Suction Drainage Research Articles

Prospective Study to Evaluate Efficacy of Single Versus Double Drains in Breast Cancer Patients Undergoing Surgery.

Seroma formation is a common sequel following modified radical mastectomy (MRM), which hinders healing, may prolong hospital stay, and cause a delay in adjuvant treatment. Closed suction drains have been used to prevent formation of seroma; however, the use of a single drain in the axilla along with draining the mastectomy flaps and axilla separately remains a topic of debate. This prospective randomized dual-arm study was conducted in the Department of Endocrine Surgery. All female patients with carcinoma breast diagnosed on core tissue biopsy, undergoing modified radical mastectomy, upfront or post neoadjuvant systemic therapy were included. Patients were randomized into two groups. In the first group, a single drain was placed in the axilla whereas in the second group, a drain each was placed below the mastectomy flaps and the axilla. Patients' particulars and the weight of the mass excised along with the operative detailswere documented. The volume of the drain was recorded daily. The flap drain was removed on postoperative day 5 and the axillary drain was removed when the drain volume was less than 30mL/24h for 2 consecutive days. The period of drain placement, volume of drainage, volume of seroma (if formed), and other complications (if any) were recorded. Patients in the single drain group had a significantly earlier drain removal time as compared to those with double drains (p = 0.01). The number of patients in whom seroma formation had occurred was more in the double drain group, but the difference was not significant. The average volume of aspirated seroma fluid was insignificantly more in the single drain group. The only other complication noticed was flap necrosis-in 5% patients of the double drain group. Total volume of drainage (p < 0.0001) and type of drain (p = 0.0208) were associated with higher rates of seroma formation, whereas BMI (p = 0.0516), weight of excised breast mass (p = 0.407), and age (p = 0.6379) were not associated with the rate of seroma formation. Outcomes in terms of drain volume or seroma formation were statistically indifferent between the two groups. Still, use of only a single axillary drain should be promoted, keeping in mind the earlier drain removal period, better patient compliance, and reduced hospital stay.

(026) Application of Gelatin Sponge as a Hemostatic Agent in Penile Prosthesis Implantation

Abstract Introduction Gelfoam® Sterile Compressed Sponge is a hemostatic that is directly applied to bleeding surfaces. This cost-effective hemostatic agent is prepared from purified porcine skin, Gelatin granules and Water for Injection. It is water insoluble, however is completely absorbed within 4–6 weeks with minimal scar formation. Gelfoam is available sterile for intra-operative use, and is applied in a multitude of surgical specialties. Objective In this work, we demonstrate for the first time the of Gelfoam to minimize the risk of bleeding in penile prosthesis implantation. Methods Eight cases received a three-piece inflatable implant (Rigicon Infla10®) through a peno-scrotal incision. Following cylinder insertion, corporotomies were closed by tying the stay sutures rather than water-tight sewing. Gelfoam was soaked in antibiotic-supplemented saline. Air bubbles were squeezed out followed by soaking. Gelfoam was then applied to the corporotomies, pump space and entry rout to the reservoir space. It was secured over the corporotomies by closing a pre-fashioned layer of Buck’s fascia. A suction drain was inserted. Mummy wrap was not used. Drain output was monitored and complications recorded. Results In two cases, drain output was an average of 80 cc’s in the first 24 hours, then 20 cc’s in the following 24 hours. However, in 6 cases, drain output was an average of 18 cc’s in the first 24 hours, mostly sero-sanguinous, then none in the following 24 hours. No cases of hematoma formation, infection, foreign body reaction, mass formation or hypersensitivity reaction were encountered. Conclusions The initial results of the current small case series demonstrate that Gelfoam is well-tolerated in penile surgeries, with possible value at minimizing post-operative bleeding, encouraging a multi-center larger study. Disclosure No.

The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm.

We evaluated the role of subgaleal closed suction drains in postoperative epidural hematoma (EDH) and wound complications following pterional craniotomy for cerebral aneurysm. We reviewed 5,280 pterional craniotomies performed on 5,139 patients between January 2006 and December 2020. A drain was placed subgalealy and tip of drain was positioned between the bone flap and the deep temporalis. 1,637 cases (31%) had a subgaleal suction drain. We analyzed demographic and clinical variables related to EDH requiring evacuation and wound complications in patients with and without drains. Univariate and multivariate logistic regression analyses were performed to determine the associated risk factors. Fourteen cases (0.27%) of EDH requiring evacuation and 30 cases (0.57%) of wound complications were identified. Univariate analysis found that drain insertion, subarachnoid hemorrhage (SAH), and operation time were associated with EDH, while drain insertion, SAH, male gender, older age, and longer operation time were associated with wound complications. Multivariate analysis found no significant association between drain use and EDH (OR=1.62, p=0.402) or wound complications (OR=1.45, p=0.342). Routine use of subgaleal closed suction drains may not be necessary after pterional craniotomy, as drain insertion was not associated with a reduced risk of EDH requiring evacuation or wound complications.

Evaluation and Surgical Outcomes of Primary Closure for Breast Abscess- 3 Year Experience in Rangpur Zone

Background: Breast abscesses are a common medical concern, often associated with pain, cost implications, and dressing-related complications. Managing breast abscesses presents an opportunity to optimize patient outcomes while streamlining healthcare resource utilization. This study aimed to evaluate the effectiveness of primary closure as a surgical approach for breast abscess management in a private practice setting, focusing on reducing hospital stays and associated costs, particularly improving patient compliance. Methods: This prospective study was conducted in private practice settings over three years, from July 2020 to June 2023. A total of 119 patients, comprising both acute (n=72) and chronic (n=47) breast abscess cases, were included in the study. The surgical procedures included incision, drainage, curettage, and primary closure using 16 FR/18 FR drains. Special measures included iodine irrigation, keeping drains for at least 7 days, suture removal on 10th-14th postoperative days, and administering antibiotics for up to 14 days. Follow-up appointments occurred after 3 weeks. Results: Among the 119 patients, 72 (60.5%) presented with acute breast abscesses, while 47 (39.5%) had chronic abscesses. All patients were discharged on the 2nd postoperative day. In cases of chronic breast abscess, drains were removed between 5-7 postoperative days, while in acute cases, drains were removed at the 10th postoperative day or upon suture removal. No suction drains were used. Over 95% of patients resumed breastfeeding shortly after surgery. Suture removal on the 10-12th postoperative days showed healthy wounds in 88 patients, minor wound gaps in 13 patients (requiring no further intervention), and secondary stitching in 10 patients. Ten patients experienced delayed abscess formations under the scar, necessitating drainage under local anesthesia and oral antibiotics. The most frequently isolated causative organism from pus was Staphylococcus aureus. .........

Corrugated Rubber Drains Versus Closed Suction Drain in Reducing Superficial Surgical Site Infection in Laparotomy Wounds

Background: Surgical site infections (SSI) remain a substantial problem for patients. Surgery for perforation peritonitis is associated with the highest rate of infective complications, especially surgical site infections because there is contamination of the operative field with microorganisms from endogenous sources. Subcutaneous drains are commonly placed in the operative setting to prevent hematoma or abscess formation in surgical wounds. In contrast to open drains, closed suction drains establish a pressure gradient between the wound and the external environment.Objectives: To evaluate the role of wound drainage in preventing surgical site infections (SSI) in patients undergoing emergency laparotomy and draw comparison between the efficacy of open corrugated rubber drainage and closed suction drainage.Methods: A prospective study was conducted on 50 patients admitted under Department of Surgery, Government Medical College, Jammu, India, between January and July of 2020, who underwent emergency laparotomy for various indications, within 24 hours of admission. All investigations for requisite anaesthesia were conducted on emergency basis. Patients received either corrugated rubber drain (group A), closed suction drain (group B) or no drain (group C) for wound drainage. Patients were followed in the post operative period for development of wound infection.Results: Mean age was 39.2 years with median age of 35 years. Male to female ratio was 1.94:1. 8 out of 19 patients from group A developed wound dehiscence, while only 1 out of 20 patients in group B developed wound dehiscence. 6 out of 11 patients in group C developed wound dehiscence. The difference was statistically significant (P&lt;0.05).Conclusion: Placement of subcutaneous drains in emergency laparotomy wounds is associated with lower incidence of wound infection. Closed suction drains appear to be more effective than open corrugated drains in reducing the risk of SSIs.International Journal of Human and Health Sciences Vol. 08 No. 01 Jan’24 Page: 75-78

Giant Pseudocyst of the Pancreas: A Rare Case Report

A Pancreatic Pseudocyst (PP) is a fluid-filled collection often found near the pancreas. It is characterised by its contained structure and homogeneous fluid composition, with little to no necrotic tissue. Individuals with a history of chronic pancreatitis, and to a lesser extent acute pancreatitis, may exhibit non specific symptoms. To minimise related morbidity and mortality, any potential complications must be identified. The authors present a case of a rare giant PP in a 28-year-old man who presented with abdominal pain and distention, severe backache, fever, frequent vomiting, loss of appetite, weight loss, and firm, sticky stools. Initially measuring 25×19.2×11.2 cm on a Computed Tomography (CT) scan, this PP was unusually large for its type. Due to the patient’s condition not being suitable, a direct cystojejunostomy was performed. Three drains were placed: an anastomotic drain near the anastomosis site, a Morrison’s drain in the Morrison pouch, and a pelvic drain. Later, a complication arose in the form of a faecal fistula, which was managed conservatively with a suction drain. The patient’s only primary complaint was non specific stomach pain, despite the size of the pseudocyst. Therefore, individuals with a history of chronic alcoholism and symptoms such as abdominal pain and distension should be evaluated for PP. A CT scan is recommended to investigate this condition, despite its rarity.

Pyogenic Liver Abscess. Pet-Ct as a New Diagnostic Resource and Suction Drainage as an Effective Therapeutic Method

Pyogenic Liver Abscess. Pet-Ct as a New Diagnostic Resource and Suction Drainage as an Effective Therapeutic Method

Zephyr 375 urinary sphincter implant by unical perineal incision. Initial experience.

The treatment of male severe stress incontinence (MUI) after surgery is the implantation of an artificial urinary sphincter (AUS). Traditionally you need two incisions: perineal and inguinal. Our objetive is present a series of patients treated with the Zephyr 375 EUA implant through a single perineal incision. We present six men operated on for MUI after Transuretral resection of the prostate (TURP) (1) and radical prostatectomy (5). Preoperatively we perform Pad-Test and cystoscopy. Under epidural anesthesia, a vertical perineal incision was made and dissection up to the bulbospongiosus muscle was divided and we dissected the bulbar urethra. After removing the probe, we place the cuff, checking that it reaches the appropriate pressure, leaving it deactivated. To place the pump-reservoir, we digitally develop a scrotal dartos pocket from the perineum that we close with Vicryl 3/0. After closing the muscle with 3/0 Vicryl, we left a suction drain and a bladder catheter. The mean age was 63 years (55-72). Mean surgical time was 68 minutes (60-85). All were discharged the next day without catheter and drain. All patients comfortably palpated the scrotal reservoir-pump. After activation, all patients were continent without needing additional adjustment, using 3 a safety pad. The degree of satisfaction was very high, all of them affirmed that they would undergo the same intervention again. The Zephyr 375 urinary sphincter allows placement through a single perineal incision, reducing surgical time, simplifying the technique, and reducing morbidity without compromising the functional outcome.

Prophylactic Sclerotherapy for Lymphatic Complications After Living Donor Renal Transplant: A Single-Center Experience.

Lymphocele formation after kidney transplant is a common complication that causes significant morbidity. In this study, we aimed to evaluate the safety and effectiveness of intraoperative prophylactic povidone-iodine sclerotherapy through the closed suction drain to prevent lymphocele after kidney transplant. In this retrospective comparative single-institution study, we compared patients who underwent intraoperative prophylactic povidone-iodine sclerotherapy through the closed suction drain (group A) with patients who did not receive sclerotherapy (group B). Patients were treated between September 2017 and July 2023. Atthe end of the kidney transplant surgery, after the closure of the external oblique muscle layer and before skin closure, 10 mL of 10% povidone-iodine in 40 mL of normal saline were instilled via the closed suction drain and dwelled in the cavity for 30 minutes. During the study period, 300 living-related donor kidney transplants were performed. Prophylactic povidone-iodine sclerotherapy was performed in 150 patients (50%).We noted a significantly lower incidence of lymphorrhea and lymphocele in group A. On postoperative days 1 and 5, we noted a significant reduction in drain output in group A (P < .001). One patient in group A and 5 patients in group B required ultrasonography-guideddrainage andpovidone-iodine sclerotherapy. No sclerotherapy-related complications were reported after a median follow-up of 16 months (range, 3-29 months). Intraoperative prophylactic povidoneiodine sclerotherapy appears to be an easy, safe, and effective procedure for preventing lymphatic complications after living donor kidney transplant.

Platelet rich plasma could replace tranexemic acid in total knee replacement? A comparative study between their postoperative- bleeding hemostatic effects

Background: The aim of the study is to detect whether platelet rich plasma (PRP) is equal to tranexemic acid (TXA) in reducing blood loss and transfusion rates following total knee arthroplasty (TKA), and compare clinical outcomes, complications, and cost effectiveness between the two groups. This is one of the first randomized, controlled trials that compare both materials in elective knee arthroplasty. Methods: 120 patients were randomized. Postoperative blood loss was determined and compared by measuring the total drainage suction together with the hemoglobin level and blood transfusion rate. Thromboembolic complications and knee society score were recorded. Results: The mean total drain output was 469 mL in the TXA group compared with 698 mL in the PRP group, with statistical significance. There were significant differences in reduction of hemoglobin level (TXA: 1.21 vs. PRP: 2.08). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given PRP, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay, pain assessment and knee society score. Conclusions: Though the blood loss was significantly bigger in the custom-made PRP group, no transfusions were required. Meanwhile, the rate of DVT in the PRP group tends to be lower than those in TXA group. We concluded that PRP was not superior to TXA in reducing perioperative blood loss, however further large-scale randomized trials are crucial to confirm these results to be added to the calling literature.

Differences in vacuum suction drainage pressure following mastectomy and its impact on the clinical outcome of breast cancer patients

Background: Vacuum suction drainage is an obligatory practice for long past following mastectomy for breast cancer. But recent studies are showing that the pressure of the vacuum suction drain is of value in determining the volume of seroma formation and thereby the drain indwelling time, duration of hospital stays and patient morbidity. Half vacuum suction may be of greater value in this regard comparing full vacuum suction drainage. Objectives were to assess and compare the clinical outcome of half versus full vacuum suction drainage following modified radical mastectomy for breast cancer. Methods: Forty patients of histologically proven breast cancer had been chosen purposively and systematically randomized in two equal groups. Group A with half vacuum suction (device was squeezed up to half of its vertical length) and group B with full vacuum suction (device was squeezed to its maximum). The outcome measured were postoperative drainage, drain indwelling time and post-surgery length of hospital stay. Results: Patients having half vacuum suction had a significantly reduced mean total drainage volume (364.25±128.52 ml versus 822.00±251.30 ml), drain indwelling time (5.50±1.32 days versus 9.05±1.90 days) and post-surgery hospital stay (7.15±2.58 days versus 10.25±2.55 days) in comparison to the full vacuum suction group. No significant difference found in regards to postoperative pain and other wound related complications. Conclusions: We concluded that half vacuum suction drain ensures a lower drain collection and were removed earlier and hence reduced the hospital stay significantly than full vacuum suction drains.

Standardizing process in acute biliary disease.

The perioperative management of biliary disease (BD) is variable across institutions with suboptimal outcomes for patients and health care systems. This results in inefficient utilization of limited resources. The aim of the current study was to identify modifiable factors impacting patients' time to theater, intraoperative time, and time to discharge as the constituents of length of stay to guide creation of a perioperative management protocol to address this variability. Data were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge. Four thousand five hundred seventy-seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement. Standardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.

Drain versus no drain after total ankle arthroplasty: are there any differences in complications rate?

While the efficacy of closed suction drains has been extensively studied in hip, knee, and shoulder surgery, it lacks scientific evidence in the foot and ankle domain, especially after total ankle arthroplasty (TAA). Thus, this study aims to compare the incidence of postoperative complications with and without the application of a closed suction drain following TAA. A retrospective monocentric chart review of all patients who had undergone TAA with an anterior approach from January 2020 to March 2023 was performed. Data were analyzed to assess the effect of drain usage on postoperative complications. A total of 110 patients were enrolled, 59 in the drain group and 51 without a drain. The mean age at surgery was 58.4 (range 28-81) years. No statistical differences were found between the two groups in the total complication rate (19.6% in no-drain group versus 20.3% in drain group, p = 0.227). This study showed no effect of applying a closed suction drain after TAA in the incidence of postoperative complications. Since the use of a drain did not negatively affect the outcome, nor did it provide a significant benefit, it can be asserted that there is no evidence to support the routine use of closed suction drains in TAA.

The optimized tourniquet versus no tourniquet in total knee arthroplasty. Analysis of muscle injury, functional recovery, and knee strength

BackgroundTourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet. MethodsIn a prospective and randomized study, 60 patients with osteoarthritis were evaluated for total knee replacement, divided in two groups: 'without tourniquet' and 'optimized tourniquet'. Outcomes were mean creatine phosphokinase levels, Knee Society Score and knee isokinetic strength. Data were considered significant when p < 0.05. ResultsCreatine phosphokinase levels and functional score were similar between groups. There were no differences between groups regarding knee extension strength on the operated limbs, although the knee flexors' peak torque in the operated limb in the optimized tourniquet group was significantly higher at 6 months relative to preoperative and 3 months assessments. ConclusionsThe optimized tourniquet protocol use in total knee replacement combines the benefits of tourniquet use without compromising functional recovery and without additional muscle damage and strength deficits compared to surgery without its use.

Transoral traumatic perforation of the pyriform sinus by a marker pen: report of an infant case

BackgroundPerforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who developed deep cervical and mediastinal abscesses due to a traumatic pyriform sinus perforation caused by accidentally falling with a marker pen in the mouth.Case presentationAn 11-month-old healthy male infant fell on a trampoline with a marker pen in his mouth. The patient developed swelling in the neck 3 h after the incident and was taken to a regional general hospital. Although a laryngoscopy showed no perforation in the oral cavity or posterior pharynx, a computed tomography (CT) scan revealed significant emphysema extending from the cervix to the mediastinum. The patient was transferred to our tertiary hospital and admitted to the intensive care unit, where he was mechanically ventilated, and antibiotic therapy was initiated. On day 3 of admission, a CT scan revealed deep abscesses in the cervical and upper posterior mediastinum with pneumomediastinum. Although his respiratory status stabilized and he was temporarily weaned, the fever recurred. Pharyngoesopagography revealed significant leakage of contrast from the left pyriform sinus to the mediastinum. Consequently, surgical drainage of the abscess was performed on day 10. Two low-pressure continuous suction drains were placed, one in the posterior mediastinum and the other close to the pyriform sinus. Pharyngoesophagography on postoperative day (POD) 7 demonstrated decreased contrast leakage into the posterior mediastinum. The patient was initiated on enteral nutrition through a nasogastric tube. The patient was discharged on POD 31 after the suction drains were replaced with open Penrose drains, and enteral nutrition via nasogastric tube was continued at home. The Penrose drains were removed on POD 54, and salivary leakage ceased on POD 111.ConclusionsAlthough injuries to the oral cavity and posterior pharynx are more easily recognized, the existence of injury in the pyriform sinus can be challenging to evaluate. However, prompt and appropriate management, including intubation, antibiotic therapy, surgical drainage, and nutritional support, is critical in preventing life-threatening complications.

Mobility in Post-Surgical Knee Arthroplasty with Compression Bandage VS Drainage

Introduction: Post-surgical management of total knee arthroplasty (TKA) includes compressive bandaging or continuous suction drainage. The arches of mobility are evaluated through some validated scales such as the Knee Society Score (KSS) questionnaire, the recovery of these is still uncertain between one management and another for not finding statistically significant differences or presenting a small sample in studies already carried out. Objective: To compare the mobility arches of patients with compressive bandage vs. continuous suction drainage undergoing TKA. Methods: Prospective, longitudinal, comparative, analytical study; patients &gt;55 years old undergoing TKA were included. They were grouped according to compressive bandage or continuous suction drainage and the arches of mobility before and after surgery were compared. Results: 68 patients were registered, 41 (60.2 %) women and 27 (39.8 %) men with a mean age of 66.5 ± 8.3 years. Compressive bandage was applied to 34 patients and continuous suction drainage to the rest. Post-surgery the final score of the questionnaire was 82.76± 8.30 for the compressive bandage group vs. continuous suction drainage 72± 12.80 (p= &lt;0.001), which translates better evolution in bandage group. Conclusions: The data of the present study suggest that compressive bandaging as a post TKA may result in better patient functionality according to mobility arcs being necessary other studies for validation.

Invasive lobular carcinoma of the breast with colonic metastasis: a case series of three patients

BackgroundAlthough metastatic spread of breast cancer to the gastrointestinal tract is very rare, it is more likely to occur in invasive lobular carcinoma (ILC) than in ductal carcinoma. Colonic metastasis is particularly rare, and the treatment strategies for these cases are not clearly defined. Herein, we report three cases of ILC with various abdominal symptoms associated with colonic metastasis.Case presentationCase 1 A 70-year-old female patient with vomiting and melena was referred to our hospital. Endoscopic examination revealed a Dieulafoy ulcer in the rectum and an elevated lesion in the descending colon. She also had two breast nodules, and was diagnosed as ILC with colonic metastasis. Considering her general condition, the best supportive care (BSC) was offered. The patient died 4 months after confirmation of the diagnosis. Case 2 An 80-year-old female patient presented with diarrhea and vomiting. She was diagnosed with ILC with colonic metastasis, and a coloscopy revealed stenosis of the transverse colon with a metastatic lesion. Ileosigmoid bypass surgery was performed for intestinal obstruction, and systemic treatment for breast cancer was initiated. The patient developed peritoneal carcinomatosis and died 1 year and 2 months after surgery. Case 3 A 56-year-old female patient underwent left total mastectomy for ILC, and laparoscopic transverse colectomy was conducted for a colonic lesion 9 years and 2 months after. The diagnosis as colonic metastasis was not confirmed at that time. Two years and 2 months later, torose lesions were detected in the hepatic flexural and descending colon, and histopathological findings indicated that all colon tumors, including the previously resected tumor, were metastatic spread of ILC. Systemic treatment was continued, but the transverse colonic lesion penetrated the abdominal wall, and an abscess formed 2 years and 11 months after the resection. The fistula improved by continuous suction drainage following ileostomy but recurred, and the patient died 3 years and 8 months after colectomy.ConclusionsColonic metastases from breast cancer can trigger various abdominal symptoms, and the prognosis in these cases is generally poor. In selected cases, surgical treatment for abdominal symptoms and subsequent systemic therapy can contribute to a prolonged prognosis.

Modified Radical Mastectomy in Female Breast Cancer - A Relative Clinical Outcomes of Half Versus Full Vacuum Suction Drainage

Modified Radical Mastectomy in Female Breast Cancer - A Relative Clinical Outcomes of Half Versus Full Vacuum Suction Drainage

Purulent Skin and Soft Tissue Infections, Challenging the Practice of Incision and Drainage: A Scoping Review.

To generate a landscape of the current knowledge in the interventional management and outcomes of purulent skin and soft tissue infections. This study is a scoping review. Electronic searches were undertaken using CINAHL, Medline, Cochrane Library, British Nursing Index, Science Direct, the National Health Service knowledge and library hub, ClinicalTrials.gov, and MedNar. The population, concept, context framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were utilised, supporting a rigorous appraisal and synthesis of literature. Data Sources. The initial search and synthesis of literature were completed in January 2022 with repeat searches completed in March 2022 and July 2023. There were no imposed chronological parameters placed on the returned literature. Nineteen papers were reviewed. Incision and drainage with primary closure, needle aspiration, loop drainage, catheter drainage, and suction drainage are viable adjuncts or alternatives to the traditional surgical management of skin and soft tissue abscesses. Despite the empirically favourable alternatives to the incision and drainage technique demonstrated, this does not appear to be driving a change in clinical practice. Future research must now look to mixed and qualitative evidence to understand the causative mechanisms of incision and drainage and its ritualistic practice. Implications. Ritual surgical practices must be challenged if nurses are to improve the treatment and management of this patient group. This will lead to further practice innovation. Impact: This study explored the challenges posed to patients, clinicians, nurses, and stakeholders, resulting from the ritualistic practice of the incision and drainage technique in purulent skin or soft tissue abscesses. Empirically and holistically viable alternatives were identified, impacting all identified entities and recommending a wider holistic study. Reporting Method. Adherence to EQUATOR guidance was achieved through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Wedgeless V-Shaped Osteotomy of the Distal Medial Femur with Locking Plate Fixation for Correction of Genu Valgum in Adolescents and Young Adults.

Genu valgum is a common disorder affecting adolescents and young adults. Treatment of this disorder requires restoration of normal mechanical axis alignment and joint orientation, for which it is important to assess whether the deformity arises from the distal femur, knee joint, or proximal tibia. Most commonly, the deformity originates from the distal femur, and various osteotomies of the distal femur have been described1-6. The presently described wedgeless V-shaped osteotomy7,8 is a good option among the various alternative procedures listed below. The anesthetized patient is placed in the supine position on a radiolucent operating table. A bolster is placed beneath the knee to relax the posterior structures. A medial longitudinal skin incision is made that extends from the level of the medial joint line to 5 cm proximal to the adductor tubercle. The vastus medialis is identified and elevated anteriorly by detaching it from its distal and posterior aspects. The leash of vessels underneath the vastus medialis is identified, and the apex of the V-shaped osteotomy is kept just proximal to it. The anterior arm of the V is kept longer than the posterior one, both of them are kept perpendicular to each other, and the apex of the V is made to point distally. The osteotomy is performed on the medial cortex with use of an oscillating saw or multiple drill holes that are then connected using a thin osteotome. Care is taken not to utilize a saw or drill on the lateral cortex. A gentle valgus thrust is applied to break the lateral cortex without periosteal disruption. The apex of the V osteotomy on the proximal fragment is trimmed, and the deformity is corrected with varus force. The osteotomy site is stabilized with use of an anatomically contoured distal medial femoral locking plate or a medial proximal tibial L-shaped buttress plate (of the contralateral side). The implant position is verified under a C-arm image intensifier. The wound is closed in layers over a suction drain in a standard manner. Various types of corrective osteotomies of the distal femur have been described in the literature, including the lateral opening wedge, medial closing wedge, dome, and spike osteotomies1-6. All of these procedures have certain limitations and shortcomings. The wedgeless V-shaped osteotomy is another described procedure that is inherently stable7,8. It is a safe procedure and yields good clinical outcomes8,9. The posterior arm of the V-shaped osteotomy is kept smaller than the anterior arm. The proximal cortical bone is allowed to dig into the cancellous bone of the wider distal metaphysis during deformity correction. Trimming the apex of proximal bone end after making the osteotomy facilitates the process. In a study of 46 patients with a mean age of 16.9 years (range, 15 years to 23 years), Gupta et al.8 reported that the mean radiographic tibiofemoral angle improved from 22.2° (range, 16° to 29°) preoperatively to 5.1° (range, 0° to 10°) postoperatively (p < 0.001). Similarly, the mean lateral distal femoral angle improved from 79.2° preoperatively to 89.1° postoperatively (p < 0.001) and the mean mechanical axis deviation improved from 19.6 mm preoperatively to 3.7 mm postoperatively (p < 0.001). A total of 44 of 46 cases had an excellent functional outcome, with the other 2 having good outcomes. None of the patients in the study had an unsatisfactory outcome. It is important to keep the whole lower limb accessible to the image intensifier intraoperatively.Identification of the leash of vessels underneath the vastus medialis is important to decide the level of the osteotomy.It is important to preserve the periosteal sleeve on the lateral aspect of the femur. CORA = center of rotation of angulationECG = electrocardiogramLDFA = lateral distal femoral angleMAD = mechanical axis deviationMPTA = medial proximal tibial angle.