cholecystolithiasis. In spite of undoubted benefits for patients, it is not a complication-free procedure. The type of complications after a classical, i.e. “open” surgery and LC do not differ in a significant way. The difference lies in their prevalence. One of the most common complications is a fluid collection in the gallbladder bed under the liver. To prevent it from developing, a drain is usually placed under the liver. For many years, it was believed that such a practice is correct, but recent reports indicate that leaving the drain after a planned laparoscopic cholecystectomy may do more damage rather than be beneficial. Moreover, it may give a false impression of safety since we are convinced that we remain in control over the situation in case of, for instance, a hemorrhage(1). In fact, when the postoperative bleeding to the peritoneal cavity is intense, a thin Redon drain, which usually remains inserted after the procedure, may become occluded by a thrombus. Decisions are made based on the patient's clinical condition or imaging examinations (including sonography) which can reveal not only a fluid collection under the liver, but also free fluid in the peritoneal cavity. The peritoneum secretes considerable amounts of peritoneal fluid daily. It becomes absorbed completely mainly via the lymphatic channels in the diaphragmatic region. Therefore, detection of a collection of serous fluid should not be alarming. It will absorb with no consequences for the patient. It has been observed that leaving a drain in the gallbladder bed causes increased fluid secretion. Moreover, Fraser et al. claim that such a practice may provoke bile leakage form slight bile ducts in the gallbladder bed(2). If it is a suction drain the risk of bile leakage is significant. Thiebe and Eggert observed that leaving the drain caused fluid to accumulate in the gallbladder bed in 44% of cases compared to 4.1% in the group without the drain(3). Their results were confirmed in ultrasound examinations which revealed that the fluid collection that developed within 24 hours after the surgery appeared considerably more frequently in the group with the drain. When, apart from ultrasound findings, patients also manifest symptoms of peritoneal irritation, the clinical picture becomes slightly different. In such a situation, we deal with bile leakage, either from damaged bile ducts of from the duct of Luschka. This can be managed by an endoscopic intervention or a US-guided puncture and drainage of the fluid collection. If the presence of fluid is concomitant with elevated temperature and general symptoms of inflammation, an abscess may be suspected to have formed under the liver. In such a situation, a surgical intervention is also necessary. To conclude, benefits of leaving a drain in the gallbladder bed after uncomplicated cholecystectomy are not significant. Numerous studies reveal that removing the drain results in fewer pain complaints, better comfort of patients, lower rate of complications and faster discharge from hospital. Furthermore, pain complaints associated with the presence of the drain restrict chest movement at the right side and result in more frequent respiratory infections. The role of sonography in the assessment of fluid collections in the peritoneal cavity following laparoscopic cholecystectomy is not overrated. An ultrasound examination is simple, repeatable, safe and can be a remarkable diagnostic and therapeutic tool in experienced hands. However, ultrasound findings must not be interpreted separately from the clinical picture. Thanks to a skillful combination of these elements, it is possible to avoid numerous unneeded instrumental actions which do not always give an expected therapeutic effect. The remarks and tips presented by Smereczynski et al.(4) regarding the usage of various diagnostic tools in the post-operative period, particularly in diagnosing complications, are of considerable practical value and are useful for every surgeon irrespective of his or her experience.

On the permanent hip-stabilizing effect of atmospheric pressure

Hip joint dislocations related to total hip arthroplasty (THA) are a common complication especially in the early postoperative course. The surgical approach, the alignment of the prosthetic components, the range of motion and the muscle tone are known factors influencing the risk of dislocation. A further factor that is discussed until today is atmospheric pressure which is not taken into account in the present THA concepts. The aim of this study was to investigate the impact of atmospheric pressure on hip joint stability.Five joint models (Ø28–44mm), consisting of THA components were hermetically sealed with a rubber capsule, filled with a defined amount of fluid and exposed to varying ambient pressure. Displacement and pressure sensors were used to record the extent of dislocation related to intraarticular and ambient pressure.In 200 experiments spontaneous dislocations of the different sized joint models were reliably observed once the ambient pressure was lower than 6.0kPa. Increasing the ambient pressure above 6.0kPa immediately and persistently reduced the joint models until the ambient pressure was lowered again. Displacement always exceeded half the diameter of the joint model and was independent of gravity effects.This experimental study gives strong evidence that the hip joint is permanently stabilized by atmospheric pressure, confirming the theories of Weber and Weber (1836). On basis of these findings the use of larger prosthetic heads, capsular repair and the deployment of an intracapsular Redon drain are proposed to substantially decrease the risk of dislocation after THA.

EComment. Post-sternotomy mediastinitis management: negative pressure is the key

I read with great interest the paper by Yu et al. in which they compare outcomes of vacuum-assisted closure (VAC) therapy with conventional management in patients with post-sternotomy mediastinitis (PSM) [1]. There is no general consensus concerning the appropriate surgical approach to PSM and multiple wound healing strategies have been proposed [2]. The treatment of PSM has changed radically with the advances made in VAC systems since the concept of negative wound pressure therapy was first described in the mid 1990s. VAC therapy was introduced to clinical practice in 1995 in North America and two years later it was available in Europe. Since the introduction of VAC techniques in the management of sternal wound infection, there has been a paradigm shift toward the use of this less invasive strategy as a first-line therapy in the management of PSM [2]. Although I recognize the efforts of Yu et al. in reviewing the literature to find the best strategy for patients with PSM, I would like to mention one important point that they failed to include in their report. Closed drainage with Redon catheters is another alternative technique for PSM first used by Durandy et al. [3]. The high negative pressure (-700 mmHg) induced by the bottles fulfils exactly the role of VAC in a different fashion. Vos et al. [4] were the first to perform a prospective study comparing clinical outcomes of VAC with primary closure using Redon catheter in the setting of PSM. They included in their study 161 patients with PSM; there were 89 patients in the VAC group and 43 patients in the Redon group. Both groups were similar in risk factors and severity of mediastinitis. Hospital stay was significantly shorter in the Redon group (45 + /-38 days) compared with the VAC group (74 + /-61 days). The in-hospital mortality rate was similar in both groups, however re-infection rate was higher in the VAC group probably due to the increased risk of wound contamination during dressing changes. The authors of the present study concluded that this treatment modality using Redon drains provides sternal wound healing without repeat intervention while significantly reducing the hospital stay without compromising mortality. By applying negative pressure to a sternal wound either by VAC or Redon drain connected to bottles several advantages are combined: removing exudate from the infected area and increasing blood flow into the wound. None of these studies is a randomized trial; therefore a prospective clinical trial is required to address this issue at a higher level of evidence. Conflict of interest: none declared

Mediokarpale Teilarthrodese des Handgelenks mittels Spiderplatte

Pain relief while preserving wrist motion in advanced carpal collapse. Advanced carpal collapse stage II/III due to scaphoid non-union, scapholunate ligament tear, idiopathic radiocarpal osteoarthritis, aseptic osteonecrosis of the scaphoid (Preisser's disease). A relative indication is chronic midcarpal instability. Osteoarthrisis of the lunate. Radiocarpal instability with ulnar translation of the wrist. Dorsal curved incision between the 3rd and 4th dorsal extensor compartment. Partial wrist denervation (posterior interosseous nerve). Raising of a radial pedicled capsule flap. Complete extirpation of the scaphoid without fragmentation. Cartilage removal of all the joint facets for arthrodesis. Reduction of the lunate and temporary fixation with K wires between the triquetrum and capitate and the triquetrum and lunate. Milling the plate hole exactly in central position of the four carpal bones. The plate should not protrude from the bone to avoid impingement with the dorsal limb of the radius. Transferring of spongiosa harvested from the removed scaphoid into the arthrodesis gap. Fixation of the 8-hole plate with 2 screws in each of the four carpal bones. Fluoroscopy of the screw fitting. Control of the correct wrist articulation (motion test). Lavage of the wrist. Suture of the capsule flap. Redon drain, wound closure, dorsal splinting. Dorsal splint for 3 weeks; finger mobilization up to complete fist closure starting on postoperative day 1. From week 4-6, active wrist motion, from week 7-10 with increasing load. Return to work after 11-12 weeks. CT scan in cases of delayed union, abnormal function, or persistence of pain. Between 2002 and 2008, 36 four-corner fusions (32 male, 4 female) with the spider plate were performed in 24 right and 12 left wrists. The mean age of the patients at surgery was 48 years (range 32-71 years). Follow-up examinations were performed in 11 patients. The Krimmer and Rudolf scores were determined: 1 excellent, 7 good, 2 satisfactory, and 1 poor result were found. The mean grip strength was 51% relative to the opposite wrist. The mean range of motion (ROM) for wrist extension/flexion was 56% of the opposite side. Wrist extension/flexion averaged 24/0/32° and ulnar/radial deviation was on average 20/0/19°. Pain during activity was on average 2.2 based on the visual analogue scale (0-10). One delayed bony union due to a screw breakage, which required total wrist fusion, was observed.

Subcutaneous Redon drains do not reduce the incidence of surgical site infections after laparotomy. A randomized controlled trial on 200 patients

Surgical site infections (SSI) cause excess morbidity and mortality in modern surgery. Several different approaches to reduce the incidence of SSI have been investigated with variable results. This is to our knowledge the first systematic randomized evaluation in patients undergoing laparotomy in visceral surgery to clarify whether widely used subcutaneous drains (Redon) affect wound infection as the primary outcome measure. In 200 patients, we were unable to show a statistically significant impact on the postoperative healing process in patients with the full variety of abdominal surgical interventions. Overall, we observed surgical site infection in 9.5% of all patients (n = 19), of these n = 9 (47.4%) were in the control group without a drain, and 10 (52.6%) were in the experimental group with a Redon drain (not significant). As this study could not demonstrate a reduction of SSI by the use of Redon drains, there is no indication for prophylactic subcutaneous suction drains after laparotomy.

Isolated recurrence of distal adenocarcinoma of the extrahepatic bile duct on a draining sinus scar after curative resection: Case Report and review of the literature

BackgroundSurgical resection remains the gold standard for the treatment of localized adenocarcinoma of the extrahepatic bile ducts. Yet, treatment of loco-regional recurrences is not well defined.Case PresentationWe present an unusual case of distal adenocarcinoma of the extrahepatic bile ducts that was treated with surgery and relapsed two years later with a solitary recurrence on the tract of a previous Redon drain. In addition, a review of the literature on management of loco regional relapses is presented.ConclusionsThe ideal management of these patients still remains undefined. Decisions are made based on clinical parameters from retrospective series, such as tumor grade, surgical margins or lymph node involvement. Prospective studies, that include molecular and genetic markers, are needed to improve patient selection and outcomes on this population.