Surgical Preparation Technique Research Articles

Surgical treatment of pseudomyxoma peritonei-Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Pseudomyxoma peritonei syndrome (PMP) is an orphan disease. Surgery is the fundament of treatment. Short review summarizing the state of the art treatment. Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) form the foundations of treatment for PMP. The peritoneal cancer index should be preoperatively determined based on imaging and/or laparoscopy, intraoperatively validated and both should be documented. An extraperitoneal surgical preparation technique leads to effective en bloc resection of the peritoneum and the affected abdominal area. The HIPEC technique should be performed with mitomycinC for 60-90 min. Complete CRS (CC = 0, CC = 1) and the histological subtype are relevant for the prognosis. Structured educational programs and mentoring can optimize the learning curve. The aftercare should be performed at the surgical center. After follow-up imaging at 3 months after CRS, in the first 2 years a control should be carried out every 6months. Thereafter, the intervals can be extended to 1 year. Standardized surgical treatment and HIPEC, optimized specific surgical training and structured follow-up at the center lead to an excellent long-term prognosis for patients with PMP.

Dual-guide template–guided socket-shield preparation and immediate implantation in maxillary anterior region implant surgery

For immediate implants in the anterior region, the socket-shield technique has received much attention in recent years. However, this technique is technically sensitive and root preparation is difficult. It is also difficult to obtain the ideal three-dimensional position for implant placement in the anterior region. This paper reports a clinical case in which socket-shield preparation and implant cavity preparation were performed with the aid of a dual guide in implant surgery. The dual guide surgical preparation technique was used to reduce the difficulty of socket-shield preparation and to achieve restoration-orientated implant placement with satisfactory clinical results.

Ovine Caesarean sections and assisted vaginal deliveries: a clinical audit

Obstetrical difficulties in sheep traditionally account for the majority of sheep veterinary work in the spring. Throughout the 2021–22 lambing season 21 practices provided data on assisted vaginal deliveries (lambings) and ovine Caesarean sections. Information including lamb presentation, medicines administered, surgical preparation, morbidity and mortality were all recorded with the aim of understanding the choices made by practitioners and any variation in outcomes, and to compare these to the existing literature to produce best practice advice to the group. 7-day survival rates were favourable (86.2% of ewes lambed and 94.8% of ewes undergoing Caesarean section). All ewes undergoing Caesarean section received meloxicam, however, wider variation in other medicines administered was recorded, alongside significant variation in surgical preparation techniques of both the patient and the surgeon. A series of safe operating procedures and information guides were produced relating to antibiotic selection (following European Medicines Agency guidance), local anaesthetic use in sheep and, performing the sacrococcygeal epidural.

Hearing rehabilitation with the cochlea implant following translabyrinthine CPA tumor removal ?

We present a quality analysis of 10 patients with an individual treatment trial for a simultaneous or consecutive cochlea implantation after translabyrinthine removal of a neurinoma at the cerebellopontine angle. The results show that most of the patients benefit from the cochlea implantation after unilateral deafness. Through a careful surgical preparation technique at the inner ear canal and its surroundings the morphological and functional integrity of the neurovascular structures can be guaranteed.

The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study.

BackgroundThe attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone.Material and Methods10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different.ResultsThe results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique.ConclusionsIn light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized. Key words:Implant primary stability, resonance frequency analysis, implant site preparation.

Analysis of repeated measures of multiple surgical sites within a factorial randomised controlled trial

Background In heart bypass surgery, pieces of artery or vein (“conduits”) taken from elsewhere in the patients’ body are used to bypass the blocked or narrowed coronary arteries and improve the blood supply to the heart. The “Hyperplasia and Atherogenesis in Bypass Vein Grafts Following Different Surgical Preparation Techniques” (HArVeST) trial, is a single-centre study investigating if new methods of taking and preparing the conduit can improve the outcome for patients.

Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques

BackgroundSome follow-up studies of high flexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implant fixation is dependant on two interfaces: the cement–implant and the cement–bone interface. The present finite-element model (FEM) is the first to analyse both the cement–implant interface and cement–bone interface. The cement–bone interface is divided into cement–cancellous and cement–cortical bone interfaces, each having their own strength values. The research questions were: (1) which of the two interfaces is more prone to failure? and (2) what is the effect of different surgical preparation techniques for cortical bone on the risk of early failure.? MethodsFEM was used in which the posterior-stabilized PFC Sigma RP-F (DePuy) TKA components were incorporated. A full weight-bearing squatting cycle was simulated (ROM=50°–155°). An interface failure index (FI) was calculated for both interfaces. ResultsThe cement-bone interface is more prone to failure than the cement implant interface. When drilling holes through the cortex behind the anterior flange instead of unprepared cortical bone, the area prone to early interface failure can be reduced from 31.3% to 2.6%. ConclusionThe results clearly demonstrate high risk of early failure at the cement–bone interface. This risk can be reduced by some simple preparation techniques of the cortex behind the anterior flange. Clinical relevanceHigh-flexion TKA is currently being introduced. Some reports show high failure rates. FEM can be helpful in understanding failure of implants.

The effect of surgical preparation technique on the bacterial load of surgical needles and suture material used during strabismus surgery

To investigate the effectiveness of 3 surgical preparation techniques in decreasing bacterial contamination of needles and suture material during strabismus surgery. Consecutive patients requiring 2-muscle strabismus surgery were randomized into 1 of 3 groups. In Group A, patients' periocular skin and bulbar conjunctivae underwent preparation with 5% povidone-iodine; the drape was placed without regard to eyebrows; and an open wire-loop lid speculum was used. Group B patients underwent the same preparation as Group A patients; however, the eyelashes and eyebrows were scrubbed with 5% povidone-iodine on cotton tip applicators, and the drape was placed to exclude the eyebrows from the surgical field. Group C patients underwent the same preparation as Group B patients; however, a bladed lid speculum was used during surgery to exclude some of the eyelashes from the surgical field. After the procedure, all needles and suture materials were sent separately for aerobic culture. The data were analyzed for differences in contamination rates between the groups. Of 77 patients, 24 (31.4%) had either a needle and/or suture contaminant. Groups A, B, and C had mean contamination rates of 29.6%, 34.6%, and 29.2%, respectively. There was no significant statistical variation in contamination among the 3 groups. The most common organism identified was a coagulase-negative staphylococcus strain. More meticulous sterile preparation of the surgical field did not result in a meaningful reduction in suture or needle contamination rates during strabismus surgery.

Surgical Preparation for Articular Cartilage Regeneration Without Penetration of the Subchondral Bone Plate

Background: To prevent hemorrhage, fibrin clot formation, and subsequent activation of the inflammatory response, surgical preparation for articular cartilage regeneration should avoid penetration of the subchondral bone plate. Hypothesis: Current surgical procedures with ring curettes do not violate the subchondral bone plate. Study Design: Controlled laboratory study. Methods: The subchondral bone plates of normal human (n = 5) or sheep (n = 12) cadaver femoral condyles were prepared in vitro using either traditional debridement for autologous chondrocyte implantation/transplantation (ACI/ACT) or a modified approach aimed at deliberately violating the subchondral bone plate (ie, brute force). Effects were analyzed by light microscopy. In addition, subchondral bone plates of osteoarthritic (OA) human knees undergoing total knee arthroplasty (n = 5) or normal sheep knees (n = 5) were prepared in vivo. To approximate normal/regular wear, in humans, only OA samples with maximally grade 3A (International Cartilage Repair Society score) were used. Results: In both human and sheep (in vitro), no penetration of the subchondral bone plate was observed by either standard preparation or brute force. In vivo, standard preparation of human or sheep knees also did not violate the tidemark line. Human and sheep specimens prepared by brute force, however, occasionally showed areas with an open bone marrow space. Conclusion: Traditional debridement techniques for ACI/ACT using a ring curette do not violate the normal subchondral bone plate in vitro or in vivo. Even in OA knee joints, the bone plate is only violated by brute force. Therefore, the standard technique appears suitable for studies on cartilage regeneration in cases of traumatic and possibly even osteoarthritic defects. Clinical Relevance: The described surgical preparation technique is the traditional debridement technique for the ACI/ACT. The classic indication for the ACI/ACT is an articular cartilage injury, common in athletes.

Bacterial Skin Contamination Before and After Surgical Preparation of the Foot, Ankle, and Lower Leg in Patients with Diabetes and Intact Skin versus Patients with Diabetes and Ulceration: A Prospective Controlled Therapeutic Study

Eradication of bacterial flora from the foot, especially the nailfolds and toe webspaces, through surgical preparation remains a challenge. All previous studies have involved healthy patients undergoing elective foot and ankle surgery or healthy volunteers. However, the patient with diabetes is considered an immunocompromised host with decreased ability to combat invasive bacterial infections. The use of an efficacious surgical preparation is therefore of paramount importance. The author conducted a prospective study involving patients with diabetes with and without ulceration who underwent the current “best evidence available” surgical preparation (i.e., chlorhexidine gluconate [4%] scrub followed by alcohol impregnated with iodine [1%] solution). Qualitative aerobic cultures before and after completion of this surgical preparation technique were obtained from the hallux nailfold; second, third, and fourth toe webspaces (as one culture); and distal anterior tibia. A total of 120 organisms were cultured before surgical preparation with 64 in the elective group and 56 in the ulcerated group. The most commonly isolated organism was methicillin-resistant Staphylococcus epidermidis, which was identified in 46 pre-preparation cultures (38.3%). This was followed by methicillin-sensitive S. epidermidis (16.7%) and “other” organisms (10.0%). There was a significant reduction for both numbers of organisms identified and positive cultures for the 3 most commonly isolated organisms after surgical preparation. Based on the results of this study, the surgical preparation used here appears to be an efficacious surgical preparation technique for eradicating aerobic bacterial pathogens from the foot in patients with diabetes both with and without ulceration. The high incidence of methicillin-sensitive and methicillin-resistant S. epidermidis found in this patient population is a cause for concern, especially when metallic fixation is intended to be implanted.

The effect of surgical preparation technique on bacterial load of surgical needles and suture material used during strabismus surgery

The effect of surgical preparation technique on bacterial load of surgical needles and suture material used during strabismus surgery

Evaluation of a one-step surgical preparation technique in dogs

Summary The efficacy of a 1-step surgical preparation technique for skin of dogs prior to elective ovariohysterectomy was evaluated. Dogs randomly assigned to group 1 (n = 30) had their skin prepared for surgery by use of a 2-step method, whereas the skin of dogs in group 2 (n = 30) was prepared for surgery by use of a commercially available product for a 1-step technique. Culture plates for quantitative bacterial counts were applied to the proposed incision site on dogs under general anesthesia after hair at the site was clipped and vacuumed but before antiseptic was applied. A second quantitative bacterial culture plate was applied to the proposed incision site after completion of the surgical preparation technique. Surgeries were routinely completed, and dogs were evaluated by physical examination the next day and at the time of suture removal (7 to 10 days after surgery) for complications. Postoperative complications were minor and consisted primarily of subcutaneous swelling, which resolved with time. All cultures obtained prior to skin preparation included bacteria or yeast. Sixteen cultures obtained after skin preparation (group 1, n = 11; group 2, n = 5) included bacteria or yeast. The total number of colonies of potential pathogens (Staphylococcus sp and Enterobacteriaceae) on the prepreparation cultures was 9,339; 4 colonies were counted on the postpreparation cultures. Potential bacterial pathogens, ie Streptococcus intermedius and gram-negative bacteria, were isolated from dogs prepared with the 2-step technique. None of the dogs that developed postoperative complications had growth on postpreparation culture plates. There was no significant difference in the percent reduction of microbial numbers after skin preparation for either group. There was a significant (P < 0.05) difference between the pre- and postpreparation microbial numbers for both preparation techniques. The 1-step technique was a simple, effective, and efficient method of skin preparation in dogs undergoing elective ovariohysterectomy.

Morphologic studies in saphenous vein grafts for aorto-coronary bypass surgery. Part I: Morphology of the Graft using ordinary surgical preparation techniques.

Vein bypass grafts in 8 patients were examined by light microscopy (LM) only or, in addition, by transmission electron microscopy (TEM) and scanning electron microscopy (SEM) before stretching, after stretching and immediately before implantation. Before stretching, the endothelium showed only discrete changes and detachment of the endothelium was rare. After stretching severe endothelial damage was evident, including loss of large areas of endothelium and extensive endothelial tears. Before implantation there had been an extension of the tears and the endothelial detachment in individual preparations. The most important factor causing damage is stretching of the vein. The incubation medium may also play a significant role. Damage incurred before operation or during removal, and hypoxia are of lesser importance. By avoiding endothelial damage it should be possible to limit the occurrence of early postoperative thrombosis and possibly severe late changes as well.