Superficial Dehiscence Research Articles

Open Surgical Implantation of Lumbosacral Dorsal Root Ganglion Stimulators for Chronic Pain: Analysis of Patient Outcomes and Operative Technique

Dorsal root ganglion (DRG) stimulator leads were designed to be placed percutaneously, yet open surgical placement via laminectomy is an option. We present the largest series to date of surgically-placed DRG stimulators and the first series where open surgical implantation was the chosen technique and not a salvage procedure. A retrospective review of a prospective database of DRG implants identified 17 patients who had open lumbosacral DRG lead placement performed by a single surgeon between October 2021 and April 2023. Descriptive statistics, fluoroscopy exposure times, and complications were reported. The window of data collection was 1month preoperatively to 12months postoperatively. Phone interviews were conducted to collect information on pain outcomes and patient satisfaction. We identified 17 patients (12 women, 5 men) who had lumbosacral DRG placement. Phone interviews were conducted for 10/17 patients, with mean follow-up of 11.9months. 53% reduction in mean pain score was achieved (n= 10, P < 0.001). There were no infections, hematomas, or symptomatic lead migrations. One of 17 experienced a superficial dehiscence and 2 of 17 had an intraoperative repairable durotomy with no postoperative sequelae. Mean fluoroscopy time per lead was 15.4±9.9s (n= 10). Open DRG lead placement via laminotomy/laminectomy is reported as a salvage procedure but may have comparable safety and efficacy profile to percutaneous implantation when utilized as the primary implantation method. Before establishing open DRG as an alternative permanent implantation method, more studies are needed to determine whether such benefits as less migration outweigh the risks of a more invasive implantation procedure.

Comparative Study of Paramedian and Midline Incision in Laparotomy for Peritonitis due to Non-traumatic Gastro-intestinal Tract Perforation

Introduction: A prospective observational study was conducted to compare the paramedian incision with midline incision in gastro-intestinal tract perforation. Objectives: To identify better or superior incision which may reduce post operative mortality and morbidity after laparotomy. Materials and Methods: A prospective observational Hospital based study was conducted from January 2009 to June 2009 at department surgery of Shaheed Ziaur Medical College Hospital, Bogura. A total 100 patients of peritonitis due to non-traumatic gastro-intestinal tract perforation were taken for study. Sample were collected by Convenience (purposive) sampling method. Midline incision and Para median incisions were performed as per standard technique. The details of operations, post-operative complications and follow up to be recorded and analyzed. Results: Opening time and closing time in midline incision is significantly less than paramedian (P &lt;0.001). Incidence of wound infection and incidence of wound dehiscence in our study in midline group was less compared to paramedian group buy it is not significant. All forms of dehiscence ranging from superficial dehiscence to burst abdomen were included. Incidence of incisional hernia was significantly higher in midline incision (P&lt;0.05). Healing time was significantly lower in midline compared to Paramedian group (P&lt;0.05). Conclusion: It is concluded that midline incision is preferred compared to paramedian incision. Incidence of wound dehiscence and wound infection is less in midline incision. Medicine Today 2023 Vol.36 (1): 45-49

Contemporary outcomes after endoscopic vein harvesting for lower extremity bypass in a multicenter subspecialty practice

Contemporary outcomes after endoscopic vein harvesting for lower extremity bypass in a multicenter subspecialty practice

Outcomes of the Bone-Block Lapidus Arthrodesis (LapiCotton) in the Treatment of the Collapsed Foot

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Progressive collapsing foot deformity (PCFD), Hallux Valgus (HV), and Midfoot Arthritis (MA) are diseases that benefit from the Lapidus procedure due to its capability to provide a stable medial column while correcting the underlying deformity. However, the technique does not go without complications. First metatarsal shortening/dorsiflexion are not uncommon, which could be exacerbated by local anatomy/revision surgery settings. Restoring length and sagittal plane position (plantarflexion) of the first ray when treating these pathologies is paramount. Performing a primary distraction and plantarflexion fusion with an allograft wedge (LapiCotton) has been advocated in the literature, potentially allowing improved deformity correction, but with the risk of increased non-union rate. The objective of this study was to report medium-term follow-up results of the LapiCotton in patients with collapsed feet. Methods: This IRB-approved comparative prospective study assessed patients diagnosed with PCFD, HV, and MA undergoing a Lapidus bone-block fusion (LapiCotton) between August 2020 and November 2022. All patients were operated on by a single fellowship-trained foot and ankle surgeon after clinical evaluation and a weight-bearing computed tomography (WBCT). After adequate joint preparation and trials, a Lapidus pre-shaped wedge allograft was placed and fixed using available implants. Adjunctive procedures were carried out as needed. Patients were kept non-weight bearing for six weeks and followed clinically, performing a WBCT at three months and subsequent follow-up. Non-Union and complications were documented. Bone healing was determined by at least 50% of bone trabeculae crossing both graft interfaces at the WBCT. Forefoot arch angle (FFA), Meary’s angle, talonavicular coverage angle (TNCA), middle facet subluxation (MFS), and foot and ankle offset (FAO) were also obtained. Two fellowship-trained readers performed all assessments. P-values &gt;0.05 were considered significant. Results: Fifty-eight patients (60 feet) were included, mean age 53.87 (range:18-77)/BMI 31.70 (SD:7.96). Twenty-four PCFD, 19 HV, and 17 MA had an average 15.47 months (4-31) follow-up. Cuneiform-Post implants were used in 62%, plates/screws in 25%, and Lapidus nails in 13%. Median allograft size was 9mm (mode:8mm,5-19mm). Minor complications were observed in 3% (two superficial dehiscences) and major in 7% (three deep infections [5%], and one EHL contracture [2%]). Healing at the 3-month WBCT occurred in 94.8% and only in 66% at the most-recent WBCT (mean:11.08 months; 6-20). The clinical non-union rate demanding reoperation was eight clinical non-unions 13%. Mean FFA (pre:6.89,SD:6.63; postop:14.21,SD:5.48; p&lt; 0.001), Meary (pre:15.17,SD:8.12; postop:6.31,SD:5.61; p&lt; 0.001), TNCA (pre:26.75,SD:11.77; postop:11.59,SD:7.91; p&lt; 0.001), MFS (pre:36.3,SD:26; postop:23.49,SD:17.35; p&lt; 0.001), and FAO (pre:6.71,SD:5.81; postop:2.2,SD:4.33; p&lt; 0.001) improved after the interventions. Conclusion: Although the Lapidus bone-block arthrodesis (LapiCotton) restored many of the markers associated with foot collapse and alignment, non-union rated was noted in 13% what is on the top range of non-union rates reported in the literature for Lapidus arthrodesis. The use of allograft wedges in the fusion site probably explains our findings. The fact that the sample was heterogeneous and composed of considerably severe deformities should also be considered. Also, important to highlight that WBCT findings of fusion site healing was initially 94% at 3-months and only 66% at most recent follow-up). Additional studies and longer-term follow up are needed.

Chronic Achilles Tendon Rupture Reconstruction with Semitendinous Autograft Tendon: A Case Series

Category: Sports; Ankle Introduction/Purpose: Chronic Achilles tendon ruptures is challenging because the tendon ends are usually retracted, and if the gap between the proximal and distal stumps are of more than 6 cms with the ankle in plantarflexion the currently literature shows that semitendinous tendon (ST) autograft reconstruction has satisfactory funcional outcome. The objetive of this study is evaluate the functional outcomes after Achilles tendon reconstruction with ST. Methods: Prospective case series, level IV of evidence, authorized by Ethics Committee of our institution, assessed the clinical outcome of patients submitted to achilles tendon reconstruction between march 2021 and june 2022. The patients were diagnosed by 2 orthopaedic foot and ankle surgeons board certificated and were subjected to the following inclusion criteria: age between 18-60 years, agreeing to participate, with chronic achilles tendon rupture (&gt; 12 weeks) and gap between proximal and distal stump larger than 6cm confirmed by ultrasound with the ankle in plantarflexion position. Demographic data was obtained, including gender, BMI and height and the full ST length was measured intraoperatively. AOFAS Hindfoot Score and Achilles Tendon Total Rupture Score (ATRS) were evaluated pre and postoperatively (last evaluation). Results: 20 patients were included, with medium age of 45 years old (range 23 to 64 )and medium gap of 6,3 cm (range 6 to 6,6). (Table 1). The pre and postoperative AOFAS-hindfoot was 71 (range 48 to 83) and 89 (range 81 to 97), respectively, and the pre and posoperative ATRS was 33 (range 30 to 47) and 88 (range 86 to 92), respectively, both with statistic significance. The medium lenght of the ST from the posterior approach was 26.3 cm and the medium VAS for pain in the ST incision was 1. There were 2 cases of superficial infection treated with oral antibiotics for 7 days of full resolution and 1 case of superficial dehiscence treated with wound dressing. Conclusion: The surgical reconstruction of AT using ST harvested from posterior approach is a safe and reliable method for treatment of chronic AT ruptures with a gap larger than 6 cm, with a significant improvement in funcional scores and just 15% of minor complications.

The Fate of the Patient With Superficial Dehiscence Following Direct Anterior Total Hip Arthroplasty

Direct anterior approach (DAA) total hip arthroplasty (THA) has been associated with higher rates of superficial incisional dehiscence. However, limited data are available regarding the outcomes following initial treatment of this complication. This study aimed to evaluate patient risk factors, reoperations, and revisions in those who developed superficial wound dehiscence following DAA THA. We identified 3,687 patients who underwent a primary DAA THA between 2010 and 2019 from our enterprise total joint registry. Of these, 98 (2.7%) patients developed a superficial wound dehiscence requiring intervention [irrigation and debridement (n= 42) or wound care with or without antibiotics (n= 56)]. Dehiscence was noted at a median of 27 (range, 2-105) days. These patients were compared to patients who did not have a superficial wound complication (n= 3,589). Landmark survivorship analysis was performed to account for immortal time bias with a 45-day landmark time. Patients who had superficial wound dehiscence compared to those who did not, were more often women (64 versus 53%, P= .02) and had increased mean body mass index (33 versus 29, P < .001). There was no difference in 4-year survivorship free from any revision between cohorts (97 versus 98%, respectively, P= .14). There were 2 (2.0%) revisions in the superficial dehiscence group: 1 for periprosthetic joint infection and 1 for aseptic femoral loosening. Superficial wound dehiscence following DAA THA was associated with higher body mass index and was more common in women. Fortunately, with proper index management, the risk of revision THA and periprosthetic joint infection was not increased for these patients.

Primary Deltoid Repair for Ankle Fracture Using All-Suture Anchors

Primary repair of the deltoid ligament is a common surgical option for unstable ankle fracture. However, controversy exists regarding whether such repair is necessary or provides any benefit to patient outcomes. A retrospective study was performed following acute deltoid repairs using all-suture bone anchors. Patients at 2 surgical centers were included when they were over 18 years old at surgery, had a medial clear space (MCS) greater than 4 mm preoperatively, and had at least 6 months of follow-up. Subjective outcomes were measured with PROMIS, FAAM, and numeric rating scale. Preoperative and follow-up scores were compared with t tests (p < .05). For the 47 patients identified, age at time of surgery was 30.6 ± 14.9 years (range 15.4-65.0 years). Follow-up data were captured for 36 (73%) of the patients at 75 ± 37 weeks (range 18-169 weeks) after surgery. Mean time to weightbearing was 4 ± 1 weeks (range 1-7 weeks). Patients returned to sport 14 ± 5 weeks after surgery (range 8-41 weeks). Various complications consisted of wound infection, superficial dehiscence, and complex regional pain syndrome (CRPS). The PROMIS, FAAM, and NRS patient outcome scores improved significantly from preoperative to postoperative follow-up. Significant reduction in the radiographic MCS postoperatively occurred in all patients. These findings suggest primary deltoid repair when associated with ankle fracture to be a safe procedure and has the potential of allowing early weightbearing and return to sports.

P-026 SMALL BITE CLOSURE IN EMERGENCY LAPAROTOMY; A RETROSPECTIVE COHORT ANALYSIS

Abstract Aims To investigate the outcomes of the implementation of small bite closure in emergency laparotomy Methods A retrospective comparative cohort analysis was performed from Northumbria NHS Trust (United Kingdon) surgical database from 2017 to 2021. All cases of emergency laparotomy were included. Cases of open appendicectomy were excluded. Small bite closure was performed by a standardised technique with slowly absorbable sutures. A matched cohort of cases who were closed with mass closure were used for comparison. Results 262 cases of emergency small bites closure were included, and 247 cases of emergency mass closure. There were comparative age, sex and ASA grade in each group. There was no significant variation in the types of procedure performed. In the small bites closure group, there were 8 cases of superficial dehiscence (3%), 4 cases of deep dehiscence (1.5%) and 16 wound infections (6%). The mean post operative stay was 10 days (2 to 74). The 30 days mortality was 18 cases (7%) and 40 cases overall (15%). In the mass closure group, there were 6 cases of superficial dehiscence (2%), 6 cases of deep dehiscence (2%) and 23 wound infections (9%). The mean post operative stay was 14 days (3 to 65). The 30 day mortality was 34 cases (14%) and 65 cases overall (26%). Conclusion Small bites closure shows comparative results to mass closure in the emergency setting in post operative outcomes. Small bites closure is safe and feasible in the emergency setting.

Early Results and Complication Rate of the Lapidus Bone Block Fusion in the Treatment of Medial Longitudinal Arch Collapse: A Prospective Cohort Study

Category: Midfoot/Forefoot; Bunion; Hindfoot Introduction/Purpose: An unstable medial column lever arm may be associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restauration of the first metatarsal length and its lever in the tripod is essential when surgically treating these deformities. Fusion of the first tarsometatarsal joint (TMT) using a structural graft aims to correct the first metatarsal malalignment and create a firm construct on the medial arch. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion in patients with collapse/instability of the medial column. Our main hypothesis is that using a structural allograft on a TMT fusion might present a considerable rate of nonunion. Methods: In this IRB-approved prospective cohort study, patients with a clinical diagnosis of PCFD, HV, MA that underwent a TMT distraction arthrodesis at our institution were evaluated. Adults undergoing the procedure and had performed a weight- bearing computed tomography (WBCT) at 12 weeks postoperatively were included. The technique was carried using a pre-shaped anatomically specific structural allograft and specific implants. Fusion was defined by two fellowship-trained orthopedic foot and ankle surgeons and one fellowship-trained musculoskeletal radiologist, unrelated to the study. A percentage higher than 50% of crossing trabeculae over the entire proximal and distal allograft surfaces had to be noticed. Complications were established as minor (superficial dehiscence, superficial infection, and neuropraxia) and major (deep dehiscence, deep infection, nerve damage, residual deformity, sesamoiditis, limited motion, lateral overload, and reoperation). Collapse correction was assessed by the talus- first metatarsal angle (TFMA). Results: A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 HV patients) with a mean age of 52.6 years (range, 19-75 years; SD, 14.4), and a mean body mass index (BMI) of 32.9kg/m2 (95% CI, 29.2 to 36.5). Mean follow-up was 5.9 months (range, 3-12), and median allograft size was 8mm (range 5-19mm). Bone healing was observed on 91% of cases, and two patients (one PCFD and one MA) presented a non-union. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection on a MA patient) were observed. Inter-observer reliability for TFMA measurements was excellent, with an ICC of 0.86. Statistically significant improvement of the sagittal plane TFMA was observed, with a mean enhancement of 9.4 degrees (95% CI, 6.7 to 12.1 degrees; p&lt;.0001). Conclusion: In this prospective cohort study of 22 patients treated with the TMT distraction arthrodesis for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major). A high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%), and one unstable non-union (4.5%) needing reoperation were noted, despite the use of a structural allograft requiring healing at two surfaces. Our results demonstrate promising initial outcomes for this technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA, and HV deformities. Long-term results are needed to confirm these promising results.

Modified Mercedes Single Incision for Combined Liver Kidney Transplant: A Case Series Report

The traditional approach in combined liver-kidney transplantation involves 2 separate and sequential incisions. We describe a modification of the standard Mercedes incision that allows a single-incision operation while providing and maintaining adequate exposure to enable safe dual-allograft transplantation. Modification of the standard Mercedes incision includes bilateral, subcostal, muscle splitting incision 4 fingerbreadths below the rib edge with a midline, cephalad incision and inferior ± medial ipsilateral extension on the side of intended iliac fossa laterality for renovascular and ureteroneocystostomy anastomosis. Five consecutive patients (3 women/2 men; mean age, 49 years; median body mass index, 29.8 kg/m2) underwent combined liver-kidney transplantation for end-stage liver disease and progressive hepatorenal syndrome via a modified Mercedes single-incision approach (at a median Model for End-stage Liver Disease of 37) without an additional kidney transplant incision, extraperitoneal exposure, or addition of wound retractors. Two out of the 5 patients experienced postoperative wound complications, including 1 with delayed wound healing and 1 with superficial dehiscence. All patients have normal dual-allograft function at or beyond 6 months posttransplantation. The modified Mercedes single-incision technique is safe and feasible. Lowering the subcostal incisions with unilateral, inferomedial extension allows adequate visualization of the lower abdominopelvic area without compromising exposure of the upper abdomen for both renal and liver allograft implantation. Further studies are needed to prove the theoretical benefits of this technique.

The Karydakis flap: How I do it

Pilonidal sinus disease is a chronic inflammatory condition typically found in the sacrococcygeal region. It is caused by loose hair penetrating natal cleft skin. Treatment of symptomatic disease is surgical. There is a lack of consensus on the ideal surgical technique. The Karydakis flap involves asymmetric excision of the disease and closing the wound off midline with a lipocutaneous flap to flatten the natal cleft. The procedure has evolved since its description in 1968 and currently entails two layered fat closure, thin flap, displacement of the caudal apex, avoidance of routine drainage and the use of absorbable skin sutures. Its design and execution remain straight forward with a short learning curve. Out of 1029 type 4 Karydakis flaps reviewed, 16% were complicated by wound dehiscence. Recurrence rate at a mean of 29 months follow-up was 1%. By achieving a scar which is totally away from the midline, the Karydakis flap achieves a low recurrence rate. Minimizing early superficial dehiscence of the caudal wound remains a surgical challenge. The flap is suitable for all types of pilonidal disease.

Progressive-Tension Sutures in Reconstruction of Posterior Trunk Defects in Pediatric Patients: A Prospective Series.

Following neurosurgical repair of spinal dysraphism defects, soft-tissue reconstruction is often required to obtain robust coverage of the dura. Layered closure utilizing local muscle and muscle fascia has proven reliable for this purpose, but it often results in significant dead space necessitating closed suction drainage. Progressive-tension sutures have been reported as an alternative to drains for prevention of fluid collection in several other procedures. In this study, the use of progressive-tension sutures for eliminating subcutaneous dead space and obtaining tension-free skin closure was prospectively evaluated in pediatric patients undergoing soft-tissue reconstruction for congenital spinal anomalies. Primary outcomes of interest included wound breakdown, seroma, hematoma, and cerebrospinal fluid leak. Patients were excluded if a lumbar, submuscular, or subcutaneous drain was placed during the index procedure. Over a 3-year period, 45 patients underwent muscle flap reconstruction for coverage of dural defects. The primary diagnoses were myelomeningocele (10 patients), lipomyelomeningocele (eight patients), myelocystocele (three patients), tethered cord release (15 patients), meningocele (three patients), spinal tumor (two patients), and hardware exposure following spinal instrumentation (three patients). During the follow-up period, three patients (6.7 percent) had postoperative wound complications. One patient had superficial dehiscence, one had cerebrospinal fluid leak requiring operative revision, and one had a surgical site infection necessitating operative drainage. No patients developed hematomas, seromas, cerebrospinal fluid fistulae, or wound breakdown requiring operative revision. The use of progressive-tension sutures is an effective method for eliminating subcutaneous dead space in pediatric soft-tissue reconstruction and eliminates the need for drain placement. Therapeutic, IV.

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

IntroductionInstability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column.MethodsIn this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed.ResultsA total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3–12) and median allograft size was 8 mm (range 5–19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7–12.1°; p < 0.0001).ConclusionIn this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results.Level of evidenceLevel II, prospective cohort study.

TP7.2.1 Outcomes of Modified Karydakis flap in the surgical management of sacrococcygeal pilonidal disease: A single surgeon’s experience

Abstract Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 month follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol. Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they had excision without closure. Pre, per and post-operative management for the remaining 87 patients was according to a standardised protocol. Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: • Seroma: 8/87 (9.2%) • Haematoma: 1/87 (1.2%) • SSI: 10/87 (11.5%) • Deep SSI: 4/87 (4.6%) • Superficial dehiscence: 7/87 (8.0%) • Re-admission: 4/87 (4.6%) • Return to theatre: 0 (0%) • Flap necrosis: 0 (0%) Secondary outcome: • Recurrence at 6 months: 2/87 (2.3%) Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

Preservation of Deep Epigastric Perforators during Anterior Component Separation Technique Results in Equivalent Wound Complications Compared with Transversus Abdominis Release

BACKGROUND: In complex abdominal wall reconstruction, the use of CST increases fascial medialization and facilitates fascial closure; however, ACST has been associated with a high rate of wound complications.1 The purpose of this study was to compare wound complications and perioperative outcomes between a perforator sparing (PS)-ACST and (TAR). METHODS: From a prospective, tertiary hernia center database, patients who underwent open abdominal wall reconstruction with PS-ACST or TAR from 2016 to 2020 were identified. Patients undergoing concurrent panniculectomy were excluded. Outcomes included wound complications, need for reintervention, length of stay, and 30-day readmission. The Carolinas Equation for Determining Associated Risks application was used to predict wound complication rates. A univariate analysis was performed between the PS-ACST and TAR groups. Standard statistical methods and logistic regression were performed. RESULTS: A total of 92 patients met criteria; 37 had PS-ACST and 55 had TAR performed. The PS-ACST and TAR groups were similar in terms of BMI (29.8 ± 8.9 versus 31.3 ± 6.3 kg/m2, P = 0.23) and diabetes (16.2% versus 25.5%, P = 0.32), but the PS-ACST group a greater history of smoking (51.4% versus 14.5%, P < 0.01). Both groups had five comorbidities on average (P = 1.00). Most hernias were recurrent (59.5% versus 61.8%, P = 0.83). CDC wound classes were equivalent. The Carolinas Equation for Determining Associated Risks predicted wound complication rates were: PS-ACS-56.9% (range: 14.2–92.9%) and TAR-39.7 % (range: 7.3–92.2%). Preoperative botulinum toxin A was performed in 43.8% versus 19.1% of cases (P = 0.06). The PS-ACST group had a larger hernia defect size (374.9 ± 156.4 versus 223.7±119.7 cm2, P < 0.01) and increased intraoperative time (242.1 ± 63.8 versus 209.5 ± 71.0 min, P < 0.01). Despite the larger defect size, the mesh size was comparable (1096.0 ± 535.6 versus 944.4 ± 391.5, P = 0.71). Biologic mesh was more frequently utilized in PS-ACS patients (51.4% versus 27.3%, P = 0.03). All PS-ACST patients had a bilateral CST compared with 72.7% who received a TAR (P < 0.01). The fascial defect was fully closed in all but two cases (94.6% versus 100.0%, P = 0.16). Placement of an incisional vacuum-assisted closure device occurred more frequently in the PS-ACST group (32.4% versus 14.5%, P < 0.01). The overall wound complication rate was not significantly different (16.2% versus 20.0%, P = 0.79), neither was superficial dehiscence (5.7% versus 5.7%, P = 1.00), deep wound infection (5.7% versus 9.5%, P = 0.70), or seroma requiring reintervention (5.4% versus 5.5%, P = 0.99). There were no patients in the PS-ACST who required return to the operating room for wound-related issues (0.0% versus 9.6%, P = 0.08), and requirement for a percutaneous drain was uncommon (2.9% versus 7.7%, P = 0.64). Length of stay was one and a half days longer for PS-ACST patients (8.9 ± 5.4 versus 7.3 ± 4.0 days, P = 0.04), but 30-day readmissions were no different (5.4% versus 10.9%, P = 0.47). Using logistic regression, none of the factors that were significantly different in the univariate analysis correlated with wound complications (P > 0.05). CONCLUSIONS: PS-ACST, despite being used for larger defects, had equivalent rates of wound complications and need for reintervention compared with patients undergoing TAR. REFERENCE: 1. Maloney SR, Schlosser KA, Prasad T, et al. Twelve years of component separation technique in abdominal wall reconstruction. Surgery (United States). 2019;166:435–444. doi:10.1016/j.surg.2019.05.043

The "Three on a Stick" Incision-A Curvilinear Solution for the Occipital and Suboccipital Region.

Different conditions of the posterior fossa such as Chiari malformations, tumors, and arachnoid cysts require surgery through a suboccipital approach, for which a typical midline vertical linear incision is used. Curvilinear incisions have been carried in all other scalp regions other than the sub region for better cosmetic outcomes; a vertical curvilinear incision in the occipital and suboccipital region has not been reported. To evaluate the cosmetic value and safety of the "3 on a stick" vertical suboccipital curvilinear incision. We compared curvilinear to linear incisions, considering the scar's width, color, how conspicuous, and how well the scar could be covered by hair naturally. Between 2010 and 2016, 68 children with Chiari I malformation were surgically intervened. The curvilinear incision was performed in 56 (82.4%) while a linear incision in 12 (17.6%) children. There were only 2 (2.9%) wound related complications (superficial dehiscences) in the curvilinear group and 1 additional dehiscence in a linear incision case. There were no neural or vascular complications. Scars were very similar among the 2 groups; both were equally conspicuous but curvilinear ones seemed to get covered better by hair. The "3 on a stick" curvilinear incision of the suboccipital region is safe and allows for better hair coverage of the scar. It can be used for multiple conditions requiring a midline suboccipital or even occipital approach, such as Chiari malformations, tumors, and cysts.

V07-08 PENILE PLICATION FOR PEYRONIE'S DISEASE: THE 8-DOT TECHNIQUE

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-08 PENILE PLICATION FOR PEYRONIE'S DISEASE: THE 8-DOT TECHNIQUE Mark Ehlers, Brad Figler, and Alysen Demzik Mark EhlersMark Ehlers More articles by this author , Brad FiglerBrad Figler More articles by this author , and Alysen DemzikAlysen Demzik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile plication is a minimally invasive and effective technique for managing mild to severe curvature from Peyronie’s disease. METHODS: Retrospective chart review of all patients undergoing penile plication for Peyronie’s disease by one surgeon at one academic institution from November 2016 – December 2020 was conducted. Those occurring during IPP placement were excluded. Technical aspects of surgery were detailed and intraoperative video footage was made to illustrate the technique including papaverine injection, incision and variations, tissue dissection, iterative 8-dot plication with absorbable suture, and post operative evaluation. Primary outcomes were intra-operative and long-term success. RESULTS: A total of 66 patients were included. Median age was 58 years old (Range 24-73 years old). Average preoperative curvature was 45 degrees (Range 20-90 degrees). Curvature direction included 64% dorsal, 20% dorsolateral, 8% ventral, 5% ventrolateral, 3% lateral. Overall, 55% had complex deformities (biplanar curvature (38%), curvature of >60 degrees (50%), or both (11%)). Hinge effect was present in 14% of patients. Erectile dysfunction was present in 57% of patients. Ventral minimally invasive incisions were most common (64%) followed by circumcising incisions (24%), only 9% of patients had concurrent circumcision. Median number of 8-dot plication sutures used was 3 (Range 1-12). Intraoperative success, defined as completely straight was 97%. The 2 technical failures were directly related to ability to maintain intraoperative erection. Mean follow up was 4.5 months (IQR 1.1–4.2) and 91% of patients reported straight erections at follow up. No patient with hinge effect had a intraoperative failure or recurrence. There were no major complications. Rate of minor complication (superficial dehiscence, hematoma) was 6%. There were no revision plication procedures or patients who proceeded to penile implant surgery. CONCLUSIONS: This iterative approach to penile plication with absorbable suture is an effective, minimally invasive, and reproducible technique for correcting acquired penile curvature. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Ehlers More articles by this author Brad Figler More articles by this author Alysen Demzik More articles by this author Expand All Advertisement Loading ...

Negative pressure wound therapy in spinal fusion patients.

Post‐operative wound complications are some of the most common acute complications following spine surgery. These surgical site infections (SSI) contribute to increased healthcare related costs. Negative pressure wound therapy (NPWT) has long been used for treatment of soft tissue injury or defects. NPWT may reduce the incident of SSI following spinal fusion procedures; however, its potential applications need further clarification. Thus, we conducted a retrospective analysis of two cohorts to compare NPWT to traditional sterile dressings following spinal fusions in regards to post‐operative outcomes. Following institutional review board approval, 42 patients who had a NPWT were matched by type of surgery to 42 patients who had traditional dressings. A retrospective chart‐review was completed. Outcome measures, particularly SSI and need for reoperation, were analyzed using one‐way ANOVA for both univariate and multivariate analysis. When controlled for sex and body‐mass index, the use of a NPWT was independently correlated with decreased SSI (P = .035). Superficial dehiscence, seroma, need for additional outpatient care, and need for operative revision were all found to occur at higher rates in the traditional dressing cohort. Closed incisional negative pressure wound therapy provides a cost‐effective method of decreasing surgical site infection for posterior elective spine surgeries.

Comparison of early surgical outcomes following anoplasty and limited PSARP for perineal fistula

Background: To present the early surgical outcomes of two different surgical methods for the treatment of perineal fistula in patients with anorectal malformation. Material and Methods: Retrospective chart analysis of patients treated with any of the two surgical approaches for perineal fistula treatment during the newborn period, without a colostomy at Academic and Community Pediatric Surgery Reference Hospital during October 1st, 2015 to December 31st, 2018. Results: Twenty-six out of 57 patients of our database met inclusion criteria during the study period. 15 in the anoplasty group and 11 in the Minimal Posterior Sagittal Anorectoplasty (MPSARP); the anoplasty group had more rate of anoplasty dehiscence (4 partial, 6 total – requiring additional stitches, p = 0.027), versus zero in the MPSARP group, albeit there was 1 superficial perineal dehiscence. All surgeries were performed without a previous colostomy. There were no other surgical complications reported, and there was no difference in age, weight, sacral ratio, and associated malformations. Conclusion: Minimal PSARP can be safely done in the newborn patient with a patent perineal fistula.

Free Lateral Forearm Flap in Head and Neck Reconstruction: An Attractive Alternative to the Radial Forearm Flap.

The lateral forearm flap-a thin, fasciocutaneous flap harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery-is an attractive alternative to the radial forearm flap. The authors hypothesized that it is safe and effective for head and neck reconstruction. They conducted a retrospective review of all lateral forearm flap reconstructions performed between 2016 and 2018. Patient demographics, defect characteristics, adjuvant therapies, and postoperative complications were recorded. Swallowing and diet were assessed in patients undergoing intraoral reconstruction. The Disabilities of the Arm, Shoulder and Hand questionnaire was completed prospectively preoperatively and postoperatively. Flap and pedicle dimensions were recorded. Twenty-five lateral forearm flap reconstructions were performed; 23 were for intraoral defects. There were no partial or complete flap losses, one venous thrombosis, and one hematoma requiring reoperation. Preoperative and postoperative Disabilities of the Arm, Shoulder and Hand questionnaire scores were equivalent (p = 0.78). In the intraoral cohort, 22 patients (96 percent) resumed an oral diet following reconstruction. The average pedicle length was 11.8 cm (range, 9 to 16 cm); skin paddle length and width were 6.6 cm (range, 4 to 12 cm) and 4.7 cm (range, 4 to 12 cm), respectively; arterial diameter was 1.5 mm (range, 1.4 to 2.5 mm); and venous diameter was 2.8 mm (range, 2.4 to 3.6 mm). All donor sites were closed primarily; one superficial dehiscence was reported. In summary, the authors found that the free lateral forearm flap provided an excellent alternative to the radial forearm flap in head and neck reconstruction. It is a thin, pliable fasciocutaneous flap with excellent pedicle length, and the donor site can be closed primarily with minimal morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.