Removal Of Staples Research Articles

Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience.

Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH. To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids. This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.

Orthopedic Skin Closure in South India: Sutures Versus Staples and Their Postoperative Outcomes.

Introduction Skin closure is an essential step in deciding the success of a surgery. Despite this, the choice of skin closure material is frequently overlooked when making surgical decisions. Skin closure plays an important role in promoting rapid wound healing and decreasing the length of hospital stay, especially in orthopedic surgeries. Our study focused on comparing the outcome of wound closure in orthopedic surgeries with sutures and staples in a South Indian population. Materials and methods We enrolled 120 patients undergoing orthopedic procedures at Chettinad Hospital and Research Institute from July 2023 to February 2024. Patients were randomly assigned to skin closure with either staples or sutures. Wound inspection was done on the 2nd, 5th, 7th and 12th post-operative days. The patients were evaluated at six months using the Visual Analog Scale (VAS) and Hollander Wound Evaluation Score (HWES). Results Staple closure significantly reduced mean closure time (5.2 ± 0.9 minutes) compared to sutures (12.6 ± 1.5 minutes, p < 0.0001). Pain during staple removal was less (VAS score 1.41 ± 0.15) than with suture removal (VAS score 1.57 ± 0.2, p = 0.024). Although patient satisfaction was similar between the groups (Staples: 8.35 ± 0.45 vs. Sutures: 8.0 ± 0.5, p = 0.062), staples provided superior cosmetic outcomes (HWES: 4.1 ± 0.7) compared to sutures (HWES: 3.3 ± 0.6, p = 0.003). Complication rates, including infection, discharge, and hypertrophic scar formation, were comparable between the two methods. Conclusion Staple closure in orthopedic surgeries offers several advantages over sutures, including reduced operative time, less pain during removal, and superior cosmetic results. These benefits occur without an increased risk of wound complications. This study suggests that staples may be a preferable option for skin closure in orthopedic procedures, though further research with extended follow-up is needed to fully assess long-term outcomes.

Total knee arthroplasty following lateral closing-wedge high tibial osteotomy versus primary total knee arthroplasty: a propensity score matching study

BackgroundThe disparity in patient-reported outcomes between total knee arthroplasty (TKA) following high tibial osteotomy (HTO) and primary TKA has yet to be fully comprehended. This study aims to compare the patient-reported outcomes, radiological parameters and complication rates between TKA following HTO and primary TKA.MethodsSixty-five patients who underwent TKA following lateral closing-wedge HTO were compared to a matched group of primary TKA at postoperative 6-months and 1-year. Between-group confounders of age, gender, smoking status, Body Mass index, preoperative Numeric Rating Scale (NRS) pain in rest, Knee injury and Osteoarthritis Outcome Score-Physical function Shortform (KOOS-PS), EuroQol five-dimensional (EQ-5D) overall health score, and Oxford Knee Score (OKS) were balanced by propensity score matching. Patient-reported outcome measures were NRS pain in rest, KOOS-PS, EQ-5D overall health score, and OKS. Radiological parameters were femorotibial angle, medial proximal tibial angle, anatomical lateral distal femoral angle, posterior tibial slope, and patellar height assessed by Insall-Salvati ratio. The complication rates of TKA were compared between the two groups. The HTO survival time, the choice of staple removal before or during TKA in patients who underwent TKA following HTO patients, and the rate of patellar resurfacing were assessed. The p value < 0.0125 indicates statistical significance after Bonferroni correction.ResultsAfter propensity score matching, no significant between-group differences in the patient-reported outcome measures, radiographical parameters and complication rates were found (p > 0.0125). In the TKA following HTO group, with an average HTO survival time of 8.7 years, staples were removed before TKA in 46 patients (71%) and during TKA in 19 patients, and 11 cases (17%) had patella resurfacing. In the primary TKA group, 15 cases (23%) had patella resurfacing.ConclusionThe short-term assessment of TKA following HTO indicates outcomes similar to primary TKA. A previous HTO does not impact the early results of subsequent TKA, suggesting that the previous HTO has minimal influence on TKA outcomes.Level of evidenceIII, cohort study.

Factors Associated With Residual Pivot Shift After ACL Reconstruction: A Quantitative Evaluation of the Pivot-Shift Test Preoperatively and at Minimum 12-Month Follow-up.

Postoperative residual rotatory laxity remains despite improvement in surgical techniques for anterior cruciate ligament (ACL) reconstruction (ACLR). To evaluate factors associated with residual pivot shift after ACLR by quantitative measurement of the pivot shift before and after surgery. Case-control study; Level of evidence, 3. A total of 97 patients who underwent primary double-bundle ACLR between June 2016 and March 2021 and underwent surgery to remove staples, with at least 12 months of follow-up evaluation, were enrolled. Quantitative measurements were performed under general anesthesia immediately before ACLR (preoperatively), after temporary fixation of the ACL graft (intraoperatively), and immediately before staple removal (postoperatively). The laxity of pivot shift was assessed using inertial sensors to measure acceleration and external rotational angular velocity (ERAV). Descriptive data were assessed for associations with postoperative acceleration and ERAV in a univariate analysis. A multiple linear regression analysis was performed to identify factors associated with postoperative acceleration and ERAV. Anterior tibial translation, acceleration, and ERAV increased from intra- to postoperatively (P < .05). Factors significantly associated with postoperative acceleration were age (β = -0.238; P = .021), lateral posterior tibial slope (PTS) (β = 0.194; P = .048), and preoperative acceleration (β = 0.261; P = .008). Factors significantly affecting postoperative ERAV were age (β = -0.222; P = .029), ramp lesions (β = 0.212; P = .027), and preoperative ERAV (β = 0.323; P = .001). Greater preoperative laxity in the pivot shift was the factor having the most significant association with residual pivot shift after ACLR using quantitative measurements under general anesthesia. Younger age, higher lateral PTS, and concomitant ramp lesions were significant predictors of residual pivot shift. These findings can help pre- and intraoperative decision-making regarding whether an anterolateral structure augmentation should be added.

An Outcome Analysis of Fibrin Sealant versus Staples for Fixation of Split-Thickness Skin Grafts.

Background Skin grafting plays a vital role in post-burn and post-traumatic wound management. Split-thickness skin grafts (STSG) are traditionally fixed using staples or sutures, which have tedious application and their removal necessitates painkillers, medical equipment, and human intervention. As an alternative, fibrin sealant is a biological tissue adhesive, composed of thrombin, calcium, and fibrinogen. Fibrin sealant promotes hemostasis and acts as a biological adherent. Objective The aim of this study was to evaluate the outcomes (graft take, wound healing and complications) of fibrin sealant and staples for STSG fixation. Methods It is a randomized controlled trial on 40 patients with wounds of minimum 400 cm 2 . Wound area was divided into equal halves and randomly allocated to the study group or control group. In the study group, 4 mL per 200 cm 2 of fibrin sealant was sprayed followed by STSG application. In the control group, STSG was fixed with only skin staples. Evaluation was done on postoperative days 3, 5, 15, and 30 for graft take, hematoma/seroma, infection, and complete wound healing. Results The mean graft take was significantly higher ( p -value < 0.05) in the study group than in the control group (91 vs. 89%). No seroma or hematoma formation was seen in either group. Complete wound healing was seen in more patients in the study group, but the difference was statistically insignificant. Conclusion Fibrin sealant is an excellent alternative to staples for skin grafting, with the advantage of better graft take and being free of pain that is incurred during staple removal.

Most Online Resources for Home Suture Removal are Poor in Quality

Introduction. At home suture or staple removal can be stressful for patients and may lead some to seek out additional instruction via online resources as an adjunct to what was explained to them by their provider. The purpose of this study was to examine the existing online resources available to patients who may be interested in or have been instructed to remove sutures at home after a simple procedure such as a skin biopsy or excision. Methods. A systematic search was conducted using internet search engines to identify videos and webpages targeting at home suture removal instruction. The DISCERN instrument was used to evaluate the information quality of each included resource. Results. There was no statistically significant difference between average DISCERN scores for videos and webpage resources, and the majority were rated poor in quality. Conclusions. The online resources for at home suture and staple removal are often not comprehensive and are below the standard quality for written information. Healthcare providers should consider referring their patients to validated online sources for suture removal to prevent misinformation and improve patient safety.

727 Development of an Acuity and Scheduling System for Wound Care

Abstract Introduction Acuity systems have been used in nursing to quantify the care needed for each patient based on the patient’s nursing needs. The benefits for using an acuity system include avoiding over or understaffing and improving patient outcomes. To date no formal acuity system has been used to quantify the work associated with burn wound care. The purpose of this quality assurance project was to develop an acuity and scheduling system for burn patients and provide more effective and equitable staffing for burn wound care. Methods A wound care subgroup was formed by Unit Based Council to develop a point-based acuity scale for wound care. Numerical points were assigned for each body area dressed and wound care procedures such as surgical dressing take downs, moderate sedation, staple removal, wound vac change, wraps or casting, initial debridement, and discharge teaching (Fig. 1). Points were totaled and associated with a range of time: 1-5 points equals 45 minutes; 6-10 points equals 60 minutes; 11-15 points equals 75 minutes, and 16-20 points equals 90 minutes (Fig. 2). The total time of all dressing changes for the day based on the acuity system determines the RN and Tech staffing for wound care. After considering provider and therapy priorities, a schedule is posted in Microsoft Teams allowing for interdisciplinary collaboration and visibility on wound care scheduling. Results To date the acuity-based schedule has been used to schedule 500 consecutive dressings. Acuity based scheduling has helped to quantify the number of staff needed for wound care related to the amount of time needed each day. Prior to the initiation of this practice, wound care was assigned based on the number of patients instead of the workload required per patient leading to over or understaffing. The use of the acuity system has allowed the unit to predict the number of staff needed for wound care each day and adherence to the schedule with a margin of 30 minutes plus/minus was achieved. Conclusions Use of an acuity and scheduling system for burn wound care can improve staffing and will be a tool to quantify productivity. Applicability of Research to Practice Acuity systems and wound care scheduling can improve staffing for burn centers.

Protruded Rode Post Posterior Spinal Fusion in Scoliosis Patient – Case Report

Scoliosis is defined as coronal plane spinal deformity. It is known as the lateral angulation of the vertebra more than 10 degrees which most commonly presents in adolescent girls from age 10 to 18. Scoliosis is divided into two groups which are congenital and idiopathic Scoliosis. We present a case of 18 years old male patient known as mental delayed and cleft palate, complaining of protruded Hardware for three years as post-T4 to L2 Posterior Spinal Fusion who diagnosed as a neuromuscular Scoliosis. The patient lost to follow-up since staples removal and came to the clinic after three years as transferred from primary health care. Upon physical examination, intact motor and sensory exam and normal reflexes, no signs of infection. A serial radiological investigation was ordered, and blood work was done as well. Irrigation and, debridement and hardware removal were performed, the four left proximal pedicle screws were removed. The proximal cutting part of the left rod. Deep tissue culture from different sites was taken for culture and sensitivity, which was positive for staphylococcus Aureus. The patient was kept in the hospital for intravenous antibiotics and seen in the clinic for follow-up. This case report suggests noncompliance can affect the outcome and lead to severe complications. We present a case of protruded rode post scoliosis correction in which underwent removal of loose left four pedicle screws and proximal rode.

2023 Code Changes: Suture Removal

This article introduces code changes that will be effective for services provided on and after January 1, 2023. It also includes a review of how the removal of sutures and staples are reported in 2022 when these services take place outside of a global period/surgical package. The following topics will be discussed: Reporting removal that requires anesthesia −Code changes−When removal is not separately reported−Relative value units (RVUs)Reporting removal when anesthesia is not required −New codes−When removal is not separately reported−Separately reported services−RVUs

Early Results with the Use of Synthetic Cartilage Implant Augmented with 3D Printed Baseplate to Prevent Implant Subsidence for Treatment of Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a common arthritic disease which causes pain and stiffness. Synthetic cartilage implant (SCI) resurfacing has become a popular treatment option since it has similar biomechanical properties as native cartilage, reduces pain, and preserves MTPJ motion. However, recent studies have reported on implant subsidence leading to SCI treatment failure and subsequent revision surgery. A novel solution involves proximally inserting a custom 3D printed baseplate in the metatarsal head to prevent SCI subsidence. The purpose of this study is to evaluate the clinical and radiographic outcomes of patients who underwent SCI resurfacing augmented with a 3D printed beasplate for the treatment of HR by a single surgeon. Methods: Electronic health records were queried from August 2017 to August 2021 for patients who were treated with SCI (Cartiva Synthetic Cartilage Implant; Cartiva Inc., Alpharetta, GA) augmented with a custom 3D printed baseplate by a single surgeon. Through a dorsal approach to the MTPJ, the custom 3D printed baseplate is inserted in the metatarsal head and the SCI implant is positioned two millimeters proud from the cortex. An akin osteotomy is then performed and fixed with a staple. For the study, surgical indications included symptomatic HR and revision of previously failed SCI treatment. Patient demographics, body mass index (BMI), medical comorbidities, and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and x-ray imaging were compared. Descriptive and univariate statistics were used to analyze data. Results: Twenty-one patients underwent SCI resurfacing augmented with a 3D printed baseplate. The cohort consisted of 18 females, and presented with a mean BMI of 30.4+-5 Kg/m2, mean age of 56.4+-10 years, and mean followup of 9.8+-13 months since the procedure. Patients experienced a significant improvement in VAS pain (P=0.002) scores. The SCI augmented with 3D printed baseplate survivorship was 90.4%, with only two (9.5%) patients requiring revision to first MTPJ arthrodesis for SCI subsidence and sesamoidal arthritis. Two (9.5%) patients additionally underwent reoperation for staple removal and infection. The first MTPJ space was maintained on x-ray imaging for 19 (90.5%) patients, with only two (9.5%) patients demonstrating implant subsidence. Conclusion: SCI resurfacing augmented with a custom 3D printed baseplate demonstrated significant improvements in pain and prevented implant subsidence in patients suffering from symptomatic HR. Future prospective studies should be performed to expand upon the clinical outcomes data analyzing this novel technique to prevent SCI subsidence in the treatment for HR.

Effect of Supplemental Oxygen on Risk of Surgical Wound Infection

Background: There is a risk of different complication after the surgery but delaying in wound healing or infection is one of most common risk. Oxidative killing is a process of tissues partial pressure of oxygen throughout the observed values ranges. The main defense against foreign particles in result of surgery is oxidative killing through neutrophils. In a study by Greif et al4 indicated oxygen 80% during the surgery and after 2 hours later of surgery 50% risk get lesser as compared to the patient who had administrated with 30% oxygen.4 Another study proved that chances of risk for infection get increase in patients who were administrated oxygen 11 % as compared to the patients with 25% oxygen administration.5 The current study was conducted to test the hypothesis that supplemental oxygen decreases the risk of post-operative wound infection. Objective: The objective of the study was to determine the effects of supplemental oxygen on risk of surgical wound infection. Materials and Methodology: A randomized Clinical Trial- double- blinded was conducted at DHQ hospital, Karachi from March 1, 2011 to October, 31, 2016. A total of 300 subjects with age around 18 to 80 years who underwent elective colorectal surgery and satisfying the inclusion and exclusion criteria were recruited in the study. Non-probability Purposive sampling technique was used to collect the data. Double-blinded technique was used. Blinded investigators diagnosed the wounds infection by following the criteria of centers of disease control and prevention. Patients were randomly allocated in two groups by sealed-envelope method. Baseline assessment was performed on each patient which included patient’s medical history, physical examination and Lab tests i.e. complete blood picture and biochemical analysis. Characteristics for patient’s baseline and aesthetic treatment were confound factors. 3rd generation antibiotics cephalosporin were administrated 1 to 2 hours before of surgery. Patients of Group 1 received oxygen fraction of inspired oxygen FIO2 of 30 and group 2 of 80 percent. Randomly chosen concentration flow of oxygen 16l/min was given. Patient was breathing ambient air. Supplemental oxygen was given to maintain the patient’s oxygen saturation to 92% that is measured by pulse oximetry. Patient’s treatment was slandered with antibiotics and anesthesia administration. For wound evaluation, tools used were National nosocomial infection surveillance scale 6 and Efficacy of infection control,7 Wounds were checked for infection on daily basis by surgeons who were blinded. And wound thought to be infected when they full fill the criteria of Centers for Disease control and prevention standard. Main outcome measure was surgical site for infection and secondary outcomes were recovery of bowl function, duration of hospital stay, ambulation and ability to absorb the solid food. Statistical Analysis: Analysis was done on SPSS by applying parametric and non-parametric test according to normality. Results: Results showed no significant difference in %age Surgical infection site, Daily ASEPSIS value ≥20 at any time (p-value&lt;0.06), Admission in ICU (p-value= 0.74), Bowel function recovery (p-value=0.74), Solid food intake (p-value=0.54), Walking (p-value=0.57), Removal of Staples( 0.72), Duration of post-surgery hospitalization(p-value=0.09) of both the groups as p-value &gt;0.05 of all variables. Practical implication: If we provide pre-operative supplemental oxygen it will be helpful to decrease SSI. Conclusion: Patients who received supplemental oxygen showed significantly decrease in the risk of wound infection. Hence, Pre-operative supplemental oxygen proved to be an effective intervention to decrease SSI in the patients having rectal or colon surgery. Keywords: ASEPSIS, Surgical Wound, Infection, Supplemental Oxygen

Lost in Follow-Up: Predictors of Patient No-Shows to Clinic Follow-Up After Abdominal Injury

The aim of this study is to evaluate risk factors for non-attendance to post-discharge, hospital follow-up appointments for traumatically injured patients who underwent exploratory laparotomy. This is a retrospective chart review of patients who underwent exploratory laparotomy for traumatic abdominal injury at an urban, Midwestern, level I trauma center with clinic follow-up scheduled after discharge. Clinically, relevant demographic characteristics, patients' distance from hospital, and the presence of staples, sutures, and drains requiring removal were collected. Descriptive statistics of categorical variables were calculated as totals and percentages and compared with a chi-squared test or Fisher's exact when appropriate. The sample included 183 patients who were largely assaultive trauma survivors (68%), male (80%), and black (53%) with a mean age of 35.4±14.9 years. Overall, 18.5% no-showed for their follow-up appointment. On multivariate analysis for clinic no-show; length of stay (odds ratio=0.92 [0.84-0.99], P=0.04) and the need for suture, staple, or drain removal were protective for clinic attendance (odds ratio=5.59 [1.07-7.01], P=0.04). Overall, 12 patients (6.4%) were readmitted. Forty patients (18.3%) had their follow-up in the emergency department (ED). On multivariate regression of risk factors for ED visits, the only statistically significant factors (P<0.05) were clinic appointment no-show (OR=2.81) and self-pay insurance (OR=4.78). Abdominal trauma patients are at high risk of no-show for follow-up appointments and no-show visits are associated with ED visits. Future work is needed evaluating interventions to improve follow-up.

Task Autonomous Medical Robot for Both Incision Stapling and Staples Removal

Surgical incision is a pervasive procedure in medical environments. Stapling is an incision closure method that is comparable to stitching. While incision closure is performed immediately after a surgery, staples are removed several weeks after the closure. The workload of surgeons and the probability of infections can be highly reduced if both stapling and staple removal procedures are accomplished by autonomous medical robots. This study proposes a medical robot system that can autonomously perform both the stapling of surgical incisions and the removal of staples after the stapled incision is healed. Individual module designs for stapling and removing staples are presented in detail. The modules were attached to an end-effector that was connected to the end joint of the manipulator. Based on binocular vision, a control method consisting of incision detection, staple position planning, and staple detection was developed to guide the robot to press the staples into a simulated piece of wounded skin and remove the staples from the same phantom. The experiments demonstrated that the prototypical robot effectively performed both stapling and staple removal tasks without human intervention.

Agraffectomy

Complications after stapled hemorrhoidopexy may include recurrence, severe pain, rectal stenosis, bleeding, fecal urgency, and incontinence. Furthermore, persistence of symptoms may warrant surgical intervention. A treatment modality for persistent complaints after stapled hemorrhoidopexy (SHP) is agraffectomy (removal of the retained staples), which ranges from the removal of staples through an anoscope to excision of the entire staple line with the associated scar tissue.

First Metatarsophalangeal Joint Fusion with Orthogonal Memory Staple Fixation

Category:Midfoot/ForefootIntroduction/Purpose:First metatarsophalangeal joint (MTPJ) fusion is one of the most commonly performed procedure for painful symptomatic arthritis. The implants used for osteosynthesis are variable and depend on surgeon preference. The aim of this paper was to study the outcome of first MTPJ fusion surgery using fixation with orthogonal shape memory alloy (Nitinol) staples.Methods:75 consecutive patients who underwent first MTPJ fusion with orthogonal memory staples were included in the study. All patients underwent surgery using standard surgical technique with fixation of the arthrodesis with two 20 mm shape memory alloy (Nitinol) staples (Memo staples, Ortho Solutions Inc). The first staple placed medially and the second staple placed dorsally in orthogonal plane. The arthrodesis surfaces were prepared and temporarily fixed with K wire. Once the position and bone approximation was confirmed satisfactory under image intensifier guidance, a flat staple bed was prepared with saw blade to make sure the staples are not proud after fixation. All patients also received standard postoperative care with heel weight bearing shoe for six weeks and follow-up at 3,6 and 12 weeks as standard regimen. Patient demography, time to clinical and radiological union, early/late complications, rate of non-union, revision surgery and implant removal were noted.Results:Average age was 64.6 years. 42 patients had severe radiologic arthritic changes while 27 patients had associated moderate to severe hallux valgus deformity. Five patients were known to have inflammatory arthritis. The average follow-up was 18.3 weeks. There were two early complication of superficial infection treated successfully with oral antibiotics. Average clinical union was 7.2 weeks and radiological union at 12 weeks. Five patients (6.6%) had radiological non-union of which four underwent revision surgery with plate fixation. One patient had delayed union while one had dorsal staple back-out but did not warrant removal. None required staple removal from hardware prominence. There was no significant difference in union or complication rates with regards to gender or presence inflammatory arthritis.Conclusion:This study demonstrates that the outcome of 1st MTPJ fusion with two memory staples in orthogonal position is comparable with other modalities of fixation in terms of rate of union and resurgery. It is safe, simple and easily reproducible technique. Besides, none of the patients in this series required implant removal for hardware related complications. This could be advantageous compared to fewer other modalities like plate fixation, though larger studies are needed to confirm it.

Stapling of an endobronchial suction tube with the bronchus during robot-assisted right lower lobectomy: a case report

BackgroundTroubleshooting intraoperative complications requires careful management, and the safest technique should be chosen. We recently experienced a unique intraoperative bronchial complication during pulmonary lobectomy in robot-assisted thoracic surgery (RATS). There is no consensus on whether to continue RATS or convert to a more familiar technique, such as video-assisted thoracic surgery (VATS) or thoracotomy, for intraoperative complications that occur during RATS, and the decision should be determined individually.Case presentationA 74-year-old woman with primary lung adenocarcinoma (clinical stage IA2) underwent robot-assisted right lower lobectomy under one-lung ventilation and CO2 insufflation. Intraoperatively, the anesthesiologist placed the endobronchial suction tube in the right bronchus with intention of maintaining the right lung collapse, which was simultaneously stapled with the right lower bronchus during the right lower lobe bronchial closure using a robotic stapler. During robot-assisted manipulation, we removed the staples involved with the suction tube, one by one, using robotic-arm forceps and sutured the partially opened stump. Subsequently, the bronchial stump was covered with a pedicled pericardial fat pad. The postoperative course was uneventful, and the patient developed no complications when followed up 8 months after discharge. Hence, we could rectify this intraoperative bronchial complication using a robot-assisted technique and avoid conversion to VATS or thoracotomy.ConclusionThe precise manipulation techniques in RATS contributed to facilitate the successful execution of surgical procedures, such as staple removal and re-suturing of the bronchial stump and may be a useful as a method for such troubleshooting such intraoperative complications.

Surgical Wound Nursing Assessment and Clinical Outcomes in Patients with Cardiac Implantable Electronic Devices

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Universitário Lisboa Central / Hospital Santa Marta With the gains in life expectancy of patients (P) with heart disease, population with cardiac implantable electronic devices (CIED) therapy for the treatment of heart failure and life-threatening arrhythmias has increasingly became a challenge, regarding the number of complications following an implantation. Aim: To analyze clinical outcomes of P with CIED participating in an integrated nursing approach in an outpatient clinic of a tertiary center. Methods: Systematic review of clinical follow-up data of P undergoing CIED implantation who were observed by a specialized nursing team after discharge. Data regarding complications related to the surgical wound, treatment, timings and outcomes were collected. Results: In 2020, out of 927 P treated with CIED in our center, 157 were referred to the nursing outpatient clinic due high risk features such as anticoagulation and frailty, previously identified surgical wound related complications or advanced hearth failure. The CIED observed were replaced devices (17%), cardioverter defibrillator (41%), cardiac resynchronization therapy with defibrillator (27%), pacemakers (11%), and event recorders (4%). In average, the first appointment took place 16 days after the procedure. In 73 cases, presenting with pocket complaints (hematoma - 34%, local edema or pain - 10%, wound scab - 36%, exteriorized suture or staple - 20%), the average number of days until medical discharge was 36 days, with an average of 5 appointments per patient. In this group, 42% were under oral coagulants, 38% under antiaggregant drugs and 11% under both. Treatment options included antibiotic prescription in 25% of the cases, cryotherapy in 22%, dressing of the surgical wound in 10% and absorbable suture or staple removal in 10%. Four P (0.43%) were submitted to complete system removal due to CIED infection. Conclusions: Surgical wound related complaints in CIED P are relatively common and represent a factor of morbidity and increase in public health spending. An integrated trained team may aid in the prompt identification and management of these complications.

Wound Management following Total Knee Arthroplasty: An Updated Review.

Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

VP Shunt With Recurrent Malfunction in Two Pediatric Patients: Is the Hydrocephalus Truly Idiopathic?

VP Shunt With Recurrent Malfunction in Two Pediatric Patients: Is the Hydrocephalus Truly Idiopathic?

Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty.

To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA). From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed. Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component. Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J2021;103-B(6 Supple A):191-195.