Tissue Incision Research Articles

Pretreatment Neutrophil-to-Lymphocyte Ratio as a Predictor of Survival and Response to Therapy in Patients Treated with Immune Checkpoint Inhibitors

Background: Treatment with immune checkpoint inhibitors (ICI) has demonstrated clinical benefit for a wide range of cancer types. Because only a subset of patients benefit, there is a strong need for predictive biomarkers. The aim of this study was to analyze the predictive capacity of neutrophil-to-lymphocyte ratio (NLR) in cancer patients treated with ICI, and to analyze the predictive value of combining NLR with tumor mutational burden (TMB). Methods: Retrospective cohort study of patients treated during 2015-2018. A total of 1714 patients with 16 different cancer types, who had complete blood count within 30 days prior to first ICI infusion, and whose tumors underwent next-generation sequencing were included. Overall survival, progression-free survival, response to ICI, and clinical benefit (response or stable disease ≥6 months) were the primary endpoints. Findings: Patients with NLR in the top 20th percentile within cancer type had significantly poorer overall survival (HR = 2·17; 95% CI, 1·89-2·50; P<0·001), progression-free survival (HR = 1·60; 95% CI, 1·41-1·81; P<0·001), response rate (18% vs 29%; P<0·001), and clinical benefit rate (21% vs 35%; P<0·001). Consistent results were obtained stratifying by cancer type. In multivariable analyses, NLR and TMB demonstrated independent association with clinical benefit. A combined variable of NLR and TMB was strongly associated with outcome. The probability of clinical benefit from ICI was 4 times higher in the NLR-low/TMB-high group compared to the NLR-high/TMB-low group (OR = 3·88; 95% CI, 2·72-5·54; P<0·001). Interpretation: In cancer patients, higher NLR was associated with poorer survival and lower likelihood of response to ICI. NLR is a suitable candidate for a cost-effective and widely accessible predictive biomarker, and can be combined with TMB for additional predictive capacity. Funding Statement: Fundacion Alfonso Martin Escudero (to CV), NIH K08 DE024774 and R01 DE027738 (to LGTM), and the NIH/NCI Cancer Center Support Grant P30 CA008748. Declaration of Interests:DH receives funding from AstraZeneca. MAP reports consulting fees from BMS, Merck, Array BioPharma, Novartis, Incyte, NewLink Genetics, and Aduro, honoraria from BMS and Merck, and research support from RGenix, Infinity, BMS, Merck, Array BioPharma, Novartis, and AstraZeneca. ANS reports advisory board position with BMS, Immunocore, and Castle Biosciences, and institutional research support from BMS, Immunocore, and Xcovery. VPB is a recipient of an immuno-oncology translational research grant from Bristol-Myers Squibb and is an inventor on a patent application related to work on neoantigen modelling. AMC reports advisory board position with Springworks Therapeutics. JJS has received travel support from Intuitive Surgical Inc. for fellow education and has served as a clinical advisor to Guardant Health, Inc. SGP has a patent PCT/US2016/026717 Methods of Cancer Detection Using PARPIFL pending, holds equity in Summit Biomedical Imaging, has a patent US 10,016,238B2 Apparatus, system and method for providing laser steering and focusing for incision, excision and ablation of tissue in minimally-invasive surgery, and holds equity in ColdSteel Laser Inc. NR reports research support from Pfizer and BMS, and consulting fees from REPARE Therapeutics, Mirati Therapeutics and Illumina. AZ reports honoraria from Illumina. TAC acknowledges grant funding from Bristol-Myers Squibb, AstraZeneca, Illumina, Pfizer, An2H, and Eisai, has served as an advisor for Bristol-Myers Squibb, Illumina, Eisai, and An2H, holds equity in An2H, and is a co-founder of Gritstone Oncology and holds equity. LGTM reports laboratory research funding from Illumina, Inc. and AstraZeneca. Ethics Approval Statement: The study was approved by the Memorial Sloan Kettering Cancer Center institutional review board (IRB).

Sentinel lymph node biopsy for breast cancer using indocyanine green fluorescence visualization

We presented the preliminary results of sentinel lymph node biopsy (SLN) using the method of fluorescent visualization with the indocyanine green. The study included 40 breast cancer patients with the prevalence of the cTis-2N0M0 process. 1 ml of Indocyanine Green (ICG) aqueous solution was administered periareolarly and subcutaneously from the tumor side with total drug dose of 5 mg. In the following few minutes the ICG trail along the lymphatic vessels was observed by its fluorescence in the infrared spectral range using a special camera with image transmitted to a computer screen. After the trail reached the axillary region and broke off, skin and subcutaneous tissue incision in axillary area was made, and the superficial fascia was dissected. The first contrasted lymph nodes were extracted. The incidence of SLN was 92.5%. Metastases were detected in 20% of cases. On average, it took 17.6 minutes to identify and remove the SLN. In 7 patients the use of the fluorescent SLN detection method was combined with radioisotope (Technefite 99m Tc colloid) – in all cases the same SLN was identified. The use of the ICG lymphotropic dye with the subsequent detection of SLN by the fluorescence method makes it possible to diagnose the status of SLN with a high degree of accuracy and can be comparable in effectiveness with the isotopic method. The specificities of lymphatic drainage were found out with the use of fluorescence lymphography: inverse dependence of the lymphatic drainage rate on the body mass index and breast size, and absence of dependence on degree of ptosis of breast.

LaryngoTORS: A Novel Cable-Driven Parallel Robotic System for Transoral Laser Phonosurgery

Transoral laser phonosurgery is a commonly used surgical procedure in which a laser beam is used to perform incision, ablation or photocoagulation of laryngeal tissues. Two techniques are commonly practiced: free beam and fiber delivery . For free beam delivery, a laser scanner is integrated into a surgical microscope to provide an accurate laser scanning pattern. This approach can only be used under direct line of sight, which may cause increased postoperative pain to the patient and injury, is uncomfortable for the surgeon during prolonged operations, the manipulability is poor and extensive training is required. In contrast, in the fiber delivery technique, a flexible fiber is used to transmit the laser beam and therefore does not require direct line of sight. However, this can only achieve manual level accuracy, repeatability and velocity, and does not allow for pattern scanning. Robotic systems have been developed to overcome the limitations of both techniques. However, these systems offer limited workspace and degrees-of-freedom (DoF), limiting their clinical applicability. This work presents the LaryngoTORS, a robotic system that aims at overcoming the limitations of the two techniques, by using a cable-driven parallel mechanism (CDPM) attached at the end of a curved laryngeal blade for controlling the end tip of the laser fiber. The system allows autonomous generation of scanning patterns or user-driven free-path scanning. Path scan validation demonstrated errors as low as 0.054 $\pm$ 0.028 mm and high repeatability of 0.027 $\pm$ 0.020 mm (6 × 2 mm arc line). Ex vivo tests on chicken tissue have been carried out. The results show the ability of the system to overcome limitations of current methods with high accuracy and repeatability using the superior fiber delivery approach.

Prehospital amputation: An experimental comparison of techniques

ObjectivePrehospital limb amputation is a rare but potentially life-saving intervention. When patients cannot be extricated due to limb entrapment or have hemodynamic compromise that precludes a prolonged extrication, they may benefit from an emergent prehospital amputation. The objective was to experimentally compare three prehospital amputation techniques on porcine legs. MethodsThe three techniques studied were a scalpel with a Gigli saw, a hacksaw, and a reciprocating saw. For the first technique, a scalpel was used to make a circumferential incision in the soft tissue and a Gigli wire saw to cut through the bone. The second and third techniques only used a saw and did not require soft tissue incision with a scalpel. Three providers including an emergency medicine physician, a paramedic, and a medical student performed three amputations of each technique, resulting in twenty-seven total amputations. The primary outcome was amputation time. Secondary outcomes were rate of instrument malfunction and cleanliness of cut. ResultsThe primary outcome of amputation time was different between techniques. The Gigli saw technique took 32.86 ± 16.53 s (mean ± SD), hacksaw technique 6.28 ± 0.76 s, and reciprocating saw technique 2.84 ± 0.40 s. There were no differences in amputation time between participants for a given amputation technique. The Gigli saw technique had an instrument malfunction on 3/9 trials which was distinct from the other techniques. Differences in cleanliness of cut were nonsignificant. ConclusionsPrehospital limb amputation with a hacksaw or reciprocating saw may result in faster completion of the time-sensitive procedure with fewer instrument malfunctions.

Seeing Is Believing: Ultrasound in Pediatric Procedural Performance.

Point-of-care ultrasound is currently widely used across the landscape of pediatric care. Ultrasound machines are now smaller, are easier to use, and have much improved image quality. They have become common in emergency departments, ICUs, inpatient wards, and outpatient clinics. Recent growth of supportive evidence makes a strong case for using point-of-care ultrasound for pediatric interventions such as vascular access (in particular, central-line placement), lumbar puncture, fluid drainage (paracentesis, thoracentesis, pericardiocentesis), suprapubic aspiration, and soft tissue incision and drainage. Our review of this evidence reveals that point-of-care ultrasound has become a powerful tool for improving procedural success and patient safety. Pediatric patients and clinicians performing procedures stand to benefit greatly from point-of-care ultrasound, because seeing is believing.

Utilization and Cost of Inpatient Dermatologic Procedures: A Cross-sectional Analysis.

Knowledge surrounding inpatient dermatologic procedure costs is limited; therefore to learn more, we performed a cross-sectional analysis of dermatologic procedures contained in a publicly available Washington State Comprehensive Hospital Reporting System database from 2014. Dermatologic procedure utilization and cost were evaluated based on several parameters including demographics, length of hospital stay, payments, and payers. SAS 9.4 was used for the analysis. A total of 14,768 patients underwent dermatologic procedures in 2014 and 81.0% were white. The average age was 53 years (SD = 0.17), and the average payment for all patients who underwent dermatologic procedures was $85,059.48 (SD = $1,284.34). The average hospital length of stay was 8.91 days (SD = 0.07). The most common admission type was elective (66.2%), the most common admit source was a non-healthcare facility point of origin (78.2%), the most common primary payer was Medicare (36.2%), and the most common procedure was incision and drainage of skin and subcutaneous tissue (26.5%), followed by closure of skin and subcutaneous tissue of other sites (20%). This analysis demonstrated that inpatient dermatologic procedures are a significant driver of inpatient health care costs, and it is critical to determine factors that increase inpatient costs related to dermatologic procedures in order to develop strategies for reducing healthcare costs.

Microfluidic‐Release Insertion Shuttle Designed for Implanting Flexible Biomedical Electronic Devices into Live Bodies

AbstractImplantable biomedical devices in flexible forms are attractive as they are more mechanically compatible with soft live tissues than rigid implants. The flexible implants can bend comfortably instead of delivering stress or strain to the surrounding live tissues when they are exposed to external stresses. However, because of the nature of the mechanical properties, the flexible biomedical implants have one important drawback, difficulty in handling the floppy implants without bending or wrinkling when inserting through small incision of live tissues. Here, the microfluidic‐release insertion shuttle is presented, which delivers flexible implants through the live tissues with added stiffness and releases the implants by dissolving a temporary adhesive layer with controlled infusing releasing solution through the structures such as post array and microfluidic channel. Experimental studies with variations in design parameters such as radii and pitches of the post array provide design guidance of the insertion shuttle. The results include in vivo experiments with functional flexible electronic implants into a live pig animal model to demonstrate feasibility of the concept.

&lt;i&gt;In vitro&lt;/i&gt; enzyme activity and &lt;i&gt;in vivo&lt;/i&gt; healing activity of the protein extract from pineapple peel

The pineapple is a fruit that has wide acceptance worldwide both in natural form, as industrialized. Your peel is a residue generated by food industries and from this residue can obtain a protein extract which is a good source of bromelain. This study aimed to obtain a protein extract from pineapple peel, evaluate its enzyme activity and its healing properties in skin lesions in rats. Seven animal groups were used: control, treated with 5% of protein extract, 10% of protein extract and pure protein extract; 5% of commercial bromelain, 10% of commercial bromelain and pure commercial bromelain. The animals were subjected to a tissue incision and treated for 21 days. Proteolytic and specific activities of the protein extract were 1.30 U mg -1 and 45 x 10 -3 U µg -1 and, for commercial bromelain, 1.04 U mg -1 and 6 x 10 -3 U µg -1 , respectively. In the histology of the lesion, there was no significant difference between the control and treated groups; however, macroscopically, the prepared topical formulations assisted in the recovery of skin lesions, providing a significant reduction in their width, in the groups treated with pure protein extract, 5 and 10% commercial bromelain, and pure bromelain.

Successful treatment of pathologic femoral shaft fracture associated with large arteriovenous malformations using a 3-dimensional external fixator and teriparatide: a case report

BackgroundArteriovenous malformations (AVMs) are rare congenital vascular lesions associated with early quiescence, late expansion, and, ultimately, infiltration and destruction of local soft tissue and bone. The extremities are a common location. Incidence of bony involvement by AVM has been reported as high as 31%. However, there are few reports on management of pathologic fracture associated with AVM. Teriparatide is a recombinant parathyroid hormone (PTH) analogue consisting of the 1–34 fragment of PTH. Recently, some reports have shown the ability of teriparatide to improve fracture healing. Here, we present a case of pathologic femoral shaft fracture associated with large AVMs that was treated successfully by external fixation and teriparatide.Case presentationA 68-year-old Japanese woman, previously diagnosed as having large AVMs, sustained a right femoral shaft fracture due to a fall. At the time of admission, she presented with massive swelling and venous varicosities of the right thigh. Plain radiography of the right thigh revealed femoral shaft fracture with bony erosion and calcification of soft tissue. We planned closed reduction and intramedullary nailing with a unilateral external fixator following embolization of the feeding artery. However, closed reduction using the fracture table was difficult. When we attempted open reduction, massive bleeding (1000 mL) after incision of subcutaneous tissue occurred. Finally, we carefully applied a Taylor Spatial Frame. Fracture displacement was corrected successfully and bony union was obtained with administration of teriparatide 15 months after the initial surgery. The patient is able to walk using 1 cane.ConclusionWe present the first report of pathologic fracture associated with large AVMs that achieved bony union using a 3-dimensional external fixator and teriparatide.

Predicting Postoperative Complications after Acute Care Surgery: How Accurate is the ACS NSQIP Surgical Risk Calculator?

The ACS NSQIP Surgical Risk Calculator (SRC) is an evidence-based clinical tool commonly used for evaluating postoperative risk. The goal of this study was to validate SRC-predicted complications by comparing them with observed outcomes in the acute care surgical setting. In this study, pre- and postoperative data from 1693 acute care surgeries (hernia repair, enterolysis, intestinal incision/excision and enterectomy, gastrectomy, debridement, colectomy, appendectomy, cholecystectomy, gastrorrhaphy, and incision and drainage of soft tissue, breast abscesses, and removal of foreign bodies) performed at a Level I trauma center over a five-year time period were abstracted. Predictions for any and serious complications were based on SRC were compared with observed outcomes using various measures of diagnostic. When evaluated as one group, the SRC had good discriminative power for predicting any and serious complications after acute care surgeries (Area Under the Curve (AUC) 0.79, 0.81). In addition, the SRC met Brier score requirements for an informative model overall. However, the predictive accuracy of the SRC varied for various procedures within the acute care patient population. For serious complications, the diagnostic measures ranged from an AUC of 0.61 and negative likelihood ratio of 0.716 for incision & drainage soft tissue to AUC of 0.91 and negative likelihood ratio of 0.064 for gastrorrhaphy. Length of stay was significantly underestimated by the SRC overall (8.56 days, P < 0.01) and for individual procedures. The SRC performs well at predicting complications after acute care surgeries overall; however, there is great variability in performance between procedure types. Further refinements in risk stratification may improve SRC predictions.

The modified method of preparation of teaser stallion for the detection of the estrus in mare in horse herd farming

The purpose of the study was a modification of the method of preparation of teaser stallion by plastic surgery on the movement of the penis to the perineum of stallion for detection of the estrus in mare in horse herd farming. The study subject was a six‐year stallion with a balanced type of nervous system, the method was an operation in the area of the external genitalia of stallion. The preoperative preparation of the stallion consisted of analgesia and sedation, felling and fixing of the stallion, sanitization of the external genitalia and the preparation of the surgical field. The operation was as follows: in the preputial sheath injected a modified two‐part crutch (Russian patent №123660) caudally toward the perineum. The end of the caudal part of crutch was bandaged. Skin, fascia and connective tissue incision in perinea region were discissed. One end of the bandage was tied to the head of the penis, it was taken out to the crotch by the caudal part of crutch, behind the scrotum. Another part of crutch was taken in the cranial direction. bead joints were put in a wound to close the surgical wound, and then the wound was treated with liniment of synthomycin. The removal of sutures was performed in 10–14 days after the surgery. Two weeks later, the stallion was used to detect estrus in mares. There was developed a technique of modified, aseptic, less labor‐consuming method of preparation of a teaser stallion for estrus detection in mares in horse farming.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Thulium Laser Vaporization versus Vapoenucleation (without morcellation) Technique for BPH: Do We Have a Winner?

Background and Objective The thulium laser surgery is a relatively new approach in which a wavelength of approximately 2 μm is emitted in continuous-wave mode, thus enabling the precise incision of tissue by using a wavelength that matches the water absorption peak of 1.92 μm in tissue. However, no published multinational study or other evidence definitively declares the superiority of thulium vaporization (ThuVAP) over thulium vapoenucle-ation (ThuVEP) without morcellator for better management of bothersome benign prostatic hyperplasia. The present study aims to evaluate the efficacy of vaporization and vapoenucleation (without a morcellator) in thulium laser prostatectomy for the treatment of benign prostatic hyperplasia. Methods A retrospective analysis of 82 patients who underwent thulium laser prostatectomy between February 2017 and January 2018 with ThuVAP and ThuVEP techniques was done and outcome measures analyzed were International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum flow rate (Q max), post-void residual (PVRU), total operating time, laser time and resected tissue weight. Results No significant differences were noted between ThuVAP and ThuVEP in terms of post-operative prostate volume (22.4 vs. 21.7 mL) and post-operative prostate specific antigen (PSA) (2.54 vs. 1.85 ng/mL). Nonetheless, there were differences between the groups in total lasing time (56.5 vs. 44.8 min, p = 0.001) and total operative time (88.5 vs. 71.5 min, p= 0.001). There was also a significant difference in IPSS, QoL score, Q max, and PVRU at 6 weeks, 3 months, 6 months and 9 months after surgery. Conclusion ThuVEP provides a superior reduction of prostate volume and better short-term clinical outcomes than ThuVAP in the treatment of patients with benign prostatic hyperplasia. Furthermore, ThuVEP results in significantly lower urethral discomfort rates with significant improvement in IPSS as compared to ThuVAP which is maintained over time. The hospital stay and catheter indwelling time are shorter in the ThuVEP group and the complications associated with it appear to be lower than ThuVAP group.

МАЛОИНВАЗИВНАЯ ТЕХНИКА ЭНДОСКОПИЧЕСКОЙ ВЕНТРИКУЛОЦИСТЕРНОСТОМИИ ДНА III ЖЕЛУДОЧКА У ДЕТЕЙ С ОККЛЮЗИОННОЙ ГИДРОЦЕФАЛИЕЙ

Objective: To introduce into clinical practice a new minimally invasive technique of endoscopic third ventriculocisternostomy (ETV) in children with occlusive hydrocephalus with using a semi-rigid needle-shaped miniature neuroendoscope. Methods: Reviewed 131 cases (73 boys, 58 girls) occlusive hydrocephalus of various genesis in children aged 1 month to 5 years, which was performed by ETV proposed by the first author of the methodology. The period of observation of children after treatment was 24.2±3.8 months. Results: Applying a minimally invasive technique of ETV with using a semi-rigid needle-shaped miniature neuroendoscope which significantly reduced the length of the soft tissue incision in the access areas, and the use of a more advanced toolkit – to reduce the size of the twist drill hole in the skull by more than 2 times. Access to the lateral ventricle is done by means of blunt trephination of the dura without the need for significant corticectomy or coagulation and is accompanied by minimal damage to the parencima of the brain. This is very important, given the operation in children with occlusive hydrocephalus, in whom the brain is already damaged by organic changes. Constant endoscopic control when accessing the lateral ventricle increases safety and reduces the risk of damage to vascular and nerve structures. It can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle such as severe narrowing or complete occlusion of the interpeduncular cistern, narrow (slit) ventricles of the brain (width of the third ventricle is less than 8 mm in the anterior sections), narrow foramen of Monro, anteroposterior size of prepontine cistern less than 6 mm. Lethal outcomes was not, and the effectiveness of surgical treatment was 77%. Postoperative neurological, endocrine and infectious complications have not been observed Conclusion: A minimally invasive technique of performing ETV using a semi-rigid needle-shaped miniature neuroendoscope is an effective and safe method of surgical treatment occlusive hydrocephalus, which minimizes surgical trauma at all stages, reduces intra- and postoperative complications and can be recommended for widespread clinical use. Keywords: Endoscopic ventriculostomy , obstructive hydrocephalus, semi-rigid needle-shaped miniature neuroendoscope, stenosis of cerebral aqueduct, floor of the third ventricle, basal cisterns.

Evaluation of Pain Following the Use of Scalpel Versus Electrosurgery for Skin Incisions in the Facial Regions.

Postoperative pain presents a significant medical problem. It can create a considerable discomfort in the immediate postoperative period and thus increase patient's morbidity. Multiple mechanisms are involved in its' etiology, one of them being the method of tissue incision. The aim of this study is to compare the early postoperative pain following incision with two different methods, scalpel and electrosurgery in the facial regions. Eighty patients with both benign and malignant skin lesions in the facial regions undergoing surgery were enrolled in this study. Patients were randomized in two groups. In group A, comprising 40 patients, cold steel surgical scalpel №15 was used for the surgical procedure. Electrosurgical microneedle with 0.06mm tip radius and generator unit KLS Martin Electrosurgical Unit ME MB 2 set on cutting mode, power 12 W was used for performing the surgery in group B including the same number of patients. After the surgery patients were given analgesics on their demand. The total number of on demand analgesics requirements was calculated. The patients were also asked to note the oral analgesics they were taking after being released from the hospital. Results of this study showed a statistically significant difference between the groups in the analgesics demand on the day of the operation (p=0.041). On the day of the operation 52.5% patients in the scalpel group and only 30% of the patents of the electrosurgery group received analgesics on demand. In all other analysed time points, the patients in the scalpel group received analgesics more often than the patients in the microneedle group, but with no statistically confirmed difference between the groups (p>0.05). Even more significant is the fact that patients treated with electrosurgery that needed analgesics, had significantly bigger excision area median 471 (rank 283-589) compared to the patients treated with the conventional method 289 (rank 177-432) (p=0.016). In accordance with previous studies our results suggested a significantly reduced postoperative pain in the electrosurgery group.

Perceptions and Practice Patterns of Holmium Laser Goggles in Endourological Procedures: An Unnecessary Evil?

The holmium laser is used increasingly for a wide array of urological procedures. Laser safety goggles are mandatory at many centers for individuals within the nominal hazard zone, as set out by the institution. Recent ex vivo studies suggest standard eye wear may be equally as protective. We sought to evaluate the perceptions and practice patterns of laser safety goggles in urology. A 24-question survey was sent out through e-mail to an international e-mail list of ∼2000 urologists that were members of the Endourological Society. Data were collected anonymously using Survey Monkey. A total of 264 (14%) urologists completed the survey. Thirty-four percent worked in the community, whereas 63% worked at an academic institution. Ninety-seven percent routinely used the holmium laser. The most common uses were lithotripsy (99%), tissue incision (71%), tumor ablation (58%), and prostate ablation (26%). Formal laser training and institutional laser safety policies were reported in 76% and 64%, respectively. Forty percent of respondents routinely wore laser safety goggles. Laser adverse events were witnessed by 19%, but there were no eye injuries reported. Seventy percent of surgeons felt that laser safety goggles may impair their vision. When presented with the information that regular eye glasses may be as effective as laser goggles for preventing harm, the majority (86%) would opt for regular eye wear. Laser safety eyewear practice patterns vary greatly. Many centers have adopted policies for universal mandatory laser goggles in the operating room. With over two thirds of surgeons suggesting laser goggles impair their vision, and recent literature suggesting regular eye wear is equivalent in preventing laser-associated eye injuries, laser goggle safety policies should be updated to better match the potential hazards inherent to the device.

The effects of changing surgical blades after skin cutting during cesarean section on the risk of postoperative infectious morbidity: a single-blinded randomized trial at a tertiary hospital

Various operative procedures and techniques have been made in attempts to diminish the incidence of postoperative wound infection. The use of two surgical knives was found to have no correlation to wound infection in several orthopedic-related surgeries. No studies, however, could be found on the effects of using such technique in cesarean section. The purpose of this study is to determine whether the use of different surgical blades for skin cutting and deep tissue incision decrease the incidence of post-cesarean infectious morbidity.

Necrotising Fasciitis of lower anterior abdominal wall post lower segment ceaserian section

Necrotising fasciitis is a rapidly progressive inflammatory infection of the fascia with secondary necrosis of the subcutaneous tissue. The speed of spread is directly proportional to the thickness of the subcutaneous layer. It moves along the fascial plane. We are presenting a case report of 27 years old Saudi female with status post Lower segment caesarian section of 10 days’ duration presented with bluish discoloration of the lower anterior abdominal wall around the surgical scar with necrotic patches and surrounding induration with foul smelling discharge from the one pocket within this area. She underwent successful simultaneous incision and wide debridement of gross necrotic tissues; together with evacuation of the pus followed by secondary closure. Both general and plastic surgical teams were involved. Patient made uneventful recovery and discharged home in good condition.

Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery.

Partial liver resection is a treatment of choice for liver tumors; the range of parenchyma excision varies from a small part of the tissue surrounding the neoplasm up to 70% of the organ. One of the major concerns during liver resection is blood loss. Thulium lasers which are characterized by the length of emission wave corresponding to a peak absorption of water create a new possibility of cutting tissues efficiently with minimal thermal damage and concurrently providing a good hemostasis control. The aim of our study was to evaluate an impact of liver transection with thulium doped fiber laser on an intraoperative bleeding and histopathological changes during postoperative period in swine model. Ten animals were subjected to open surgery partial liver resection and an incision of liver tissue with an all-fiber, diode-pumped, and continuous-wave Tm3+-doped fiber laser emitting 37.4 W of output power at ~1.94 μm wavelength. The macroscopic and histopathological evaluation was performed intraoperatively as well as 7 and 14 days after surgery. Macroscopically almost no bleeding was observed during surgery and no signs of bleeding were stated after 7 and 14 days. Histopathological analysis of the transection margin revealed a thermal damage area ranging in depth from 620.23 ± 23.82 μm on the day of surgery to 1817.70 ± 211.98 μm after 7 days. In the samples taken intraoperatively and after 7 days a superficial zone of carbonization was visibly separated from the deeper changes. After 14 days one 765.35 μm deep zone characterized by a granulation was present. In conclusion, thulium doped fiber laser is efficacious in cutting with a narrow zone of thermal injury and provides a good hemostasis during liver transection, thus being a potential tool for oncotic liver surgery.

Deep Tissue Incision Enhances Spinal Dorsal Horn Neuron Activity During Static Isometric Muscle Contraction in Rats

Translational correlates to pain with activities after deep tissue injury have been rarely studied. We hypothesized that deep tissue incision causes greater activation of nociception-transmitting neurons evoked by muscle contraction. In vivo neuronal activity was recorded in 203 dorsal horn neurons (DHNs) from 97 rats after sham, skin-only, or skin + deep muscle incision. We evaluated DHN responses to static, isometric muscle contractions induced by direct electrical stimulation of the muscle. The effect of pancuronium on DHN response to contractions was also examined. Approximately 50% of DHNs with receptive fields in the hindpaw were excited during muscle contraction. One-second .5- and 1.0-g muscle contractions produced greater DHN activity after skin + deep muscle incision (median [interquartile range], 32 [5–39] impulses, P = .021; and 36 [26–46] impulses, P = .006, respectively) than after sham (6 [0–21] and 15 [8–32] impulses, respectively). Neuromuscular blockade with pancuronium inhibited the muscle contractions and DHN activation during electrical stimulation, demonstrating contraction-induced activation. The greater response of spinal DHNs to static muscle contraction after skin + deep muscle incision may model and inform mechanisms of dynamic pain after surgery. PerspectiveCompletion of various activities is an important milestone for recovery and hospital discharge after surgery. Skin + deep muscle incision caused greater activation of nociception-transmitting DHNs evoked by muscle contraction compared with skin-only incision. This result suggests an important contribution of deep muscle injury to activity-evoked hyperalgesia after surgery.

Selective inhibition of CaV3.2 channels reverses hyperexcitability of peripheral nociceptors and alleviates postsurgical pain.

Pain-sensing sensory neurons of the dorsal root ganglion (DRG) can become sensitized or hyperexcitable in response to surgically induced peripheral tissue injury. We investigated the potential role and molecular mechanisms of nociceptive ion channel dysregulation in acute pain conditions such as those resulting from skin and soft tissue incision. We used selective pharmacology, electrophysiology, and mouse genetics to link increased current densities arising from the CaV3.2 isoform of T-type calcium channels (T-channels) to nociceptive sensitization using a clinically relevant rodent model of skin and deep tissue incision. Furthermore, knockdown of the CaV3.2-targeting deubiquitinating enzyme USP5 or disruption of USP5 binding to CaV3.2 channels in peripheral nociceptors resulted in a robust antihyperalgesic effect in vivo and substantial T-current reduction in vitro. Our study provides mechanistic insight into the role of plasticity in CaV3.2 channel activity after surgical incision and identifies potential targets for perioperative pain that may greatly decrease the need for narcotics and potential for drug abuse.