Risk Factors For Wound Healing Research Articles

SURGICAL OUTCOMES IN INTRAMEDULLARY FIBULAR NAIL FIXATION COMPARED WITH PLATE FIXATION OF DISTAL FIBULAR FRACTURES

IntroductionThe condition of the soft tissues surrounding an ankle fracture influences timing and treatment of injuries. Conventional treatment used an open approach to facilitate anatomical reduction and rigid internal fixation. Intramedullary devices for fibular fractures provide a safe alternative in patients in which the condition of the soft tissue envelope or the patient's co-morbidities may benefit from a less invasive approach. We compared outcomes for patients treated with open reduction internal fixation (ORIF) with those undergoing treatment with fibular nails (FN)Methods13 consecutive patients treated with fibular nails (FN) were compared with 13 age-matched patients that underwent open reduction and internal fixation (ORIF). All patients were followed to union. Study outcomes were time from admission to surgery, length of stay, wound failure, implant failure, revision surgery, OMAS and SF-36ResultsThere was no difference in age or sex distribution between groups. There was no difference in OMAS at 1 year (83 ± 9 in FN group; 80± 21 in ORIF group) and SF-36 (94 ± 11 and 90 ± 20). There were 2 implant failures in the ORIF group and none in the FN group. There was one wound failure in the ORIF group and none in the FN group. Patients treated with FN had a shorter time to surgery (1 day ± 24 hours vs 3 days ± 24 hours) and shorter length of stay (1 day ± 24 hours vs 4 days ± 96 hours)ConclusionFN is a safe method to treat patients with displaced distal fibular fractures that may have a poor soft tissue envelope and risk factors for wound healing. FN reduces the time to surgery and overall length of stay compared with similar patients treated with conventional ORIF.

A prospective randomized comparison of functional and cosmetic outcomes of a coronal zigzag incision versus a conventional straight incision pattern for craniotomy.

Wound healing problems after neurosurgical procedures can lead to serious complications and may require complex revision or even reconstructive surgery. Therefore, optimal surgical management is critical to prevent complications. In a recent experimental study in animals, the authors demonstrated the superiority of a zigzag skin incision over a straight incision pattern. In this study, the authors applied these findings to clinical situations of neurosurgical patients with an indication for a coronal skin incision. The aim of this study was to objectively assess the functional and cosmetic outcomes between straight coronal and zigzag incisions in neurosurgical procedures. This prospective, randomized, controlled, single-center trial included adult patients undergoing frontal craniotomy for cerebrovascular or tumor pathologies. The study primarily included patients who were not expected to receive adjuvant radiation or chemotherapy. The zigzag incision was standardized using a template. A common straight skin incision behind the hairline served as a control. Complication rates, functional (2-point discrimination, width of the wound, Vancouver Scar Scale [VSS], and Patient and Observer Scar Assessment Scale [POSAS]), and cosmetic outcomes were assessed postoperatively and at 3-month follow-up evaluations. Additionally, all patients answered a wound-specific questionnaire and the SF-36 questionnaire. Twenty-eight patients were randomized to the zigzag and 29 to the straight incision groups. Indications for surgery were cerebrovascular in 16 cases and tumors in 41 cases. Risk factors for wound healing were equally distributed in both groups. One patient in the zigzag group with poor postoperative compliance required surgery for secondary wound healing problems. Overall, the width of the scar was significantly smaller (p = 0.001) and local 2-point discrimination better (p = 0.005) in the zigzag group. Scores on the VSS (p = 0.003) and POSAS (p = 0.005) proved to be significantly superior in the zigzag group as well. A zigzag coronal skin incision pattern leads to significantly superior functional and cosmetic outcome scores. For certain patient groups, these findings may prove to be practice-changing.

Correlation between Preoperative Osteitis Degree with Postoperative Endoscopic Score in Chronic Rhinosinusitis

BACKGROUND: In chronic rhinosinusitis patients, there is a subgroup of patients with persistent symptoms after treatment, who often shows bone thickening and remodeling in their paranasal sinuses and described as osteitis. Osteitis can be evaluated by several methods, one of which is the Global Osteitis Score (GOS) AIM: To analyse the correlation between preoperative osteitis degree with the postoperative endoscopic scores in chronic rhinosinusitis METHOD: It was an observational study with cross-sectional design. We use GOS from CT scan before surgery and Lund Mackay’s endoscopic score 4 weeks after Functional Endoscopy Sinus Surgery (FESS). The analysis performed with Spearman correlation test. RESULT: There were 30 patients as subjects. There statistical analysis test between preoperative osteitis degree with post operative endoscopic score showed p = 0.296 with r = 0.197. The analysis result between risk factors for wound healing with the postoperative endoscopic score were allergic rhinitis (p = 1.000), polyps (p = 0.624), and smoking (p = 0.309) CONCLUSION: There is no significant correlation between preoperative osteitis degree with the postoperative endoscopic score, but there is a tendency for a positive correlation between preoperative osteitis degree with the postoperative endoscopic score. There was no significant correlation between allergic rhinitis, polyps, and smoking habits with postoperative endoscopic score

Immediate Titanium Mesh Cranioplasty After Debridement and Craniectomy for Postcraniotomy Surgical Site Infections and Risk Factors for Reoperation

We previously published a novel strategy for management of postcraniotomy bone flap infection consisting of single stage debridement, bone flap removal, and immediate titanium mesh cranioplasty. Postcraniotomy patients with surgical site infections treated with surgical debridement, bone flap removal, and immediate titanium mesh cranioplasty were retrospectively reviewed. The primary outcome measure was reoperation due to persistent infection or wound healing complications from the titanium mesh. We included 48 patients, of which 15 (31.3%) were female. The most common primary diagnoses were glioblastoma (31.3%), meningioma (18.8%), and vascular/trauma (16.7%). Most patients had a history of same-site craniotomy prior to the surgery complicated by surgical site infection and 47.9% had prior cranial radiation. Thirty-six (75.0%) patients achieved resolution of their infection and did not require a second operation. Twelve (25.0%) patients required reoperation: 6 (12.5%) patients were found to have frank intraoperative purulence on reoperation, whereas 6 (12.5%) had reoperation for poor wound healing without any evidence of persistent infection. Cochran Armitage trend test revealed that patients with increasing number of wound healing risk factors had significantly higher risk of reoperation (P= 0.001). Prior intensity modulated radiotherapy alone was a significant risk factor for reoperation (6.5 [1.40-30.31], P= 0.002). Median follow-up time was 20.5weeks. Immediate titanium mesh cranioplasty at the time of debridement and bone flap removal is an acceptable option in the management of post-craniotomy bone flap infection. Patients with multiple wound healing risk factors are at higher risk for reoperation.

Individualized Risk Prediction for Improved Chronic Wound Management.

Significance: Chronic wounds are associated with significant morbidity, marked loss of quality of life, and considerable economic burden. Evidence-based risk prediction to guide improved wound prevention and treatment is limited by the complexity in their etiology, clinical underreporting, and a lack of studies using large high-quality datasets. Recent Advancements: The objective of this review is to summarize key components and challenges in the development of personalized risk prediction tools for both prevention and management of chronic wounds, while highlighting several innovations in the development of better risk stratification. Critical Issues: Regression-based risk prediction approaches remain important for assessment of prognosis and risk stratification in chronic wound management. Advances in statistical computing have boosted the development of several promising machine learning (ML) and other semiautomated classification tools. These methods may be better placed to handle large number of wound healing risk factors from large datasets, potentially resulting in better risk prediction when combined with conventional methods and clinical experience and expertise. Future Directions: Where the number of predictors is large and heterogenous, the correlations between various risk factors complex, and very large data sets are available, ML may prove a powerful adjuvant for risk stratifying patients predisposed to chronic wounds. Conventional regression-based approaches remain important, particularly where the number of predictors is relatively small. Translating estimated risk derived from ML algorithms into practical prediction tools for use in clinical practice remains challenging.

Anterolateral Thigh Free Flap Donor-Site Morbidity: A Retrospective Cohort Study.

The ability to achieve a good functional outcome, quality of life, and patient satisfaction related to the donor site of free flaps is an important factor in flap selection. One of the main advantages of an anterolateral thigh (ALT) free flap is its minimal donor-site morbidity. We conducted a study to analyze healing of ALT flap donor sites based on the type of closure. A total of 65 patients were included in the study. We divided the participants into two cohorts (i.e., primary closure [n = 51] and skin grafting [n = 14]). There were no statistically significant differences between the two cohorts relative to age, gender, or risk factors for wound healing (e.g., tobacco use, obesity, diabetes mellitus, and cardiovascular disease). We found there was a statistically significant difference (p < .05) between the mean donor-site wound healing time in the primary closure group (n = 51; 22.41 days [±9.94]) compared with the skin grafting group (n = 14; 54.57 days [±21.59]). To reduce wound healing time, improve cosmetic results, and increase functional outcomes in patients undergoing ALT free flap, we recommend using primary closure for the donor sites and avoiding skin grafting whenever possible.

A multidisciplinary approach to complex oncological spine coverage in high-risk patients.

The consequences of failed spinal hardware secondary to wound complications can increase the burden on the patient while also significantly escalating the cost of care. The objective of this study was to demonstrate the effectiveness of a protocol-based multidisciplinary approach in optimizing wound outcome in complex oncological spine care patients. A retrospective consecutive case series was performed from 2015 to 2019 of all patients who underwent oncological spine surgery. A protocol was established to identify oncological patients at high risk for potential wound complications. Preoperative and postoperative treatment plans were developed by the multidisciplinary tumor board team members. Wound healing risk factors such as diabetes, obesity, prior spine surgery, pre- or postoperative chemotherapy or radiation exposure, perioperative steroid use, and poor nutritional status were recorded. Operative details, including the regions of spinal involvement, presence of instrumentation, and number of vertebral levels operated on, were reviewed. Primary outcomes were the length of hospitalization and major (requiring reoperation) and minor wound complications in the setting of the aforementioned identified risk factors. A total of 102 oncological cases were recorded during the 5-year study period. Of these patients, 99 had local muscle flap reconstruction with layered closure over their surgical hardware. The prevalence of smoking, diabetes, and previous spine surgery for the cohort was 21.6%, 20.6%, and 27.5%, respectively. Radiation exposure was seen in 72.5% of patients (37.3% preoperative vs 48% postoperative exposure). Chemotherapy was given to 66.7% of the patients (49% preoperatively and 30.4% postoperatively). The rate of perioperative steroid exposure was 60.8%. Prealbumin and albumin levels were 15.00 ± 7.47 mg/dL and 3.23 ± 0.43 mg/dL, respectively. Overall, an albumin level of < 3.5 mg/dL and BMI < 18.5 were seen in 64.7% and 13.7% of the patients, respectively. The mean number of vertebral levels involved was 6.76 ± 2.37 levels. Instrumentation of 7 levels or more was seen in 52.9% of patients. The average spinal wound defect size was 22.06 ± 7.79 cm. The rate of minor wound complications, including superficial skin breakdown (epidermolysis) and nonoperative seromas, was 6.9%, whereas that for major complications requiring reoperation within 90 days of surgery was 2.9%. A multidisciplinary team approach utilized in complex multilevel oncological spine reconstruction surgery optimizes surgical outcomes, reduces morbidities, and improves care and satisfaction in patients with known risk factors.

Closed Incision Negative Pressure Therapy for Management of Incision Wounds in the Groin After Revision Vascular Surgery: A Randomized Controlled Trial

Wound healing complications (WHCs) in the groin after vascular surgeries are a serious problem for patients and surgeons in various surgical disciplines. The incidence of WHCs of up to 44% after incisions in the groin is often responsible for prolonged hospital stay and high treatment costs. An effective reduction of WHCs for various wound types after using closed incision negative pressure therapy (ciNPT) has been documented in many case reports and clinical studies. As the majority of studies have addressed the effect of ciNPT on primary groin incision wounds, concerning groin incision wounds after revision vascular surgery are extremely scarce. The aim of this prospective, randomized clinical study was to investigate the effectiveness of ciNPT compared with conventional therapy on groin incisions after revision vascular surgery. We analyzed the cases of a total of 94 patients with 100 groin incisions. Patients were randomized and treated with either PREVENA™ (n=47 groins) or a conventional adhesive dressing (n=53 groins; control group). PREVENA™ was applied intraoperatively and was removed on day 5, 6 or 7 postoperatively. Wound evaluation was carried out on the 5th to 7th and 30th postoperative day. Compared with the control group, the ciNPT group showed a reduction in the overall incidence of WHCs assessed 30 days postoperatively (p<0.0005). With regard to prevention of revision surgeries, the ciNPT had no significant impact (p=0.056). Subgroup analysis revealed a significant effect of ciNPT for almost all wound healing risk factors. Based on our results, ciNPT provides a promising therapeutic option to reduce the frequency of postoperative WHCs and the need for revision surgeries in the groin after revision vascular surgery in patients with wound healing risk factors.

Case Report of a Nipple Amputation After a Horse Bite

Horse related injuries include falling from a horse, being stepped on by a horse, kicks, or bites. Bites are rare and often associated with fatalities. We present a case of a 41-year-old healthy female who suffered a complete amputation of her right nipple and abrasion of the areola following a horse bite. We managed the nipple injury as a full-thickness skin graft, similar to that of a compromised nipple in a reduction mammaplasty or mastopexy case. Barring a lack of projection and minor hypopigmentation, the nipple had normal sensation with no scar contracture. Overall, the patient was happy with her final outcome. With a healthy, minimally contaminated wound bed, and lack of poor wound healing risk factors, we believe that treating a nipple amputation as a full thickness skin graft in the emergency setting results in aesthetic outcomes, sensation, and patient satisfaction comparable if not superior to other means of nipple reconstruction in adults.

Use of fibrin adhesive for preventing pharyngocutaneous fistula in total laryngectomy.

Minimizing pharyngocutaneous fistula after total laryngectomy is a perpetual focus for head and neck surgeons. Multiple intrinsic and extrinsic factors have been implicated in the wound healing process. Activated fibrin glue uniquely promotes healing as a tissue adhesive as well as a biochemical growth factor. We present a pilot case series of total laryngectomy with simple pharyngeal closure with a single surgeon. Fibrin tissue adhesive was incorporated in all patients along with standardized pre-operative, operative, and post-operative care. Outcomes measured included pharyngocutaneous fistula rate, perioperative complications, and other wound complications as well as long term swallowing function and voice rehab outcomes. We also present a review of the literature for the theoretical basis of using fibrin glue as well as other similar applications. Fibrin tissue adhesive was successfully used in 18 consecutive patients undergoing total laryngectomy and pharyngoplasty. Despite the presence of a variety of wound healing risk factors including prior radiation and tobacco use, there were no pharyngocutaneous fistulas or other significant wound problems. No locoregional or free tissue overlay flap was done. Fibrin tissue glue is a readily available, easily applied, and cost-effective adjunct that may reduce pharyngocutaneous fistula.

Associations between patient, treatment, or wound-level factors and venous leg ulcer healing: Wound characteristics are the key factors in determining healing outcomes.

Chronic venous leg ulcers are challenging to heal and often recur. This has a significant impact on older individual health and is a financial burden on health care resources. This study aimed to identify factors associated with the healing of venous leg ulcers via secondary examination of data from a previously published prospective randomized controlled trial of elastic and inelastic compression systems. The data from the 45 patients who finished the trial was reanalyzed for a hypothesis generating study. Larger ulcers, higher exudate levels, larger calf circumferences, and longer ulcer duration at baseline were associated with lack of healing at 12 weeks. There was some evidence that NSAID use was associated with an increased likelihood of nonhealing (unadjusted OR for healing, 0.13, 95% CI (0.02, 0.70)). There was no evidence that other variables, including gender and BMI, were associated with healing. The key risk factors for wound healing are largely wound based or inherent to wound development, as these were found to be the factors with the strongest associations in the analysis. Future research should address how and why these factors are associated with wound healing over a longer time frame and explore how NSAIDs may affect wound healing outcomes.

Use of oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressings to help manage skin graft donor site wounds

Harvesting donor site explants for split-thickness skin grafting creates an iatrogenic wound that presents additional challenges to clinicians due to morbidities such as persistent bleeding, pain, infection, and delayed epithelialization. Although there have been several randomized controlled trials to compare wound dressing effectiveness, there is still a lack of standardization for donor site wound dressings.A retrospective comparison of 59 patients that underwent split-thickness skin graft reconstructions between January 2017 and September 2018 was performed. Donor sites of Group 1 patients (n = 29) were treated with a transparent film dressing and transitioned to petrolatum gauze dressings if exudate management became problematic; Group 2 patients (n = 30) were treated with oxidized regenerated cellulose/collagen/silver-oxidized regenerated cellulose (ORC/C/Ag-ORC) dressings. Evaluations of time to epithelialization, number of dressings required, signs of inflammation, and objective pain were compared between groups.Group 1 was comprised of 18 female and 11 male patients, whereas Group 2 was comprised of 14 females and 16 males. There were no significant differences between groups when comparing age, sex, comorbidities, or donor site size (area or depth). Patients in Group 2 had a significantly shorter time to complete re-epithelialization (P < .0001), fewer dressing changes (P < .0001), and less objective pain as measured by the need for opioid pain mediation (P < .0001) when compared to Group 1. The percentage of patients with signs of inflammation was also lower for Group 2, although this difference was not statistically significant (P = .0797).Although prospective, controlled studies are still needed, data from this study suggest that ORC/C/Ag-ORC dressings could become a more effective alternative for the management of donor site wounds, especially in patients with known risk factors for wound healing.

Wound healing after revascularization for critical limb ischemia.

Wound healing is one of the most important endpoints after revascularization for critical limb ischemia. The purpose of this study was to evaluate the risk factors for wound healing after revascularization for critical limb ischemia (CLI). A retrospective study was conducted at a single university hospital, and data were collected retrospectively between January 2005 and September 2016. All admitted patients who were diagnosed with CLI and underwent revascularization for the first time were enrolled. The risk factors for wound healing were analyzed. The risk factors for wound healing were analyzed in 153 patients. The cumulative rate of wound healing at 12 months after revascularization was 79%. The independent risk factors for wound healing were non-ambulatory status (hazard ratio, 1.95; 95% CI [1.22-3.21], P=0.004), and wound, ischemia and foot infection (WIfI) stage 4 (hazard ratio, 1.89; 95% CI [1.25-2.91], P=0.002). In our study, non-ambulatory status and WIfI stage 4 were independent risk factors for wound healing after revascularization. WIfI criteria well reflected the prognosis of patients with CLI in wound healing, as well as limb salvage.

Evidence in Practice of Tissue Healing with Latex Biomembrane: Integrative Review.

Wound healing is a perfectly coordinated cascade of cellular, molecular, and biochemical events which interact in tissue reconstitution. Chronic diseases such as pressure ulcers (PU) and diabetes mellitus (DM) are considered risk factors for wound healing. Patients with such diseases often have higher sepsis, infection, and complication rates, since they have revascularization inhibition and low growth factor expression. Thus, latex biomembrane (LBM), a biocompatible material, derived from the latex of the rubber tree (Hevea brasiliensis) appears to create tendencies as an angiogenic-inducing tissue healing agent and as biomaterial, resulting from its structural qualities and its low cost when compared to conventional treatments. Therefore, this work aims at summarizing the results, experiments, and scientific findings that certify or recommend the use of LBM as a new technique to be applied effectively in the treatment of wounds. An integrative review was held in the BIREME, LILACS, Burns, MEDLINE, PubMed, and SciELO databases, from 2000 to 2016, using the following descriptors: “healing,” “diabetes mellitus,” “wounds,” and “latex membrane.” As a result, 600 experiments (out of 612) presented satisfactory results; however, 33% of the cases received explicit recommendations, 11% required more studies on the subjects, and 1% was denied. On the other hand, half of the studies did not expressly endorse its use, despite presenting satisfactory results. The LBM was characterized as a good therapeutic alternative in cases of wounds, including chronic diseases, such as diabetes mellitus and PU, due to its relevant potential for wound healing stimulation, acceleration of cell tissue mending and revascularization, or the reestablishment of angiogenic functions (creation of new blood vessels). The LBM was also confirmed to be safe as a biocompatible material whose structural qualities (elasticity, adaptability, impermeability, and possibility of suture), devoid of toxicity, allowed interaction between tissues and presented no hypersensitivity inducer and no antimicrobial effect.

Rectus Abdominis Myofascial Flap for Vaginal Reconstruction After Pelvic Exenteration.

Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap. Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non-flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated. Eleven (68.8%) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3%) are still alive. Early complications were reported in 7 patients (43.8%), with 2 (12.5%) flap-related and 5 (31.3%) non-flap-related complications. Similarly, late complications were reported in 5 patients (31.3%), with 2 (12.5%) flap-related and 3 (18.8%) non-flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042). This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study.

Groin wound infections in patients undergoing vascular procedures often cause a lengthy process of wound healing. Several clinical studies and case reports show a reduction of surgical site infections (SSIs) in various wound types after using closed incision negative pressure therapy (ciNPT). The aim of this prospective, randomised, single‐institution study was to investigate the effectiveness of ciNPT (PREVENA™ Therapy) compared to conventional therapy on groin incisions after vascular surgery. From 1 February to 30 October 2015, 100 patients with 129 groin incisions were analysed. Patients were randomised and treated with either ciNPT (n = 58 groins) or the control dressing (n = 71 groins). ciNPT was applied intraoperatively and removed on days 5–7 postoperatively. The control group received a conventional adhesive plaster. Wound evaluation based on the Szilagyi classification took place postoperatively on days 5–7 and 30. Compared to the control group, the ciNPT group showed a significant reduction in wound complications (P < 0·0005) after both wound evaluation periods and in revision surgeries (P = 0·022) until 30 days postoperatively. Subgroup analysis revealed that ciNPT had a significant effect on almost all examined risk factors for wound healing. ciNPT significantly reduced the incidence of incision complications and revision procedures after vascular surgery.

Analysis of wound healing time and wound-free period as outcomes after surgical and endovascular revascularization for critical lower limb ischemia

BackgroundTraditional end points, such as amputation-free survival, used to assess the clinical effectiveness of lower limb revascularization have shortcomings because they do not account independently for wound nonhealing and recurrence or patient survival. Wound healing process and maintenance of a wound-free state after revascularization were not well-studied. The aim of this study was to elucidate the long-term clinical course of ischemic wounds after revascularization. We focused on initial wound healing process as well as the maintenance of a wound-free state after achievement of wound healing. We introduced a wound-free period (WFP; the period during which limbs maintained an ulcer-free state) and Wound Recurrence and Amputation-free Survival (WRAFS) as parameters and tested their effectiveness in evaluating clinical outcomes of limbs treated using endovascular therapy (EVT) and surgical revascularization. MethodsThe medical records of patients developing lower critical limb ischemia with tissue loss who underwent surgical or endovascular revascularization of the infrainguinal vessels between 2009 and 2013 were reviewed retrospectively. The risk factors for achieving wound healing and WRAFS were analyzed using Kaplan-Meier survival curves and Cox regression model. Risk factors to prolong wound healing time (WHT) and reduce WFP were determined by the least squares method. ResultsIn total, 233 patients underwent 278 limb revascularizations; 138 endovascular and 140 surgical procedures were performed as first treatments. The proportion of healed wounds 1, 2, and 3 years after primary revascularization was 64.0%, 69.7%, and 70.5%, respectively. Significant risk factors for wound healing were an EVT-first strategy (risk ratio [RR], 2.47), congestive heart failure (RR, 2.05), and wound, ischemia, and foot infection wound grade (RR, 1.59). The mean WHT was 143.7 days. An EVT-first strategy and wound infection contributed to significantly longer WHT. The mean WFP was 711.0 days. An EVT-first strategy, history of coronary artery disease, and dialysis dependence were associated with significantly shorter WFPs. WRAFS at 1 and 2 years after achievement of wound healing were 76.9% and 64.2%, respectively. Significant risk factors against WRAFS were a history of coronary artery disease (RR, 1.68), dialysis dependence (RR, 2.03), and being wheel chair bound (RR, 1.64). ConclusionsEVT revascularization was associated with longer WHT, reduced wound healing rate, and a shorter WFP compared with surgical revascularization. wound, ischemia, and foot infection grade was associated with longer WHT and reduced wound healing rate, but not associated with a shorter WFP. Systemic conditions such as dialysis dependence, congestive heart failure, and being wheel chair bound were associated with reduced wound healing rate and shorter WFP, presumably because they limited life expectancy. WHT and WFP are useful criteria for evaluating limb outcomes in patients with critical limb ischemia.

Analysis of risk factors of pressure ulcer healing

Objective To investigate the risk factors of wound healing 30 days after treatment in patients with pressure ulcer. Methods Two hundred and forty-five hospitalized patients with pressure ulcer between January 2015 and October 2016 were selected. They were divided into the healed group and the unhealed group 30 days after the treatment. The influencing factors 13 indexes including age, gender, edema, the number of diseases, the number of pressure ulcer, the size of pressure ulcer, PUSH score (Pressure Ulcer Scale Healing), hemoglobin, serum albumin, low density lipoprotein cholesterol and blood homocysteine underwent single factor and Logistic regression analysis. Results Single factor analysis of 12 indicators of risk factors affecting healing were age, Hb, Alb, Hcy, area of ulcer and PUSH scores of the 6 indicators in the regression equation (Z=3.11-6.63, All P < 0.01), gender also entered the regression equation (χ2 = 0.19, P < 0.01); further multivariate regression analysis showed that there were statistically significant differences in PUSH score index (χ2=10.47, P<0.01, OR=0.001, 95% confidence interval were 0.001-0.037). Conclusions Age, gender, Hb, Alb, Hcy and PU area were the risk factors of pressure ulcer healing. Key words: Pressure ulcer; Pressure ulcer scale healing; Wound healing; Regression analysis

Pedicled omental flaps in the treatment of complex spinal wounds after en bloc resection of spine tumors

The present paper presents a retrospective study of 5 patients who underwent pedicled omental flap procedure following spine tumor removal. Postoperative wound dehiscence represents a major complication in spinal surgery, particularly after en bloc tumor resection, because of the extended sacrifice of soft tissues and adjuvant radiation therapy and chemotherapy. Five patients, with a mean age of 52 years (range, 24-71 years), who underwent omental flaps for the treatment of postoperative complication in spine tumor resections were retrospectively evaluated. Four of 5 patients underwent omental transposition after a mean of 15 months (range, 4-27) from the previous surgery because of dehiscence of the wound (all of them had cerebrospinal fluid leak: 1 transpleural and in 3 cases, associated with deep infection), whereas one patient underwent the omental flap procedure at the time of elective spinal surgery because of several contemporary risk factors for wound healing. At the time of discharge after a mean of 36 days (range, 23-53), all patients had well-healed surgical wounds with an acceptable structural and aesthetic result. One of the patients had ileus, requiring surgical lysis of abdominal adhesions 3 months after omentum flap procedure. No other complications were observed. Our data suggest that pedicled omental flap is a viable option for the treatment of complicated spinal wounds, helping in the resolution of the infection and CSF leak.

Complications, hospital length of stay, and readmission after total laryngectomy.

The purpose of this study was to describe the 30-day incidence of complications after total laryngectomy (TL) in a high-volume institution and their impact on the hospital length of stay (LOS) and readmission rates. A retrospective cohort study of all patients who underwent TL at The University of Texas MD Anderson Cancer Center from January 1, 2010 through June 30, 2013 was conducted. The patient demographics, treatment history, LOS, and 30-day post-TL complications and readmissions were extracted from the medical record. Univariate associations were analyzed, and stepwise backward selection methods were used to fit multivariate models. Two hundred forty-five patients were included. Complications occurred in 83 patients (33.9%) and included 3 deaths (1.2%). Wound complications occurred in 53 patients (21.6%), and 34 were pharyngocutaneous fistulas (PCFs; 13.9% overall). Thirty-four patients (13.9%) were readmitted within 30 days. A multivariate analysis revealed the following: wound complications were associated with former (odds ratio [OR], 5.1; P = .03) and current smokers (OR, 5.8; P = .02), PCFs were associated with prior wide-field radiation (OR, 3.1; P = .01) but not prior narrow-field (larynx-only) radiation (OR, 1.4; P = .61), LOS was associated with the type of flap (P = .002) and postoperative hematomas (P = .05), and readmissions were associated with preoperative hypoalbuminemia (P = .003) and postoperative wound complications (P < .001). Complications occurred in approximately one-third of TL patients and particularly in patients with poor wound-healing risk factors such as prior smoking and radiation. As expected, LOS was longer among reconstructed patients. Readmission was associated with hypoalbuminemia and postoperative wound complications. These data can inform quality improvement efforts and the counseling of high-risk patients undergoing TL. Cancer 2017;123:1760-1767. © 2016 American Cancer Society.