Healing Of Surgical Incisions Research Articles

Perioperative Nutritional Considerations In Patients With Inflammatory Bowel Disease

Despite significant advances in medical therapy for inflammatory bowel disease (IBD) in recent decades, surgical management remains common in the setting of both Crohn’s disease (CD) and ulcerative colitis (UC). While the risk of colectomy for UC has declined in the biologic era, most patients with CD will undergo at least one intestinal resection in their lifetime. Preoperative nutritional status is a wellestablished determinant of surgical morbidity. Surgery elicits a metabolic stress response that is proportional to the extent of surgical injury. Adequate lean body and micronutrient stores are needed for healing of surgical incisions, and the individual must be metabolically capable of anabolism for tissue repair. Deficits at any point in this process may lead to complications including anastomotic failure, surgical site infections, delayed return of gastrointestinal (GI) function, and postoperative physical disability with prolonged length of hospital stay.

Glucopeptide Superstructure Hydrogel Promotes Surgical Wound Healing Following Neoadjuvant Radiotherapy by Producing NO and Anticellular Senescence.

Neoadjuvant radiotherapy, a preoperative intervention regimen for reducing the stage of primary tumors and surgical margins, has gained increasing attention in the past decade. However, radiation-induced skin damage during neoadjuvant radiotherapy exacerbates surgical injury, remarkably increasing the risk of refractory wounds and compromising the therapeutic effects. Radiation impedes wound healing by increasing the production of reactive oxygen species and inducing cell apoptosis and senescence. Here, a self-assembling peptide (R-peptide) and hyaluronic-acid (HA)-based and cordycepin-loaded superstructure hydrogel is prepared for surgical incision healing after neoadjuvant radiotherapy. Results show that i) R-peptide coassembles with HA to form biomimetic fiber bundle microstructure, in which R-peptide drives the assembly of single fiber through π-π stacking and other forces and HA, as a single fiber adhesive, facilitates bunching through electrostatic interactions. ii) The biomimetic superstructure contributes to the adhesion and proliferation of cells in the surgical wound. iii) Aldehyde-modified HA provides dynamic covalent binding sites for cordycepin to achieve responsive release, inhibiting radiation-induced cellular senescence. iv) Arginine in the peptides provides antioxidant capacity and a substrate for the endogenous production of nitric oxide to promote wound healing and angiogenesis of surgical wounds after neoadjuvant radiotherapy.

Analysis of risk factors affecting wound healing and wound infection after meningioma resection.

To analyse the risk factors affecting wound healing and infection after spinal meningioma resection surgery. The surgical incision healing of 137 patients who underwent spinal meningioma resection at our hospital from January 2021 to January 2024 was analysed. The data collected included physical examination findings, haematological and biochemical measurements, and various scales assessed upon admission and after surgery. These data were then analysed. The surgical wound healing, infection and postoperative complications were statistically analysed. Multiple logistic regression analysis method was used to conduct risk factor analysis on corresponding indicators; the odds ratio and p value of 95% confidence interval were calculated. Factors such as age and smoking history were significantly negatively correlated with wound healing after meningioma resection (odds ratio < 1.000, p < 0.05), while preoperative albumin and platelet count were significantly positively correlated with wound healing (odds ratio > 1.000, p < 0.05). Age, WHO Meningioma Grading, preoperative albumin and preoperative platelet were significantly negatively correlated with wound infection after meningioma resection (odds ratio < 1.000, p < 0.05). The history of virus infection and history of neurological disorders were significantly positively correlated with wound infection (odds ratio > 1.000, p < 0.05). The influence of each factor is different. Age, smoking history, WHO Meningioma Grading, preoperative albumin, preoperative platelets, history of virus infection and history of neurological disorders had the greatest influence on wound healing and infection after meningioma resection.

Evaluating the effectiveness of proactive perioperative nursing strategies on the prevention of surgical site infections and the enhancement of skin healing in paediatric abdominal surgery

AbstractThe present study aimed to investigate the comparative efficacy of proactive perioperative nursing interventions versus conventional perioperative nursing care in improving wound healing, reducing the incidence of surgical site infections (SSIs) and enhancing patient satisfaction among paediatric patients undergoing elective open abdominal surgery. A total of 100 paediatric patients were enrolled in a randomised controlled trial at our hospital between January 2021 and December 2022. Inclusion criteria were patients aged &lt;18 years who met the requirements for surgical intervention and had no contraindications to surgery or anaesthesia. Patients were randomly assigned to either an observation group receiving proactive perioperative nursing care, or a control group subjected to conventional care. Primary outcome measures included surgical incision healing grades (A, B, C), infection rates confirmed by bacterial culture within 30 days post‐surgery, patient satisfaction scores and length of hospital stay. Comprehensive statistical analyses were performed using IBM's SPSS software (version 27.0). Both groups demonstrated statistically similar baseline demographics and surgical parameters. However, the observation group showed significant improvement in wound healing outcomes (Grade A) and decreased incidence of complications (Grade C) and infections compared to the control group (P &lt; 0.05). Patient satisfaction was significantly higher in the observation group, with 80% of patients reporting satisfaction as opposed to 20% in the control group (p &lt; 0.05). The distribution of pathogenic bacteria in SSIs predominantly included Escherichia coli (E. coli), Pseudomonas aeruginosa, Enterococcus spp., Staphylococcus aureus and Klebsiella pneumoniae. Proactive perioperative nursing interventions demonstrate considerable benefits in improving wound healing, reducing surgical site infection rates and enhancing patient satisfaction in elective open abdominal surgery settings. However, these results require validation through large‐scale trials.

Exploration of machine learning models for surgical incision healing assessment based on thermal imaging: A feasibility study

AbstractIn this study, we explored the use of thermal imaging technology combined with computer vision techniques for assessing surgical incision healing. We processed 1189 thermal images, annotated by experts to define incision boundaries and healing statuses. Using these images, we developed a machine learning model based on YOLOV8, which automates the recognition of incision areas, lesion segmentation and healing classification. The dataset was divided into training, testing and validation sets in a 7:2:1 ratio. Our results show high accuracy rates in incision location recognition, lesion segmentation and healing classification, indicating the model's effectiveness as a precise and automated diagnostic tool for surgical incision healing assessment. Conclusively, our thermal image‐based machine learning model demonstrates excellent performance in wound assessment, paving the way for its clinical application in intelligent and standardized wound management.

Evaluating the Healing Potential of J-Plasma Scalpel-Created Surgical Incisions in Porcine and Rat Models.

Cold atmospheric plasma devices generate reactive oxygen and nitrogen species that can be anti-microbial but also promote cell migration, differentiation, and tissue wound healing. This report investigates the healing of surgical incisions created using cold plasma generated by the J-Plasma scalpel (Precise Open handpiece, Apyx Medical, Inc.) compared to a steel scalpel in in vivo porcine and rat models. The J-Plasma scalpel is currently FDA approved for the delivery of helium plasma to cut, coagulate, and ablate soft tissue during surgical procedures. To our knowledge, this device has not been studied in creating surgical incisions but only during deeper dissection and hemostasis. External macroscopic and histologic grading by blinded reviewers revealed no significant difference in wound healing appearance or physiology in incisions created using the plasma scalpel as compared with a steel blade scalpel. Incisions created with the plasma scalpel also had superior hemostasis and a reduction in tissue and blood carryover. Scanning electron microscopy (SEM) and histology showed collagen fibril fusion occurred as the plasma scalpel incised through the tissue, contributing to a sealing effect. In addition, when bacteria were injected into the dermis before incision, the plasma scalpel disrupted the bacterial membrane as visualized in SEM images. External macroscopic and histologic grading by blinded reviewers revealed no significant difference in wound healing appearance or physiology. Based on these results, we propose additional studies to clinically evaluate the use of cold plasma in applications requiring hemostasis or when an increased likelihood of subdermal pathogen leakage could cause surgical site infection (i.e., sites with increased hair follicles).

A multifunctional surgical suture with electroactivity assisted by oligochitosan/gelatin-tannic acid for promoting skin wound healing and controlling scar proliferation

Surgical wound closure is accomplished most frequently with sutures, optimally proceeding rapidly and without complication. However, surgical sutures can trigger foreign body reactions and incite abnormal collagen deposition. Sustained inflammation can result in abnormal wound healing with hypertrophic scar formation. Therefore, evolution of suture material to inhibit inflammation and scar formation is of great clinical significance. In the present study, commercial 3-0 PPDO [poly(p-dioxanone)] suture was used as the base material and modified by adding two layers: a drug-loaded layer and an electroactive layer. The former layer was curcumin (Cur) encapsulated by PLGA [poly (lactic-co-glycolic acid)] and the latter layer was composed of oligochitosan-gelatin/tannic acid/polypyrrole (OCS-GE/TA/PPy). The multifunctional sutures, named S@LC@CGTP, had desirable sustained-drug release properties in vitro where Cur could be released for 8 days due to the action of PLGA. The three-dimensional network structure of OCS-GE/TA ensured S@LC@CGTP against surface cracking and maintained electrical. Furthermore, using an in vivo experiment, S@LC@CGTP could attenuate inflammation and promote scar-free wound healing according to suppression of infiltrating inflammatory cells, down-regulation of TGF-β1 and collagen type I expression, and improved collagen arrangement. Cumulatively, we indicated that S@LC@CGTP suture material has great potential to facilitate optimal, nearly scarless healing of surgical incisions.

Evaluation of primary wound healing and potential complications after perioperative infiltration with lidocaine without adrenaline in surgical incisions in dogs and cats

BackgroundPre-emptive local analgesia with the use of lidocaine is practised increasingly in veterinary medicine as part of applied multimodal analgesia, despite its controversial impact on wound healing. The purpose of this prospective, randomised, double-blinded, placebo-controlled clinical study was to evaluate if preoperative subcutaneous infiltration of lidocaine has a negative impact on primary wound healing of surgical incisions. Fifty-two companion animals (3 cats and 49 dogs) were enrolled in the study. The inclusion criteria were as follows: American Society of Anaesthesiologists (ASA) score I or II, a minimum body weight of 5 kg, and a planned incisional length of at least 4 cm. Surgical incisions were infiltrated subcutaneously with lidocaine without adrenaline or NaCl (placebo). Follow-up questionnaires for owners and veterinarians and thermography of the surgical wound were used to assess wound healing. Antimicrobial use was documented.ResultsThere was no significant difference in either the total score or the individual assessment points between the treatment and the placebo group on the owner or the veterinary questionnaires in regard to primary wound healing (P > 0.05 for all comparisons). No significant difference was found between the thermography results of the treatment and placebo group (P = 0.78), and there was no significant correlation between the total score from the veterinary protocol and thermography results (Spearman’s correlation coefficient − 0.10, P = 0.51). Surgical site infections developed in 5/53 (9.4%) surgeries and its occurrence varied significantly between the treatment and the placebo group as all cases of infection were in the placebo group (P = 0.05).ConclusionThe results of this study indicate that lidocaine used as a local anaesthetic did not affect wound healing in patients with ASA scores I-II. The results suggest that lidocaine infiltration in surgical incisions can be safely used to reduce pain.

Clinical value of combined serum MMP-2, MMP-9 and TIMP-1 for the prognosis of perianal fistula patients who received minimally invasive surgery.

This study aimed to investigate the clinical value of combined serum matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) for the prognosis of perianal fistula patients. Patients diagnosed and treated for perianal fistula by minimally invasive surgery (MIS) were enrolled. The concentrations of serum MMP-2, MMP-9 and TIMP-1 were measured at 24 h after surgery. Different levels of wound secretion, growth of granulation tissue and wound pain were used as criteria to evaluate surgical incision healing. The receiver operating characteristic curve was used to analyze the predicted assessment value. The concentrations of serum MMP-2 and MMP-9 were significantly higher, while the concentrations of serum TIMP-1 at 24 h after surgery were significantly lower in the poor healing group than in the good healing group. It was further found that high levels of serum MMP-2 and MMP-9 were risk factors for poor healing, while high concentrations of serum TIMP-1 at 24 h after surgery were protective factors for poor healing. High concentrations of serum MMP-2 and MMP-9 and low concentrations of serum TIMP at 24 h after surgery are risk factors for poor healing in perianal fistula patients who receive MIS, and the combined test has a higher predictive value.

Modulation of Lymphangiogenesis in Incisional Murine Diabetic Wound Healing Using Negative Pressure Wound Therapy.

Objective: Despite the significant function of lymphatics in wound healing, and frequent clinical use of Negative Pressure Wound Therapy (NPWT), the effect of mechanical force application on lymphangiogenesis remains to be elucidated. We utilize a murine incisional wound healing model to assess the mechanisms of lymphangiogenesis following NPWT. Approach: Dorsal incisional skin wounds were created on diabetic mice (genetically obese leptin receptor-deficient mice [db/db]; n = 30) and covered with an occlusive dressing (Control, n = 15) or NPWT (-125 mmHg, continuous, 24 h for 7 days; NPWT, n = 15). The wounds were macroscopically assessed for 28 days. Tissue was harvested on day 10 for analysis. Qualitative functional analysis of lymphatic drainage was performed on day 28 using Evans Blue staining (n = 2). Results: NPWT increased lymphatic vessel density (40 ± 20 vs. 12 ± 6 podoplanin [PDPN]+ and 25 ± 9 vs. 14 ± 8 lymphatic vessel endothelial receptor 1 [LYVE-1]+) and vessel diameter (28 ± 9 vs. 12 ± 2 μm). Western blotting verified the upregulation of LYVE-1 with NPWT. Leukocyte presence was higher with NPWT (22% ± 3.7% vs. 9.1% ± 4.1% lymphocyte common antigen [CD45]+) and the leukocytes were predominately B cells clustered within vessels (8.8% ± 2.5% vs. 18% ± 3.6% B-lymphocyte antigen CD20 [CD20]+). Macrophage presence was lower in the NPWT group. Lymphatic drainage was increased in the NPWT group, which exhibited greater Evans Blue positivity. Innovation: The lymphangiogenic effects take place independent of macrophage infiltration, appearing to correlate with B cell presence. Conclusion: NPWT promotes lymphangiogenesis in incisional wounds, significantly increasing the lymph vessel density and diameter. This study highlights the potential of NPWT to stimulate lymphatic drainage and wound healing of surgical incisions.

Evaluation of healing progression at surgical incision sites and the use of antiseptics for enhancing post-operative survival in subyearling Chinook salmon (Oncorhynchus tshawytscha).

In an attempt to develop more effective surgical implantation methods for fish, surgical incisions typical of those made for implanting micro-acoustic transmitters into the peritoneal cavity were evaluated on a weekly basis for healing progression using a suite of metrics. Additionally, four chemicals were evaluated at concentrations commonly used in aquaculture for their ability to prevent surgical site infection and thus to promote incision healing and survival. Chemical treatments included hydrogen peroxide (25, 50, and 100 mg l-1), salt (10 and 30 ppt), Argentyne (1:1, Argentyne:water), and PolyAqua (1/2 tsp 36 l-1). For all study fish, the presence of two intact sutures seven days post-surgery (generally associated with good suturing technique) was negatively correlated with survival. A generalized linear mixed effects model indicated that suture presence, increasing tagging temperature, and the presence of foreign material on sutures decreased survival by 0.56, 0.72 and 0.60 respectively. Conversely, evidence of suture tearing and increasing fork length at tagging increased survival by 0.24 and 0.17. The antiseptic treatments tested promoted neither faster healing of surgical incisions nor higher survival for fish held for 28 days compared to a reference group and two of the chemicals may be contraindicated for prophylactic use at published doses. These findings underscore the need for researchers to adopt a decidedly cautious approach to planning and interpretation of study outcomes that rely on telemetry tagging, carefully considering the study subjects, potential effects of the techniques used, and implications of the environmental conditions experienced.

Smartphone-based infrared thermography to assess progress in thoracic surgical incision healing: A preliminary study.

Immediate assessment of surgical incisions is an important component of wound management, and the development of relevant technologies has the potential to address these challenges. Smartphone-based handheld thermal imagers can collect infrared radiation from the skin to monitor local blood perfusion and metabolic levels in incisions. Here, we used this imaging technology for early assessment of healing progress and potential for predicting the healing status of thoracic surgical incisions. Thermal image acquisition and temperature extraction were performed on 40 patients for 7 consecutive days postoperatively, and visualised early warning information was observed, with temperature and temperature readings showing non-linear trajectory changes during the measurement period, and temperature readings on day 4 achieving high prediction of healing status at 1-2months capability with sensitivities and specificities of 91.67% and 85.71%, respectively, suggesting a promising clinical application of portable thermography for assessing incision healing dynamics and providing a scientific basis for later artificial intelligence-driven decision algorithms.

A comparison between different suture techniques in lumbar spine surgery.

As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications of surgical incision healing is a real challenge in lumbar spine surgery. We performed a retrospective study to compare different types of wound closure in lumbar spine surgery. 4383 patients were included in this study. Wound dehiscence was more common in the intracutaneous suture group than in the far- near-near-far suture group. Delayed wound healing occurred more in the far-near near-far suture group than intracutaneous suture group. Also, the far-near near-far interrupted point suture group showed a higher ratio of delayed wound healing compared with crossover suture. The superficial wound infection rate was roughly the same in all types of sutures with an average value of 0.79% with 0.81% SD. This is a preliminary study to compare different types of operative wounds showing the pros and cons related to each option.

Time to closure of orthopaedic surgical incisions: a novel skin closure device versus conventional sutures.

New technologies are being developed to optimise healing of surgical incisions. BandGrip (US) is a micro-anchor skin closure device that replaces the need for subcuticular suturing and further dressing. The purpose of this study is to perform a matched cohort analysis comparing time to closure of surgical incisions between sutures and the novel skin closure device. Patients undergoing orthopaedic surgery in 2019 underwent skin closure with either conventional sutures or the novel skin closure device. Patients were divided into three groups according to their procedural incisions: anterior cruciate ligament reconstruction (ACLR); simple arthroscopy; and general incisions. Patients who underwent closure of their surgical incision with the novel skin closure device were matched with patients undergoing superficial closure with sutures. Statistical analysis was performed to compare time to closure per centimetre of skin incision between the groups. A total of 86 patients were included in the study. Overall mean time to closure using the novel skin closure device was less than with sutures (8.6 seconds/cm versus 42.8 seconds/cm, respectively, p<0.001). Mean time to closure for ACLR incisions was 3.7 seconds/cm using the novel skin closure device and 35.5 seconds/cm using sutures (p<0.001). Mean time to closure for simple arthroscopy portals was 19 seconds/cm using the novel skin closure device and 47.6 seconds/cm using sutures (p<0.001). BandGrip is a novel skin closure device that allows for efficient surgical incision closure. Time to surgical skin incision closure is significantly less with the use of the novel skin closure device when compared with conventional sutures.

Nursing Effect of Hyaluronic Acid/Silver Nanoclusters on Patients After Total Laryngectomy

Postoperative bacterial infections are a major obstacle to patient recovery after total laryngectomy, and the development of antibiotics seemed to satisfactorily solve this problem. However, bacteria develop drug resistance to a large number of antibiotic drugs and form “superbugs,” which cause great harm to the public health. Based on this, the development of new antimicrobials has become the focus of research worldwide. In this study, we prepared a hyaluronic acid/silver nanocluster (HA/Ag NC) composite hydrogel based on a hyaluronic acid carrier and proved with clinical trials that it has an excellent antibacterial effect and can significantly reduce the incidence of inflammatory reactions in postoperative patients. In addition, the hydrogel effectively promotes the healing of surgical incisions and accelerates the proliferation of granulation tissue. As a result, the HA/Ag NCs compound hydrogel can offers a high-quality healing effect in patients after total laryngectomy.

Coating Cutting Blades with Thin-Film Metallic Glass to Enhance Sharpness

In this study, we sought to enhance the cutting properties of the various blades by coating them with Zr- and Fe-based thin film metallic glasses (TFMGs) to a thickness of 234–255 nm via sputter deposition. In oil-repellency/sliding tests on kitchen blades, the sliding angle and friction forces were as follows: bare blades (31.6°) and (35 µN), Ti-coated blades (20.3°) and (23.7 µN), and Z-TFMG coated blades (16.2°) and (19.2 µN). Comparisons were conducted with bare blades and those with a Teflon coating (a low-friction material commonly used for the coating of microtome blades). We also found that the Teflon coating reduced the cutting forces of an uncoated microtome blade by ~80%, whereas the proposed Z-TFMG achieved a ~51% reduction. The Z-TFMG presented no indications of delamination after being used 30 times for cutting; however, the Teflon coating proved highly susceptible to peeling and the bare blade was affected by surface staining. These results demonstrate the efficacy of the TFMG coating in terms of low friction, non-stick performance, and substrate adhesion. The performance of Z-TFMG and F-TFMG was also evaluated in split-thickness skin graft surgery using dermatome blades aimed at elucidating the influence of TFMG coatings on the healing of surgical incisions. When tested repeatedly on hairless skin, the surface roughness of uncoated blades increased by approximately 70%, whereas the surface roughness of TFMG-coated blades increases by only 8.6%. In the presence of hair, the surface roughness of uncoated blades increased by approximately ~108%, whereas the surface roughness of TFMG-coated blades increases by only ~23%. By Day 7, the wounds produced using TFMG-coated blades were noticeably smaller than those produced using uncoated blades, and these effects were particularly evident in hairy samples. This is a clear demonstration of the efficacy of TFMG surface coatings in preserving the cutting quality of surgical instruments.

Experience of one-stage repair of the wounds after excision of soft tissue malignant tumor in lower limb by deep inferior epigastric perforator flap in 11 cases

Objective To investigate the clinical efficacy of one-stage repairing the wounds after excision of soft tissue malignant tumor in lower limb with deep inferior epigastric perforator (DIEP) flaps. Methods From August, 2016 to July, 2018, 11 patients(8 males and 3 females; aged 35-76 years) with the soft tissue defects in the lower limb underwent immediate reconstructive operations with DIEP flap after their tumor resection. The defects ranged in area from 11 cm×7 cm to 25 cm×10 cm after extended resection, including 5 cases of bone exposure. The DIEP flap area ranged from 11 cm×8 cm to 26 cm×18 cm. Among them, 9 cases were treated with free transplantation and 2 cases with pedicle transplantation. The donor sites were closed directly. The patients’ limb function, tumor recurrence and the healing of surgical incision had been followed-up. Results Eleven flaps survived and the donor sites healed directly. One flap had skin pigmentation due to postoperative vascular crisis, and the other flaps had satisfied texture and appearance. All patients were followed-up from 6 to 30 months. The lower limb movement was normal. All the donor sites had a good healing with no pain and abdominal complications. No tumor recurrence was observed during the followed-up period. Conclusion DIEP flap have many advantages, such as large cutting area, which is suitable for large-area wound repair after extended excision of soft tissue malignant tumor in lower limb. At the same time, the perforator vessel is constant and the caliber are thick, also the donor area is concealed and can be sutured directly. This kind of the technique for reconstruction of lower limb soft tissue defects after malignant tumor resection is well acceptable. Key words: Deep inferior epigastric perforator flap; Lower limb; Soft tissue malignant tumor; Wounds after excision; Repair

Ventilation strategies with different inhaled Oxygen conceNTration during CardioPulmonary Bypass in cardiac surgery (VONTCPB): study protocol for a randomized controlled trial

BackgroundThere is no consensus on the ventilation management during cardiopulmonary bypass (CPB), and the anesthesiologists or the surgeons usually ventilate the lungs with different ventilation strategies or keep them static. Better outcomes are more likely to occur when the ventilation is administered during CPB according to the existing literatures. However, the use of high fraction of inspired oxygen (FiO2) is debatable in cardiac surgery. And the potential effects of strategies combining low tidal volume (VT) ventilation with different FiO2 during CPB on postoperative pulmonary complications (PPCs) are unclear.DesignThe VONTCPB trial is a single-center, prospective, double-blinded, randomized, controlled trial. We are going to recruit total 420 elective cardiac surgery patients with median sternotomy under CPB, who will be equally randomized into three different ventilation strategy groups: NoV, LOV and HOV. (1) The NoV group receives no mechanical ventilation during CPB; (2) the LOV group receives a low VT of 3-4 ml/kg of ideal body weight (IBW) with the respiratory rate (RR) of 10–12 acts/min, and the positive end-expiratory pressure (PEEP) of 5–8 cmH2O during CPB; the FiO2 is 30%; (3) the HOV group receives a low VT of 3-4 ml/kg of IBW with the RR of 10–12 acts/min, and the PEEP of 5–8 cmH2O during CPB; the FiO2 is 80%. The primary endpoints are the incidence of the composite of PPCs and the PPCs score. The secondary endpoints refer to the incidence of the oxygenation index (PaO2/FiO2 ratio) < 300 mmHg at three time points (the moment arriving in the ICU, 6 and 12 h after arrival in the ICU), the surgical incision healing grade, the intubation time, the stay of ICU, the length of hospital stay, and mortality at 30 days after the surgery.DiscussionThe VONTCPB trial is the first study to assess the effects of strategies combining low tidal volume (VT) ventilation with different FiO2 during CPB on patients’ outcomes.Trial registrationChiCTR1800015261. Registered on 20 March 2018.

Arthroscopic double Endobutton plate internal fixation for acute acromioclavicular joint dislocation

Objective To investigate the clinical efficacy of arthroscopic double Endobutton plate internal fixation in the treatment of acute acromioclavicular joint dislocation. Methods A retrospective case series study was performed to analyze the clinical data of 32 patients with Rockwood type III or V acute acromioclavicular joint dislocation admitted to Foshan Hospital of TCM from May 2015 to February 2018. There were 26 males and six females, aged 22-56 years [(37.7±1.6)years]. There were 22 patients with Rockwood type III and 10 patients with type V. The duration from injury to operation was 2-5 days. All patients were treated with arthroscopic double Endobutton plate internal fixation for coracoclavicular ligament reconstruction. The operation time, hospitalization time, and postoperative shoulder joint braking time were recorded. The shoulder joint function was evaluated by the Constant-Murley score (CMS), visual analogue scale (VAS), American shoulder and elbow surgeons (ASES) score, University of California Los Angeles (UCLA) score and simple shoulder test (SST) before operation and at the last follow-up. Meanwhile, complications such as infection, loosening and joint dislocation were recorded. Results All patients were followed up for 8-48 months [(27.8±11.6)months]. The operation time was 48-93 minutes[(65.0±24.6)minutes], the hospitalization time was 3.2-10 days [(6.5±2.6)days], and the postoperative braking time was 21-35.3 days[(28.2±7.1)days]. All patients had a grade A healing of surgical incision. The VAS was decreased from preoperative (5.7±2.5)points to (1.2±0.8)points at the last follow-up (P<0.01); CMS wasvincreased from preoperative (29.3±3.4)points to (93.2±2.1)points at the last follow-up (P<0.05); ASES score was increased from preoperative (28.9±10.1)points to (95.7±5.6)points at the last follow-up (P<0.05); UCLA score was improved from preoperative (11.6±2.8)points to (34.2±1.5)points at the last follow-up (P<0.05); SST score was improved from preoperative (3.5±1.2)points to (9.7±1.4)points at the last follow-up (P<0.01). The incidence of intraoperative and postoperative complications was 16% (5/32). In two patients, the surgery was changed to U shape fixation circulating the coracoid base due to the coracoidbone tunnel cutting out. One patient was found to have insufficient reduction and received the acromioclavicular joint operation. One patient had reduction loss due to the clavicle button collapsing, and one patient had excessive reduction. Conclusions For Rockwood type III or V acute acromioclavicular dislocation patients, arthroscopic double Endobutton plates for coracoclavicular ligament reconstruction has the advantages of less intraoperative trauma, quick recovery and satisfactory clinical result. However, the incidence of intraoperative and postoperative complications is relatively high, and indications should be strictly controlled. Key words: Acromioclavicular joint; Dislocations; Arthroscopes; Endobutton plates

Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome

Category: Arthroscopy Introduction/Purpose: We introduce a novel method of combining the standard anteromedial and anterolateral approaches and dual posterolateral approaches in the arthroscopic treatment of posterior and anterior ankle impingement syndrome and compare the postoperative outcomes with conventional anteromedial/anterolateral and posteromedial/posterolateral Methods: From January 2015 to January 2017, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. The patients were divided into the conventional group (n = 13) and the modified group (n = 15) according to the surgical approaches used in the operation. Preoperative and postoperative American Orthopaedic Foot &amp; Ankle Society (AOFAS) score, visual analog scale (VAS) score, range of ankle motion, and operation time were recorded. The average follow-up was 16 months (range 6-24 months). Results: Posterior and anterior ankle impingement syndrome was confirmed arthroscopically in all patients. After the operation, the range of ankle motion in all patients was restored. There was no significant difference in postoperative AOFAS score, VAS score, dorsiflexion, and plantarflexion between the conventional group and the modified group. Moreover, the operation time was significantly reduced in the modified group compared with the conventional group. There was no recurrence of osteophyte and no complications such as infection, neurovascular injury, or delayed healing of surgical incision in the modified group. Conclusion: Dual posterolateral approaches combined with standard anteromedial and anterolateral approaches was a novel method for arthroscopic treatment of posterior and anterior ankle impingement syndrome. It proved to be safe and effective, and significantly reduced the operation time. Reposition, repeated prep and drape, and limb distraction were avoided.