Standard Closure Research Articles

Tissue Adhesive for Wound Closure Reduces Immediate Postoperative Wound Dressing Changes After Primary TKA: A Randomized Controlled Study in Simultaneous Bilateral TKA.

Prolonged wound drainage after TKA is associated with increased risk of infection. To decrease wound drainage, tissue adhesive has been suggested as an adjunct to wound closure after TKA; however, no studies of which we are aware have investigated the effect of tissue adhesive in a modern fast-track TKA setting. The purpose of this study was to evaluate the effect of wound closure using a high-viscosity tissue adhesive in simultaneous bilateral TKA with respect to (1) postoperative wound drainage, measured as number of dressing changes in the first 72 hours postoperatively; and (2) wound healing assessed using the ASEPSIS score. Thirty patients undergoing simultaneous bilateral TKA were included in the study. The left knee was randomized to receive either standard three-layer closure with staples or the same closure supplemented with tissue adhesive with the opposite treatment used on the contralateral knee. One patient underwent a constrained TKA and underwent revision 2 days after the index procedure and was therefore excluded leaving 29 patients (58 knees) for analysis. Sixty-two percent (n = 18) were female. Mean age was 64 years (range, 42-78 years). Mean body mass index was 28 kg/m (range, 21-38 kg/m). Postoperative wound drainage was evaluated as drainage resulting in a dressing change. The wound dressing was changed if it was soaked to the borders of the absorbable dressing at any point. The nurses changing the dressing were blinded to treatment allocation up to the first dressing change. The number of dressing changes during the first 72 hours postoperatively was recorded. The secondary study endpoint was the ASEPSIS score, which is a clinical score assessing wound healing. ASEPSIS score, measured by a nurse not involved in the treatment, was compared between the groups at 3 weeks followup. Knees with tissue adhesive underwent fewer dressing changes (median, 0; interquartile range [IQR], 0-1) compared with the contralateral knee (IQR, 1-2; difference of medians, one dressing change; p = 0.001). A total of 59% of knees in the intervention group did not undergo any dressing changes before discharge, whereas 24% of knees in the control group did not undergo any dressing changes before discharge (p = 0.02). The knees in the intervention group and the control group did not differ with respect to ASEPSIS score at 3 weeks. Tissue adhesive as an adjunct to standard wound closure after primary TKA reduced the number of dressing changes after surgery, but did not change the appearance or healing of the wound at 3 weeks based on the ASEPSIS scores. Whether the small differences observed here in terms of the number of dressing changes performed will justify the additional costs associated with using this product or whether there are other differences associated with the use of tissue adhesive that may prove important such as patient preferences or longer term differences in wound healing or infection should be studied in the future. Level I, therapeutic study.

Long-term results of a prospective randomized trial of midline laparotomy closure with onlay mesh.

Incisional hernia (IH) continues to be one of the most common complications of laparotomy. The short-term protective effect of the use of mesh has been demonstrated in several studies. At present, there is little evidence on the long-term results of the prophylactic use of mesh. The aim of the present study is to analyze the long-term prevention of IH 5years after a midline laparotomy during elective surgery. A prospective study was performed including all of the 160 patients that had been previously included in the prospective, randomized, controlled trial performed between May 2009 and November 2012. The protocol and results at 1year have been previously published in 2014. The patients in group A (mesh) were fitted with a polypropylene mesh to reinforce the standard abdominal wall closure. The patients in group B (non-mesh) underwent a standard abdominal wall closure and were not fitted with the mesh. All patients were followed for 5years or until the diagnosis of incisional hernia was made, further surgery was performed, or the patient died. Cases lost to follow-up were also registered. Five years after surgery, in group A (mesh) we have found 4/80 (5.1%) incisional hernias, while in group B (no mesh) 37/80 patients were diagnosed with an incisional hernia (46.8%). The Kaplan-Meier survival curves for these results show statistically significant differences (p > 0.001). The protective effect of the use of an onlay mesh in abdominal wall closure is significantly maintained in the long-term, up to 5years after surgery. International Standard Randomized Controlled Trial number: ISRCTN98336745.

Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery

BackgroundMorbidly obese patients (body mass index [BMI] ≥ 35 kg/m2) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. To explore a potential solution to this problem, we examined the utility of transverse sternal plating for primary sternal closure in morbidly obese cardiac surgical patients.MethodsWe retrospectively reviewed data from cardiac surgical patients who underwent single primary xiphoid transverse titanium plate reinforcement for primary sternal closure from August 2009 to July 2010 (n = 8), and we compared their outcomes with those of patients with BMI ≥35 kg/m2 who underwent cardiac surgery without sternal plate reinforcement from April 2008 to July 2009 (n = 14). All cases were performed by the same surgeon.ResultsThe 2 groups of patients had similar demographics and comorbidities (P > 0.05 for all). All patients with sternal plate reinforcement reported sternal stability at last follow-up (at a median of 27 months postoperatively; range, 8.4–49.3 months), whereas 1 patient (7.1%) who underwent standard closure developed sterile sternal dehiscence (P = 0.4). Postoperative patient-controlled analgesia (PCA) morphine usage was significantly higher for patients without sternal plate reinforcement than for patients who had sternal plate reinforcement (3.6 mg/h vs 1.3 mg/h, P = 0.008). No patient in the sternal plate group had wound seroma or perioperative complications attributable to sternal closure technique.ConclusionSingle xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage.Ultramini abstractMorbidly obese patients (body mass index ≥35 kg/m2) have a higher-than-normal risk of sternal dehiscence after cardiac surgery. In a pilot study, we found that those who underwent transverse sternal plating (n = 8) had no sternal dehiscence and required less postoperative analgesia than patients who underwent standard wire closure (n = 14).

Reduced rate of incisional hernia after standardized fascial closure in emergency laparotomy

Emergency laparotomy is a high-risk procedure, and incisional hernia is a common complication. This study aimed to investigate whether a standardized fascial closure technique, using slowly absorbable monofilament suture in a ratio of at least 1:4, could reduce the long-term occurrence of incisional hernia after emergency laparotomy. The single-center study was conducted as a questionnaire study including all patients who had an emergency laparotomy at Copenhagen University Hospital Herlev from May 2009 to May 2013 and June 2014 to November 2015. The historic cohort was used as a control. In the historic cohort of 2009-2013, different fascial closing techniques were used according to the preference of the individual surgeon. On June 1, 2014, we introduced a standardized method of fascial closure. A total of 465 patients met our inclusion criteria. The response rate was 77%. In all, 104 patients developed an incisional hernia: 77(27.0%) in the historic group and 27(15.0%) in the 2014-2015 group (p = 0.02). At long-term follow-up, 104 patients had undergone elective incisional herniotomy or had an incisional hernia confirmed by a medical doctor. The rate of incisional hernia was reduced from 27.0 to 15.0% (p = 0.02) comparing years 2009-2013 with 2014-2015. This study suggests that development of incisional hernia may be reduced significantly if a standardized technique is applied using slowly absorbable monofilament suture in a ratio of at least 1:4 in emergency laparotomies.

Validation of an extrinsic compression and early ambulation protocol after diagnostic transfemoral cerebral angiography: a 5-year prospective series

Background and purposeAccess-site complications constitute a substantial portion of the morbidity associated with transfemoral cerebral angiography, yet no standardized protocol exists for femoral closure and practice patterns vary widely. The...

Early Laparoscopic Ileostomy Reversal After Rectal Cancer Surgery - Technique and Outcomes.

Background: A temporary diverting ileostomy (TDI) is performed in a significant number of patients undergoing colorectal surgery. The best timing for ileostomy reversal (IR), early or late after its formation and the proper technique used for its closure are controversial.The objective of the present study is to describe the particular aspects of the laparoscopic technique of ileostomy reversal and to analyze the outcomes of its early closure. Methods: A retrospective analysis on all the patients who underwent laparoscopic ileostomy reversal (LIR) after MIS rectal surgery between 2015 and 2018 in Ponderas Academic Hospital was performed. No patient was excluded from the study. The outcomes of the early laparoscopic closure of the diverting ileostomy (less than 30 days) were analyzed and compared with the standard closure ones. Results: Twenty-one patients, (10 males), average age and BMI of 57 years (range 33-77) and 21.6 kg/m2 (range 14.4-34) were included into the study. All the procedures were completed laparoscopically. No patient was lost from follow-up. The laparoscopic ileostomy reversal was performed at 50.4 days (range 7-150) from the open (1 patient) or laparoscopic (20 patients) rectal cancer resection. Twelve patients had preoperative RCT (48%), 17 low colorectal anastomosis and the coloanal one was performed in three patients with TDI. Eleven patients (52%) had an early ileostomy reversal after 23.6 days (7-30 days). A very early LIR (7-10 days) was necessary in 3 patients with complicated evolution after TDI. No significant intra-operative or postoperative complications between the two subgroups of early or late LIR was encountered. The hospital stay (LOS) after LIR was 3.9 days (2-5) with no difference between the two subgroups. We encountered one postoperative complication (5%), - enteral bleeding conservatively treated. Conclusions: Laparoscopic ileostomy reversal may be considered as a primary option for temporary diverting ileostomy after colorectal resection. The early ileostomy reversal is safe and improved postoperative outcomes in are demonstrated selected patients. Careful investigation and rigorous selection of the patients for EIR is mandatory.

BioGlue® sealed fish-mouth closure of the pancreatic remnant as a feasible alternative to stapler closure during laparoscopic distal pancreatectomy

Background: Postoperative pancreatic fistula formation (POPF) remains the main problem after distal pancreatectomy (DP). Stapler closure of the pancreatic remnant is considered the standard technique during laparoscopic DP but is limited especially in “hard” pancreatic tissue remnants. After promising results during open DP we have now developed a novel BioGlue® sealed hand sutured fish-mouth closure technique of the pancreatic remnant during laparoscopic DP. Methods: 14 patients underwent BioGlue® sealed hand sutured fish-mouth closure of the pancreatic remnant during laparoscopic DP at our institution. Perioperative and postoperative results were analysed with regard to clinically relevant POPF and overall postoperative morbidity. Essential technical steps will be demonstrated as a video presentation. Results: Indications for distal pancreatectomy included pancreatic adenocarcinoma, IPMN, MCN, chronic pancreatitis, neuroendocrine tumor and SPN. 4 out of 14 patients (29%) developed a grade B pancreatic fistula, which could all be treated conservatively. There was no postoperative mortality. The median length of hospital stay was 11 days. Conclusion: The performance of a BioGlue® sealed hand sutured fish-mouth closure of the pancreatic remnant during laparoscopical DP was shown to be technically feasible and may thus be considered as a safe alternative to standard stapler closure especially in patients with a “hard” pancreatic tissue remnant.

Postoperative Pain Perception and Patient's Satisfaction After Mandibular Third Molar Surgery by Primary Closure With Distal Wedge Surgery.

BackgroundThe aim of this study was to compare periodontal conditions of the distal aspect of mandibular second molar and patient’s satisfaction between standard surgical technique and primary closure with or without distal wedge surgery used for the removal of mandibular third molar impaction (MTMI).MethodsTwenty-four patients, aged 18 - 25 years, were invited to participate in this prospective, single-blinded, split-mouth randomized controlled study. Each participant owned similar bilateral impacted mandibular third molar. Periodontal parameters (i.e. probing depth (PD), gingival index (GI), plaque index (PI) and the distance from cusp tip to gingival margin (CT-GM)) were measured. The standard mandibular third molar surgery was performed on one side while for the other side the distal wedge surgery with or without osseous contouring was added to the protocol. Information about satisfaction was taken from questionnaire.ResultsAt the site where distal wedge was performed, significant change in CT-GM occurred at all aspects and a significant PD reduction was observed at disto-buccal and mid-distal sites. Distance between cemento-enamel junction (CEJ) and gingival margin reduced significantly at all sites. No significant difference between two groups was found in GI, PI and patient’s satisfaction.ConclusionsIncorporating distal wedge surgery into MTMI removal protocol does improve periodontal health of adjacent second molar and does not affect patient’s satisfaction.

Numerical Simulation of Ice Cover of Saline Lakes

A new version of the one-dimensional thermo-hydrodynamic and biogeochemical model LAKE2.1 is presented. The model is supplemented with a description of the dynamics and vertical distribution of salinity in an ice cover. Simulation results are compared to in situ and satellite data of water temperature and ice cover at Uvs Nuur Lake (Mongolia) from 2000 to 2015. It is shown that underestimating the mixed-layer depth by the model with standard turbulence closure k−e during summer and autumn leads to a significant shift in the timing of the onset of ice. It is also demonstrated that, while neglecting the salinity of the lake, the freeze-up according to the model happens 16–17 days earlier than in reality. This error is removed if the effect of salinity on water density and freezing temperature is included. However, in this case, the model underestimates the maximal seasonal ice thickness on average by ≈0.2 m. In turn, this error decreases an order of magnitude if the dynamics and vertical distribution of salinity in ice are simulated in the model.

Open Implantation of Autologous Chondrocytes Cultured on Porcine Collagen Membrane for the Treatment of a Full-Thickness Patellar Cartilage Lesion.

Large cartilage defects in the knee are debilitating for patients and challenging for surgeons to treat. Autologous chondrocyte implantation (ACI) has gained popularity over the past 20 years and has become the treatment of choice for large cartilage defects for some surgeons. Termed matrix-applied ACI (MACI), use of autologous chondrocytes cultured on porcine collagen membrane has recently been approved by the U.S. Food and Drug Administration for the treatment of symptomatic full-thickness cartilage defects in the knee. This new technique for cartilage repair is the third generation of chondrocyte implantation technology and the first to involve the use of a scaffolding to grow chondrocytes1. MACI is a simpler technique than previous generations and has more reliable chondrocyte seeding. Research has shown that patients do well postoperatively, with improvements in patient-reported outcome out to 5 years postoperatively3. These improvements are statistically greater for patients who underwent MACI when compared to those who underwent microfracture2. (1) Preoperative evaluation: patients are indicated for a cartilage procedure after magnetic resonance imaging (MRI) and clinical examination. (2) Stage 1: a diagnostic arthroscopy is performed, and chondrocytes are harvested and cultured. (3) Approach: a short vertical incision is made, followed by a medial parapatellar arthrotomy. (4) Debridement: the lesion is identified and debrided back to stable cartilage. (5): Hemostasis: hemostasis is obtained with an epinephrine-soaked sponge. (6) Template creation: foil is used to create a template of the lesion. (7) Cells cutting: with use of the foil, the membrane of cells is cut to the appropriate size and shape. (8) Implantation: the cut membrane is placed on the lesion and secured with fibrin glue. (9) Testing: the knee is taken through a range of motion and the stability of the membrane is confirmed. (10) Closure: standard closure in layers is performed.

Wound closing method with 2‑octyl cyanoacrylate after single-incision laparoscopic surgery for colorectal cancer

The use of 2‑octyl cyanoacrylate (CA) for the umbilical wound after single-incision laparoscopic surgery (SILS) for colorectal cancer has not been described. A consecutive experience of SILS for colorectal cancer is presented. Three hundred sixty-four patients (172 women) were treated with SILS for colorectal cancer between December 2010 and December 2015. Our institution introduced CA in September 2012. The data of patients treated with CA were compared to a historical group who underwent standard sutured skin closure with thin adhesive strips (AS) at our institution. The Centers for Disease Control and Prevention criteria were used for the diagnosis of superficial surgical site infection (SSI). Of these 364 patients, 20 patients (5.5%) were converted to laparotomy including the extension of the skin incision longer than 3 cm. In 344 patients completed with SILS, CA was used in 247 patients. Superficial SSI occurred in two patients (0.81%) with CA and one (1.03%) with AS. No patients completed with SILS suffered wound dehiscence in this series. There were no significant differences in wound-related complication rate between the two groups. CA provides sufficient wound closure in SILS for colorectal cancer. SILS with CA has the possibility to provide a lower superficial SSI rate in patients with colorectal cancer.

Systematic review of the use of cyanoacrylate glue in addition to standard wound closure in the prevention of surgical site infection.

Surgical site infection (SSI) is associated with increased morbidity, length of stay, and cost. Cyanoacrylate glue is a low-cost, fluid-proof, antimicrobial barrier. The aim of this systematic review is to assess the use of cyanoacrylate glue after standard wound closure versus dressings in the reduction of SSI. Medline, Embase, Cochrane Library, and clinical trial registries were searched with no restrictions in accordance with PRISMA guidelines. Eligibility criteria were prospective studies comparing glue versus dressings after standardised wound closure. Two reviewers independently screened articles and utilised GRADE for quality assessment. Meta-analysis was not performed because of the heterogeneity of the data. Three articles were included in the review. Study quality was uniformly low. Incidence of SSI was low, between 0% and 4%. No significant differences were reported in the single randomised controlled trial. A single non-randomised parallel group trial reported a significant reduction in the incidence of SSI in the cyanoacrylate group. There was no consistent evidence demonstrating reduction in SSI as a result of the use of cyanoacrylate glue. Future studies should assess the use of cyanoacrylate in procedures with a higher rate of SSI, for example, lower limb bypass.

Surgical Protocol for Infections, Nonhealing Wound Prophylaxis, and Analgesia: Development and Implementation for Posterior Spinal Fusions

To analyze the effects of a surgical protocol for infections, nonhealing wound prophylaxis, and analgesia among patients who underwent posterior spinal fusion at a single tertiary-care neurosurgical center. This prospective study was conducted in the neurosurgery department of a tertiary-care neurosurgical center and compared a control group of patients who had posterior spinal fusion within 3 months before implementation of a surgical protocol with a study group of patients enrolled within 1 year after protocol implementation. The protocol included a surgical safety checklist, control of modifiable risks associated with surgical site infection, administration of intrawound vancomycin and local analgesia, and standard closure. Postoperative pain, demand for analgesics, and postoperative surgical site infections were assessed among patients before and after the introduction of the protocol. The control group (n= 35; 30 women; median age, 40 years [interquartile range, 31-54 years]) experienced a higher-than-predicted rate of minor surgical infections and nonhealing wounds (12 patients; 34%). In the study group (n= 113; 74 women; median age, 45 years [interquartile range, 37-54 years]), 11 patients (10%) had minor surgical infections and nonhealing wounds. Introduction of the protocol was associated with a 24% absolute risk reduction for minor surgical site infection and a significant decrease in pain on postoperative days 1 and 2 (P < 0.01 for both). Interpersonal communication improved among specialists involved in patient management. The protocol was effective in reducing postoperative pain and the rate of surgical site infection among patients with posterior spinal surgeries.

Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery

Incisional hernia is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. To compare the incidence of incisional hernia among patients after prophylactic intraperitoneal mesh implantation with that among patients after standard abdominal closure. An open-label randomized clinical trial was performed in 169 patients undergoing elective open abdominal surgery from January 1, 2011, to February 29, 2014. Follow-up examinations were performed 1 year and 3 years after surgery. The study was conducted at Bern University Hospital, Bern, Switzerland, a referral center that offers the whole spectrum of abdominal surgical interventions. Patients with 2 or more of the following risk factors were included: overweight or obesity, diagnosis of neoplastic disease, male sex, or history of previous laparotomy. Patients were randomly assigned to prophylactic intraperitoneal mesh implantation or standard abdominal closure. Data were analyzed in August 2017. Intraperitoneal implantation of a polypropylene-polyvinylidene fluoride mesh with circumferential fixation. The primary end point was the incidence of incisional hernia 3 years after surgery. Secondary end points included mesh-related complications. After the exclusion of 19 patients, 150 patients (81 in the control group and 69 in the mesh group; mean [SD] age, 64.2 [11.1] years; 102 [68.0%] male) were studied. The cumulative incidence of incisional hernia was significantly lower in the mesh group compared with the control group (5 of 69 [7.2%] vs 15 of 81 [18.5%], log-rank test P = .03). Abdominal pain was observed in significantly more patients in the mesh group compared with the control group at 6 weeks (34 of 52 [65%] vs 26 of 59 [44%], P = .04) but not at 12 and 36 months postoperatively. No difference in surgical site infections was observed, but time to complete wound healing of surgical site infection was significantly longer in patients with mesh implantation (median [interquartile range], 8 [6-24] weeks compared with 5 [1-9] weeks; P = .03). Trunk extension was significantly decreased after mesh implantation compared with the control group (mean [SD], 1.73 [0.97] cm vs 2.40 [1.23] cm, P = .009). In patients at elevated risk for incisional hernia, prophylactic intraperitoneal mesh implantation reduces the incidence of hernia formation but with increased early postoperative pain and prolonged wound healing of surgical site infection. ClinicalTrials.gov Identifier: NCT01203553.

Wound Closure After Posterior Multi-level Lumbar Spine Surgery: An Anatomical Cadaver Study and Technical Note

Meticulous attention to wound closure in posterior lumbar spine surgery is an important principle in reducing surgical site infections. We detail standardized wound closure used for posterior lumbar spine surgery at a tertiary care referral center and illustrate this as a step-by-step cadaveric dissection. The lumbar spine of a cadaveric specimen (male, 73 years at death) was used for dissection. Standardizing wound closure in posterior lumbar spine surgery may help limit wound complications and infection. Some key points of our technique, as demonstrated on a cadaveric specimen, include separating fascial compartments, avoiding suture abscesses, and creating a tension-free wound.

Complexity column

In 1975, Ladner proved that computational complexty is dense in the sense that if C 0 is strictly contained in C 1 , for any two complexity classes satisfying standard closure properties, then there is a complexity class C 0.5 strictly between them. However, naturally occuring algorithmic problems tend to be complete for one of a tiny stable of important complexity classes. This is often observed and leads to the great practical usefulness of the study of algorithms and complexity.

New sternal closure methods versus the standard closure method: systematic review and meta-analysis.

This study aimed to evaluate, by means of a systematic review, the efficiency of new methods for sternal closure in order to prevent sternal wound complications after sternotomy. The method of study was a systematic review of randomized clinical trials. We included studies that used rigid plates, thermoreactive clips, cables and flat wires, in comparison with the standard closure method. Patients included adults, regardless of gender and race. Seven clinical trials were included involving 1810 patients. Five trials were carried out in the USA, 1 in Australia and 1 in Italy, and the trials include both male and female patients. The included studies compared conventional sternal closure with new closure methods (rigid plate, thermoreactive clips, cables and flat wires). The new sternal closure methods make little or no difference compared to the standard closure when we analyse deep sternal wound infection [risk ratio 0.38, 95% confidence interval (CI) 0.02-7.63; I2 = 74%; 5 studies], superficial wound infection (risk ratio 1.34, 95% CI 0.46-3.92; I2 = 11%, 3 studies) and death (risk ratio 1.16, 95% CI 0.42-3.21; I2 = 0%, 3 studies), but pain score was lower in new sternal closure methods (mean difference -0.57, 95% CI -0.98 to -0.16, I2 = 0%, 3 studies). There were no meta-analyses of sternal union, hospital stay, reoperation or mechanic ventilation time because of the high heterogeneity between the studies in terms of these outcomes. New sternal closure methods probably make little or no difference regarding the prevention of sternal complications in the postoperative period when compared to the standard closure method.

Circulating monocytes from prostate cancer patients promote invasion and motility of epithelial cells.

BackgroundRecruited myeloid cells are known to promote cancer initiation, malignant progression, metastasis, and resistance to therapy in the tumor niche. We tested the hypothesis that circulating blood monocytes from advanced prostate cancer (PCa) patients exhibit a protumor phenotype and directly influence the tumor microenvironment in response to tumor‐derived signals.MethodsBlood monocytes from advanced and stable PCa patients were cultured, and the conditioned media (CM) were collected and analyzed using standard invasion and wound closure assays to measure effects on invasion and motility of PCa tumor cells. We then identified the proteome profile of these monocytes using proteome array and ELISA.ResultsConditioned media from circulating monocytes in patients with metastatic prostate cancer (PCa‐M) increased invasion of epithelial PCa cells in vitro. Proteome Profiler Analysis revealed that monocyte‐derived CM from metastatic castration‐resistant (mCRPC) patients presented high levels of chitinase‐3‐like 1 (CHI3L1, YKL‐40) when compared to patients with stable disease (PCa‐N) and healthy control individuals (HC). The only described receptor for CHI3L1, interleukin‐13 receptor α2 (IL‐13Rα2), was significantly up‐regulated in the human metastatic PCa cell line, ARCaPM. Accordingly, we observed that the activation of IL‐13Rα2 from PCa‐M CM increased the invasiveness of ARCaPM cells while siRNA directed against this receptor significantly reduced invasiveness of these cells in the presence of CM from PCa‐M patients.ConclusionsThus, we show that circulating monocytes from metastatic PCa patients exert a tumor‐promoting role via the secretion of CHI3L1, and CHI3L1 demands further exploration as a possible therapeutic target in advanced PCa.

Plastic Multilayered Closure in Pediatric Nonidiopathic Scoliosis Is Associated With a Lower Than Expected Incidence of Wound Complications and Surgical Site Infections

ObjectiveTo compare the incidence of surgical site infection (SSI) and wound complications between standard and plastic multilayered closure (PMC) in patients with pediatric nonidiopathic scoliosis undergoing primary or revision instrumentation or fusion. Study DesignRetrospective cohort study. Summary of Background DataAlthough PMC has been used for adult spine patients as well as infected spinal wound closure, it has not been reported as routine closure in the pediatric nonidiopathic scoliosis population. MethodsPatients with nonidiopathic scoliosis undergoing primary or revision instrumentation or fusion between 2013 and 2016 were enrolled. Clinical charts and operative reports were reviewed. Following September 2015, all patients with nonidiopathic scoliosis received PMC closure by plastic or orthopedic surgery. The SSI and wound complication incidence in patients undergoing PMC was compared to standard closure. The mean Risk Severity Score (RSS) for SSI, which uses patient characteristics to calculate the excepted SSI probability, was compared to the observed (actual) incidence. The CDC definition of SSI (infection ≤90 days of surgery) was used. Results115 patients were identified, including 56 standard closure and 59 PMC (mean age of 10.6 years; 54.8% female; mean preoperative major curve = 57.5°). There was no significant difference in age, sex, race, preoperative major curve, BMI, hemoglobin, blood loss, mean RSS score, or etiology between both groups (p > .05). Following PMC implementation, the observed incidence of wound complications decreased significantly from 19.6% in standard closures to 5.1% in the PMC group (p = .02), and the SSI incidence decreased from 8.9% to 1.7% (p = .11). The overall change in the observed (actual) incidence versus expected (RSS score) incidence of SSI indicated a 7.1% reduction following PMC. ConclusionUtilizing PMC in patients undergoing spinal surgery for nonidiopathic scoliosis significantly decreases the incidence of wound complications. Surgeons should consider using PMC in patients with nonidiopathic scoliosis. Level of EvidenceLevel II.

To Mesh or Not To Mesh? That Is the Question!

To Mesh or Not To Mesh? That Is the Question!