Type Of Wound Closure Research Articles

The Efficacy of Modified Ilizarov Distraction-Tension Device on Limb Wound Difficult to Cover with Skin Flaps.

Closure of complex limb wounds poses challenges and requires innovative approaches. This research aimed to evaluate the effectiveness of a modified distraction-tension device using Ilizarov external fixation for wound closure in challenging cases. A retrospective analysis was conducted on 43 patients with extremity wounds that were difficult to cover with skin flaps between January 2019 and December 2022. Tension-relieving traction was applied using the Ilizarovexternal fixator apparatus, tailored to individual wound characteristics. Three types of wire-pin connections were used in this study. The distraction begins on the third postoperative day, with a speed of 0.5mm/d. Clinical wound healing scores were evaluated at 5 and 30 days postoperatively. Complications were documented following the Paley classification system. Traction using modified Ilizarovexternal fixation promoted a significant reduction in wound size. The mean traction period was 11.2 ± 7.3 days, and the mean healing duration was 17.0 ± 3.7 days. The clinical wound healing score improved from 3.7 ± 2.9 at 5 days to 1.7 ± 0.7 at 30 days postoperatively (p < 0.05). Complications were minimal, with no significant obstacles or sequelae observed. Direct closure healing was achieved in 21 cases, skin graft healing in 13 cases, and suture healing in 9 cases. No recurrences were reported. Using Paley's classified complications, there were 17 problems, 9 obstacles, and 0 sequelae. The Ilizarov tension-relieving traction shows promise in facilitating wound closure that is challenging to manage with skin flaps. The modified three types of pin-skin connection configuration could satisfy various types of wound closure.

A Comprehensive Analysis on Compartment Syndrome of the Thigh Okoro Ogheneyebrorue Godswill and Isioma Cynthia Nwaokoro

The surgical emergency known as compartment syndrome of the thighs carries a high risk of mortality as well as morbidity. The purpose of this review was to evaluate the degree of effect regarding compartment syndrome of the thighs. This evaluation included a thorough literature review in order to accomplish the study's objective. Also, relevant literatures were adopted and specific search terms including " thigh” and syndrome” utilized while data achieved from EBSCO and Google Scholar libraries. According to some writers, to be able to reduce the possibility of recurring ischemic alterations, all muscle compartments of the implicated limb must be released during the fasciotomy. To be able to prevent fibrosis and contracture, which impair transfers and lower extremity dressing abilities in patients with concurrent spinal cord injury, surgical decompression is necessary. There is currently a dearth of information on the causes, effectiveness of one versus two fasciotomies, types of wound closure, and complication rates of compartment syndrome of the thighs.

Risk Factors for Surgical Site Infections Following Fasciotomy in Patients With Acute Compartment Syndrome: A Study on the February 2023 Kahramanmaraş Earthquake.

Surgical site infections (SSIs) developing after fasciotomy are difficult to treat, costly, and an important source of mortality and morbidity. This study aimed to determine the risk factors affecting the development of SSI in patients who underwent fasciotomy with the diagnosis of acute compartment syndrome (ACS) within 72 hours after two consecutive earthquakes of 7.7 and 7.6 magnitude that occurred in Kahramanmaraş on February 6, 2023. A total of 116 patients were retrospectively analyzed. Patients were divided into two groups: those who developed SSI and those who did not. In this study, variables such as basic demographic characteristics, time of fasciotomy, center performing fasciotomy, type of wound closure, affected extremity, concomitant renal failure, hyperbaric oxygen (HBO) therapy, blood creatine kinase (CK) level were examined. Of 116 patients, 58 (50%) had SSI. It was statistically observed that patients who underwent treatment with vacuum-assisted closure (VAC), those who underwent primary closure with the shoelace method, those who went into renal failure, and those whose fasciotomy was performed in an earthquake zone had a higher incidence of SSI (p<0.001). Blood CK level above 17.839 seemed to be a risk factor according to receiver operating characteristic (ROC) analysis (P<0.01). Age (p=0.193), gender (p=0.125), fasciotomy time (p=0.843), lower extremity (p=0.234), upper extremity (p=0.806), and HBO treatment (p=0.56) were not associated with SSI. Infection was found to be a significant risk factor for amputation (p<0.001). The use of VAC as a wound closure technique for SSI after fasciotomy in patients who developed ACSdue to the earthquake, the presence of renal failure in the patients, and performing fasciotomy in the earthquake zone were independent risk factors. A blood CK level above 17.839 was also determined as a risk factor, but the confidence interval was found to be low.

Dosimetric Analysis of Major Wound Complications Following Preoperative Ultra-Hypofractionated Radiation Therapy for Soft Tissue Sarcoma

Preoperative radiation therapy (RT) for soft tissue sarcomas (STS), delivered with conventional fractionation, has been shown to reduce long-term toxicity at the expense of increased postoperative major wound complications (MWC). Ultra-hypofractionated RT has emerged as a potential alternative preoperative modality with early but comparable outcomes to conventional regimens. However, limited data are available evaluating dosimetric, patient, and treatment specific factors associated with development of MWC in this setting. This IRB approved review included STS patients treated with preoperative 5 fraction daily RT followed by surgical resection within 7 days. Patients were evaluated for MWCs in association with patient and tumor characteristics, dosimetric parameters, and treatment techniques. MWCs were defined as a return to operating room, readmission for wound care or IV antibiotics, and persistent deep packing for >120 days. Prescription isodose line, PTV mean dose and the PTV volume exposed to 105% and 110% of prescribed dose were recorded. Dose to tissue likely to be involved in wound healing was assessed by creating a 1 cm thick superficial skin strip within 2 cm of the PTV which was then evaluated for volume, mean dose, V15, V21, V27, and V30. Secondary endpoints were locoregional control (LRC), metastasis free survival (MFS), and overall survival (OS). A total of 31 patients with a median age of 66 years (range 28-87) and a median follow up of 21 months (IQR 8-43) were included. All patients received 30 Gy in 5 fractions using IMRT/VMAT. There were 11 upper limb (36%) and 20 lower limb (65%) tumors included. Median time to resection following RT was 1 day (IQR 0-3). Median tumor size was 8 cm (IQR 5-13). MWC occurred in 13 patients (42%) with 10 patients (32%) requiring additional surgery. Dehiscence and infection requiring IV antibiotics occurred in 12 (39%) and 6 patients (19%), respectively. RT plans were predominately prescribed to the PTV mean (87%) with a median prescription isodose of 97% (IQR 96-97) and PTV mean dose of 3110 cGy (IQR 3089-3142). Median PTV volume, mean dose, and volume of PTV receiving 105% and 110% of the prescribed dose were higher in the MWC cohort although none reached significance. Similarly, for the 1 cm skin strip the median volume, mean dose, V30, V27, V21, and V15 were all higher in the MWC cohort without significant difference. Among patient, treatment, and tumor factors: tumor size, location, grade, margin status, type of wound closure, and prior non-oncologic resection were not associated with MWC. LRC, MFS, and OS at 3-years were 96%, 67%, and 76%, respectively. Although not reaching significance, increased plan homogeneity and reduced dose/volume relationships in proximity to the skin trended to reduced MWC in this limited cohort. Multi-institutional collaboration may be warranted to better identify factors associated with MWC in patients treated with preoperative ultra-hypofractionated RT.

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.

Surgery, Limb Edema and Health-related Quality of Life: A Prospective Follow-up Study on Patients With Cutaneous Malignant Melanoma.

The latest developments in oncological therapies for malignant melanoma, and the discovery that complete lymph node dissection offers no survival benefit, are changing the landscape of melanoma surgery. There is a need for more information on health-related quality of life (HRQoL) consequences of melanoma surgery. This longitudinal cohort study was carried out from 2004 to 2009 in the Helsinki and Uusimaa Hospital District and patients were followed-up at 6, 12 and 24 months. The patients were asked to fill in the generic 15D questionnaire and the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). In addition, they were asked selected questions from the EORTC Item Library regarding upper and lower limb edema. A total of 169 (64.5%) patients with local or locally advanced melanoma referred for surgical treatment responded, of whom 161 were included in the final analysis. For the whole patient group, distress, depression and emotional function improved over time. Worse HRQoL in some of the dimensions were associated with female sex, skin transplant versus direct wound closure and complications 30 days or more after surgery, but none was associated with worse overall HRQoL. Postoperative complications, type of wound closure or lymph node surgery had no effect on overall HRQoL. Patient-reported limb edema was associated with worse overall HRQoL at baseline and during follow-up by both instruments. Patients reporting limb edema reported worse mobility and more pain throughout the study. Patient-reported limb edema, regardless of the cause, seems to be an important predictor of worse HRQoL among patients with melanoma.

Risk Factors and Operative Findings of Abdominal Wound Dehiscence in Emergency Laparotomy

Introduction: Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. Wound dehiscence primarily occurs after a surgery relating to an open wound. It is sometimes called wound breakdown, wound disruption, or wound separation. It can be influenced by various preoperative and postoperative factors. Various preoperative and postoperative variables might impact it, and these factors can also influence the patient's result following surgery. Aim of the Study: The aim of the study was to observe the risk factors and operative findings of abdominal wound dehiscence cases in emergency laparotomy. Methods: This prospective clinical study was conducted at the Department of Surgery, MAG Osmani Medical College, Sylhet, Bangladesh. The study duration was 8 months, from July 2008 to February 2009. A total of 460 participants were selected from those undergoing emergency laparotomy in the study place for this study. A consecutive selection method was followed for the selection of the participants. The participants were divided into two groups depending on whether wound dehiscence was developed or not. Result: All the baseline characteristics (age, body mass index, and smoking habit) of patients except sex were significantly associated with wound dehiscence. The history of receiving steroid and cytotoxic drug were higher in patients with wound dehiscence than that in patients without wound dehiscence. However, the history of receiving the immunosuppressive drug was almost identical between the groups. The patients who did not take hygienic measures or take bath before an operation or change clothing had a higher incidence of wound dehiscence. The risk factors tuberculosis, diabetes mellitus, jaundice, bronchial asthma, anemia, edema, and dehydration were found significantly higher in wound dehiscent patients compared to those without wound dehiscence. The mean duration of operation, prolene suture used for closure, midline incision, mass closure technique and drain given had significant influence on development of wound dehiscence. presence of ascitic fluid, pus and contaminated fecal material demonstrated their significant presence in patients who develop wound dehiscence than those who did not develop wound dehiscence. Postoperative conditions like abdominal distention, coughing and wound infection tend to be associated with wound dehiscence more frequently than their counterpart. Conclusion: The current study recommends evaluating patient-related risk factors before to surgery and quickly addressing them. A skilled surgeon should do surgery on high-risk patients. The study contends that the development of wound dehiscence is significantly influenced by baseline traits like age and BMI. The degree of patient cleanliness before surgery greatly influences the likelihood of wound dehiscence. According to the study, other factors that may affect the occurrence of postoperative abdominal wound dehiscence include surgical procedures, skin preparation, the length of the procedure, and the type of wound closure. Coughing, vomiting, and subsequent infection are additional postoperative side effects that increase the risk of wound dehiscence.

Outcomes in Sutured Versus Sutureless Wound Closure in Pediatric Cataract Surgery.

To analyze the postoperative course, specifically postoperative complications, of pediatric patients who underwent cataract surgery by a single surgeon. The type of wound closure was compared to provide an evidence-based approach to surgical technique in pediatric cataract surgery. This retrospective study analyzed pediatric patients who underwent cataract extraction by a single surgeon from 2014 to 2020. Excluded from the study were patients with postoperative follow-up of less than 1 month. The primary outcome compared postoperative complications between patients with sutured and sutureless wound closure. Other outcomes analyzed included intraocular pressure, mean corrected distance visual acuity, and incidence of procedure needed to remove posterior capsule opacification. The study comprised 116 eyes with sufficient follow-up; 86 had sutureless wound closure and 30 had sutured wound closure. An intraocular lens was placed in 52% of eyes in the sutureless group and in 80% of eyes in the sutured group. There was no statistically significant difference between preoperative and postoperative intraocular pressure between groups. The best corrected distance visual acuity was better in the sutured group at 6 months but not at the most recent follow-up visit. No cases of endophthalmitis were found in either group. There was no statistically significant difference between the incidence of retinal detachments and iris prolapse. The incidence of endophthalmitis, retinal detachment, and iris prolapse was similar between pediatric patients who underwent cataract removal with sutureless versus sutured wound closure. Therefore, it may be reasonable to avoid the suture after pediatric cataract surgery. [J Pediatr Ophthalmol Strabismus. 2023;60(2):147-151.].

Subcuticular Barbed Suture and Skin Glue Wound Closure Decreases Reoperation and Length of Stay in Geriatric Hip Fractures When Compared With Staples.

Introduction:Patients with geriatric hip fracture are notoriously frail and at risk for complications. Persistent postoperative wound drainage can lead to prolonged hospital stay, increased risk for infection, and need for revision surgery. The purpose of this study was to determine the effect of wound closure technique, barbed monofilament subcuticular suture and skin glue versus staples on rates of intervention for wound drainage and length of hospital stay after geriatric hip fracture fixation.Methods:A retrospective review of isolated hip fractures in patients older than 60 years at a single institution over a 3-year period was done. Hip fractures included femoral neck, intertrochanteric, and subtrochanteric femur fractures treated with internal fixation or arthroplasty. Skin closure technique, at the discretion of the operating surgeon, included either barbed subcuticular monofilament suture and skin glue or staples. Charts and radiographs were reviewed to determine patient characteristics, Charlson Comorbidity Index, type of wound closure, length of stay, and interventions for persistent wound drainage.Results:There were 175 patients in the barbed suture and skin glue group and 211 patients in the staples group. The barbed suture group had an average postsurgical length of stay of 5.0 days which was significantly lower than the staples group (7.0 days, P < 0.00001). In the staples group, 17 patients (8%) required incisional negative pressure wound therapy due to wound drainage with five patients (2.4%) returning to the operating room secondary to persistent wound drainage. No patients were observed in the barbed suture group that required intervention for wound drainage.Discussion:Barbed suture and skin glue closure is associated with markedly shorter hospital stay and fewer interventions for wound drainage when compared with staples after surgical treatment of geriatric hip fractures.

Oral Adverse Outcomes Associated with the Buccal Mucosa Graft for Urethroplasty

The buccal mucosal graft (BMG) has become the standard graft material in reconstructive urology due to its large surface area and compatibility.1 Currently, there are 3 methods to manage the BMG donor site, including primary closure, healing via secondary intention, and graft-assisted closure. The ideal technique for managing the BMG donor site remains disputed, as postoperative oral complications have been reported with all 3 techniques. Based on prior studies, the researchers hypothesize that larger BMG grafts are associated with more oral adverse outcomes.2 This study sought to ask the following research question: In subjects undergoing urethroplasty with BMG, does the method of donor site management (closure, non-closure, or xenograft-assisted closure) have an association with long-term postoperative oral adverse outcomes?A retrospective cohort study was conducted, enrolling a sample of patients treated at Harborview Medical Center, Seattle, WA, between January 2012 and December 2018. Eligible subjects had a history of urethroplasty utilizing a unilateral BMG treated more than 2 years ago. An IRB-approved survey was designed to assess oral adverse outcomes using a Likert scale for responses. Predictor variables were donor site management methods, defined as closure, non-closure, and xenograft-assisted closure. The primary outcome variables were presence/absence of postoperative oral adverse outcomes, defined as subjective changes in mouth opening, smile, chewing, speech, intraoral bleeding, paresthesia, trismus, and infection. Other study variables included the BMG surface area, review of oral rehabilitation instructions, and patient satisfaction. Descriptive, univariate, and multiple linear regression statistics were computed, with statistical significance set at P < .05.The sample was composed of 137 subjects (95% male; mean age 48 years). The mean surface area of the BMG for closure, non-closure, and xenograft was 1059mm2, 1178mm2, and 1228mm2, respectively. Thirty-nine patients replied to the survey (response rate 29%); after applying exclusion criteria, 34 were included in the analysis (7 closure, 17 non-closure, and 10 xenograft-assisted closure). Univariate analyses between survey questions and donor site management methods did not show significant differences in subjective paresthesia, change in speech, smile, chewing ability, mouth opening, trismus, or satisfaction. Multiple linear regression was performed to assess the effect of BMG surface area on the association between type of wound closure and survey responses. The xenograft group was associated with the best-rated ability to chew and decreased trismus, when accounting for larger graft surface area (P < .01). Although not statistically significant, multiple trends suggest xenograft-assisted closure out-performed primary closure and non-closure with respect to changes in speech, smile, mouth opening, and satisfaction with increasing graft sizes. Conversely, with increasing graft size, the xenograft group was associated with more paresthesia. Seventy-seven percent of survey respondents reported that they did not receive oral rehabilitation instructions.This study suggests that xenograft-assisted closure may reduce long-term oral adverse outcomes associated with trismus, subjective changes in chewing, mouth opening, speaking, and smiling with larger graft sizes. However, increased BMG surface area was associated with paresthesia in this group. Additional studies with a larger sample size are needed to support these findings. Finally, regardless of closure method, the researchers note a lack of postoperative patient education for oral rehabilitation exercises and wound care. The addition of this practice will improve long-term outcomes associated with intraoral healing.

American Brachytherapy Society (ABS) consensus statement for soft-tissue sarcoma brachytherapy

PurposeGrowing data supports the role of radiation therapy in the treatment of soft tissue sarcoma (STS). Brachytherapy has been used for decades in the management of STS and can be utilized as monotherapy or as a boost to external beam radiation. We present updated guidelines from the American Brachytherapy Society regarding the utilization of brachytherapy in the management of STS. Methods and MaterialsMembers of the American Brachytherapy Society with expertise in STS and STS brachytherapy created an updated clinical practice guideline including step-by-step details for performing STS brachytherapy based on a literature review and clinical experience. ResultsBrachytherapy monotherapy should be considered for lower-recurrence risk patients or after a local recurrence following previous external beam radiation; a brachytherapy boost can be considered in higher-risk patents meeting implant criteria. Multiple dose/fractionation regimens are available, with determination based on tumor location and treatment intent. Techniques to limit wound complications are based on the type of wound closure; wound complication can be mitigated with a delay in the start of brachytherapy with immediate wound closure or by utilizing a staged reconstruction technique, which allows an earlier treatment start with a delayed wound closure. ConclusionsThese updated guidelines provide clinicians with data on indications for STS brachytherapy as well as guidelines on how to perform and deliver high quality STS brachytherapy safely with minimal toxicity.

"Safe incision" in calcaneal sliding osteotomies reduces the incidence of sural nerve injury.

The purpose of this study was to demonstrate whether application of the so-called safe incision when performing calcaneal sliding osteotomies reduces the risk of sural nerve injury. Patients who underwent either medial or lateral sliding calcaneal osteotomies between 2010 and 2018 were analysed retrospectively. A thorough neurological examination was performed, and the location of the surgical wound and the type of wound closure were recorded. The European Foot and Ankle Surgery (EFAS) score and 12-item Short Form Survey (SF-12) were also documented. A total of 57 patients were included, of which 20 (35.1%) had a sural nerve injury. Five patients had a neurapraxia (8.8%), while 15 patients had a permanent injury (26.3%). Respecting the "safe incision" decreased sural nerve injury (p = 0.02). The type of osteotomy and closure was not significant. No significant differences were found in the functional tests between the different techniques, or between patients who presented sural nerve injury and those who did not. Sural nerve injury after calcaneal sliding osteotomies is higher than previously reported in the scientific literature, with an incidence of 35.1% (20/57 patients). Respecting the so-called safe zone (oblique incision that runs through the point that is > 1/3 of the distance from the tip of the lateral malleolus to the posteroinferior margin of the calcaneus) clearly decreases the incidence of sural nerve injury. Finally, the majority of patients remained asymptomatic despite the neurological injury.

Evaluation of the orthopaedic trauma association open fracture classification (OTA-OFC) as an outcome prediction tool in open tibial shaft fractures.

It was the goal of this study to determine if the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) correlates with complication rates and to determine if it can be used as a predictive tool in the treatment of open tibial shaft fractures. Retrospective review from two high-volume level 1 trauma centers of open tibial shaft fractures over a 5year period. Variables of interest included OTA-OFC, type of wound closure, 90-day wound complication, unplanned re-operation, non-union, and amputation. 501 consecutive open tibial shaft fractures. 57.3% (n = 287) were closed primarily; local soft tissue advancement/rotational flap was used in 9.6% (n = 48); free soft tissue transfer used in 22.8% (n = 114); 8.6% (n = 43) required amputation. Of those followed for 90days (n = 419), 45 (9.0%) had a wound complication, of which 40 (8%) required an unplanned reoperation. 40 (8.0%) patients went on to a documented non-union. All OTA-OFC classification groups significantly correlated with type of definitive closure (r = 0.18-0.81, p < 0.05) with OTA-OFC skin showing the strongest correlation (r = 0.81). OTA-OFC bone loss weakly correlated with wound complication (r = 0.12, p = 0.02) and no OTA-OFC classification correlated with the need for an unplanned secondary procedure. OTA-OFC skin, muscle and arterial all weakly correlated with non-union (r = 0.18-0.25, p < 0.05). OTA-OFC muscle was predictive of non-union (OR = OR = 2.2, 95% CI = 1.2-4.1) and amputation (OR 9.3, 95% CI = 3.7-23.7). OTA-OFC arterial was also predictive of amputation (OR 4.8, 95% CI = 2.5-9.3). The OTA-OFC correlates variably with the type of definitive closure, the development of a 90-day wound complication, and the occurrence of a non-union. Importantly, OTA-OFC muscle classification is predictive of non-union while both OTA-OFC muscle and arterial were predictive of amputation.

Analysis of donor site complications at the anterior iliac crest harvest site for treatment of tibial plateau fractures

Introduction: In tibial plateau fractures with intraarticular depression and metaphyseal comminution, bone grafting or the use of a bone substitute may be required. Harvesting autologous iliac crest bone graft for other orthopedic procedures has complications. The aim of this study was to evaluate the complication rate after harvesting bone graft as used for the treatment of tibial plateau fractures. Patients and methods: Patients treated in a tertiary care hospital with operative intervention for tibial plateau fractures with iliac crest bone graft between January 2015 and December 2018 were included in this retrospective study. Patients’ records were evaluated and clinical evaluation was performed at follow-up. Results: 46 patients (20 females, 26 males, mean age 55.2±14.9 years) were included in this study. Follow-up was mean 4.3±1.2 years. Only minor complications such as hematoma could be identified; in one patient, repeat surgery for bleeding was performed. No nerve injuries, long-term pain, fractures, infections or wound healing disturbances could be seen. The use of a drain, the type of wound closure or amount of harvested bone did not influence complication rate. Conclusion: This study shows that harvesting of iliac crest bone graft for the treatment of tibial plateau fractures is a safe procedure with a very low complication rate. Keywords: Tibial plateau fractures Iliac crest bone graft Donor site complications

Prevention of infection in open fractures: Where are the pendulums now?

Soft tissue management and fracture fixation including initial external fixation in Gustilo-Anderson type II and type III open fractures are cornerstones in the treatment but details on timing and type of wound closure, irrigation and debridement, systemic and local antibiotics, antimicrobial-coated implants and the use of Bone Morphogenetic Protein-2 remain controversial. This article looks at current clinical evidence of these items for the management of open fractures. Timing of debridement and wound closure remains critical. Early debridement by an experienced team within 24 h seems adequate while gross contamination, a devascularized limb, a multi-injured patient and compartment syndrome require immediate surgical intervention. Wound closure during the first surgery was shown to result in reduced rates for infections and nonunion. If soft-tissue reconstruction is needed, it should be performed within the first 7 days. Regarding types of irrigation fluid, antiseptic and antibacterial solutions did not prove to be superior to saline. High pressure irrigation has not been demonstrated to be beneficial whereas antibiotic administration as soon as possible has been proven to be favorable. Administration of more than 72 h was not superior to shorter systemic antibiotic intervals. For Gustilo-Anderson type I and II, broad spectrum antibiotic therapy is reasonable. Additional aminoglycosides for broader coverage are recommended in Gustilo-Anderson type III fractures. There is newer literature on the beneficial effects of the use of local antibiotics, e.g. by antibiotic beads. Coating of internal fixation devices is a modern approach to improve infection prophylaxis and gentamicin-coated implants have been demonstrated to be safe in clinical application. Vacuum assisted closure (VAC) could not evidence negative pressure wound therapy to reduce infection risk, improve self-rated disability or quality of life in open fractures, however, enhance treatment costs. Recombinant human bone morphogenetic proteins (rhBMP)-2 showed promising data in Gustilo-Anderson type III open tibial shaft fractures with lower rates of invasive secondary procedures. In conclusion, there is evidence for thorough debridement and irrigation with saline, early soft tissue coverage and the use of systemic and local antibiotics. Except for a short-term soft tissue coverage VAC seems not to be beneficial and rhBMP-2 is an additional tool in Gustilo-Anderson type III open fractures.

Negative Pressure Wound Therapy In Elective Stoma Reversal Surgery: Results Of A UK District General Hospital Pilot

The role of negative pressure wound therapy in stoma reversal surgery remains unknown. To evaluate this, a retrospective, non-randomized, single-institution, pilot study was conducted. Surgeon preference determined type of wound closure and application of the single-brand negative wound pressure device. No patient in the intervention group suffered wound complications, but five of the thirty-six patients in the control group suffered surgical site infection-related complications. Primary closure and negative pressure wound therapy use decreases wound complications in stoma reversal surgery, thereby alleviating the wound-management burden in hospitals and in the community. This has cost-saving implications, but further studies are needed.

Donor site complications following anterior iliac crest bone graft for treatment of distal radius fractures

In distal radius fractures with metaphyseal comminution, bone grafting or the use of a bone substitute may be necessary. Harvesting autologous iliac crest bone graft for other orthopedic procedures has complications. The aim of this study was to evaluate the complication rate after harvesting a small amount of bone as used for the treatment of radius fractures. Patients treated in a single level I trauma center with surgical treatment for distal radius fracture with iliac crest bone graft between January 2008 and December 2012 were included in this retrospective study. Patients' records were evaluated and clinical evaluation was performed at follow-up. 42 patients (20 females, 22 males, mean age 56.3 ± 15.9years) were included in this study. Follow-up was mean 6.3 ± 1.2years. Only minor complications such as hematoma could be identified; in one patient, revision surgery for bleeding was performed. No nerve injuries, long-term pain, fractures, infections or wound healing disturbances could be seen. The use of a drain of hemostyptics, the type of wound closure or pattern of harvested bone did not influence complication rate. This study shows that harvesting a small amount of iliac crest bone graft for the treatment of distal radius fractures is a safe procedure with a very low complication rate.

Systematic Review and Meta-Analysis of Hard Tissue Outcomes of Alveolar Ridge Preservation.

Alveolar ridge preservation procedures have been advocated to minimize postextraction dimensional loss. There is a need for systematic analyses of clinical factors affecting the outcomes of these procedures in order to improve their clinical outcomes. This systematic review and meta-analysis aimed to assess the efficacy of alveolar ridge preservation procedures in terms of hard tissue dimensional changes and to determine clinical factors affecting outcomes of these procedures. Studies comparing alveolar ridge preservation procedures with tooth extraction alone that reported quantitative outcomes for hard tissue dimensional changes were included. The primary outcome variable was horizontal dimensional changes of alveolar bone. Subgroup analyses evaluated effects of wound closure, flap elevation, type of grafting materials, use of barrier membranes, use of growth factors, socket morphology, and the position of teeth on outcomes of alveolar ridge preservation procedures. Twenty-one studies were included, and quantitative analyses were performed for seven outcome variables. Significant differences between alveolar ridge preservation and control sites were found for six outcome variables, all favoring alveolar ridge preservation procedures. The magnitude of effect for the primary outcome variable (horizontal dimensional changes of alveolar bone) was 1.86 mm (95% CI = 1.44, 2.28; P < .001). This magnitude of effect for the primary variable (as determined by subgroup analysis) was also significantly affected by type of wound closure (P = .033), type of grafting materials (P = .001), use of barrier membranes (P = .006), use of growth factors (P = .003), and socket morphology (P < .001). Alveolar ridge preservation procedures are effective in minimizing postextraction hard tissue dimensional loss. The outcomes of these procedures are affected by morphology of extraction sockets, type of wound closure, type of grafting materials, use of barrier membranes, and use of growth factors.

Resection Margins in Merkel Cell Carcinoma: Is a 1-cm Margin Wide Enough?

Guidelines regarding specific resection margins for primary Merkel cell carcinoma (MCC) are not well established. The current National Comprehensive Cancer Network (NCCN) guidelines recommend 1- to 2-cm resection margins. This study aimed to determine the impact of margin width on local recurrence (LR), disease-specific survival (DSS), overall survival (OS), and type of wound closure. All patients who underwent resection of primary MCC at a single institution from 2000 to 2015 were reviewed. Patient demographics, clinicopathologic characteristics, treatments, and outcomes were reviewed. A total of 240 patients underwent resection of primary MCC with resection margin width identified in the operative report. The median age was 76years, and 65.8% of the patients were men. Of the 240 patients, 85 (35.4%) had head and neck primaries, 140 (58.3%) had extremity primaries, and 15 (6.3%) had trunk primaries. In terms of margins, 69 patients (28.8%) had a margin of 1cm, 36 patients (15%) had a margin of 1.1-1.9cm, and 135 patients (56.2%) had a margin of 2cm or more. The median follow-up period was 21months. The LR rate was 2.9% for a margin of 1cm, 2.8% for a margin of 1.1-1.9cm, and 5.2% for a margin of 2cm or more (p = 0.80). The 5-year OS was 63.6% for a margin of 1cm, 59.7% for a margin of 1.1-1.9, and 70.7% for a margin of 2cm or more (p = 0.66). The 5-year DSS was 80.3% for a margin of 1cm, 66.2% for a margin of 1.1-1.9cm, and 91.8% for a margin of 2cm or more (p = 0.28). For wound closure, 43.5, 50, and 65.9% of the patients respectively required a flap or graft with a margin of 1, 1.1-1.9, and 2cm or more (p = 0.006). A 1-cm resection margins did not increase the risk of LR. Margin width did not make a significant difference in DSS or OS. Larger resection margins increase the need for a graft or flap closure.

Comparative study of steristrips and subcuticular suture for wound closure after thyroid surgery

Background: Any skin closure technique aims at opposing the skin edges precisely without tension for sufficient time to allow healing to take place. The ease and speed with which the skin closure is completed, the level of patient discomfort, the complication rate, and the final cosmetic result are the factors which has to be considered in making a comparison of different types of wound closure. This study aims at comparing steristrips and subcuticular sutures for wound closure after thyroid surgery based on assessment of post-operative pain, neck mobility and cosmetic appearance.Methods: A comparative study was carried out among 90 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex undergoing thyroidectomy will be randomized to had their wounds closed by steristrips or subcuticular sutures using a simple randomization table. Patients who underwent previous neck irradiations, secondary neck surgeries, and patients with poor compliance were excluded from the study. Descriptive statistics, unpaired t-test and chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 48.6 (range 24-76) years. The gender distribution showed a higher number of females (82) as compared to males (8). 70 patients were diagnosed with multinodular goitre, 16 patients were of thyroid neoplasms and 4 were of inflammatory thyroid conditions. 12 patients underwent subtotal thyroidectomy and 78 patients underwent total thyroidectomy. Wound closure by steristrips had less post-operative pain, acceptable neck mobility and excellent scar appearance as compared to subcuticular sutures.Conclusions: The choice of materials for wound closure will depend on the surgeon's preference. However, this study does show that steristrips sutures can be removed more quickly and is more acceptable method of wound closure as compared to subcuticular sutures after thyroid surgery.