Risk Factors For Poor Healing Research Articles

Clinical value of combined serum MMP-2, MMP-9 and TIMP-1 for the prognosis of perianal fistula patients who received minimally invasive surgery.

This study aimed to investigate the clinical value of combined serum matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) for the prognosis of perianal fistula patients. Patients diagnosed and treated for perianal fistula by minimally invasive surgery (MIS) were enrolled. The concentrations of serum MMP-2, MMP-9 and TIMP-1 were measured at 24 h after surgery. Different levels of wound secretion, growth of granulation tissue and wound pain were used as criteria to evaluate surgical incision healing. The receiver operating characteristic curve was used to analyze the predicted assessment value. The concentrations of serum MMP-2 and MMP-9 were significantly higher, while the concentrations of serum TIMP-1 at 24 h after surgery were significantly lower in the poor healing group than in the good healing group. It was further found that high levels of serum MMP-2 and MMP-9 were risk factors for poor healing, while high concentrations of serum TIMP-1 at 24 h after surgery were protective factors for poor healing. High concentrations of serum MMP-2 and MMP-9 and low concentrations of serum TIMP at 24 h after surgery are risk factors for poor healing in perianal fistula patients who receive MIS, and the combined test has a higher predictive value.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

EP.TH.1063Independent Risk Factors influencing healing times in pilonidal sinus excision surgery

Abstract Aims Pilonidal Sinus excision surgery is commonly accompanied by a complex healing process. This study assesses the risk factors associated with poor wound healing from pilonidal excision surgery, and which patient demographics would benefit from assisted healing interventions, such as vacuum assisted closure, to enhance recovery times in a cost effective manner. Methods OMIS Theatre databases were used to identify primary pilonidal sinus excision procedures between January 2016 and January 2018 with a 32-patient cohort. Clinical workstation highlighted the time of wound healing based on date of clinic discharge. Risk factors for poor healing including smoking status, BMI, Diabetes, Vascular disease, gender, immunocompromised status, Chronic Renal impairment and ASA classification were identified. Results Of the 32: 16% have not healed at present and require further surgical intervention and 10% had not been followed up. The median duration for wounds healed was 105.5 days. The risk factors highlighted for complicated wound healing was gender, smoking status and diabetes. Median time for current smokers (30%) was 187 as opposed to 96.5 within the non-smoking population. Males (65%) had a longer healing time of 111 in comparison with females (75 days). Diabetic patients (9%) had a median time of 196.5 in comparison with non-diabetes patients with 96 days. Conclusion The highest risk factors for a prolonged healing process are the male gender, presence of diabetes and current smoking status. Therefore consideration of assisted healing interventions should be taken for patients with these demographics, implementing a cost effective approach to complex wound healing procedures.

07 Fascia lata autologous transobturator midurethral sling

The objective of this video is to demonstrate a minimally invasive approach to transobturator autologous sling placement with a novel anchoring system. Autologous fascia slings are typically placed using a retropubic approach1 but there is little data on use of fascial slings with a transobturator approach.2,3 This may be secondary to difficulty anchoring the sling at the desired tension, a technical challenge we aim to address. Fascia lata is a viable resource for sling graft, which can be harvested in a minimally invasive fashion, avoiding abdominal incision. Using a 3 cm transverse incision on the lateral thigh, a Crawford fascial stripper is used to harvest a 12 cm by 1.5 cm graft. The length of the graft is purposefully 12 cm to include the 6.4 cm obturator-to-obturator distance4 and approximately 3 cm on either end for anchoring. The graft is prepared for insertion by removing fat and creating frictional ends (inspired by “hook and loop” technology) with delayed-absorbable monofilament barbed suture. A 0-Vicryl tie is used to further secure the barbed suture and increase tensile strength of the graft. A 2-0 monofilament suture is used to create a loop at each end of the graft for tensioning. The graft is passed from a mid-urethral vaginal incision through the obturator foramen in a similar fashion to polypropylene mesh for stress incontinence. Loose tensioning is maintained by holding a knuckle of graft with an atraumatic instrument, while guiding the middle of the graft to the mid-urethra. The tensioning loops and the knuckle are then released, leaving a tension-free autologous mid-urethral sling. Loose placement at the mid-urethra through a transobturator approach likely decreases the risk of urinary retention5, irritative voiding symptoms6, and voiding dysfunction7. This minimally invasive technique is a practical approach to the patient with aversion to mesh, risk factors for poor healing and higher likelihood for de novo or exacerbation of voiding dysfunction.

Application of Color Doppler Ultrasound in the Clinical Diagnosis of Uterine Incision Infection

Objective: To observe the early changes of uterine incision defects after cesarean section by transvaginal color Doppler ultrasound, and to analyze the risk factors of their formation. Methods: A total of 181 women who underwent cesarean section from September 2016 to June 2018 and who underwent transvaginal ultrasound examination at 6 weeks, 3 months, and 6 months after birth were divided into two groups. (142 cases) and incision defect group (39 cases). The incision changes and the risk factors of incision defect in different periods of postpartum were analyzed. Results: Compared with the group with good incision healing, the length of the incision defect in the cesarean section at 6 months after delivery was shorter than that at 6 weeks after delivery (P < 0.05). The results of non-conditional logistic regression showed that the number of cesarean sections increased and the number of operators was lower. Seniority, postoperative infection, posterior uterine position, and incision close to the cervix are risk factors for poor healing of uterine scars. Conclusion: As the postpartum time increases, the length of the cesarean section incision defect shortens; multiple cesarean sections, puerperal infections, posterior uterus, low incision position and inexperience of the operator are the risk factors for the formation of uterine incision defects and increase uterine scars. Risk of poor healing.

Surgical delay of anterior chest wall prior to open coronary arterial bypass grafting surgery may decrease postoperative sternal complications

Open coronary arterial bypass grafting (CABG) procedures are inherently risky in regards to the healing capacity of the subsequent sternal wound. Patients often have underlying risk factors for poor healing and the procedure itself often reduces vascularity to the anterior chest with internal mammary artery (IMA) dissection. Currently unrelated is the surgical delay procedure. It is a well-established technique for augmenting vascularity and ultimatelytissue survival. It involves partial disruption of the blood supply to a flap for a period of time prior to fully elevating the flap (usually between 3 and 21 days). Recently, endoscopic robotic IMA dissection has become possible as a part of totally endoscopic CABGs for left-sided vessel disease. We are proposing a new technique, using surgical delay for patients who require open sternotomies for CABGS to reduce the rate of postoperative sternal wound complications. To delay the CABG, the majority of a robotic internal IMA dissectionwould be performed prior to an open CABG via a midline sternotomy. We hypothesize that this may decrease sternal wound complication rates. Potential pitfalls include consequences of disrupting the normal anatomic location of the IMAs and causing inflammation before the open CABG. Animal models will be the next step, as they will evaluate the feasibility of the delay as well as help to determine the optimal timing for the procedure.

The role of biologic in foot and ankle trauma-a review of the literature.

The use of biologics in orthopedics is becoming increasingly popular as an adjuvant in healing musculoskeletal injuries. Though many biologics involved in the management of foot and ankle injuries are used based on physician preference, reports of improved outcomes when combined with standard operative treatment has led to further clinical interest especially in foot and ankle trauma. The most recent studies have shown benefits for biologic use in patients predisposed to poor bone and soft tissue healing. Biologics have shown benefit in treating soft tissue injuries such as Achilles ruptures as well as the complications of trauma such as non-unions and osteoarthritis. Biologics have shown some benefit in improving functional and pain scores, as well as reducing time to heal in foot and ankle traumatic injuries, with particular success shown with patients that have risk factors for poor healing. As the use of biologics continues to increase, there is a need for high-level studies to confirm early findings of lower level reports.

Clinical predictors of leg ulcer healing

Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic leg ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic leg ulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community leg ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the ulcer duration (P = 0.002), complexity of the ulcer aetiology (P = 0.035), presence of lipodermatosclerosis (P = 0.02), history of deep vein thrombosis (DVT) (P = 0.03) and thrombophlebitis (P = 0.03). Multivariate analysis showed that ulcer duration (P = 0.014), DVT (P = 0.008) and a lack of Pseudomonas on wound swab (P = 0.005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic leg ulceration. There appears to be little scope for interventions to improve healing from the factors identified.

Role of hyperbaric oxygen therapy in the treatment of bacterial spinal osteomyelitis

Hyperbaric oxygen therapy (HBO) is used as primary and/or adjunctive therapy in the treatment of various clinical conditions complicated by local hypoxia. It may have therapeutic potential in the treatment of neurosurgical infections such as spinal osteomyelitis that are associated with significant morbidity rates. The purpose of this study was to evaluate the efficacy of HBO therapy in the treatment of spinal osteomyelitis. The clinical records of patients diagnosed with spinal osteomyelitis who received HBO therapy during their treatment at the authors' institution over the past 10 years were retrospectively reviewed. Six adult patients were identified. Four patients had recently undergone spinal surgery and secondary spinal osteomyelitis had developed. These patients received adjunctive HBO therapy due to significant comorbidities and risk factors for poor healing. All patients remained symptom and infection free over the subsequent follow-up period. Two patients had primary spinal osteomyelitis that had recurred despite a full course of appropriate antimicrobial therapy. Infection control was achieved after HBO therapy in 1 patient. The mean follow-up period for the study group was 2.9 years (range 5 months to 5 years). Hyperbaric oxygen therapy enabled infection cure in 5 of 6 patients with spinal osteomyelitis complicated by medical comorbidities or the failure of primary therapy. These results show that HBO may be a useful adjunctive therapeutic modality in the treatment of spinal osteomyelitis, particularly when there are medical comorbidities that increase the risk of poor healing. Hyperbaric oxygen therapy may also be beneficial in patients with relapsing primary spinal osteomyelitis after standard therapy has failed.

Refractory Venous Leg Ulcers: A Study of Risk Factors

Although certain risk factors for poor healing of leg ulcers have been identified, data concerning the characteristics of refractory ulcers have not been specifically studied in the literature. To study the characteristics of refractory venous leg ulcers. We retrospectively studied prognostic factors for healing in patients with refractory venous leg ulcers followed and treated in our dermatology department between January 1993 and January 2000. Each patient included in this study was compared with two patients matched for age and gender and presenting leg ulcers with normal healing, followed during the same period. Thirty-two of 571 patients with leg ulcers were included. The study population consisted of 20 females and 12 males with a mean age 73.5 years. The control population comprised 64 patients, 40 females and 24 males, with a mean age of 73 years. Univariate analysis demonstrated the negative prognostic impact of several previously identified factors (including surface area and history of the ulcer). In particular, multivariate analysis identified four main risk factors for refractory ulcer that are often associated in these patients: associated arterial disease, presence of post-thrombotic popliteal sequelae, recurrence of the ulcer, and disability. Four main risk factors that are often associated were identified, indicating the multifactorial nature of these refractory ulcers.

Adjunctive hyperbaric oxygen in irradiated patients requiring dental extractions: Outcomes and complications

Purpose: This study assessed complications of hyperbaric oxygen (HBO) therapy, potential predictors of poor outcome, and treatment outcomes in irradiated patients undergoing dental extractions. Patients and Methods: This was a prospective, descriptive study of 40 consecutive patients treated with HBO before and after dental extractions in an irradiated field. All patients had radiation caries; none had osteoradionecrosis (ORN). All were prescribed a protocol of 20 pre-extraction and 10 postextraction HBO treatments at 2.4 ATA for 90 minutes. Potential risk factors for poor healing and risk factors for complications were identified. All complications were recorded. Extraction site healing was evaluated at the conclusion of HBO therapy, at 1 month, and 1 year later. Results: There were no serious complications. There was no correlation between preidentified risk factors and poor healing. At 1 year, 98.5% of all extraction sites were healed. Patients who did not heal were an average of 8 years since radiation, compared with 3.3 years for those who healed (P <.001). Conclusion: Use of HBO is associated with a very low incidence of ORN at 1-year follow-up. However, the time since radiation has a positive correlation with risk for ORN. © 2001 American Association of Oral and Maxillofacial Surgeons