Secondary Wound Research Articles

Innovations in Gritti-Stokes Amputation: A Focused Analysis of Immobile Patient Outcomes.

Background Major lower limb amputation is a surgical operation performed for different reasons, including life-threatening infection, ischemia, trauma, and tumors. This study aims to investigate the viability of Gritti-Stokes amputation as a suitable alternative for individuals with impaired mobility and peripheral vascular disease. Patients and methods This was a descriptive, retrospective, and observational study. All patients who met the criteria and underwent Gritti-Stokes amputation were included. The study had a duration of one year, commencing in December 2022 and concluding in December 2023. The data was processed using statistical software (SPSS, version 21; IBM Corp., Armonk, NY, US). Results Twenty-four patients were included. Concerning the complications, 16 patients (66.7%) did not experience any complications, while 7 patients (29.2%) had stump infections. Three of them ultimately required more extensive amputation. A phantom limb was observed in a single patient, accounting for a mere 4.2% of the total. Total of 21 patients, 87.5% reported great stability and lever motion when transitioning from bed to chair, as well as vice versa. Furthermore, wound healing was observed in 21 individuals (87.5%), encompassing both primary and secondary wound healing. Conclusion The Gritti-Stokes amputation provides patients with excellent stability and lever function to facilitate movement. The Gritti-Stokes amputation is a suitableoption for immobile and high-risk patients.

Can we use superglues for superfi cial lacerations?

Objectives: To compare the histopathological and cosmetic outcomes of ethyl-cyanoacrylate to n-butyl-2-cyanoacrylate in rats using an incision wound model. Methods: Two longitudinal incisions were made on the dorsal region of the back of 18 Wistar rats after ketamine anesthesia. Rats were divided into three groups of six: the incisions were closed either using medical tissue adhesive or superglue or were left for secondary wound healing. In each group, three rats were randomly euthanized on the 7th day. The rest were euthanized on the 21st day of the procedure. Tissue samples taken on days 7 and 21 were Histopathologically evaluated blindly by a histologist. The cosmetic appearance was evaluated by a plastic surgeon blinded to the method of closure using a visual analog scale. Results: Histopathological evaluation revealed impaired epithelialization, infl ammation, fi brosis, and dehiscence on connective tissue, and foreign substance reactions were worse in the ethyl-2-cyanoacrylate group when compared with the other groups. A statistically signifi cant diff erence was not found among groups regarding the cosmetic outcome. Conclusions: Cyanoacrylate glues produced for commercial purposes should not be used for the repair of skin lacerations due to their worse histopathological results of epithelialization, infl ammation, fi brosis, dehiscence on connective tissue, and foreign substance reaction. Keywords: Lacerations, Wound closure techniques, Tissue adhesives, Cyanoacrylates, Wound healing.

Secondary Healing Following Trauma-Induced Partial Glossectomy: Case Report of an Arabian Horse

The tongue serves as an organ of food prehension, mastication, grooming, deglutition, taste, and vocalization, and is suspected to play a role in upper airway stability. A seven-year-old riding horse, weighing 350 kg and employed for load-carrying purposes, was brought to Atatürk University Faculty of Veterinary Medicine Hospital due to a transversal injury in the rostral part of the tongue caused by trauma from the bridle's rope. During the general examination, it was observed that the tongue protruded outside the mouth, there was a presence of necrotic odor, paralysis in the apex lingualis region, and bloodstains on the mouth corner and front limbs. After the removal of the tongue tissue, debridement of the necrotic areas in the remaining caudal portion was performed, and it was left for secondary wound healing. Postoperatively, intramuscular injections of 200,000 IU benzylpenicillin procaine were administered every 24 hours for 7 days, along with flunixin meglumine given for 3 days. Additionally, a 0.12% chlorhexidine gluconate solution was used as an oral antiseptic three times daily for a duration of 7 days. Daily phone calls were made to the patient owner to inquire about the overall condition of the patient. Upon the follow-up appointment on the seventh day, improvement in the healing of the tongue was observed.

Immersive Virtual Reality for Pain and Anxiety Management Associated with Medical Procedures in Children and Adolescents: A Systematic Review.

(1) Objectives: The purpose of this study was to investigate the studies that evaluate the effectiveness of immersive virtual reality (VR) as a distraction technique for pain and anxiety associated with medical procedures in children and adolescents. (2) The methods involved a systematic review of randomized controlled trials retrieved from databases in health sciences (Pubmed, CINHAL, Scopus, WOS, ProQuest, Cuiden Plus, InDICEs-CSIC). PRISMA guidelines were followed. (3) Results: Twelve trials were included. Four involved venipuncture, four involved surgical procedures, one involved vaccination, one involved burn care, one involved secondary wound closure, and the last one involved subcutaneous port access. (4) Discussion: Children who undergo medical procedures often experience pain and anxiety, which affects their physical condition and their relationships with caregivers and health professionals. Immersive VR is an effective alternative to medications to help in these cases. No author found statistically significant differences against the use of VR for distraction and palliation of pain and anxiety, which seems to be more effective at a younger age. It is important to personalize the immersive VR experience and equipment. (5) Conclusions: VR, when used with analgesics and anesthetics, appears effective in managing pain and distress caused by medical procedures.

Temporary diverting loop ileostomy in Crohn's disease surgery; indications and outcome.

Crohn's disease can present with complex surgical pathologies, posing a significant risk of morbidity and mortality for patients. The implementation of a loop ileostomy for selected patients may help minimize associated risks. In this retrospective cohort study, we investigated the utilization of temporary fecal diversion through the creation of a loop ileostomy in Crohn's surgery. Closure of all ostomies involved a hand-sewn single-layer technique. We then conducted bivariate analysis on 30-day outcomes for closures, focusing on favorable recovery defined as the restoration of bowel continuity without the occurrence of two challenges in recovery: newly developed organ dysfunction or the necessity for reoperation. In total, 168 patients were included. The median age of the patients was 38 years (IQR 27-51). The most common indication for a loop ostomy was peritonitis (49%). After ileostomy closure, 163 patients (97%) achieved favorable recovery, while five encountered challenges; four (2.4%) underwent abdominal surgery, and one (0.6%) developed acute renal failure requiring dialysis. Two patients (1.2%) had a re-creation of ileostomy. Patients encountering challenges were older (56 [IQR 41-61] vs. 37 [IQR 27-50]; p 0.039) and more often required secondary intention wound healing (40% vs. 6.7%; p 0.049) and postoperative parenteral nutrition following their index surgery (83% vs. 26%; p 0.006). Selectively staging the Crohn's disease operations with a loop ileostomy is a reliable practice with low morbidity and high restoration rates of bowel continuity. Our hand-sewn single-layer technique proves effective in achieving successful surgical recovery.

Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis.

Pilonidal sinus disease impacts patient's quality of life. In the Netherlands, it is often treated with excision and secondary healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates. The present study aims to compare successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift. This is a multicenter retrospective study. Three institutions in the Rotterdam region of the Netherlands participated in the study. Patients who underwent excision with secondary healing or Bascom Cleft Lift between July 2015 and August 2021 were included. Primary endpoints included the rate of successful wound healing and the time to achieve healing. Secondary endpoints included postoperative complications and recurrence rate within twelve months after surgery. Out of 272 patients, 128 underwent Bascom cleft lift and 144 patients excision and secondary healing. Recurrent PSD (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. Wound healing was 84.4% after Bascom cleft lift vs. 32.6% after excision and secondary healing (p < 0.001), with median time to wound healing of 55 days and 101 days, respectively (p < 0.001). Complications were 28.9% for Bascom cleft lift vs. 13.2% for excision and secondary healing (p = 0.003). Recurrent disease was 6.3% after Bascom Cleft Lift and 11.8% after excision and secondary healing (p = 0.113). It has a retrospective design which makes it prone to selection bias and residual confounding. Additionally, the study's short follow-up period further adds to these limitations as longer follow-up may better identify true recurrence rates. Finally, a deficiency is the absence of collected patient satisfaction data, which is nowadays a common scientific issue. This retrospective study shows that Bascom cleft lift is superior to excision and secondary healing given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract.

DS06 A multicentre qualitative study of patient perceptions and experiences with secondary intention wound healing and skin grafting

DS06 A multicentre qualitative study of patient perceptions and experiences with secondary intention wound healing and skin grafting

Peceleganan Spray for the Treatment of Skin Wound Infections

Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear. To assess the safety and efficacy of peceleganan spray for the treatment of wound infections. This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022. Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189). The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions. Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar. This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain. Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Design of chitosan-based drug-loaded laminated materials with superhydrophilic/superhydrophobic properties for simultaneous effective hemostasis and antiadhesion

Hemostatic materials play a crucial role in trauma medicine. However, existing materials have poor hemostatic efficacy and a tendency to adhere to the wound surface, limiting their clinical effectiveness. Herein, a drug-loaded, superhydrophilic/superhydrophobic laminated material (DSLM), consisting of a superhydrophobic inner layer with a micropore array, a superhydrophilic chitosan-based sponge layer loaded with hemostatic/antimicrobial drugs, and a superhydrophobic outer layer, was developed. Furthermore, the DSLM allows unidirectional flow of blood and exudates from the wound bed through the superhydrophobic inner layer while facilitating efficient drug delivery. In addition, it possesses excellent biocompatibility and antiadhesion properties, as confirmed by in vivo and in vitro experiments. Compared with traditional hemostatic materials, the DSLM remarkably increased the survival time by over threefold in the acute femoral transaction wound bleeding model, and simultaneously prevented secondary wound damage by reducing peeling force to one-eighth incomparison to pristine gauze. The DSLM holds promise as a versatile clinical biomaterial for prehospital acute trauma treatment, with its simple structure facilitating manufacturing and expanding applications in biomedicine.

Primary vs. secondary wound closure following transvenous system explantation in CIED infection

Abstract Background &amp; Introduction Patients undergoing an explantation of cardiac implantable electronic devices (CIED) receive either a primary or secondary wound closure or open wound treatment depending on departmental practice. To date, there is limited data on whether secondary wound closure or open wound treatment has any benefit in terms of future complications although it requires a more intensive wound care. Material &amp; Methods Patients who underwent CIED explantation for system infection at our institution between 2016 and 2022 were retrospectively reviewed. From this cohort, patients diagnosed with pocket infection were isolated and divided into two groups: (i) Patients who underwent primary wound closure with or without temporary use of a drain (PG), and (ii) patients who underwent secondary wound closure or open wound management (SG). Patients were followed up by telephone contact for short and long term complications. Results 387 patients underwent CIED explantation due to local or system infection at a heart centre. Of this cohort, 205 patients (135 female; 74.4 ±11.4 y.o.) had a pocket infection. In addition to local infection, 25.9% of all patients presented with a pocket perforation. The onset of infection was early (within 28 days) in 16.1%, intermediate (29 days - 1 year) in 50.2% and late (after 1 year) in 33.2%. Wound swabs and blood cultures were positive for pathogens in 61.0% and 14.1% respectively. 136 (65.9%) underwent primary wound closure, 69 (34.1%) underwent secondary wound closure or open wound management. Post-operative (p.o.) hematoma was present in 12.2% of the cases (6.6% of PG and 24.6% of SG). The risk of developing a p.o. hematoma was significantly more likely in the SG (OR=4.61; IC95%: 1.93 − 11.01). Re-implantation occurred in 70.2%, including 25.7% of leadless pacemakers an 1.5% subcutaneous defibrillators. In 13.7% re-implantation was not indicated, 4.4% refused and 1.0% had contraindications. Mean length of hospitalization was 12.4 ±8.9 days in the PG and 15.7 ±9.6 days in the SG (ρ = 0.0083). A total of 24 (34.8%) patients were discharged with an open wound with or without vacuum treatment (0.74% of PG; 34.8% of SG). Mean telephonic follow-up was 27 ±18 months in 147 cases (n1 = 99; n2 = 48). 91.8% of the cases had no pathological findings at follow-up. 2.7% developed a wound healing disorder (WHD) which was treated conservatively, 4.1% required revision, 0.7% explantation and 0.7% endocarditis. No statistical difference of complication risk between both groups was found (OR=1.8; IC95%: 0.51 - 6.17). Summary &amp; Conclusions Management of CIED pocket infection with primary wound closure compared to secondary wound closure showed a statistically significant shorter hospital stay and reduced likelihood of post-operative hematoma, with no increase in long-term complication rates.

Limited debridement combined with ReCell® Techniques for deep second-degree burns.

The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep second-degree burn wounds. A total of 20 patients suffered with deep second-degree burns less than 10% of total body surface area (TBSA) who were admitted to our department, from June 2019 to June 2021, participated in this study. These patients first underwent limited debridement with an electric/pneumatic dermatome, followed by the ReCell® technique for secondary wounds. Routine treatment was applied to prevent scarring after the wound healed. Clinical outcomes were scored using the Vancouver Scar Scale (VSS). All wounds of the patients healed completely. One patient developed an infection in the skin graft area and finally recovered by routine dressing changes. The average healing time was 12 days (range: 10-15 days). The new skin in the treated area was soft and matched the colour of the surrounding normal skin and the VSS score ranged from 3~5 for each patient. Of the 20 patients, 19 were very satisfied and 1 was satisfied. This article reports a useful treatment method that combines electric dermatome-dependent limited debridement and the ReCell® technique for the treatment of deep second-degree burn wounds. It is a feasible and effective strategy that is easy to implement and minimally invasive, and it is associated with a short healing time, mild scar formation and little damage to the donor skin area.

Mind the gap! Interdisciplinary approach to anterior chest wall reconstruction after total sternectomy

BackgroundThere are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery.MethodsFour patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center.ResultsAll patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up.ConclusionsWe recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry.

Analysis of Factors Influencing Trauma Healing in Children with Second-Degree Burns: A Single-Center Retrospective Study

Background: The complexity of studying secondary burn wound healing in children arises from the varying ability of skin tissue regeneration across different ages. Despite advancements, there are still gaps in our understanding. Objectives: This study aimed to explore factors influencing wound healing in children with second-degree burns to guide clinical treatment and nursing practices. Methods: We conducted a retrospective analysis of children with second-degree burns treated in our burn surgery department from January 2020 to December 2022. Based on the events per variable (EPV) rule, 220 children were included. They were categorized based on the quality of wound healing 14 days post-admission (good or poor), evaluated by the healing rate and scar formation. Children's clinical data were extracted from medical records for analysis. Binary logistic regression identified factors associated with poor healing outcomes in second-degree burns. Results: Among 220 patients with secondary burns, 166 (75.46%) experienced good wound healing, while 54 (24.54%) had poor outcomes. The Hosmer-Lemeshow test indicated a good model fit (χ2 = 9.739, P = 0.28). Significant variables included burn area (odds ratio [OR] = 1.217, 95% confidence interval [CI] = 1.109 - 1.335, P &lt; 0.05), number of drug changes (OR = 1.902, 95%CI = 1.392 - 2.599, P &lt; 0.05), white blood cell count (OR = 1.076, 95%CI = 1.008 - 1.150, P &lt; 0.05), neutrophil count (OR = 1.080, 95%CI = 1.018 - 1.146, P &lt; 0.05), and neutrophil ratio (OR = 1.040, 95%CI = 1.002 - 1.081, P &lt; 0.05). Conclusions: Effective treatment and nursing of children with second-degree burns should prioritize managing large burn areas and high levels of inflammatory markers. Additionally, minimizing drug changes during the nursing process can enhance wound healing in children.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial.

The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Peri-wound skin lesions of allergic nature

Peri-wound dermatoses are a fairly common occurrence in clinical practice. In general, they are all allergic in nature and occur on the skin around the surface area of both primary and postoperative wounds. Peri-wound skin lesions can develop as paratraumatic eczema, simple contact or allergic dermatitis. All these dermatoses can be complicated by a secondary bacterial or mycotic infection, both exogenous and endogenous, which significantly complicates the course of the dermatitis itself and wound healing. The patient is exposed to a fairly large number of potential allergens in the course of surgical care provided at all stages: both in the pre- and postoperative period, and during the surgical intervention. Among them may be drugs and antiseptics, surgical sutures, implants, and even latex gloves of healthcare practitioners in some cases. When it comes to potential allergens, foci of chronic infection in the patient’s body, as well as secondary wound infections should be noted as a separate matter. The presence of peri-wound dermatoses is the most common cause of delayed surgical debridement, and can also become an obstacle to surgical treatment and healing of the wound surface. In addition, pre-existing paratraumatic eczema can progress to a chronic course and contribute to the further spread of the inflammatory process. Thus, peri-wound dermatoses are a pressing interdisciplinary issue. Patients with peri-wound dermatoses require a personalized selection of combination therapy and additional consultative assistance from highly specialized doctors. Fixed-dose topical glucocorticoids combined with antibiotics and antimycotics may be the drugs of choice for patients with peri-wound eczematous process, with due account for complex pathogenetic effects and ease of use. The article describes clinical cases of dermatoses developed in surgical patients.

The effects of a synthetic epidermis spray on secondary intention wound healing in adult horses.

To evaluate secondary intention wound healing in the horse's limbs when treated with the synthetic epidermis spray (Novacika®, Cohesive S.A.S, France) or with a standard bandaging technique. Six Standardbred mares were included in the study. Four 2.5 x 2.5 cm full-thickness skin wounds were created on each thoracic limb. Two wounds were located on the dorsoproximal aspect of the cannon bone and the other two at the dorsoproximal aspect of the fetlock. Six hours after creation, wounds were randomly treated with synthetic epidermis spray or standard bandaging. The wounds were assessed every 4 days by gross visual assessment and using a 3D imaging camera. Analysis was performed with a 3D imaging application. Out of 46 wounds, 22 showed exuberant granulation tissue and were part of the standard bandaging group. Whether the wounds were treated with synthetic epidermis spray or standard bandaging, the time for healing was the same. The synthetic epidermis spray studied in this model has allowed healing without the production of exuberant granulation tissue but did not reduce the median wound healing time compared to a standard bandaging technique. The synthetic epidermis spray is potentially an interesting alternative for the management of secondary intention wound healing of superficial and non-infected distal limb wounds in adult horses on economical and practical aspects. However, all statistical inference (p-values especially) must be interpreted with caution, given the size of the sample.

Wound healing of the oral mucosa: process, factors affecting healing and complications

The oral mucosa is made up of an epithelium supported by the lamina propria and the submucosa. When the mucosa is damaged, wound healing is characterized by distinct, sequential phases. How does the healing process proceed? Both primary and secondary wound healing, encompasses haemostasis, inflammation, proliferation, and remodelling. Secondary healing also involves a granulation phase to cover the wound. Saliva and the oral microbiome play a role in the healing process, too. Smoking, certain systemic disorders and medication can have a negative effect on the healing process.

DermaClose: A Case Series in the Management of Large Soft Tissue Defects in Diabetic Foot Infection

Abstract: Diabetic foot infection poses a complex problem due to several interrelated issues, including rapidly spreading infection, poor vascular supply, and reduced healing ability. Management may require multiple operative procedures and prolonged treatment with a high risk of morbidity, such as amputation, and mortality. Debridement of infection commonly creates large wounds and soft tissue defects, with limited soft tissue reconstructive options due to adverse local and systemic factors. In this setting, treatment often consists of protracted periods of secondary wound healing by granulation, de-tensioning the tissues by removing bone, and minor or major amputation. Flaps and grafts may be considered but often carry unacceptable rates of failure. We present 3 cases in which DermaClose, an automated wound management system, was employed by a joint Orthopedic and Plastic Surgery team with excellent results and rapid closure of large soft tissue defects. Level of Evidence: Level IV.

Effect of right internal mammary artery versus radial artery as a second graft vessel in coronary artery bypass grafting on postoperative wound infection in patients: A meta-analysis.

Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta-analysis of observational studies starting in 2023, we looked at the effect of re-operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re-surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re-operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed-effect model of wound infection and re-operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re-operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients.

Novel Technique to Reconstruct Peri-Implant Keratinised Mucosa Width Using Xenogeneic Dermal Matrix. Clinical Case Series.

Reconstruction of sufficient buccal peri-implant keratinised mucosa width (PIKM-W) is reported to reduce the symptoms of peri-implantitis. In order to reduce the drawbacks of autogenous graft harvesting, we investigated a novel porcine dermal matrix (XDM, mucoderm®) using a modified surgical technique for augmentation of PIKM-W. Twenty-four patients were recruited with insufficient (<2 mm) PIKM-W. After split thickness flap preparation, the XDM was trimmed, rehydrated and tightly attached to the recipient periosteal bed using modified internal/external horizontal periosteal mattress sutures via secondary wound healing. Change of the PIKM-W and dimension of the graft remodelling were evaluated at 6 and 12 months postoperatively. The mean PIKM-W changed from 0.42 ± 0.47 to 3.17 ± 1.21 mm at 6 M and to 2.36 ± 1.34 mm at 12 M in the maxilla and from 0.29 ± 0.45 mm to 1.58 ± 1.44 mm at 6 M and to 1.08 ± 1.07 mm at 12 M in the mandible. Graft dimensions decreased by 67.7 ± 11.8% and 81.6 ± 16.6% at 6 M, and continued to 75.9 ± 13.9% and 87.4 ± 12.3% at 12 M, in the maxilla and mandible, respectively. Clinical parameters showed statistically significant intra- and intergroup differences between the baseline and 6 and 12 months (p < 0.05). The present technique using the XDM was safe and successfully reconstructed PIKM-W in both arches. The XDM alone seems to be a suitable alternative to autograft for PIKM-W augmentation in the maxilla.