Superficial Wound Infection Research Articles

Does the stemless reverse arthroplasty compare to a conventional stemmed implant? Clinical and radiographic evaluation at 2 years’ minimum follow-up

AimReverse shoulder arthroplasty (RSA) is a well recognized treatment for many shoulder conditions, including rotator cuff arthropathy, primary glenohumeral joint arthritis, rheumatoid arthritis and can be utilized in both trauma and revision settings. Over the past 10 years its popularity in New Zealand has been increasing, with a 6-7% annual growth during this period. The proposed advantages of a stemless (sRSA) design are to preserve humeral bone stock, limit periprosthetic fractures and can be indicated in patients with abnormal diaphyseal humeral anatomy. To date there is only one study evaluating the outcomes of Lima stemless SMR implant. We present our data with an aim to report how the stemless reverse arthroplasty compares to a conventional stemmed implant. MethodsA retrospective review was performed of a consecutive series from a single institution between 2015 to 2020. Endpoints were defined as final follow-up at a minimum of 2 years. Patients were excluded from final analysis if they had a revision. Thirty-three patients were identified as having had sRSA. Thirty patients had PROMS and radiographs at minimum 2 years follow-up. Three patients were revised within 2 years. The same sample size (n=33) of stemmed RSA was selected for comparison ResultsA total of 60 patients were included in the final analysis, of which 30 were stemless and 30 stemmed. The demographic characteristics of the two groups were comparable except age at operation which was statistically significant (P=0.001), 77 years (stemmed) vs 65 years (stemless). The mean OSS score in the stemless group was 40.1 versus 40 in the stemmed group. The ASES was 72.9 in the stemless group and 79 in the stemmed group. The patient reported outcome measures, pain scores or satisfaction were not statistically significant between the two groups. In terms of radiographic data, subsidence of two sRSA was observed but the patients had no clinical symptoms. Also in the sRSA group one patient had an acromial stress fracture, and one patient had a superficial wound infection successfully treated with oral antibiotics. In terms of revisions in the sRSA group, one patient was revised due to chronic infection, one revised as a result of a periprosthetic fracture following a fall and one revised for gross instability. ConclusionsEarly results of sRSA are promising and show similar outcomes to a conventional stemmed implant.

Effects of negative‐pressure wound therapy in the prevention of surgical‐site wound infection after vascular surgery: A meta‐analysis

AbstractThis meta‐analysis systematically evaluates the impact of negative‐pressure wound therapy (NPWT) on surgical‐site wound infection after vascular surgery. A comprehensive computerized search was conducted, from database inception to November 2023, in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for randomized controlled trials (RCTs) on the application of NPWT in vascular surgery. Two researchers independently screened the literature, extracted data, and conducted quality assessments based on inclusion and exclusion criteria. Data analysis was performed using RevMan 5.4 software. A total of 11 RCTs involving 1597 vascular surgery patients were included. The analysis revealed that the application of NPWT in vascular surgery significantly reduced the incidence of wound infections (OR = 0.43, 95% CI: 0.32–0.58, p < 0.001) and complications (OR = 0.40, 95% CI: 0.27–0.58, p < 0.001). Additionally, NPWT was found to decrease the occurrence of both superficial wound infections (OR = 0.63, 95% CI: 0.36–1.12, p = 0.12) and deep wound infections (OR = 0.47, 95% CI: 0.19–1.16, p = 0.10), although these differences were not statistically significant. This study indicates that NPWT, compared with conventional treatment methods, has significant advantages in preventing postoperative wound infections and complications in vascular surgery patients and is therefore worthy of widespread clinical adoption.

Post-operative morbidity after neoadjuvant chemotherapy and resection for gallbladder cancer: A national surgical quality improvement program analysis.

Gallbladder cancer is the most common malignancy of the biliary tract. Neoadjuvant chemotherapy (NACT) has improved overall survival by enabling R0 resection. Currently, there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer. As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients, we examined American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to determine if there was higher morbidity among the neoadjuvant group within the 30-day post-operative period. We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity. To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery. A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity (bile leak, infection rate, rate of converting to open surgery, etc.) compared to the group who only had surgery. To calculate the odds ratio for the primary and secondary outcomes, a crude logistic regression was performed. Of the 452 patients, 52 patients received NACT prior to surgery. There were no statistically significant differences in the odds of morbidity between the two groups, including bile leak [odds ratio (OR), 0.69; 95% confidence interval (95%CI): 0.16-2.10; P = 0.55], superficial wound infection (OR, 0.58; 95%CI: 0.03-3.02; P = 0.61), and organ space wound infection (OR, 0.63; 95%CI: 0.18-1.63; P = 0.61). There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.

Reverse total shoulder arthroplasty for proximal humerus fracture: a complex episode of care associated with increased surgical and medical complications

IntroductionReverse total shoulder arthroplasty (rTSA) remains a viable treatment option in elderly patients with proximal humerus fractures (PHF). However, the risk profile of this procedure in this patient population has not been well established by prior studies. The aim of this study is to examine whether there are differences in sociodemographic variables, underlying medical comorbidities, and 90-day outcomes between patients undergoing rTSA for osteoarthritis (OA) vs. PHF. We hypothesized that patients with PHF would be older and have higher comorbidity burden compared to glenohumeral OA controls. Furthermore, we hypothesized that rTSA would yield inferior outcomes and higher costs of care in patients with PHF compared to glenohumeral OA. MethodsPatients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. PHF patients were identified using the International Classification of Diseases, Tenth Revision diagnosis codes and compared to OA controls. All patients < 18 years old and those who underwent rTSA for other indications were excluded. Patients were matched in a 2:1 fashion based on age (± 3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, comorbidities and 90-day surgical (wound complications, dislocation, periprosthetic fracture, periprosthetic joint infection, stiffness, loosening, mechanical complications, and revision) and medical (deep vein thrombosis/pulmonary embolism, pneumonia, respiratory failure, renal failure, stroke, myocardial infarction, and sepsis) complications and readmission were compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at P < .05. Odds ratio (OR) and 95% confidence interval were calculated. ResultsBefore matching 51,150 OA controls and 11,394 PHF cases were identified. After matching, 8661 PHF cases were matched to 17,332 controls. Regarding surgical complications, PHF patients were at significantly increased risk of periprosthetic fracture (OR 2.35), dislocation (OR 2.87), superficial wound infection (OR 5.51), periprosthetic joint infection (OR 1.91) and 90-day revision (OR 4.76). PHF patients were at increased risk of all medical complications examined including hemorrhage (OR 2.20), anemia (OR 2.78) deep vein thrombosis (OR 3.10), pulmonary embolism (OR 2.83), pneumonia (OR 2.93), respiratory failure (OR 3.37), pneumonia (OR 2.93), stroke (OR 2.61), myocardial infarction (OR 2.79), acute renal failure (OR 4.06), urinary tract infection (OR 5.50) and sepsis (OR 3.71) as well as 90-day readmission (OR 2.13). Discussion/ConclusionPatients undergoing rTSA for PHF are at significantly increased risk of complications compared to OA controls. Furthermore, these patients are at increased risk of 90-day readmission. These findings should prompt diligent preoperative risk stratification by surgeons and healthcare providers to prevent patient morbidity.

Early experience and perioperative risk of GammaTile for upfront brain metastases: Report from a prospective multicenter study.

GammaTile (GT), a form of brachytherapy utilizing cesium-131 seeds in a bioresorbable collagen tile, has gained popularity for the treatment of recurrent intracranial tumors and more recently for newly diagnosed metastases. This study reports early experience utilizing GT in upfront brain metastases with a focus on clinical applications and perioperative safety. The STaRT Registry (NCT04427384) was queried for all patients receiving GT for upfront metastases from August 2021 to August 2023. Data regarding patient demographics, procedure details, and adverse events (AEs) were extracted and analyzed. Twenty-eight patients, median age 65 years (range 28-81), with 30 treated metastases were reported from 6 institutions. Patients had 2.8 metastases on average (range 1-15) at the time of surgery; however, most patients had a single metastasis (60.7%). The mean diameter of treated metastases was 3.4cm (range 1.5-4.7). A median of 4.0 tiles (range 1-10) were used per tumor. The median follow-up was 3.0 months (range 1.0-11.2) with 6 attributed AEs (21.4%), including 1 grade ≥ 3 (infection). In the immediate postoperative period (<14 days), 2 patients reported pain or headache, and 1 reported facial edema. One patient developed seizures on postoperative day 8 requiring medication. At 1-month follow-up, there was 1 superficial wound infection, in a previously colonized patient, requiring surgical intervention without explantation of tiles. At 3-month follow-up, 1 patient reported facial pain not requiring treatment. There were no symptomatic hematomas. GT demonstrates a favorable safety profile in upfront brain metastases with a 3.6% rate of serious AEs (grade ≥ 3) within 90 days of the procedure.

Use of Fibula Nails With Proximal and Distal Fixation.

Ankle fractures are a frequent injury in the adult population and a quarter of all ankle fractures are classified as unstable, requiring surgical intervention. Plate-and-screw construct is the traditionally used fixation method for fibula fractures. The use of an intramedullary nail is an alternative fixation method, with current literature supporting very low complication rates and hardware removal surgeries. The purpose of this study was to evaluate the outcomes, including complication rates and implant removal rates, using a fibula nail with both proximal and distal fixation capabilities by an experienced surgeon. We retrospectively reviewed 203 consecutive fibula nail cases from a single surgeon using a mini-open technique for anatomic reduction. Demographic, operative, clinical, and radiographic outcome data were analyzed, specifically examining complication rates and need for implant removal. The average follow-up was 18.8 months (6-54 months). All fractures healed. We identified 2 cases of superficial wound infection, 1 superficial peroneal nerve irritation, and 1 case of implant removal. In the first 110 cases, 2 fractures were converted to a plate intraoperatively prior to a technique modification which has prevented this occurrence. No deep infection, delayed union, or nonunion occurred. Our data support that fibula nails with proximal and distal locking capabilities offer an alternative to plating with the potential for lower complication rates and lower need for implant removal. Level IV, case series.

Minimally invasive removal of dumbbell shaped schwannomas with transforaminal lumbar fusion: a retrospective study with a minimum 3-year follow-up

To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization. A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year. Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients. Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.

Short-term results of combined anterior cruciate ligament and anterolateral ligament reconstruction using a novel hamstrings graft construct in obese patients: a pilot study

Abstract Background Elevated body mass index (BMI) was associated with increased complication rates including failures in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. We present our short-term results of our technique used for ACL reconstruction in obese patients with the aim to reduce chances for graft failure and improve outcomes. Patients and methods We present our case series of obese patients (BMI &gt; 30) operated for ACL reconstruction during the period from January 2017 to January 2022 using a dedicated technique for ACL reconstruction. We are using hamstring tendons prepared in a single construct to reconstruct both the intra-articular ACL and the anterolateral ligament. All patients received the same surgical technique and associated injuries were operated on according to their indications and guidelines. All patients completed the subjective knee evaluation form of the International Knee Documentation Committee at the time of the procedure and at the last follow-up visit and assessment of knee laxity was performed using a KT-1000 arthrometer before the surgery and at the last follow-up. Results Twenty patients underwent anterior cruciate ligament reconstruction (ACLR) using this technique during the study period, with average follow-up period of 1 year. All cases were males, mean BMI was 32.2 (30.4–36.2), 18 cases were operated on using ipsilateral Semitendinosus and Gracilis grafts, 2 cases were operated on using contralateral knee hamstrings. All cases were instructed nonweight bearing for 6 weeks after surgery and received the same standard accelerated rehabilitation protocol. Two cases developed postoperative superficial wound infection at the graft harvest site that resolved with conservative treatment of oral antibiotics and wound care. The mean postoperative International Knee Documentation Committee score improved from 45.195 to 79.245 (P&lt;0.001), and the mean KT-1000 arthrometer differential improved from 11.8 to 2.77 (P&lt;0.001) and pivot shift tests were negative in the postoperative exam for all the cases. Conclusion ACLR in obese patients should be approached with care, our technique can offer a feasible solution to obtain an acceptable outcome, Further work is required to provide insight on the long-term outcome of ACLR in obese patients.

Functional and Radiological Outcomes of Total Knee Arthroplasty in Osteoarthritis with Varus Deformity of Knee: A Prospective Study

Introduction: Total knee replacement (TKR) is the most commonly performed orthopedic surgical procedure for treating severe arthritis of the knee joint either due to osteoarthritis or due to inflammatory arthropathy. There was cartilage damage in either the medial or patella femoral joint/lateral compartment. Severe pain through deformity develops, subsequently necessitating a total joint replacement. This study assessed the Functional and radiological outcomes of total knee arthroplasty in osteoarthritis with varus deformity of the knee. Materials and Methods: From February 2021 to July 2022, all patients with osteoarthritis with varus deformity of knee were subjected to total knee arthroplasty after obtaining approval from the Institutional Ethics Committee were required to enroll patients. Results: The age of the patients in our study was 63.58 years ranging from 52 to 79 years. In 72.09% of the patients were females while the remaining 27.91% were females. In our study, 45% of the patients were overweight while the remaining 59.48% were overweight. In our study, 55.81% of the patients get their left knee operated first while the remaining 44.19% of the patients get their right knee operated first. In 25.58% patella resurfacing was done. The p-value was found to be significant between the pre- and post-oper knee society scores. In our study, 5 patients had complications out of which 4.65% of the patients had superficial wound infection, 4.65% of them patient had anterior knee pain and 2.33% had popliteal artery thromboembolism. Conclusion: Total knee arthroplasty is a relatively safe procedure. Treatment with total knee arthroplasty resulted in greater pain relief and functional improvement after 6 months. It improves the functional ability of the patient and the ability of the patient to get back to pre-disease state, which is to have a pain-free mobile joint, There was a significant association between the knee clinical score and knee functional score at six months follow-up.

Total hip replacement among sickle cell patients in alow-income country-Yemen.

Sickle cell patients presented with progressive hip pain and limitation of daily activities, as evidenced by low preoperative hip scores and failed conservative therapy. Management of femoral head avascular necrosis (AVN) using total hip replacement (THR) in sickle cell disease (SCD) is widespread in developed countries, but it is still in its initiation stage in developing countries. The outcome of using cementless THR among SCD patients is still unknown with lack of published studies from regional countries. This study aimed to evaluate the outcome of using cementless primary THR among patients with sickle cell disease with end-stage hip avascular necrosis in Yemen. Thirty cementless primary total hip arthroplasty (THA) were performed for AVN of the femoral head in 27 sickle cell patients, at Al.-Thawra Modern General Hospital-Sana'a, Yemen, from January 2018 to December 2022. The mean age of the patients was 27 ± fiveyears (ranged 18-37years) with a male to female ratio was 3:1. Steinberg staging for hip AVN was stage IV, one patient (3%); stage VI, thirteen patients (45%); and stage V, sixteen patients (51%). THR was on right side 14 (52%), left side 10 (37%), and bilateral 3 (11%). The implant used was ceramic on polyethylene acetabular liner. All patients showed improvement in Harris hip score from preoperative mean hip score was 25 ± 8 points to postoperative mean hip score was 88 ± 6 points at the last follow-up. Mean of the length of stay in hospital was 12.7 ± eightdays (ranged from 4 to 32days); the mean operating time was 107 ± 23min. Three cases had superficial wound infection; four patients had five intraoperative fractures; two cases had pulmonary complications; one case had abdominal crisis. All patients had postoperative leg length discrepancy less than 2cm. None had deep infection, nerve injury, wound hematoma, aseptic loosing, dislocation, DVT, heterotopic ossification, or death. THR in SCD has a good outcome using cementless THA with a low rate of complication in Yemen, a developing country.

Comparison of Open Lichtenstein Repair and Laparoscopic Transabdominal Preperitoneal of Inguinal Hernia: A Pragmatic RCT in Bangladesh

Background: Laparoscopic inguinal hernia repair has emerged as an effective alternative to open Lichtenstein mesh repair for inguinal hernias. Objective: The purpose of the present study was to compare the surgical outcomes of laparoscopic trans-abdominal pre-peritoneal (TAPP) and open Lichtenstein mesh repair for the treatment of inguinal hernia. Methodology: This single centered, pragmatic randomized controlled trial was conducted in the Department of Surgery at 300 bed hospital, Narayanganj, Bangladesh from January 2018 to June 2020 for a period of two and half year. Patients who were presented with reducible, primary/recurrent, complete/incomplete inguinal hernias among male and female in more than or equal to 18 years of age were selected as study population. Lichtenstein mesh repair was performed which was compared with the laparoscopy group. Open Lichtenstein repair was done under spinal anesthesia with lightweight poly propylene mesh. Laparoscopy was performed by trans-abdominal pre-peritoneal (TAPP) technique under general anesthesia and heavy weight mesh was used. The hospital stay, operating time, post-operative complications like superficial wound infection, seroma formation, scrotal swelling as well as early recurrence and chronic groin pain were compared among these group. Results: A total number of 90 patients presented with inguinal hernia were recruited for this study of which TAPP was performed in 25 cases and 65 cases were undergone Lichtenstein repair. The mean age of laparoscopy and open group of patients were 49.28±9.9 years and 55.05±14.4 years respectively (p-0.03). The mean operation time was 85±10.31 minutes and 52.1±15.36 minutes in laparoscopy and open group respectively (p-0.000). The mean post-operative hospital stay was 2.9±0.78 days and 2.9±0.71 days in laparoscopy and open group respectively (p-0.94). In this study 21 (23.3%) patients developed 25 different early and late post-operative complications, out of which 15 (23.1%) in open group and 06 (23.3%) in laparoscopy group (p-0.52). One early recurrence was reported after 6 months follow up in laparoscopy group. Chronic groin pain was reported in 7 cases of which 5 (7.7%) cases in open group and only 2 (8.0%) cases in laparoscopy group (p-0.002). Conclusion: In conclusion the surgical outcomes of laparoscopic TAPP performed by a young surgeon in Bangladesh has given a clinically better result than open Lichtenstein repair considering hospital stay, seroma formation, wound infection, scrotal swelling and chronic groin pain. Journal of Current and Advance Medical Research, January 2023;10(1):35-40

Trigger thumb treatment approach: Results of a survey of EPOS members.

The aim of this study is to analyze the clinical reality of pediatric trigger thumb among members of the European Paediatric Orthopaedic Society. A 35-question survey was sent to all European Paediatric Orthopaedic Society members, focusing on surgeon's profile and experience, trigger thumb diagnostic and trigger thumb treatment approach. Descriptive statistics were performed. A total of 99 responses were analyzed. Most important factor considered in the therapeutic approach was the presence of a locked interphalangeal joint (52%). Regarding treatment, 41.4% opt for conservative approach as the first line of treatment, while 30.3% consider surgery and 28.3% just observe. Nevertheless, 76% mention to treat conservatively their patients and 99% to consider surgery at some stage. Regarding surgical technique, 96% do it open and 56% consider 2 years as the minimum age for procedure. Most surgeons perform this procedure in out-patient care (87%), don't administer prophylactic antibiotherapy (80%), use a tourniquet (75%), don't use any postoperative immobilization (64%), and report complications related to surgery (64%), mainly recurrence/incomplete division (59%) and superficial wound infection (30%). Our study shows a significant variability in the initial management of pediatric trigger thumb with a predominance of conservative management, followed by surgery and observation without treatment. The disparity in treatment options and timing, or waiting times before moving on to different therapeutic options, shows us that this is a controversial issue and that the development of prospective randomized controlled studies is needed to analyze the different treatment methods and determine which ones give the best outcomes.

Primary Closure Versus Delayed Primary Closure of Class III and IV Surgical Wounds Following Emergency Laparotomy: A Prospective Comparative Study.

Introduction Emergency surgery has a high risk of complications due to the detrimental effect of perioperative sepsis and the relative lack of preoperative optimization of patients. Despite advances in critical care for the management of sepsis, its prevention is dependent on various patient and surgeon factors. Surgical site infection continues to be a major determinant of morbidity and mortality following emergency abdominal surgery, especially in contaminated or dirty wounds. This study aims to compare two techniques of abdominal wall closure, primary closure with subcutaneous suction drains and delayed primary closure following negative pressure wound therapy, in terms of incidence of surgical site infection and morbidity. Materials and methods The study was a prospective comparative study including 50 patients with an acute surgical abdomen requiring laparotomy. The patients were randomized into two groups, Group A (n=25) who underwent primary closure, and Group B (n=25) who underwent delayed primary closure. In Group B patients, a vacuum-assisted closure device was applied in the subcutaneous space for five days prior to the closure of the skin. Outcomes were compared in terms of the incidence of superficial and deep surgical site infection, its association with diabetes mellitus, and the total duration of hospital stay. A chi-square test and an unpaired t-test were used for the test of significance. Results A total of 50 patients, comparable in age, were included in the study. The overall incidence of surgical site infection was significantly higher in patients of Group A as compared to Group B (p=0.0046). There was a positive correlation between diabetes mellitus and the occurrence of wound infection in both groups with the odds ratio being 2.67 and 2.38 respectively. The incidence of superficial wound infection was significantly higher in Group A when compared to Group B (52% versus 24%; p=0.04). Deep surgical site infection was higher in patients of Group A (20% versus 8%) but was not statistically significant (p=0.22). The average duration of hospital stay was 41.56 ± 6.96 and 37.86 ± 6.68 days for patients who developed complications fromGroups A and B respectively, while it was nearly two and a half times lower in uncomplicated cases of Groups A and B (11.71± 1.70 days and 16.58± 1.06 days respectively). The one-tailed unpaired t-test showed a significant difference in means of hospital stay between patients with and without complications (T: 17.06, critical value: 1.677). Conclusion Delayed primary closure is an effective method of managing contaminated and dirty wounds following emergency laparotomy. Negative pressure wound therapy is one technique for preventing wound bed infection and accelerating wound healing in such cases. By combining the above in emergency surgeries, the incidence of surgical site infection and duration of hospital stay can be significantly reduced.

Safety and efficacy of a modified WALANT technique using undiluted adrenaline during open surgical carpal tunnel release: a prospective report of 308 procedures

PurposeThe current study aimed to report on the safety and efficacy of utilizing a modified WALANT (mWALANT) technique during open surgical carpal tunnel release (CTR), where we used undiluted epinephrine compared to the originally described WALANT technique.MethodsFrom January 2015 till the end of June 2021, 200 patients (175 (87.5%) were females) who presented with carpal tunnel syndrome, either bilateral (108 (54%) patients) or unilateral (92 (46%)) were included, formulating a total of 308 procedures. Open surgical CTR was performed as a daycare procedure by the same surgeon. The mWALANT injectable mixture was prepared by mixing 8 CC of 2% lidocaine HCl + 1 CC of 0.25 mg/1 ml epinephrine without dilution (2.5 times the concentration used in the original WALANT technique). The injection was performed before draping.ResultsThe patients’ average age at surgery was 42.88 ± 13.03 years old; they were followed up for an average of 31 ± 17.17 months. The average operative time was 9.5 ± 1.87 min. None (0.0%) of the patients needed top-up of local anesthesia or shift into general anesthesia, and no (0.0%) patients needed postoperative hospital stay. The average VAS during the surgical procedure was 2.5 ± 2.1, mainly reported during infiltration of the local anesthesia; no patients reported discomfort during the surgical procedure itself. 180 (90%) patients reported a full return to their usual preoperative ADL after an average of 4.7 ± 1.2 weeks. No (0.0%) postoperative fingers ischemic or temperature changes. Two (1%) patients experienced an adrenaline rush in the form of tachycardia that needed sedation and close monitoring by the anesthesiologist; they were discharged on the same day. One (0.5%) patient (who had uncontrolled diabetes mellitus) showed a superficial wound infection which resolved after conservative management.ConclusionsUsing undiluted epinephrine during the mWALANT technique is safe and effective. There is no need to wait until the drugs fully function, and no epinephrine-related complications were encountered apart from occasional adrenaline rush symptoms.

Treatment of cerebrospinal fluid leakage with prolonged use of subfascial epidural drain and antibiotics in patients of thoracic myelopathy after posterior decompression surgery.

Cerebrospinal fluid leakage (CSFL) is a prevalent and vexing complication associated with spine surgery. No standard protocol is available guiding CSFL management, especially for thoracic CSFL. The aim of this study was to retrospectively evaluate the efficacy of prolonged use of subfascial epidural drain and antibiotics to treat CSFL after posterior thoracic decompression surgery. Fifty-six patients with an average age of 52.3 years (24-76 years), who underwent thoracic decompression with CSFL (group A) and 65 patients with an average age of 54.9 years (25-80 years) without CSFL (group B) were retrospectively reviewed. Patients in group A had prolonged use of subfascial drainage and antibiotics and patients in group B were treated with conventional methods. The surgical results and rate of wound related complications was compared between the two groups. The average subfascial drainage time was 7.0 ± 2.7 days (2-16 days) and 3.8 ± 1.4 days (2-7 days) in group A and B, respectively. Higher occupation rate (>49%), presence of dural ossification and higher MRI grade (>2) were more likely to presented with CSFL. In group A, four patients (7.1%) presented with deep wound infection and were successfully managed with wound debridement or intravenous antibiotics. In group B, one patient (1.5%) had a superficial wound infection and was treated with antibiotics. No patients presented with wound dehiscence, wound exudation or CSF fistulation. The occupation rate of ossified mass and presence of dural ossification were the major risk factors of CSFL. No significant difference in infection rates was observed between the patients in group A and B.

Expanding the Horizons of Minimally Invasive Spine Surgery: Experience of the Destandau Technique for the Treatment of Multiple Spinal Diseases

ObjectiveMinimally invasive spine surgery is rapidly gaining popularity owing to its versatile nature. Traditionally prolapsed disc has been the most common pathology targeted using this technique. However, its utility for various other pathologies has also been shown in studies. Here we present our experience of using this technique for various spinal pathologies apart from prolapsed discs. MethodsThis is a retrospective study in which patients operated by a single surgeon from January 2019 to April 2023 were included. Cases which required conversion to open technique were excluded. Intraoperative findings and post-operative courses were obtained from patient records. ResultsA total of 47 cases were included in the study, of which 29 were male and 18 were female. Various pathologies treated include- intradural extramedullary tumors – 23, hypertrophied/ossified ligamentum flavum- 9, arachnoid cysts- 6, dermoid/epidermoid- 4, detethering of cord- 3 and posterior cervical decompression for an ossified posterior longitudinal ligament in 2 patients. The average duration of surgery was 2.1+1.2 hrs and the mean intraoperative blood loss was 138.4+ 59.1 ml. The mean hospital stay was 2.3+0.9 days. Two patients had superficial wound infection and none of the operated patients had cerebrospinal fluid leakage. Re-exploration was not required in any of the operated patients. ConclusionsMinimally invasive techniques for dealing with multiple pathologies involving the spine are as good as traditional open techniques with some additional advantages of lesser tissue trauma, early return to work etc. However, one must overcome the steep learning curve before adopting them in day-to-day practice.

The clinical utility of immediate post-operative PACU plain film radiographs following uncomplicated open Latarjet procedure – An institutional series of consecutive patients

BackgroundImmediate post-operative plain film radiograph x-rays in PACU following open Latarjet procedure are often ordered as routine. However, such radiographs utilize institutional cost and time, whilst potentially exposing patients to often-unnecessary additional radiation. This study sought to evaluate whether routine immediate post-operative radiographs following uncomplicated open Latarjet procedures impacted clinical decision-making in our institution. MethodsFrom 2017 to 2020, patients who underwent open Latarjet procedure by one of four fellowship-trained upper limb surgeons at a single institution were included in this study. Post-operative radiographs taken immediately in PACU were reviewed to determine if any reported radiographic findings impacted on clinical decision-making in the immediate post-operative setting. SPSS was used for descriptive statistics. ResultsA total of 337 patients underwent an X-ray in PACU immediate after uncomplicated open Latarjet procedure. Overall, 98.5% were male (n = 332), the mean patient age of included patients was 22.9 ± 4.2 years. No patient had an abnormal finding on their post-operative x-ray. Two patients returned to the operating room in the immediate post-operative period, both requiring washout and debridement due to haemtoma or superficial wound infection. ConclusionThe findings of this study suggest that the use of post-operative plain films in PACU following open Latarjet procedure remains a costly use of resources, with little ultimate impact on clinical decision making in the short-term post-operatively. Level of EvidenceIV – Institutional Case Series of Consecutive Patients.

THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN ZONE II AND ZONE V ACUTE FLEXOR TENDON INJURIES

Our study sought to establish the necessity of prolonged pre-operative antibiotic prophylaxis in patients presenting with zone II and zone V acute flexor tendon injuries (FTI). We hypothesized that a single dose of prophylactic antibiotic was adequate in prevention of post-operative wound infection in acute zone II and V FTI.This was a prospective study of 116 patients who presented with zone II and zone V acute FTI. The study included patients who were 18 years and older. Those with macroscopic contamination, immunocompromised, open fractures, bite injuries, and crush injuries were excluded. Patients were randomised into a group receiving a single dose of prophylactic antibiotic and another group receiving a continuous 8 hourly antibiotic doses until the day of surgery. Each group was subdivided into occupational and non-occupational injuries. Their post-operative wound outcomes were documented 10 – 14 days after surgery. The wound outcome was reported as no infection, superficial infection (treated with wound dressings), and deep infection (requiring surgical debridement).There was 0.9% rate of deep post-operative wound infections, which was a single zone V acute FTI case in a single dose prophylactic antibiotic group. There was a 7.8% superficial post-operative wound infection rate, which was mainly zone II acute FTI in both antibiotic groups. There was a strong association between zone II acute FTI and post-operative wound infection (p &lt; 0.05). There was no association between (antibiotic dosage or place of injury) with post-operative wound infection (p &gt; 0.05).There is no benefit in prescribing prolonged pre-operative antibiotic in patients with acute, simple lacerations to zone II and zone V FTI if there is no macroscopic wound contamination.

Operative Treatment of Peritrochanteric Osteoporotic Fractures with Proximal Femur Locking Compression Plate: A Consecutive Study

Advances in modern medical science have increased life expectancy and the incidence of peritrochanteric fractures. Conventional implants such as sliding hip screws and angular blade plates can be used to effectively treat these fractures, but proximal femoral locking compression plates offer superior three-dimensional fixation and angular stability. From December 2012 to May 2015, 40 peritrochanteric fracture treated with LCP (Locking Compression Plate) were studied prospectively. With an average age of 69.77 years (range: 60 -80 years), there were fifteen females and six males. Patients with multiple fractures, open fractures, co morbidities, pathological fractures and more than 3 weeks old fractures were excluded. After six weeks, partial weight bearing was initiated and serial radiographs were taken at six, twelve and two months. 1.5 years later, union was achieved. The peritrochanteric fractures were categorized by AO classification. In our study, the majority of patients (n=21) had A1 fractures, with A1.1 (n=13 patients) being the most common, followed by A1.3 and A1.2 (n=5 and n=3, respectively). In our study, seventeen patients had A2 fractures, with A2.1, A2.2 and A2.3 occurring in eight, four and five patients, respectively. We only had two patients in A3 and one each in A3.1 and A3.2. The surgery ranged from 50 to 90 minutes, with a mean of 69 minutes (SD 11.29). In our study, complications included superficial wound infection in two individuals and deep infection in one patient. Three patients (n=3) developed Coxavara with shortening and one patient had a screw back out. At the final follow-up, patients were evaluated using the Modified Harris Hip Score. Our study found that LCP plates are more useful for unstable peritrochantric fractures in elderly osteoporotic patients, with a higher percentage of Coxavara in our study. This can be prevented by delaying weight bearing in unstable fractures. However, there was no control group to compare our results with other modalities of treatment.

Obesity Does Not Affect Major Outcomes in Robotic Coronary Surgery

Background: Robotic-assisted coronary surgery is gaining attraction as an alternative to traditional open-heart procedures, offering potential benefits such as decreased mortality rates, shorter hospital stays, and reduced complications. This study aimed to investigate the outcomes of robotic-assisted coronary surgery, focusing particularly on the impact of obesity. Methods: A total of 210 consecutive patients underwent robotic-assisted coronary surgery over an eight-year period at a single institution. Patients were categorized based on body mass index (BMI), distinguishing between obese (BMI ≥30 kg/m2) and non-obese (BMI &lt;30 kg/m2) groups. The analysis encompassed preoperative characteristics, operative factors, and postoperative outcomes. Results: Comparisons between obese and non-obese patients revealed similar preoperative comorbidities. However, the operation time was prolonged in the obese group (p = 0.03). Major cardiac and cerebrovascular events, along with overall complications, displayed no significant disparities between the groups. Notably, superficial wound infections were more prevalent among obese patients (p = 0.03). Importantly, intensive care unit and hospital stay times were comparable between the two groups. Conclusion: Robotic-assisted coronary surgery demonstrates its potential as a viable alternative to conventional open-heart procedures, offering benefits such as reduced mortality rates, shorter hospital stays, and minimized perioperative complications. This study's findings underscore the feasibility and safety of this approach, with outcomes comparable between obese and non-obese patients.