Surgical Wound Research Articles

Risk factors for incisional hernia after open abdominal aortic aneurysm repair: a systematic review and meta-analysis.

The incidence of incisional hernia (IH) after an open abdominal aortic aneurysm (AAA) repair can reach up to 35%, contributing to long-term morbidity. Individual studies have been limited in identifying modifiable risk factors for IH after an open AAA repair. This meta-analysis aims to review all the risk factors for IH after an open AAA repair. We searched Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science databases for original studies. Risk factors assessed were age, sex, comorbidities, surgical incision, blood loss, and surgical site infection (SSI). Data analysis was done using RStudio 4.1.2. We computed Relative Risk (RR) for dichotomous outcomes and Mean differences (MD) with 95% Confidence Interval (CI) for continuous outcomes. P-values less than 0.05 were considered statistically significant. Ten studies met the inclusion criteria among 1,795 screened articles. Among those ten studies, there were a total of 1,806 patients of which 341 patients developed IH. Older age (Mean 69.6-70.7 years, MD 1.39 years, CI [1.12-1.66], P < 0.01), midline vertical incision (RR 1.55, CI [1.06-2.25], P = 0.02) and increased intraoperative blood loss (MD 429.8ml, CI [234.8- 624.8], P < 0.01) were associated with an increased incidence of IH. Surgical site infection (SSI) was noted as a risk factor for IH after open AAA repair (RR 2.36, CI [1.31-4.24], P = 0.004). No statistically significant association was found between the incidence of IH and sex (RR 1.0, CI [0.8-1.14], P = 0.98), smoking (RR 1.01, CI [0.93-1.09], P = 0.88), diabetes (RR 1.38, CI [0.85-2.25], P = 0.19), and chronic kidney disease (RR 1.55, CI [0.47-5.09], P = 0.46). This meta-analysis shows that age, midline vertical incision, intraoperative blood loss, and SSI are risk factors for IH after open AAA repair.

Methotrexate-Loaded solid lipid nanoparticles enhance the viability of cutaneous flaps: potential for surgical wound healing

Skin flaps are employed to cover cutaneous denuded surfaces, but ensuing flap necrosis often occurs. Previously, rats with myocardial infarction treated with lipid-core nanoparticles (LDE) loaded with methotrexate (MTX) improved myocardial irrigation and reduced necrosis. Here, the aim was to investigate the efficacy of LDE-MTX to preserve the viability of cutaneous flaps and its implications for surgical wound healing. Twenty-eight male rats were divided into 4 groups: (1) LDE, injected intraperitoneally with LDE only; (2) MTX (1 mg/Kg commercial MTX): (3) LDE-MTX (1 mg/Kg MTX associated with LDE), and controls without treatment. LDE, MTX or LDE-MTX were repeated after 2 days. Then, flap surgery (9x3cm) was performed on the dorsal region. Injections were continued every other day until day 7 when animals were euthanized. LDE-MTX treatment improved the total viable area of the flaps with a fourfold increase in blood flow and reduced inflammatory cell number (p < 0.001), accompanied by decreased protein expression of pro-inflammatory factors. SOD-1 was higher in LDE-MTX-treated rats (p < 0.05). In conclusion, LDE-MTX treatment achieved total viability of cutaneous flaps, with increased irrigation and diminished local inflammation. LDE-MTX may offer efficient and cost-effective prevention of cutaneous flaps and treatment for wounds from surgical procedures to be tested in future clinical studies.

Multi-drug loaded electrospinning nanofibers promote healing with less scar formation by remodeling wound microenvironment via modulating TGF-β1/Smads/EN1 signal

Excessive scar formation following severe burn injury, deep trauma or surgical incision is a critical complication and still is a thorny clinical troublesome, which are mainly characterized by the disordered microenvironment during wound healing. A specialty wound dressing remodeling wound microenvironment is urgently desired. Herein, we fabricate a multi-drug loaded nanofiber delivery system for promoting healing and mitigating scar formation by modulating TGF-β1/Smads/EN1 signal, which encapsulates free rhubarb anthraquinones (RAs) and honey in polyvinylpyrrolidone core layer, and borneol in cellulose acetate shell layer by coaxial electrospinning. The nanofibers exhibited a linear morphology with smooth surface, nanometer in diameter, high porosity, ideal water vapor transmission rate and wettability, a biphasic release profile of RAs with the enhanced dissolution under the synergism of honey and borneol. Furthermore, this nanofiber wound dressing possesses the desired biocompatibility and pro-migration effects on HSF cells and HUVEC, long-term effects against Methicillin-resistant Staphylococcus aureus (MRSA) in vitro, remarkably, promoted healing of the MRSA-infected postsurgical wound and severe burn injury characterized by enhanced closure rates and more hair follicles, and mitigated scar formation characterized by less dermal thickness and more organized collagen arrangement by decreasing the expressions of TGF-β1, Smads2/3 and EN1, and increasing Smad7 expression in wound tissues. Collectively, the findings indicate that the multi-drug loaded nanofiber wound dressing can serve as a promising candidate for the application of MRSA-infected wound and severe burn injury healing.

The role of subcutaneous drain in laparotomy patients

Background: In surgical incision wounds, hematoma, serous fluid, and dead space increase the risk of infection because they provide a surface for microbial growth. Subcutaneous drain reduces dead space in the subcutaneous tissue plane, which prevents fluid from accumulating and seroma from forming by removing infectious content, residual effusion, and blood from the wound. This study attempts to determine the efficacy of subcutaneous drain in laparotomy in the management of surgical site infection (SSI). Methods: This prospective study was conducted at the Department of Surgery in various hospitals in Cumilla, Bangladesh. This study includes 150 adult patients aged between 18 to 70 years. A closed subcutaneous suction drain was inserted before the skin was closed in 75 patients at random (drain group), whereas the rest of the 75 patients' subcutaneous suction drains were not kept (no-drain group). Results: The association between comorbidities and SSI in both the drain and no-drain groups were significant, p value &lt;0.001 respectively. SSI was mainly in the group with fewer surgery hours (72.4%). Patients with SSI also have longer hospital stays on average. Conclusions: Patients with SSI have increased morbidity, and those undergoing major procedures are more likely to experience SSI afterwards. The presence of a subcutaneous closed suction drain contributes to reducing SSI.

Seroma incidence and risk factors in women undergoing mastectomies as surgical breast cancer treatment.

Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. Assess seroma incidence and risk factors in women undergoing mastectomies. This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02-3.61; p = 0.042; and OR = 2.06; 95% CI 1.17-3.63; p = 0.012), respectively. Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).

Guidelines in Practice: Sterile Technique.

Sterile technique is the collective actions taken to reduce potential contaminants in the OR and maintain a sterile field during operative or other invasive procedures. Practicing and applying the principles of sterile technique is a cornerstone of perioperative nursing and providing safe patient care. The recently updated AORN "Guideline for sterile technique" provides perioperative nurses with information on the principles of and processes associated with sterile technique. This article provides an overview of the guideline and discusses recommendations for actions to take before preparing the sterile field, while preparing and maintaining the sterile field, for limiting movement, for surgical wound classification, and for quality. It also includes a scenario describing the implementation of isolation technique (ie, clean closure) for colon procedures. Perioperative nurses should review the guideline in its entirety and apply the recommendations when practicing sterile technique.

COMPARISON OF FIXATION USING SCREWS AND SUTURE BUTTONS IN THE TREATMENT OF DISTAL TIBIOFIBULAR DIASTASIS ASSOCIATED WITH ANKLE FRACTURES

Purpose: We aimed to compare the treatment results of fixation using screws and a suture button when treating distal tibiofibular joint diastasis combined with ankle fractures Materials and Methods: A retrospective study was conducted on 30 patients with ankle fractures who were treated with screws and 34 patients who were treated with suture buttons for distal tibiofibular joint diastasis. Postoperative clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, and radiologic outcomes were evaluated by measuring tibiofibular clear space, tibiofibular overlap, and medial clear space on pre- and post-operative radiographs. The average length of hospital stay, whether surgery was performed to remove the internal fixation, the time of weight bearing, and whether the internal fixation was damaged were investigated. Results: One year after surgery, the average AOFAS score showed no statistically significant difference between the screw surgery group and the suture button surgery group. The averages of tibiofibular clear space, tibiofibular overlap, and medial clear space measured immediately postoperatively did not show statistically significant differences between the screw surgery group and the suture button surgery group, but the measurements taken 1 year after surgery were significantly different statistically. Screw removal surgery was performed in all cases in the screw surgery group. In the screw surgery group, there were 3 cases of screw breakage and 3 cases of surgical wound infection, and the length of hospitalization and the postoperative weight-bearing start time in the screw surgery group were longer. Conclusion: When treating distal tibiofibular joint diastasis, the screw surgery group and the suture button surgery group showed no statistically significant difference in clinical outcomes measured by AOFAS 1 year after surgery, but the suture button surgery group had better results in radiological evaluation and in complication frequency.

Ambulation Support for Reduction of Pain and Uterine Fundal Height in Post-Cesarean (Case Study)

Cesarean sections continues to increase globally and now accounts for more than 1 in 5 (21%) of all births. A common problem after a cesarean section is discomfort. One of the discomforts felt after surgery is pain. The pain experienced by post-cesarean mothers is related to two main factors: surgical wounds and uterine contractions. This study aims to describe the effect of implementing ambulation support on pain and the reduction of uterine fundal height post-cesarean. The writing method is a case study. Ambulation support intervention was carried out gradually over 48 hours. After the implementation, the NRS pain scale results decreased from 5 to 3. The WBPRS pain scale decreased from 6 to 3. The uterine fundal height decreased from 12.5 cm to 8 cm, decreasing more rapidly by 4.5 cm on the second day. The results show that ambulation support can help reduce pain and uterine fundal height more quickly. It is hoped that through patient education, accompaniment, and support during ambulation, and supervision during implementation, it can significantly facilitate the recovery of cesarean patients.

Cost-benefit analysis and short-term outcomes after implementing an ERAS protocol for colorectal surgery: a propensity score-matched analysis.

Enhanced Recovery After Surgery (ERAS) has become increasingly popular in the post-operative management of abdominal surgery. Published data suggest that patients on ERAS protocols have fewer minor and major complications, and highlight a reduction in medical morbidity (such as urinary and respiratory infections). Limited data is available on surgical complications. The aim of the study was to evaluate the impact of the ERAS protocol on post-operative complications and length of hospital stay. Furthermore, we aimed to determine the impact of this protocol on cost-effectiveness. From January 2016 to December 2022, 532 colectomies for colorectal cancer (CRC) were performed. A prospective observational study was conducted in a tertiary hospital on the cohort of patients, aged 18years and older, operated on for non-urgent colorectal cancer. The impact on post-operative complications, hospital stay and economic impact was analysed in two groups: patients managed under ERAS and non-ERAS protocol. A propensity score-matching analysis was performed between the two groups. After propensity score matching 1:1, each cohort included 71 patients, and clinicopathological characteristics were well balanced in terms of tumour type, surgical technique and surgical approach. ERAS patients experienced fewer infectious complications and a shorter postoperative stay (p < 0.001). In particular, they had an 8.5% reduction in anastomotic dehiscence (p = 0.012) and surgical wound infections (p = 0.029). After analysis of medical complications, no statistically significant differences were identified in urinary tract infections, pneumonia, gastrointestinal bleeding or sepsis. ERAS protocol was more efficient and cost-effective than the control group, with an overall savings of 37,673.44€. The implementation of an enhanced recovery protocol for elective colorectal surgery in a tertiary hospital was cost-effective and associated with a reduction in post-operative complications, especially infectious complications.

MASSIVE HEMORRHAGE DUE TO RUPTURE OF A RIGHT ILIAC ANEURYSM REVEALING BEHCET'S DISEASE: A CASE REPORT FROM THE FESTOC CENTER IN BAMAKO

INTRODUCTION: Behçet's disease is a chronic inflammatory disorder. It is clinically characterized by oral and genital aphthoses; skin lesions and systemic manifestations. Arterial aneurysms are defined as a loss of parallelism of the arterial walls, localized to an arterial segment, and corresponding to an increase of at least 50% of the normal arterial diameter. We report a case of Behcet's disease revealed by a ruptured aneurysm of the right primitive iliac artery. OBSERVATION: This was a 44-year-old patient with no known history, referred for management of a right inguinal mass that had progressively increased in volume and had been evolving for about 1 month. On admission, the physical examination revealed conjunctival pallor, a pulsatile right inguinal mass approximately 10 cm in diameter, and a suppurating sore on the scrotum. Doppler ultrasound of the lower limbs revealed an aneurysm of the right common iliac artery. The aneurysm ruptured during the short preparation period for surgery, resulting in cataclysmic hemorrhage. This prompted manual compression and the transfusion of several packed red blood cells. During transport to the OR, the patient experienced hemorrhagic shock and altered consciousness, prompting the administration of drugs (noradrenaline) and emergency orotracheal intubation. The aneurysm was controlled upstream and downstream by approaching the right primitive iliac artery, followed by dissection and clamping after general heparinization. The common femoral artery was then approached and checked. Surgical exploration revealed numerous clots which were evacuated, revealing a large neck extending over 7 cm. The procedure involved reconstruction of the common femoral artery with a patch saphenous graft and excision of the necrotic tissue. The post-operative course was marked by suppuration of the surgical wound, which progressed well with appropriate antibiotics and local care. CONCLUSION: Arterial involvement in Behçet's disease manifests as arterial thrombosis or, more frequently, aneurysm. This is due to inflammation of the media, intima and vasa vasorum. Their management can be envisaged in our context.

Evaluation of the efficacy of perioperative tranexamic acid in patients with pelvic and acetabular fractures: A systematic review and meta-analysis.

Tranexamic acid (TXA) is commonly used to reduce perioperative bleeding in various surgeries, including acetabular and pelvic fractures treated with open reduction and internal fixation (ORIF). However, research on TXA's effectiveness and safety in this context is conflicting. To address this, we conducted a systematic review and meta-analysis on TXA's efficacy and safety in patients with acetabular and pelvic fractures undergoing ORIF. We systematically searched Cochrane, PubMed, and EMBASE databases until August 30, 2023. Our evaluation of TXA focused on 6 domains: estimated blood loss (EBL), blood transfusion units, transfusion rates, thromboembolic events, other complications, and surgery duration. Data from these studies were analyzed using RevMan Manager 5.4. This study included 4 randomized controlled trials with 179 patients with acetabular and pelvic fractures treated with TXA. The analysis showed that TXA did not significantly reduce EBL, packed red blood cell transfusion units, blood transfusion rates, or surgery duration. There was no significant difference in thromboembolic events or other postoperative complications, like surgical wound issues, pneumonia, heterotopic ossification, and sciatic nerve injuries, between the TXA and control groups. TXA did not demonstrate a significant benefit in reducing perioperative bleeding or complications in patients treated with ORIF for acetabular and pelvic fractures. The utilization of TXA in such clinical scenarios remains a topic necessitating further rigorous investigation to delineate its role in this clinical setting.

The feasibility of a novel method to remove circumferentially ruptured balloons during ultrasound-guided percutaneous transluminal angioplasty for arteriovenous dialysis access

Objective: Angioplasty balloon rupture is a rare complication during percutaneous transluminal angioplasty (PTA). Conventional approach to retrieve circumferentially ruptured balloons is open surgery. This study examined the feasibility of a novel approach which can remove ruptured balloon during PTA in vascular access. Methods: This retrospective study analyzed 35 patients of a total 6465 patients that underwent ultrasound-guided PTA with a circumferential balloon rupture from February 2016 and August 2023. The patients underwent surgery (Group I, n = 13) or the novel method (Group II, n = 22) for balloon retrieval. Kaplan–Meier curve was used to assess the primary patency rates of the two groups. Result: The total incidence of circumferential balloon rupture was 0.5% in our center. Balloon retrieval was successful in both groups with no complications except one case had an infection in the surgical wound. Kaplan–Meier curve analysis showed that the post-intervention primary patency rates of the two methods were not significantly different ( p &gt; 0.05). There was a significant difference between pre-operation and post-operation brachial arterial flow ( p &lt; 0.001). Conclusion: The feasibility of the novel technique for retrieval of circumferential ruptured balloons during ultrasound-guided PTA is validated. The technique enables less invasive retrieval and continuation of PTA.

Surgical Management of Canine Transmissible Venereal Tumor with Adjunctive Chemotherapy Combination

One male and a female 2-year-old Neapolitan Mastiff dogs weighing 41 and 40 kg, respectively, were presented to the University Veterinary Teaching Hospital, Jos, Nigeria, with complaints of continuous bleeding from the prepuce and vulva which were first observed about 2 months before presentation. Clinical examination revealed preputial bleeding of the male dog and serosanguinous vulva discharges with the presence of palpable masses with multiple nodules that were cauliflower-like. Cytological evaluations of smears from preputial and vaginal swabs revealed characteristic round cells with large eccentric nuclei, large nuclear-cytoplasmic ratio, and intracytoplasmic vacuolations as well as anisocytosis and anisokaryosis. Based on these cytological features, a diagnosis of canine transmissible venereal tumor (CTVT) was made in each case. Blood samples were collected for hematology and clinical chemistry. Debulking of the masses was carried out under general anesthesia using atropine sulfate and chlorpromazine as pre-anesthetics and Ketamine hydrochloride as induction and maintenance anesthetics. Following debulking, the resulting defect was reconstructed and the surgical wound was managed by daily wound cleaning and the administration of vincristine sulfate (0.025 mg/kg) slowly intravenously, ivermectin (0.3 mg/kg) subcutaneously, and piroxicam (0.3 mg/kg) and 20% amoxicillin (20 mg/kg) intramuscularly. There were no observed known vincristine sulfate-associated adverse effects as the dogs recovered and were discharged 3-week post-tumor debulking with no recurrence within 6 months of follow-up examinations. The debulked mass histologically showed several sheets of round neoplastic cells with prominent nuclei, mitotic figures, and infiltrating lymphocytes. Based on these findings, a diagnosis of CTVT was further confirmed. The hemogram showed moderate leukocytosis at day 1 in the bitch with a mild left shift at days 1 and 14 while clinical chemistry showed a marked increase in alkaline phosphatase, moderate increase in serum creatinine, and mild hypoproteinemia. In conclusion, management of CTVT with adjunctive vincristine sulfate and ivermectin combination resulted in complete healing with amelioration of known associated adverse effects.

Comparative study of the direct closure of surgical incision for external dacryocystorhinostomy using 6-0 Prolene versus Dermabond ®.

In this study, we aimed to compare closure of the incision for external dacryocystorhinostomy (ext-DCR) by suturing with 6-0 Prolene versus closure with 2-octyl cyanoacrylate and assess the results in terms of the aesthetic and functional aspects of the scar, operating time, postoperative symptoms and complications, and the economic cost of the two techniques. Sixty-three patients with distal lacrimal obstruction and indication of ext-DCR were initially enrolled in a longitudinal prospective cohort study. Patients underwent ophthalmologic evaluations including lacrimal probing, external examination with photograph, measurement of the surgical wound, timing the cutaneous closure phase of the surgery, recording postoperative wound pain using visual analog scale (VAS), and recording the patient's and clinician's subjective satisfaction with the scar using Patient and Observer Scar Assessment Scale (POSAS) at 6 months postsurgery. The 63 eyes were divided into two groups: the wounds in group 1 were closed with 6-0 Prolene using continuous locking suture and the wounds in group 2 were closed with 2-octyl cyanoacrylate. There was no difference in baseline characteristics (age, sex, and race), and no statistically significant differences were found in wound length, POSAS score, VAS score, or serious complications of the wound between the two groups. There were differences in surgery time and economic cost for group 2 compared to group 1 of -2.39 min and -€5.37/operation, respectively. This is the first study in the literature that compares 6-0 Prolene versus Dermabond ® . The latter one presents advantages compared to Prolene, given that it reduces the length of surgery, reduces costs, and allows for greater flexibility in postoperative follow-up visits.

Asuhan Keperawatan pada Tn. S dengan Post Operasi Hernioraphy pada Hernia Inguinalis Lateralis Dextra di Ruang Mawar 2 RSUD dr. Soeselo Kabupaten Tegal

A hernia is a protrusion or protusion of the contents of a cavity through a defect or weak part of the abdominal wall. A hernia consists of a ring, a sac and the contents of the hernia. The occurrence of a hernia is triggered by an increase in intra-abdominal pressure that is repeated or continuous (Sayuti, et al., 2023). The purpose of this paper is to find out and provide nursing care to Mr. S with post-operative hernioraphy on the right lateral inguinal hernia in the mawar 2 ward of dr. Soeselo Hospital, Tegal Regency according to nursing standards. The method used is the data collection method in the form of interviews, observations and examinations. From the case review, it was found that the client’s main complaint was pain in the surgical wound, P: pain when moving, Q: like being pulled, R: upper right groin, S: 6, T: continuous pain. The nursing problems found were acute pain, impaired physical mobility and knowledge deficit. Interventions were arranged based on the theory in SDKI, SLKI and SIKI as well as on the client’s condition and could be implemented.

Automated Surgical Wound Classification for Intelligent Emergency Care Applications

Developing AI-powered solutions for emergency care is critical to improving patient outcomes. This study presents an advanced AI model designed to accurately classify surgical wounds to facilitate prompt and appropriate emergency response. We used two state-of-the-art image classification models, ResNeXt and Vision Transformer (ViT), to evaluate their effectiveness in classifying wound images. These models were selected based on preliminary evaluations of several popular models, and their superior performance metrics justified their final selection. The models were trained on a combined dataset of approximately 1,000 images from the Medetec and AZH(Advancing the Zenith of Healthcare) datasets. To improve classification accuracy, the dataset was preprocessed, including image resizing, flipping, normalization, and augmentation. The ViT model demonstrated superior performance, achieving an accuracy of 92.78%, precision of 94.89%, recall of 91.87%, and an F1 score of 92.44%. These results surpass those of existing studies such as Shenoy et al. (85.1% accuracy), Rostami et al. (68.7% accuracy), and Gao et al. (76.6% accuracy). Our proposed AI system not only accelerates life-saving first aid by providing timely and accurate wound classification but also enhances the skills of emergency responders through continuous learning and real-time feedback. By integrating AI into emergency service protocols, we aim to improve response times and collaboration among medical personnel, ultimately contributing to better patient survival rates.

Asuhan Keperawatan pada Nn. M dengan Gangguan Sistem Endokrin: Post Op Isthmolobektomi dengan Indikasi Struma Nodusa Non Toksik di Ruang Mawar 2 RSUD dr. Soeselo Kabupaten Tegal

Non-toxic goiter nodusa is an enlargement of the thyroid gland in which one or more nodules are clinically detected without hyperthyroidism (Sari et al., 2021). The purpose of this writing is to find outand provide nursing care to Ms. M with endocrine system disorders: post op isthmolobectomy with indications of non-toxic nodal goiter in mawar ward 2 RSUD dr. Soeselo Tegal Regency in accordance with nursing standards. The method used is a descriptive method in the form of interviews, observation, documentation studies, library and literature studies. From the case review, it was found that the patient’s main comlaint was pain in the surgical wound on the left side to the neck, P:pain worsened when mobilizing, speaking and swallowing, Q: pain like being cut, R: pain on the left side of the neck, S: scale 4, T: disappears. There were three diagnoses found, namely acute pain, knowledge deficit and risk of infection. Intervetions are prepared based on the theory of SDKI, SLKI and SIKI as well as on the client’s condition and can be implemented.

Challenging Dogmas in Plastic Surgery.

In medicine, dogmas are subject to evolution and refinement as new research and technologies emerge. The aim of this study was to search for dogmas which were challenged and potentially revised in the plastic surgery field. A search on PubMed for "dogma and plastic surgery" yielded 80 papers. The queries "surgical dogma and craniofacial surgery" and "surgical dogma and flap" returned 9 and 21 papers, respectively. "Surgical dogma and hand" and "surgical dogma and wound healing" produced 41 and 25 papers, respectively. Removing 35 duplicate papers, 141 abstracts were reviewed. Of these, 78 were excluded, leaving 63 papers for analysis. The dogmas being challenged within the field of plastic surgery were classified into various categories. The distribution of these challenged dogmas was as follows: wound healing: 14.29%, epinephrine use: 9.52%, flap surgery: 7.94%, breast reconstruction: 6.35%, rhinoplasty: 7.94%, hand surgery: 4.76%, pressure sores: 4.76%, chemical peel: 4.76%, and hand injuries: 3.17%. The widespread focus on improving wound healing techniques indicates a need for more effective treatments and faster recovery times. Significant attention has been directed toward the use of epinephrine, particularly in fingers, which may reflect ongoing debates about its safety. Innovations and improvements in flap surgery could lead to better reconstructive outcomes. Challenging existing dogma is a vital process and a driving force in the advancement of clinical science. These challenges and potential revisions reflect the dynamic nature of plastic surgery, where ongoing research, patient outcomes, and evolving societal norms drive continuous improvement and adaptation in practices and principles.

Management Options for Traumatic Posterior Sternoclavicular Joint Dislocation: A Narrative Review with a Single Institution's Experience.

Background: Posterior sternoclavicular joint (SCJ) dislocations are rare events that can evolve into real emergencies due to the vital structures in the mediastinum. When closed reduction maneuvers fail, open SCJ reconstruction becomes mandatory, with literature proposing several stabilization techniques that either preserve or remove the SCJ's mobility. This study is a narrative review of the most recent literature regarding posterior trauma to the SCJ along with a single institution's experience of this pathology, managed either conservatively or surgically, with a figure-of-eight autologous semitendinosus graft in case of closed reduction failure. Methods: This article provides an overview of posterior traumatic SCJ dislocation, and it describes five cases of patients managed for traumatic posterior SCJ dislocation treated either conservatively or surgically with a figure-of-eight semitendinosus tendon autograft reinforced with high-strength suture tape. A comparison with the most recent literature is performed, focusing on biomechanics. Results: The demographics, the mechanism of injury, the management algorithm and the surgical strategy align with the most recent literature. Despite the final treatment, at one year of follow-up, the ROM was restored with full strength throughout the range of motion of the shoulder with no neurological deficits. The reduced joint successfully healed in imaging, and patients returned to their daily lives. The surgical site wounds and donor harvest sites were perfectly healed. Conclusions: Although recent recommendations for treating posterior traumatic SCJ dislocation have advanced, no universally accepted method of stabilization exists, and the surgical strategy is generally entrusted to the surgeon's experience. The literature still increasingly supports figure-of-eight ligament reconstruction with a biological or synthetic graft. This work further implements the literature by reporting good outcomes at follow-up.

Levels of Synovial Fluid Inflammatory Biomarkers on Day of Arthroscopic Partial Meniscectomy Predict Long-Term Outcomes and Conversion to TKA: A 10-Year Mean Follow-up Study.

The purpose of the present study was to evaluate the relationships of the concentrations of pro- and anti-inflammatory biomarkers in the knee synovial fluid at the time of arthroscopic partial meniscectomy (APM) to long-term patient-reported outcomes (PROs) and conversion to total knee arthroplasty (TKA). A database of patients who underwent APM for isolated meniscal injury was analyzed. Synovial fluid had been aspirated from the operatively treated knee prior to the surgical incision, and concentrations of pro- and anti-inflammatory biomarkers (RANTES, IL-6, MCP-1, MIP-1β, VEGF, TIMP-1, TIMP-2, IL-1RA, MMP-3, and bFGF) were quantified. Prior to surgery and again at the time of final follow-up, patients were asked to complete a survey that included a visual analog scale (VAS) for pain and Lysholm, Tegner, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) questionnaires. Clustering analysis of the 10 biomarkers of interest was carried out with the k-means algorithm. Of the 82 patients who met the inclusion criteria for the study, 59 had not undergone subsequent ipsilateral TKA or APM, and 43 (73%) of the 59 completed PRO questionnaires at long-term follow-up. The mean follow-up time was 10.6 ± 1.3 years (range, 8.7 to 12.4 years). Higher concentrations of individual pro-inflammatory biomarkers including MCP-1 (β = 13.672, p = 0.017) and MIP-1β (β = -0.385, p = 0.012) were associated with worse VAS pain and Tegner scores, respectively. K-means clustering analysis separated the cohort of 82 patients into 2 groups, one with exclusively higher levels of pro-inflammatory biomarkers than the second group. The "pro-inflammatory phenotype" cohort had a significantly higher VAS pain score (p = 0.024) and significantly lower Lysholm (p = 0.022), KOOS-PS (p = 0.047), and Tegner (p = 0.009) scores at the time of final follow-up compared with the "anti-inflammatory phenotype" cohort. The rate of conversion to TKA was higher in the pro-inflammatory cohort (29.4% versus 12.2%, p = 0.064). Logistic regression analysis demonstrated that the pro-inflammatory phenotype was significantly correlated with conversion to TKA (odds ratio = 7.220, 95% confidence interval = 1.028 to 50.720, p = 0.047). The concentrations of synovial fluid biomarkers on the day of APM can be used to cluster patients into pro- and anti-inflammatory cohorts that are predictive of PROs and conversion to TKA at long-term follow-up. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.