Significant Wound Complications Research Articles

Is barbed better? Evaluation of triclosan-coated barbed suture on wound complications following emergency laparotomy.

Emergent laparotomy is associated with significant wound complications including surgical site infections (SSIs) and fascial dehiscence. Triclosan-coated barbed (TCB) suture for fascial closure has been shown to reduce local complications but primarily in elective settings. We sought to evaluate the effect of TCB emergency laparotomy fascial closure on major wound complications. Adult patients undergoing emergency laparotomy were prospectively evaluated over 1 year. Patients were grouped into TCB versus polydioxanone (PDS) for fascial closure. Subanalysis was performed on patients undergoing single-stage laparotomy. Primary outcomes were SSI and fascial dehiscence. Multivariate analysis identified independent factors associated with SSI and fascial dehiscence. Of the 206 laparotomies, 73 (35%) were closed with TCB, and 133 (65%) were closed with PDS. Trauma was the reason for laparotomy in 73% of cases; damage-control laparotomy was performed in 27% of cases. The overall rate of SSI and fascial dehiscence was 18% and 10%, respectively. Operative strategy was similar between groups, including damage-control laparotomy, wound vac use, skin closure, and blood products. Surgical site infection events trended lower with TCB versus PDS closure (11% vs. 21%, p = 0.07), and fascial dehiscence was significantly lower with TCB versus PDS (4% vs. 14%, p < 0.05). Subanalysis of trauma and nontrauma cases showed no difference in SSI or fascial dehiscence. Multivariable analysis found that TCB decreased the likelihood of fascial dehiscence (odds ratio, 0.07; p < 0.05) following emergency laparotomy. Increased odds of fascial dehiscence were seen in damage-control laparotomy (odds ratio, 3.1; p < 0.05). Emergency laparotomy fascial closure with TCB showed significantly decreased rates of fascial dehiscence compared with closure with PDS and a strong trend toward lower SSI events. Triclosan-coated barbed suture was independently associated with decreased fascial dehiscence rates after emergency laparotomy. Therapeutic/Care Management; Level III.

Factors Associated With Respiratory Failure After Open Ventral Hernia Repair: An Evaluation of the NSQIP Database.

An analysis of ACS-NSQIP open ventral hernia repair (OVHR) data (2017-2019) was performed. Respiratory failure (RF) occurred in 643 patients (1%) and not in 63,213 (99%) (nRF). Respiratory failure patients were older (63.7 vs 57years, P < .001) and more comorbid: insulin-dependent diabetes (14.7% vs 5.8%, P < .001), COPD (19.4% vs 5.2%, P < .001), BMI (36.0 vs 32.8, P < .001), and current tobacco use (24.9% vs 17.6%, P < .001). Respiratory failure patients had greater ASA scores (ASA 3: 63.3% vs 47.8%, P < .001), bowel resection (8.2% vs 1.3%, P < .001), component separation (20.1% vs 9.0%, P < .001), operative times (178.4 vs 98.8minutes, P < .001), complications (deep wound infections 3.6% vs 1.0%, organ space infections 13.2% vs 1.0%, wound dehiscence 3.1% vs 0.6%, acute renal failure 11.7% vs 0.1%), and hospital stay (13.7 vs 2.3 days), with fewer home discharges (44.3% vs 96.4%) (all P < .001). Respiratory failure patients had higher mortality compared to nRF (20.2% vs 0.1%, P < .001). Respiratory failure after OVHR is rare but correlates closely with significant wound, systemic, and social complications. Preoperative management of risk factors would be appropriate in high-risk patients.

Republication of "Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?"

Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected (P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified-a significantly lower complication rate than that reported in the literature (P < .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature (P < .0001; CI 0.067-1.94). In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients' overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level IV.

(344) The Surgical Outcome of Buried Penis Surgery

Abstract Introduction Buried penis is a condition where the penis retracts and becomes hidden beneath the skin. It has a significant impact on quality of life of the patient and can present with a variety of symptom including lower urinary tract symptoms and erectile dysfunction. Whilst there are several causes, obesity is the most common in adults. Objective The aim of this study is to assess the variety of different operations performed with patient and surgeon satisfaction rates. Methods This is a retrospective study on patients with a buried penis operated on between 2010 and 2020. Data retrieved included presenting complaints, previous surgery, co-morbidities, surgical details and patient and surgeon satisfaction rates with cosmesis. Results A total of 141 patients were recruited with buried penis (median age 54, range 20-80). The presenting complaints were inability to void standing n = 30, erectile dysfunction n = 18, small penis n = 94. Aetiological factors included diabetes n=47, vascular disease n=62, penile cancer surgery n= 3 and BXO n= 13. The BMI was recorded in 44 patients (range 23-52) with 7 being morbidly obese (BMI &amp;gt;40). 47 patients had only a weight was recoded with a median of 114kg (range 68-169kgs). A total of 96 (68%) patients had had previous surgery prior to referral and in particular circumcision in 49 patients. The operations performed on the 141 patients were circumcision n=40, scrotoplasty n=35, V-Y plasty n=11, skin grafting n=34, suprapubic fat pad excision n=77, abdominoplasty n=25, malleable penile prosthesis n=7, inflatable prostheses n=7 and division of suspensory ligament n=24. The post-operative length of stay was median 3 days (range 0-52 days) but for abdominoplasty and grafting this was a median of 5 days (range 1-52 days). There were 27 complications (19%); infections (n=15), dehiscence (n=5), haematomas (n=2) The mean follow up was 506 days (range 0-4313 days) with a surgical satisfaction rate of 87% and patient satisfaction of 79%. Of note the highest dissatisfaction occurred in patients having circumcision or suprapubic fat pad removal. Conclusions Buried penis is a complex condition with patients likely requiring a combination of surgical techniques. Circumcision alone usually does not treat the problem and may make things worse. A prolonged hospital stay with significant wound complications may occur but the majority of patients are happy with the final outcome. Disclosure No

Implementing intact cord resuscitation in very preterm infants: feasibility and pitfalls.

The purpose of this study is to evaluate the feasibility of intact cord resuscitation (ICR) in very preterm infants using a custom-equipped mobile resuscitation trolley (LifeStart®). We collected maternal and neonatal data of all inborn infants < 32weeks eligible for ICR per our protocol over 9months from ICR implementation. We compared rates of ICR between the beginning and the end of the study period. We reviewed maternal and neonatal adverse events related to the procedure and direct outcomes. In order to assess potential quality improvements related to the procedure, we collected the same data in the infants born in the 9-month period preceding ICR implementation. Out of 44 infants born < 32weeks during the period, 27 were eligible for ICR. Failure to initiate ICR occurred in 9/27, exclusively in the first 5.5months of the study. In one infant, ICR was interrupted prior to 2min due to placental abruption. No ICR procedure had to be interrupted due to insufficient cord length. Among the 18 infants who completed ICR, cord clamping timing increased significantly over the study period, from 3.0 [2.5-3.5] to 4.2min [3.1-8.3] (p = 0.02). No significant maternal blood loss or wound complications were noted. No infant deaths were attributable to failure or direct consequence of ICR, and no infant experienced hypoxic respiratory failure (intubation, FiO2 ≥ 0.4), asphyxia (pH < 7.2), or blood pressure instability (< 2 SD) following stabilization. Hemoglobin level after cord clamping was higher in the ICR cohort than in the pre-implementation group. Seven out of 18 infants exposed to ICR had a temperature < 36.5°C on admission. Conclusion: ICR is feasible in very preterm infants. Temperature management requires special attention. Multidisciplinary simulation training before implementation and systematic post-implementation quality improvement meetings may significantly increase ICR program success. What is Known: • Because infants born < 32weeks often require cardiorespiratory resuscitation at birth, they are not offered delayed cord clamping in the majority of neonatal intensive care units. • Recently, fully equipped mobile trolleys have been developed in order to allow bedside resuscitation with an intact cord. What is New: • Variable timing of cord clamping based on the infant's transition and respiratory stability, i.e., "physiology-based cord clamping," is safely achievable in very preterm infants. • Intact cord resuscitation requires specific equipment, operational protocols, and a high level of preparation from both obstetrical and neonatal teams, with a learning curve that can be streamlined by multidisciplinary simulation training.

The surgical outcome of buried penis surgery

Buried penis is a condition where the penis retracts. It has a significant impact on quality of life of the patient and can present with a variety of symptom. Whilst there are several causes, obesity is the most common in adults. A retrospective study on patients with buried penis operated on between 2010 and 2020. Data retrieved included presenting complaints, previous surgery, co-morbidities, surgical details and patient and surgeon satisfaction rates. A total of 141 patients were recruited with buried penis (median age 54). The presenting complaints were inability to void standing n=30, erectile dysfunction n=18, and small penis n=94. 96 patients had had previous surgery, 49 were circumcisions. The operations performed on the 141 patients were circumcision (n=40), scrotoplasty (n=35), V-Y plasty(n=11), skin grafting (n=34), suprapubic fat pad excision(n=77), abdominoplasty (n=25), penile prosthesis (n=14), and division of suspensory ligament (n=24). The post-operative length of stay was 0-52 days. There were 27 complications; infections (n=15), dehiscence (n=5), haematomas (n=2)The mean follow up was 506 days (range 0-4313 days) with a surgical satisfaction rate of 87% and patient satisfaction of 79% (p=0.021). Of note the highest dissatisfaction occurred in patients having circumcision and/or suprapubic fat pad removal. Buried penis is a complex condition with patients likely requiring a combination of surgical techniques. Circumcision alone usually does not treat the problem and may make things worse. A prolonged hospital stay with significant wound complications may occur but the majority of patients are happy with the final outcome. No conflict of interest to declare.

Wound Complications Following Veno-arterial Ecmo Decannulation Is Associated With COVID-19 Infection And Ipsilateral Dual Cannulation

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a well-established tool for treatment of cardio-pulmonary collapse. The use of large bore cannulas in the femoral vessels for an extended period of time has been associated with significant wound complications. There is a lack of data analyzing risk factors related to these complications. The primary purpose of this study was to identify modifiable risk factors to reduce wound complication after VA ECMO decannulation.

Endoscopic vein harvesting: a guide for approaching difficult cases and assessing patients preoperatively.

Coronary artery bypass grafting remains the most commonly performed cardiac surgical procedure worldwide. The long saphenous vein still presides as the first choice conduit as a second graft in multivessel coronary artery bypass grafting surgery. Traditionally, the long saphenous vein has been harvested with an open approach which can potentially result in significant wound complications in certain circumstances. Endoscopic vein harvesting is a minimally invasive vein harvesting technique, which requires a single 2–3 cm incision and is associated with a quicker return to normal daily activities, decreased wound complications and better quality of life in the longer term. There is a learning curve associated with endoscopic vein harvesting adoption and there are certain patient factors that can prove to be challenging when adopting an endoscopic approach. This commentary aims to provide a concise guide of certain challenging patient factors that operators may encounter during endoscopic vein harvesting, and how to approach these patients in both the preoperative and intraoperative settings. We suggest that with appropriate planning and awareness of the challenging patient factors and problematic venous anatomy that exists, the operator can consistently formulate a strategy for ensuring a successful endoscopic harvest.

Great Saphenous Vein Sparing Robot-Assisted Video Endoscopic Inguinal Lymphadenectomy for Carcinoma of Penis: Video Demonstration

Abstract Introduction: Inguinal lymph node dissection in carcinoma of the penis is associated with significant wound complications such as flap necrosis, infection, and lower limb edema. Video endo...

PARAUMBILICAL HERNIA IN A SOUTHEAST ASIAN POPULATION

Background: Paraumbilical hernias are a common surgical problem constituting about 33% of all anterior abdominal wall hernias. Since Mayo popularized the simple suture repair, there has been a continuous evolution of different techniques for repairing paraumbilical hernias due to the high recurrence rate attendant to the simple suture repair. With the advent of mesh came significant wound complications that led surgeons to introduce the laparoscopic technique. However, there is as yet no consensus on the optimal repair technique for paraumbilical hernias. This study aimed to determine the clinical presentations, various repair techniques, and their outcomes in managing paraumbilical hernias. Materials and Methods: This was a prospective descriptive study that was carried out from August 2018 to July 2020. 75 patients who fulfilled the inclusion criteria were recruited for the study. Data was collected using a proforma. Variables of interest were age, sex, body mass index, co-morbidities, type of operation and duration, post-op pain score, duration of hospital stay, wound complications and recurrence. Follow up was for 6 months. Results: 57 patients were females, and 18 males. The mean age was 53 years. 12 patients had co-morbidities. 72 patients had BMI≥ 25kg-m2. 52 patients underwent open repair (simple suture or mesh) while 23 cases were repaired by laparoscopic mesh implantation (intra-peritoneal Onlay or pre-peritoneal Onlay mesh). All 18 emergency cases had an open repair. 17 patients in the open and 5 in the lap groups developed wound complications. Mean post-op pain on day 1 was 4.71+/-0.96 and 5.37+/-0.96 in the lap and open groups, respectively (p-value= 0.003). The mean duration of hospital stay was 5.3+/-1.0 and 7.6+/-3.8 in the lap and open groups, respectively (p-value

Total laparoscopic retrieval of a cava filter: case series

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.

Femoral vein transposition is a durable hemodialysis access for patients who have exhausted upper extremity options

ObjectiveAccess surgeons often encounter patients with end-stage renal disease who have exhausted all upper extremity hemodialysis access options. Although the lower extremity is often the next alternative, prosthetic lower extremity access can be prone to infectious complications and historically has poor patency. We describe our contemporary experience with an autogenous femoral vein transposition (FVT) arteriovenous fistula. MethodsAll FVTs performed at an academic medical center from 2006 to 2018 were analyzed. FVTs were placed after upper extremity access was deemed no longer possible by the treating surgeon. Patient demographics, comorbidities, and access history were described, and perioperative and short-term outcomes, including maturation, were analyzed. ResultsTwenty-one patients treated with FVT were identified. The mean age was 55.3 ± 11.1 years; 23.8% were female, and 71.4% were African American. The median body mass index was 27.1 kg/m2 (range, 17-46 kg/m2). Comorbidities included hypertension (100%), diabetes (61.9%), coronary artery disease (57.1%), congestive heart failure (47.6%), and obesity (38.1%). Twenty patients had at least one prior arm access, whereas 13 patients (61.9%) had more than three prior arm accesses. Seventeen patients (81%) had central venous stenosis or occlusion confirmed on preoperative imaging. The mean operative time was 250 minutes (range, 144-406 minutes), and estimated blood loss was 140.5 mL. Preanastomotic tapering was performed in 20 (95.2%) patients. Four (19%) patients returned to the operating room within 30 days. Thirty-day postoperative cardiac and wound complications occurred in 9.5% and 19% of patients, respectively. Distal arterial ischemia requiring revascularization occurred in one (4.8%) patient at 7 months. There were no access-related infections that resulted in fistula ligation. There was no mortality at 30 days. Successful fistula maturation rate at 6 months was 88.9%. At 1 year, primary and secondary patency rates were 65.9%, and 94.7%, respectively. ConclusionsAlthough autogenous FVT performed in patients without upper extremity options has a significant wound complication rate, it is associated with an outstanding maturation rate and excellent patency rates at 1 year. This access should be readily considered in hemodialysis patients without upper extremity access options.

Twelve years of component separation technique in abdominal wall reconstruction

BackgroundComponent separation technique involves incision of abdominal muscle and its aponeurosis, which generates a myofascial advancement flap to assist with fascial closure in abdominal wall reconstructions. This tissue mobilization allows for musculo-fascial approximation of much larger abdominal wall defects than would otherwise be possible. With extensive tissue mobilization, however, there is concern for significant wound and systemic complications. MethodsA prospective, single institution hernia database was queried for patients undergoing component separation from January 2006 to May 2018. Emergency operations were excluded. Anterior component separation (external oblique release with posterior rectus sheath release) and posterior component separation (transversus abdominus release and posterior rectus sheath release) were examined. ResultsOf the 775 component separation, 33.4% included anterior component separation and 66.6% posterior component separation. Mean age was 58.8 ± 11.5 years, mean body mass index was 33.6 ± 7.1 (kg/m2), and 27.9% of patients were diabetic. Hernias were large (280.0 ± 220.9 cm2) and often complex (recurrent: 62.6%, incarcerated: 41.5%, concomitant panniculectomy: 39.1%, and contaminated: 37.0%). Defect size was larger in anterior component separation group compared with posterior component separation (379.5 ± 265.2 vs 230.0 ± 175.0 cm2, P < .001). There was a 35.1% wound complication rate with 32 recurrences (4.1%) during a mean follow-up of 23.3 ± 25.1 months. Complete fascial closure and lack of wound complications significantly improved outcomes (P < .01). Patients undergoing anterior component separation demonstrated more wound complications (42.9% vs 31.2%, P < .001) and recurrences (7.0% vs 2.7%, P = .005). In multivariate analysis, anterior component separation was associated with increased risk of wound complications (odds ratio 1.660; confidence interval, 1.125–2.450), but not recurrence (odds ratio 2.95; confidence interval, 0.72–12.19). Since 2013, prehabilitation and perforator sparing techniques reduced anterior component separation wound complications to 19.6% (P = .008). ConclusionBoth anterior component separation and posterior component separation are associated with low recurrence rates, but anterior component separation is associated with higher wound complications. Prehabilitation and operative techniques improve outcomes of component separation.

Single port component separation: endoscopic external oblique release for complex ventral hernia repair.

Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.

Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?

Background: Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. Methods: A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. Results: There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected ( P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified—a significantly lower complication rate than that reported in the literature ( P &lt; .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature ( P &lt; .0001; CI 0.067-1.94). Conclusion: In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients’ overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level of Evidence: Level IV.

Technical tip: distal locking of a tibial nail in the presence of a preexisting distal tibial plate

Tibial refracture is a common problem among active individuals, with a second surgery presenting several challenges and difficulties. Previously implanted metalwork can cause obstruction of distal locking of the intramedullary tibial nails due to radiographic overlap. Full removal of a distal tibial plate is associated with significant surgical morbidity and wound complications as well as increased operative time and X-ray exposure. We report a simple method to overcome the above problem by removing only some tibial plate screws percutaneously, leaving the plate itself in situ and using some of the plate holes for distal locking of the tibial nail.

Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis

Despite advances in surgical technique, ventral hernia repair (VHR) remains associated with significant postoperative wound complications. A systematic review and meta-analysis was performed to identify whether the application of negative pressure wound therapy to closed incisions (iNPWT) following VHR reduces the risk of postoperative wound complications and hernia recurrence. The PubMed/MEDLINE, EMBASE and SCOPUS databases were searched for studies published through October 2015. Publications that met the following criteria were included: adult patients undergoing VHR; comparison of iNPWT with conventional dressings; and documentation of wound complications and/or hernia recurrence. The methodological quality of included studies was independently assessed using the Methodological Index for Non-Randomized Studies guidelines. Outcomes assessed included surgical site infection (SSI), wound dehiscence, seroma, and hernia recurrence. Meta-analysis was performed to obtain pooled ORs. Five retrospective cohort studies including 477 patients undergoing VHR were included in the final analysis. The use of iNPWT decreased SSI (OR 0.33 [95% CI 0.20 to 0.55]; P<0.0001), wound dehiscence (OR 0.21 [95% CI 0.08 to 0.55]; P=0.001) and ventral hernia recurrence (OR 0.24 [95% CI 0.08 to 0.75]; P=0.01). There was no statistically significant difference in the incidence of seroma formation (OR 0.59 [95% CI 0.27 to 1.27]; P=0.18). For patients undergoing VHR, current evidence suggests a decreased incidence in wound complications using incisional NPWT compared with conventional dressings.

Factors associated with neonatal ostomy complications

BackgroundNeonatal ostomies, either temporary or permanent, are created for numerous reasons. Limited attention has been given to understanding what factors might place infants at risk for surgical wound complications. PurposeThe purpose of the study is to identify factors associated with risk of significant abdominal wound complications (wound dehiscence and wound infection) following neonatal ostomy creation. MethodsThis is a retrospective chart review of infants undergoing ostomy between January 2009 and December 2013 at the University of Alberta Hospital. Main findings66 infants were identified of which 18.2% (12/66) had wound complications. Variables associated with wound dehiscence included: findings of bowel necrosis during laparotomy (7/9 wound dehiscence, 18/57 none, p=0.008), perioperative sepsis (3/9 wound dehiscence, 3/57 none, p=0.006), and perioperative blood transfusion (9/9 wound dehiscence, 30/57 none, p=0.007). Wound infection was not predicted by any variables collected. ConclusionsNeonates undergoing creation of an ostomy appear to be at substantial risk for wound complications. As wound complications are significant issues for infants undergoing surgery, emerging strategies should be explored to either avoid ostomy creation or promote wound healing.

Minimally invasive component separation techniques in complex ventral abdominal hernia repair: a systematic review of the literature.

Open component separation (CS) has traditionally been a popular method for management of complex abdominal wall hernias. However, it has been associated with significant wound complications. The aim of this systematic review was to examine the evidence in the literature on modern CS techniques (endoscopic and minimally invasive) for the management of such hernias. A systematic literature search was performed (2000 to 2013) using major electronic databases (PUBMED, EMBASE). The outcomes of interest were hernia recurrence rate and wound morbidity. A total of 33 publications were retrieved. Thirteen studies involving in total 220 patients were included in this analysis. No randomised controlled trials were identified. The overall hernia recurrence and wound complication rates appear similar and in some studies superior to the results of open CS. The initial results of the 2 more recent component separation techniques appear encouraging. However, better quality studies with longer follow-up are needed.

Enhanced recovery after surgery protocols as a management strategy following major pancreatic surgery.

396 Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to have positive effects on lengths of stay (LOHS) and resource utilisation without a rise in readmission and post-operative morbidity rates in colorectal, hepatic and oesophago-gastric surgery. This study aimed to investigate the effects of an ERAS protocol on postoperative morbidity and readmission rates following pancreatic surgery in a tertiary referral centre. Methods: The perioperative care of patients undergoing pancreatic surgery was guided by a locally developed ERAS protocol incorporating pre-operative counselling and carbohydrate loading. Intra-thecal opiate and Patient Controlled Analgesia devices were utilised for postoperative analgesia. Supplemental intravenous fluid prescription was protocolised. Oral intake was restarted from post-operative day (PoD) 1 and escalated on an on-demand basis. Patients were mobilised from PoD 1 and escalated daily. Drain removal and step down care decisions were guided by serum markers and clinical progress. Results: 212 consecutive patients from 2010 to 2014 were included (conventional, N = 108, ERAS protocol, N = 104). 134 (63.2%) patients underwent pancreaticoduodenectomy, 41 (19.3%) patients underwent distal pancreatectomy, 11 (5.2%) patients underwent total pancreatectomy and the rest underwent palliative bypass or other procedures. There was a statistically significant reduction in the volume of supplemental intravenous fluids received with no significant renal impairment noted. Median LOHS was reduced to 10 days (Inter-quartile range [IQR] 7 – 19) from 16 days (IQR 12 – 26) (P &lt; 0.001). Median critical care stay was reduced from 7 days (IQR 5 – 10) to 6 (IQR 4 -7) (P = 0.020). There was a statistically significant reduction in clinically significant wound complications (P = 0.019). There were no statistically significant increases in readmission rates, pancreas-specific or other generic post-operative morbidity rates. Conclusions: ERAS protocols are a viable peri-operative management strategy after major pancreatic surgery, and data suggests that LOHS can be reduced without an associated increase in readmission or post-operative morbidity rates.