Risk Of Wound Healing Problems Research Articles

Effects of Comorbidities on the Inferior Pedicle Reduction Mammaplasty: A Statistical Analysis.

Multiple studies have analyzed the impact of comorbidities on breast reduction surgery with mixed results. The purpose of this investigation was to perform a statistical analysis of all complications by a single surgeon, using a single technique for breast reduction. Records of patients undergoing breast reduction from 1984 to 2019 with an inferior pedicle were reviewed. Comorbidities analyzed included hypertension, diabetes, nicotine use, weight of breast tissue resected, pedicle length, and basal metabolic index. The literature on the effects of comorbidities on outcomes for breast reconstruction was also reviewed. Although increasing body mass index significantly increased the rate of fat necrosis, it did not impact those patients requiring reoperation for this complication. Body mass index greater than 35 kg/m 2 , weight of tissue resection greater than 1000 g, and nipple-to-inframammary fold distance greater than 20 cm all increased the odds ratio of having a breast with some fat necrosis. Increasing body mass index increased the risk of wound healing problems (both major and minor), but not for patients requiring reoperation. Body mass index greater than 35 kg/m 2 , breast tissue resection greater than 1000 g, and nipple-to-inframammary fold distance greater than 20 cm only minimally increased the odds ratio for a major wound complication. Patients with increased body mass index are at greater risk for fat necrosis and wound healing complications. However, these usually can be managed conservatively in patients undergoing inferior pedicle breast reduction. Patients do not require free nipple grafting. The use of nicotine or the presence of diabetes or hypertension does not impact outcome. Risk, III.

Longitudinal Plantar Approach for Excision of Morton's Neuroma: Long-Term Results

Longitudinal plantar approaches are generally considered at risk for wound healing problems. Thus, we wanted to investigate long-term outcomes after a primary Morton's neuroma excision through a longitudinal plantar approach. A retrospective study of patients with primary neuroma excision was conducted. Twenty-four patients (28 feet) were evaluated at a mean 9-year follow-up (range, 6-14) by a single trained examiner using a specific postoperative evaluation protocol, including AOFAS Forefoot subjective and objective scores. Good-to-excellent outcomes were reported in 25 (89.3%) cases. A hypertrophic scar formation and keratosis occurred in only 2 cases (7.1%). All the patients, with a single exception, achieved full weightbearing with a postoperative shoe from the first day after the operation. A longitudinal plantar approach can lead to long-term, good-to-excellent outcomes with no case of recurrence or reoperation. Accurate wound closure and immediate weightbearing with a postoperative shoe can minimize the rate of complications. This approach should be considered for primary resection of Morton's neuromas.

Comparative Results of Percutaneous Calcaneal Osteotomy in Correction of Hindfoot Deformities

Category:HindfootIntroduction/Purpose:Calcaneal osteotomies are often required in correction of hindfoot deformities. The traditional open techniques as lateral or oblique incision are occasionally associated with wound healing problems and neurovascular injury.Methods:In a prospective study 122 consecutive patients who underwent a calcaneal osteotomy for hindfoot realignment treatment were included. 58 patients were operated using an open incision technique and 64 patients with 66 feet using a percutaneous technique. Clinical and radiological assessments were performed preoperatively, six weeks and one year postoperatively.Results:The AOFAS score and VAS improved in both groups postoperatively. The difference was not significant. The results of the radiological measurements pre- and postoperatively were not significantly different. No pseudarthrosis occurred in both groups. The comparison of both groups showed a significant lesser risk for wound healing problems in percutaneous group (B). The hospitalisation time was significantly shorter in the percutaneous group.Conclusion:Due to the excellent results with the percutaneous calcaneal osteotomy the authors feel encouraged to establish this procedure as a standard technique for calcaneus osteotomy at our clinic.

Minimally invasive components of the treatment of tibialis posterior insufficiency in adults : Tendoscopy of the Achilles tendon, minimally invasive calcaneus displacement osteotomy and the sinus tarsi spacer

Minimally invasive medializing calcaneal osteotomy, the implantation of atarsi spacer and the tendoscopy of the posterior tibial tendon have been established as treatment options for tibialis posterior insufficiency gradeII. The minimally invasive medializing calcaneal osteotomy allows acorrection of the hindfoot valgus like an open procedure with asignificantly lower risk of wound healing problems. It has gained increasing popularity within recent years. There is also good evidence for arthroereisis, with the use of the sinus tarsi spacer being primarily an addition to calcaneus sliding osteotomy. The possibilities for tendoscopy of the posterior tibial tendon are limited to debridement and synovectomy. Various papers report minimally invasive alternatives to the strayer procedure for ashortened gastrocnemius muscle. The proximal lengthening of the medial head of the gastrocnemius muscle is particularly popular as asoft tissue-sparing, less traumatic procedure. So far, no reports of aminimally invasive cotton osteotomy have been found in the literature.

A percutaneous repair technique of closed Tendo-Achilles rupture using suture anchors and fiber wire prati technique a retrospective functional outcome study of 20 cases

Background: Achilles tendon is the strongest and thickest tendon in the human body. Rupture of the Achilles tendon usually occurs in middle-aged population following recreational activities. Incidence rate of these ruptures range from 6 to 18 per 100000 population. Several operative and non-operative treatment options are available. Operative methods include percutaneous, mini-open, open Achilles repair etc. Open repairs carry an increased risk of wound healing problems, whereas minimally invasive techniques are reported to have an increased risk of iatrogenic nerve injury. Materials and Methods: Twenty patients with acute closed traumatic Tendo Achilles rupture were operated using above mentioned technique between January 2010 to June 2017 in Bangalore out of which 15 were males and 5 were females. Patient was put on anterior below knee slab in plantar flexion of the foot for 2 weeks followed by walking below knee cast for 4 weeks. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year following surgery and complications if any were observed. Postoperative AOFAS ankle – hindfoot score was taken at last follow up. Result: Percutaneous Tendo Achilles repair has a good outcome in 90% of the cases. There was one case with complication. The complication was sural nerve hypoesthesia but with no functional disability. The average AOFAS score was 89% (76-92) in which 65% (13) were considered excellent, 30% (6) were considered good and 05% (1) were considered fair outcome. There were no re-ruptures. Conclusion: We present our technique of percutaneous Tendo Achilles repair which has minimal wound and nerve injury complications, early return to activities with a good functional outcome, distal bony fixation with the use of suture anchors reducing the number of suture-tendon interfaces which in turn reduces the chance of failure. It also decreases overall operative time. However further studies are required.

Implant Based Breast Reconstruction With Acellular Dermal Matrix: Safety Data From an Open-label, Multicenter, Randomized, Controlled Trial in the Setting of Breast Cancer Treatment.

To evaluate clinical outcomes of using acellular dermal matrix (ADM) with implant based breast reconstructions (IBBRs) in a randomized controlled trial. The use of ADMs in IBBRs is widespread, but link between ADM and complications remain a controversial topic. In view of reports concerning harm, we present 6-months safety data of ADM-assisted IBBR in the setting of breast cancer treatment. An open-label, randomized, controlled trial recruiting patients from 4 centers in Sweden and 1 in UK. Eligible were women with breast cancer planned for mastectomy with immediate IBBR. Participants were randomly allocated to IBBR with or without ADM (Strattice, Branchburg, NJ), with stratification by center in blocks of 6. Main primary endpoint was number of unplanned reoperations at 24 months, and safety expressed as the incidence of adverse events with a 6-month follow-up time for all participants. Analysis were done per protocol using Fisher exact test for complications and reoperations. From start of enrolment on April 24, 2014, to close of trial on May 10, 2017, 135 women were enrolled, of whom 64 with ADM and 65 without ADM were included in the final analysis. Four patients (6%) in each group had reconstructive failure with implant loss, but IBBR with ADM exhibited a trend of more overall complications and reoperations (difference 0·16, 95% CI, -0·01 to 0·32, P = 0·070), and with higher risk of wound healing problems (P = 0·013). With 6-months follow-up for all participants, immediate IBBR with ADM carried a risk of implant loss equal to conventional IBBR without ADM, but was associated with more adverse outcomes requiring surgical intervention. Further investigation of risk factors and patient selection in a long-term follow-up is warranted.

Evaluation of neck node response after radiotherapy: minimizing equivocal results

About two-thirds of patients with head and neck squamous cell carcinoma(HNSCC)originatingfromthemucosal linings of the upper aerodigestive tract present with advanced stage disease. If the primary tumour is located in the pharynx or larynx, patients are generally treated with radiotherapy with or without chemotherapy. In patients with functionally unresectable HNSCC (resectable but high morbidity of surgical treatment expected) who are treated with this nonsurgical treatment, salvage surgery is kept in reserve in case residual disease occurs. The decision to perform a neck dissection following (chemo)radiotherapy isclear whenpatientshaveprovenresidual nodal disease in the neck. However, distinguishing between residual metastasis and radiotherapy sequelae is difficult in most patients with a residual neck mass, since posttreatment induration and fibrosis make accurate clinical assessment difficult. Because no reliable clinical parameters are available to predict pathological neck status after (chemo)radiotherapy, routine planned neck dissection is performed in many institutions. The integration of planned neck dissection into the multidisciplinary management of patients with locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy is highly effective in controlling residual neck nodal disease. However, in the majority of neck dissection specimens, no viable tumour cells are found. Moreover, neck dissection after radiotherapy is associated with a significant risk of wound healing problems and shoulder morbidity. On the other hand, late recurrences in the neck are rarely surgically salvageable and are associated with an increased risk of metastatic spread to distant sites. Therefore, early detection of residual neck disease after (chemo)radiotherapy is important [1–4].

Medial Achilles tendon island flap—a novel technique to treat reruptures and neglected ruptures of the Achilles tendon

There is a strong consensus for surgical treatment of reruptures and neglected ruptures of the Achilles tendon. A number of different surgical techniques have been described and several of these methods include extensive surgical exposure to the calf and technically demanding tendon transfers. The overall risk of complications is high and in particular the risk for wound healing problems, which are triggered by an increased tension in the skin when inserting a bulky graft to cover the rupture. In order to reduce the risk for wound healing problems a new, less complicated surgical technique was developed, as described in this study. Nine consecutive patients (including six chronic ruptures and three reruptures) with complicating co-morbidities and with a tendon defect between three and eight centimetres were operated upon using the described novel technique. Patient-reported functional outcome was reported after two to eight years. All tendon defects were successfully repaired. Neither early nor late surgical complications occurred. High patient satisfaction was reported for all patients. The new surgical technique with a medial Achilles tendon island flap seems to be safe and results in a good patient reported outcome.

Leg ulcer treatment

Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.

Oxygen tensiometry as a predictor of wound healing in total ankle arthroplasty

Total ankle arthroplasty (TAA) typically involves an anterior approach to the ankle that has been shown to have a risk for wound healing problems. We explored the possibility of using oxygen tensiometry as a predictor of incision healing problems in patients undergoing TAA. The study included 25 patients who underwent TAA with the Scandinavian Total Ankle Replacement (STAR) system at our institution during a three-year period. Transcutaneous oxygen measurements of both ankles were obtained postoperatively to determine whether the results of transcutaneous oxygen tensiometry correlated with wound healing problems. Patients with wound healing problems were compared with those who had an uneventful incision healing. Seven patients (28%) had wound healing problems after TAA, and five patients (20%) had early wound erythema. Wound healing problems included delayed healing in five patients and dehiscence in two patients. Three patients had transcutaneous oxygen tension of less than 40 mmHg (a threshold for impaired skin oxygenation) on the operative side, of whom one had healing difficulty whereas two did not. When the threshold was extended to 50 mmHg, seven patients (28%) had low readings, two having wound healing problems. There was no significant difference with respect to oxygen measurements between patients with and without wound healing problems (p=0.3). Oxygen tensiometry is not thought to be useful for predicting patients at risk for postoperative wound healing complications after TAA, suggesting that, if adequate pulses are present before surgery, the trauma of using excessive superficial traction on the skin during surgery is more responsible for wound healing problems than the underlying blood supply.

Wound healing problems in smokers and nonsmokers after 132 abdominoplasties.

To study the effects of smoking on wound healing, the authors retrospectively analyzed the records of 132 patients (121 women and 11 men) who had undergone abdominoplasty in the previous 5 years. All patients had received a full abdominoplasty, with large mobilization up to the ribs and a belly transposition. Patients were excluded from the study if they had arteriosclerosis, diabetes mellitus, or other systemic diseases, and if they had received a simple pannus resection without a belly transposition. The following study parameters were taken for analysis: age at the time of operation, body mass index, preoperative weight loss, amount of resection, and smoking habits indicated by the patients preoperatively. Smokers were interviewed by telephone postoperatively concerning their perioperative smoking habits. Wound healing problems were registered when medical intervention was necessary, such as débridement, treatment for infection, lavage after fat necrosis, or a secondary skin closure after skin slough. Hematoma and seroma were not considered to be wound healing problems and were registered separately. Among the 132 patients, 53.8 percent admitted to smoking and 46.2 percent reported being nonsmokers. No significant difference was seen between smokers and nonsmokers concerning age or body mass index. Smokers reported consuming, on average, 18.4 cigarettes per day. The rate of wound problems and wound dehiscence showed a statistical difference between smokers and nonsmokers (p < 0.01); 47.9 percent of the smokers showed wound healing problems before hospital discharge versus 14.8 percent of the nonsmokers. The patients had been asked to quit smoking 2 weeks before the operation through 2 weeks postoperatively. The retrospective telephone inquiry found that just 14.7 percent stopped smoking preoperatively and only 41.2 percent quit temporarily after the operation. Smokers should be informed about their possible higher risk of wound healing problems. Because it seems impossible to turn smokers into nonsmokers, the authors continue to perform abdominoplasties in smokers. During the operation, they try to mobilize and resect less tissue and to immobilize patients for the critical first 3 postoperative days to prevent them from smoking.

The treatment of tibial plafond fractures with external fixation: closed or limited open reduction technique

Objectives: To evaluate the results of treatment for tibial plafond fractures with the use of external fixation with closed or limited open reduction. Methods: Twenty-two fractures of 21 patients (14 males, 7 females; mean age 28.2 years; range 19 to 52 years) were evaluated. According to the Ruedi and Allgower classification, the types of fractures were I, II, and III in four, four, and 14 patients, respectively. Four patients had grade I, four had grade II, and five had grade III open fractures. The tibial joint surface restoration was made by limited open reduction and minimal osteosynthesis (n=7); and fibular restoration with tubular plates (n=4), and Rush pins (n=6). The fixators were circular (n=8), monolateral (n=10), and hybrid (n=4). Primary otogeneous bone grafting was performed in four cases with metaphyseal bone defect, and skin grafting for soft tissue coverage in two cases. The results were evaluated according to the Teeny criteria. The mean duration for external fixation was nine weeks (6 to 15 weeks); the mean follow-up was 27 months (6 to 48 months). Results: The results were excellent in five cases, good in five, fair in seven, and poor in five cases. Bone and soft tissue infections were not encountered. Complications included skin slought (n=3), malunion having more than 5° tilt on the tibial joint surface (n=4), and post-traumatic osteoarthrosis that required ankle arthrodesis (n=1). Conclusion: Treatment with external fixators with limited open reduction or closed reduction is safe and effective in high energy fractures that may present an increased risk for wound healing problems when treated by the traditional method.

Long-term results of total knee arthroplasty after the use of soft tissue expanders.

The success of total knee arthroplasty can be jeopardized by poor wound healing. In the current study, the results of knee arthroplasty after soft tissue expansion were reviewed retrospectively in 27 patients (29 knees) at risk for problematic healing. The incidence of wound complications was recorded for all patients after the expansion procedure and the arthroplasty. A Knee Society score also was calculated at the latest evaluation. Minor wound complications occurred after 21% (six of 29) of the tissue expansion procedures and after 18% (five of 28) of the subsequent arthroplasties. One major wound complication occurred during tissue expansion necessitating abandonment of the planned arthroplasty. No major wound complications occurred in those patients who underwent knee arthroplasty. At an average followup of 34.4 months, the average Knee Society score was 83.7 points. The results of the current study show that the technique of soft tissue expansion before total knee arthroplasty in patients at high risk for wound healing problems can successfully prevent catastrophic wound complications after the arthroplasty procedure and can avoid the need for disfiguring soft tissue reconstructions.

Smoking

Smoking is known to have a potentially adverse effect on the outcomes of plastic surgical procedures and, in particular, on wound healing. Numerous clinical studies have substantiated that cigarette smokers are at increased risk for wound healing problems. Cigarette smoke contains a number of toxic products. Of these toxins, nicotine has been studied in detail and is known to inhibit macrophages and fibroblasts, potentiate vascular thrombosis, and cause vasoconstriction. Carbon monoxide combines with hemoglobin to form carboxyhemoglobin, which reduces oxygen availability to tissues. When operating on cigarette smokers a few options exist that may improve outcomes: less undermining with rhytidectomy; sympathetic blockades; limited use of alternate nicotine sources; and of course smoking cessation, which is ideal.