Surgical Closure Research Articles

Multifunctional wet-adhesive chitosan/acrylic conduit for sutureless repair of peripheral nerve injuries

The incidence of peripheral nerve injury (PNI) is high worldwide, and a poor prognosis is common. Surgical closure and repair of the affected area are crucial to ensure the effective treatment of peripheral nerve injuries. Despite being the standard treatment approach, reliance on sutures to seal the severed nerve ends introduces several limitations and restrictions. This technique is intricate and time-consuming, and the application of threading and punctate sutures may lead to tissue damage and heightened tension concentrations, thus increasing the risk of fixation failure and local inflammation. This study aimed to develop easily implantable chitosan-based peripheral nerve repair conduits that combine acrylic acid and cleavable N-hydroxysuccinimide to reduce nerve damage during repair. In ex vivo tissue adhesion tests, the conduit achieved maximal interfacial toughness of 705 J m−2 ± 30 J m−2, allowing continuous bridging of the severed nerve ends. Adhesive repair significantly reduces local inflammation caused by conventional sutures, and the positive charge of chitosan disrupts the bacterial cell wall and reduces implant-related infections. This promises to open new avenues for sutureless nerve repair and reliable medical implants.

Complications after surgical correction of penile fractures-Is there a clinical impact?

Surgical exploration and closure of the tunica albuginea is the recommended treatment for penile fractures. The recovery of sexual function is the main result that surgeons and patients pursue. We sought to evaluate the sexual health effects of a surgically corrected penile fracture. Secondarily, we sought to identify risk factors that may influence long-term sexual function and their effects on genital body image satisfaction. A retrospective analysis of patients who underwent surgical correction of penile fractures between 2007 and 2022 in a tertiary center was performed. Lesion characteristics, weeks until the resumption of sexual activity, and post-operative sexual function were recorded. The presence of glans hypoesthesia, penile deformation, penile nodule palpation, and self-satisfaction with body image were assessed. Sixty-nine patients with a mean age of 42.30±12.98 years and a median follow-up of 70 (20-134) months were identified. Sexual intercourse was recorded as a percentage. Penile deformation was the most common complication, appearing in 14.5% of patients, erectile dysfunction in 5.8%, penile nodules in 4.3%, and glans hypoesthesia in 2.9%. The median post-operative International Index of Erectile Function-5 was 24 (21.5-24). Self-satisfaction with body image had a median of 9 and was negatively associated with bilateral lesions and penile deformation. Distal fractures could be linked to erectile dysfunction and glans hypoesthesia. Surgical correction of penile fractures shows positive functional and self-reported outcomes, and the potential andrological complications rarely necessitate specific treatment.

A method for eliminating a chest wall defect after the sternoclavicular joint resection

Purulent arthritis of the sternoclavicular joint requires surgical treatment. The volume of the intervention depends on the degree of the joint's transformation and patient's general condition. The resulting defect of the chest wall tissues requires surgical closure at the reconstructive stage. In case of an extensive defect area with a skin deficiency, it is most advisable to use full-thickness flaps of the latissimus dorsi or pectoralis major muscles.
 The article presents a clinical case of a patient operated for purulent arthritis of the sternoclavicular joint. The surgical treatment was planned in two stages. During the first stage, the use of vacuum-assisted dressings demonstrated its effectiveness. The second, reconstructive stage, included plastic surgery for the chest wall defect using a full-thickness flap of the pectoralis major on the thoracic branch of the thoracoacromial artery. The progress of the patient's surgical and general treatment was described in detail.

Diabetic Foot Osteomyelitis Caused by Co-Infection with Methicillin-Resistant Staphylococcus aureus and Multidrug-Resistant Extended-Spectrum ß-Lactamase-Producing Escherichia coli: A Case Report

This case report describes a 47-year-old man with type 2 diabetes and its associated complications. The patient developed co-infection with methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant (MDR) extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli following surgical amputation for osteomyelitis caused by diabetic foot infection (DFI). The patient had a history of recurrent hospitalization due to DFI and had received multiple antimicrobials. Intraoperative wound cultures identified MRSA and MDR ESBL-producing E. coli as the causative agents of the co-infection. Intravenous vancomycin and meropenem were administered. After surgery, daily debridement and hyperbaric oxygen therapy were performed. The patient underwent surgical wound closure and was discharged on day 86. Polymicrobial infections in DFIs worsen antimicrobial resistance, impede wound healing, and increase the risk of osteomyelitis and amputation. Furthermore, infections caused by MDR bacteria exacerbate challenges in infection control, clinical treatment, and patient outcomes. In DFI cases caused by co-infection with MDR bacteria, prompt and appropriate antimicrobial therapy, debridement, and regular wound care while considering transmission are essential.

Total Diz Artroplastisinde Cerrahi Yara Kapatılması Öncesinde Kontrollü Arteriyel Hipertansiyon ile Yapılan Hemostazis Kanama Miktarını ve Transfüzyon İhtiyacını Etkiler mi?

Objective: We aimed to assess the efficacy of hemostasis while controlled augmentation of arterial blood pressure before surgical closure after total knee arthroplasty (TKA). 
 Materials and Methods: This retrospective cohort involved data collected from the medical files of 87 patients (62 women, 25 men) who underwent TKA using hypotensive epidural anesthesia (HEA). Patients were allocated into two groups. Group I (n=44) received HEA, while Group II (n=43) had controlled arterial hypertension before surgical closure. Perioperative hemoglobin and hematocrit levels, systolic and diastolic blood pressure, and the amount of erythrocyte suspension transfusion were compared between the two groups. 
 Results: The average age of our series was 66.41 ± 6.17 (range: 57-78) years. Notably, the amount of bleeding on postoperative 1st, 2nd, 4th, 12th, and 24th (p=0.031, 0.032, 0.001, 0.001, 0.001, respectively) hours was significantly less in Group II. There were no significant differences between the two groups for complications, operative duration, perioperative bleeding, duration of follow-up and hospitalisation, and compared descriptives. 
 Conclusion: Our data indicated that controlled elevation of mean arterial pressure before surgical closure might allow the achievement of meticulous hemostasis after TKA. Further prospective, randomised, controlled trials on more extensive series are warranted to verify our preliminary results.

Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2: A Global Multicenter Study

To report on macular hole repair in macular telangiectasia type 2 (MacTel2). Global, multicenter, retrospective case series. Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH). Standardized data collection sheet distributed to all surgeons. Anatomic closure and visual outcomes of MTMH. Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range, 34-573 μm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 μm (range, 97-697 μm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 μm (range, 132-687 μm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P=0.08). Visual acuity improved at least 2 lines in 25%. Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Importance of Multimodal Spinal Cord Monitoring and Hemodynamic Augmentation during High Thoracic Ventral Dural Tear Repair Using the Posterior Approach

AbstractCerebrospinal fluid (CSF) leakage due to large ventral dural tears (VDT) often requires surgical intervention. Surgical closure of a high thoracic VDT is challenging and associated with high morbidity, especially if it is performed after multiple epidural blood patch (EBP)/fibrin glue injections. A 44-year-old woman was diagnosed with spontaneous intracranial hypotension due to VDT at T1-T2, causing CSF leakage. Multiple EBP and fibrin glue injections failed to treat her symptoms; hence, the patient underwent surgical closure using the posterior approach. The patient was anesthetized using standard anesthetic drugs and was maintained under total intravenous anesthesia to facilitate continuous motor-evoked potential (MEP) monitoring. The surgical course was complicated by bleeding, hypotension, and MEP loss. Continuous MEP monitoring, effective team communication, quick restoration of blood pressure(BP) and BP augmentation with fluid, blood, and vasopressor helped to restore the MEP back to baseline. Hence, the patient recovered without neurological morbidity. This case report highlights the importance of adequate vascular access, multimodal spinal cord monitoring, and BP augmentation during a high thoracic VDT repair.

Patent ductus arteriosus closure in patients weighing 2 to 6 kilos. Monocentric comparison between surgical and transcatheter closure

Patent ductus arteriosus closure in patients weighing 2 to 6 kilos. Monocentric comparison between surgical and transcatheter closure

Trends in Procedural Closure of the Patent Ductus Arteriosus among Infants Born at 22 to 30 Weeks’ Gestation

To describe recent trend in procedural closure of the patent ductus arteriosus (PDA) among premature infants and compare the clinical characteristics of infants receiving surgical vs transcatheter closure. We conducted a descriptive, retrospective cohort study of preterm infants born between 220/7 and 296/7weeks' gestation from 2014 through 2021. Infants were identified from the Pediatrix Clinical Data Warehouse. We excluded infants with any major congenital anomaly. We identified all preterm infants with a PDA and all those who underwent procedural closure (surgical ligation or transcatheter occlusion) and compared changes over time using ANOVA for continuous variables and the Cochran-Armitage trend test to evaluate time-related changes in proportions. The study cohort included 64 580 infants, of whom 24 028 (37.2%) were diagnosed with a PDA. The number of infants receiving any procedural closure of the PDA decreased from 371 (4.4%) in 2014 to 144 (1.9%) in 2021. During the same period, number of surgical ligations decreased from 369 (4.36%) to 64 (0.84%), and the number of transcatheter occlusions increased from 2 (0.02%) to 80 (1.05% p for all < 0.001). The median age at time of surgical ligation increased from 25 days (10th and 90th percentile, 10, 61) to 31days (10th and 90th percentile, 16, 66), and the median age of transcatheter occlusion decreased from 103days (10th and 90th percentile, 32, 150) to 43days (10th and 90th percentile, 22, 91). There was a decrease in surgical closure and an increase in transcatheter occlusion of the PDA in infants born at 22-30weeks' gestation from 2014 to 2021. Despite the decline in overall procedural closure, the rate of transcatheter occlusion surpassed surgical ligation by 2021. Narrowing differences in the median age and weight at closure suggest increasing overlap in the types of infants who received each type of procedural closure.

A prospective study on enterocutaneous fistula in a tertiary care centre: A single institution study

Background: Aberrant connection linking gastrointestinal tract and the skin is termed Enterocutaneous fistula. Enterocutaneous fistulas can lead to significant morbidity and mortality. Death pertaining to enterocutaneous fistulas remains enormous when juxtaposed with other surgeries. The treatment of Enterocutaneous fistula may be a significant challenge to surgeons and gastroenterologists. Method: After obtaining ethical committee clearance, a total of 25 patients of Enterocutaneous fistula who presented to Surgical department and Surgical Gastroenterology department were included in the study. The cause, site and output of fistula, clinical course and complications of fistula were studied. Patients were managed either surgically or conservatively depending on the output of the fistula, nutrition and metabolic profile. Results: 19 patients were managed conservatively and 6 patients were managed surgically. Amidst the conservative group, 16 out of 19 patients had spontaneous closure of fistula and remaining three had died as fistulas failed to close. Surgical closure was accomplished in 5 patients but failed in one patient and that patient died. 96% (24 out of 25) of patients in our study had developed fistula post operatively. Among 25 patients studied, nearly 44% each i.e., 11 out of 25 patients had colonic and small bowel fistula respectively followed by fistula at appendix accounting for 12% (i.e., Fistula Output: 11 (44%) fistulae were low output, 8 (32%) were medium output. Conclusion: Enterocutaneous fistulas are more common in postoperative period. Conservative treatment should be the mainstay in management of Enterocutaneous fistula.

103 Outcomes and Complications of Simple Layered Closure of Persistent Tracheocutaneous Fistula After Tracheostomy in Childhood

Abstract Aim Up to half of all children with a tracheostomy develop persistent trachea-cutaneous fistula (TCF) after decannulation. Surgical closure of it is technically easy but post-operative complications can be immediate and life-threatening. We reviewed our experience in TCF closures to identify potential risk factors for complications. Method Retrospective case records review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following the development of a persistent TCF after decannulation of a tracheostomy. Results 67 children were identified. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%): life-threatening air leak occurred in the immediate post-operative period in 2 children (3%) and respiratory distress in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications. Conclusions Further analysis of the potential associations between patient factors, surgical factors, and complications is necessitated in guiding future practice.

Surgical Correction of Aneurysmal Dilatation in a Coronary Cameral Fistula: A Case Report

Coronary cameral fistula (CCF) is an uncommon congenital anomaly that is typically discovered incidentally or may manifest with symptoms of angina. We present a case of CCF originating from the right coronary artery (RCA) and extending to the main pulmonary artery (MPA), characterized by aneurysmal dilatation at the pulmonary artery end. The patient presented with angina and exhibited ischemic changes in the inferior leads on electrocardiography. Additionally, the patient had coexisting stenosis of the left anterior descending artery (LAD). Consequently, the patient underwent a successful surgical closure of the fistula, along with surgical revascularization of the LAD.

Incisional complications after skin closure with stainless‐steel skin staples compared to nylon sutures in horses undergoing colic surgery

SummaryBackgroundIncisional complications following ventral midline celiotomy represent a challenge for equine surgeons. Preventative measures to minimise risks of incisional complications are continuously being investigated. This includes the search for an ideal surgical closure method.ObjectiveTo compare the incidence of incisional complications after skin closure with nylon sutures versus stainless‐steel skin staples (SSS) following ventral midline celiotomy for colic surgery in horses and to assess additional risk factors for incisional complications.Study designProspective blinded randomised study (2012–2014).MethodsOne hundred and twenty‐three horses that underwent colic surgery between May 2012 and May 2014 and survived for &gt;2 weeks were included in the study. Horses were allocated randomly to two groups—65 horses were closed with skin staples, and 58 horses were closed with skin sutures (nylon‐0). Patient records and a follow‐up questionnaire were used to record incisional complications that occurred during hospitalisation and after discharge.ResultsFollow‐up information was available in 119 of 123 horses. Four horses without follow‐up were excluded. With strict inclusion criteria, incisional drainage was recorded in 43% (49/115) of the horses, including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group. Pregnancy and large colon intestinal lesions were risk factors for incisional complications. Surgeon 3 was found to decrease the incidence of incisional infection. No association was detected between incisional complications and hernia development.Main limitationsThe non‐uniformity of the follow‐up examination; reliance on owners or caregiver of the horse for follow‐up information, horses lost to follow‐up, incomplete data. Another limitation was the single‐centre design of the study.ConclusionsAlthough not significantly superior, the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure.

Left Atrial Appendage Closure: What Do We Know?

Atrial fibrillation (AF) is the most common arrhythmia in the United States and the most common cause of embolic cerebrovascular events, with the majority of these thrombi originating in the left atrial appendage. The left atrial appendage (LAA) has separate developmental, ultrastructural, and physiological characteristics from the left atrium. Although LAA anatomy is highly variable, it can be categorized into 4 types: cactus, cauliflower, chicken wing, and windsock. The cauliflower type is associated with higher stroke risk in patients with nonvalvular AF. Although the cornerstone of therapy to prevent embolic strokes from AF has been anticoagulation with thrombin inhibitors, a large group of patients are unable to tolerate anticoagulation due to bleeding. This has led to the development and advancement of multiple surgical and percutaneous LAA closure devices to prevent embolic cerebrovascular accidents without the need for anticoagulation. In this article, we discuss the outcomes of major studies that utilized surgical LAA occlusion and its effectiveness. Furthermore, we summarize nonsurgical methods of LAA closure and future directions regarding LAA closure.

Minimally invasive surgical closure for ventricular septal defects through a horizontal right axillary minithoracotomy: early results at one center

Objectives: To investigate the early outcomes and cosmetic results of a horizontal right axillary minithoracotomy for closure of ventricular septal defects (VSDs) at Hanoi Heart Hospital.[1]&#x0D; Methods: a descriptive cross-sectional study. We retrospectively reviewed 119 children who underwent horizontal right axillary minithoracotomy for ventricular septal defects closure at Hanoi Heart Hospital from January 2022 to December 2022.&#x0D; Results: the average weight was 11.1 ± 8.2 kg, from 2.6 to 51.0 kg. The number of children below 6 months old accounted for 34.5% (41 patients). The rates of perimembranous VSD, infundibular VSD, inlet VSD, and muscular VSD were 68.1%, 27.7%, 3.4%, and 0.8%, respectively. The aortic cross-clamping time was 53.1 ± 23.5 minutes, the duration of cardiopulmonary bypass was 77.9 ± 29.7 minutes. The length of postoperative hospital stay was 7.4 ± 2.3 days. Postoperative residual shunt accounted for 5.9%, the rate of severe complications and hospital mortality were 0%.&#x0D; Conclusion: ventricular septal defects repair through a horizontal right axillary minithoracotomy at Hanoi Heart Hospital provided good early outcomes with satisfactory aesthetic results.

Comparing Planned Surgical versus Percutaneous Access Vascular Outcomes and Complications in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract Background Increased expertise and technical advancements lead to a significant reduction of major access site-related vascular complications that occur, nowadays Post and intra-procedural in &amp;lt; 10% of cases. Due to its wide diffusion and feasibility, the trans-femoral access is the preferred route in the majority of the clinical trials and is recommended as first choice by all guidelines and consensus documents, as vascular complications are a non-comparable factor to traditional SAVR so it is a new side effect that has emerged with TAVI that is in need to be minimized. Aim The aim of this work is to compare surgical versus percutaneous access peripheral vascular outcomes in TAVI procedure during hospital stay. Patients and Methods This was a Comparative cross-sectional study that was conducted at Ain Shams university hospitals &amp; Helwan university hospital this study included 68 retrospective and prospective patients that were scheduled for TAVI 29 with percutaneous access followed by device closure (Proglide) and 37 surgical cut-down patients followed by surgical closure. Result A total of 68 patients were enrolled, 34 patients were females (50 %) and 34 patients were males (50 %). Their age ranged from 65-97 years with mean age (75.12) years. Patients in this study are classified into 2 groups: Group I: included patients who did the procedure with percutaneous vascular approach followed by device closure. Group II: included patients included patients who did the procedure with surgical cutdown vascular approach. Conclusion There is no significant difference in vascular complications between the 2 approaches indicating that whenever closure devices (Proglide) are available it can be used safely on patients undergoing TAVI, a more dedicated closure device to larger puncture sites such as MANTA should be properly studied as a promising step. Recommendation Larger studies with increased sample size are recommended for proper evaluation of intra and post procedural predictors of vascular complications. Further studies on the new MANTA device as it is a dedicated device to larger puncture sites. Long-term follow up.

Subocclusion of the Left Main Coronary Artery During Surgical Left Atrial Appendage Closure

Subocclusion of the Left Main Coronary Artery During Surgical Left Atrial Appendage Closure

Assessment of microcirculation variables and endothelial glycocalyx using sidestream dark field videomicroscopy in anesthetized dogs undergoing cardiopulmonary bypass.

To evaluate microcirculation and endothelial glycocalyx (eGC) variables using sidestream darkfield (SDF) videomicroscopy in canine cardiopulmonary bypass (CPB). Dogs undergoing CPB for surgical correction of naturally-occurring cardiac disease were prospectively included. Variables collected included patient demographics, underlying cardiac disease, red blood cell flow (Flow), 4-25 μm vessel density (Density), absolute capillary blood volume (CBVabs), relative capillary blood volume (CBVrel) and eGC width assessed by perfused boundary region (PBR). Anesthetized healthy dogs were used as control. Microcirculation and eGC variables were compared at baseline under anesthesia (T0), on CPB prior to cross clamping (T1), after cross clamp removal following surgical correction (T2) and at surgical closure (T3). Twelve dogs were enrolled, including 10 with a complete dataset. Median Flow was 233.9, 79.9, 164.3, and 136.1 μm/s at T0, T1, T2, and T3, respectively, (p = 1.00). Median Density was 173.3, 118.4, 121.0 and 155.4 mm/mm2 at T0, T1, T2, and T3, respectively, (p = 1.00). Median CBVabs decreased over time: 7.4, 6.6, 4.8 and 4.7 103μm3 at T0, T1, T2, and T3, respectively, (p < 0.01). Median CBVrel increased over time: 1.1, 1.5,1.1, and 1.3 103μm3 at T0, T1, T2, and T3, respectively, (p < 0.001). Median PBR increased over time: 1.8, 2.1, 2.4, 2.1 μm at T0, T1, T2, and T3, respectively, (p < 0.001). Compared to control dogs (n = 8), CPB dogs had lower CBVabs at T0. Alterations in eGC thickness and microvascular occur in dogs undergoing CPB for naturally-occurring cardiac disease.

Transthoracic device closure of perimembranous ventricular septal defect via a small left intercostal incision in children.

In children with perimembranous ventricular septal defect, surgical repair requires sternotomy and leaves unsightly scars, which can trigger long-term physical and psychological distress. However, transcatheter device closure is limited by vascular diameter, radiographic exposure, and expensive DSA equipment. We used an ultra-small left intercostal incision for transthoracic device closure to avoid the above problems and investigated its safety and feasibility by comparing it with surgical repair. This study enrolled 358 children with perimembranous ventricular septal defect. Among them, 152 patients were treated by surgical closure and 206 by transthoracic device closure via an ultra-small left intercostal incision. Perioperative clinical data and postoperative follow-up results were collected and analyzed retrospectively. The success rate was similar (P = 0.265) in the two groups: 203/206 patients in the device group vs. 152/152 patients in the surgical group. The operative time, intensive care unit time, mechanical ventilation time, and postoperative hospital stay were significantly shorter in the device group than in the surgical group. Although the incision length of the device group (1.1 ± 0.2 cm) was significant shorter (P < 0.001) than that of the surgical group (6.7 ± 1.5 cm), there was no difference in hospitalization costs between the two groups (P = 0.099). Except for small residual shunt (16/206 vs. 3/152, P = 0.017), the incidence of complications in the device group was lower or equal to that in the surgical group, and all small residual shunt disappeared during follow-up. There was no thoracic deformity in the device group, compared with 11 cases in the surgery group during follow-up (P < 0.001). Transthoracic device closure via an ultra-small left intercostal incision under transesophageal echocardiography guidance is safe and feasible. With appropriate indications, it can be a suitable alternative to surgical closure for treating perimembranous ventricular septal defect in children.

FTP8.14 Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood

Abstract Up to half of all children with a tracheostomy develop persistent trachea-cutaneous fistula (TCF) after decannulation. Surgical closure of it is technically easy but post-operative complications can be immediate and life-threatening. We reviewed our experience in TCF closures to identify potential risk factors for complications. Methods Retrospective case records review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following the development of a persistent TCF after decannulation of a tracheostomy. Results 67 children were identified. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%): life-threatening air leak occurred in the immediate post-operative period in 2 children (3%) and respiratory distress in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications. Conclusion Further analysis of the potential associations between patient factors, surgical factors, and complications is necessitated in guiding future practice.