Repair Of Ulcer Research Articles

Clinical and financial outcomes of transplant recipients following emergency general surgery operations

IntroductionDue to immunosuppression and underlying comorbidities, transplant recipients represent a vulnerable population following emergency general surgery (EGS) operations. The present study sought to evaluate clinical and financial outcomes of transplant patients undergoing EGS. MethodsThe 2010–2020 Nationwide Readmissions Database was queried for adults (≥18 years) with non-elective EGS. Operations included bowel resection, perforated ulcer repair, cholecystectomy, appendectomy and lysis of adhesions. Patients were classified by transplant history (Non-transplant, Kidney/Pancreas, Liver, Heart/Lung). The primary outcome was in-hospital mortality while perioperative complications, resource utilization and readmissions were secondarily considered. Multivariable regression models evaluated the association of transplant status on outcomes. Entropy balancing was employed to obtain a weighted comparison to adjust for intergroup differences. ResultsOf 7,914,815 patients undergoing EGS, 25,278 (0.32 %) had prior transplantation. The incidence of transplant patients increased temporally (2010: 0.23 %, 2020: 0.36 %, p < 0.001) with Kidney/Pancreas comprising the largest proportion (63.5 %). Non-transplant more frequently underwent appendectomy and cholecystectomy while transplant patients more commonly received bowel resections. Following entropy balancing, Liver was associated with decreased odds of mortality (AOR: 0.67, 95 % CI: 0.54–0.83, Reference: Non-transplant). Incremental hospitalization duration was longer in Liver and Heart/Lung compared to Non-transplant. Odds of acute kidney injury, readmissions and costs were higher in all transplant types. ConclusionThe incidence of transplant recipients undergoing EGS operations has increased. Liver was observed to have lower mortality compared to Non-transplant. Transplant recipient status, regardless of organ, was associated with greater resource utilization and non-elective readmissions. Multidisciplinary care coordination is warranted to mitigate outcomes in this high-risk population.

A comparative study of laparoscopic versus laparotomy repair of perforated peptic ulcer: A prospective study

Background Laparoscopic surgery is still gaining popularity in conditions associated with peritonitis, such as a perforated peptic ulcer. Aim of the work This study aimed to compare laparoscopic and laparotomy repair of perforated peptic ulcers regarding intraoperative parameters, postoperative pain, time of the start of oral feeding, postoperative complication, hospital stay, resuming normal activity, and outcomes. Patients and methods This is a prospective study of 50 patients (males and females), of any age with perforated peptic ulcer. Those patients will be divided by the random serial number method into two groups: the laparoscopic group and the open (laparotomy) group. In a period from 15th April 2022 to 15th February 2023 data related to patients were recorded and subjected to analysis. Results All patients were divided into two groups: Laparoscopic group with 25 patients (23 of them underwent successful laparoscopic repair and two patients were converted to open) and the open (laparotomy) group with 25 patients underwent laparotomy repair (of which 23 patients were living, and two patients died on the third and tenth postoperative days). There were no significant differences in baseline characteristics between both groups in terms of age, gender, special habits, preoperative risk factors, comorbidities, laboratory, and radiological findings; also both groups showed insignificant differences regarding the American Society of Anesthesiologists (ASA) scores (P=0.83), total Boey’s score (P=0.77), shock on admission (P= 1.00), and the duration of symptoms &gt; 24 hours (P= 0.77). Operative time was significantly increased in the laparoscopic versus open group (P=0.0001). While, first-day pain score (VAS), opioid requirements, time of starting oral feeding, length of hospital stay, and return to normal activity were highly significantly decreased in laparoscopic repair compared with open repair (P= &lt;0.0001 for each). Total postoperative complications showed insignificant difference between the studied groups (P=0.16), but they were more prevalent between the open group (14 patients, 56%) versus the laparoscopic group (9 patients, 36%). Good cosmetic results of wounds were more prevalent in the laparoscopic group [20 patients (80.00%)] than the open group [13 patients (56.52%)], but insignificant, P=0.17. Conclusion Laparoscopic repair had an upper hand over open repair regarding less intraoperative blood loss, less postoperative pain, requiring less postoperative analgesia, early starting of oral feeding, less postoperative complications, shorter hospital stay, early return to normal activity, and good cosmetic results of wounds.

Outcomes of endovascular repair of infrarenal penetrating aortic ulcers.

Background: To report technical success as well as perioperative outcomes of patients who underwent endovascular aortic repair (EVAR) of penetrating abdominal aortic ulcers≤35mm in diameter (PAU). Patients and methods: The abdominal aortic aneurysm (AAA) quality registry of the German institute for vascular research (DIGG) was used to identify patients with standard EVAR for infrarenal PAU≤35mm between 1/1/2019 and 12/31/2021. Infectious, traumatic, inflammatory PAUs, PAUs associated with connective tissue disease, PAUs following aortic dissection as well as true aneurysms were excluded. Demographics, cardiovascular comorbidity, technical success as well as perioperative morbidity and mortality were determined. Results: Amongst 11 537 patients who underwent EVAR during the study period, 405 with PAU≤35mm were eligible from 95 participating hospitals across Germany (22% women, 20.5% octogenarians). The median aortic diameter was 30mm (Interquartile range 27-33). Cardiovascular comorbidities were frequent with coronary artery disease (34.8%), chronic heart failure (30.9%), history of myocardial infarction (19.8%), hypertension (76.8%), diabetes (21.7%), smoking (20.8%), history of stroke (9.4%), symptomatic lower extremity peripheral arterial disease (20%), chronic kidney disease (10.4%) and chronic obstructive pulmonary disease (9.6%). Most patients were asymptomatic (89.9%). Among the symptomatic patients, 13 presented with distal embolization (3.2%) and 3 with contained ruptures (0.7%). Technical success of endovascular repair was 98.3%. Both, percutaneous (37.1%) or femoral cut-down access approaches (58.5%) were registered. Endoleaks of any type were present with type 1 (0.5%), type 2 (6.4%) and type 3 (0.3%) endoleaks. Overall mortality was 0.5%. Perioperative complications occurred in 12 patients (3.0%). Conclusions: According to this registry data, endovascular repair of PAU is technically feasible with acceptable perioperative outcomes, but further studies investigating mid- and long-term data are needed before invasive treatment of PAU disease in an elderly and comorbid patient population should be recommended.

Outcome of Laparoscopic Repair of Duodenal Ulcer Perforation Compared with Open Technique

Background: The surgical treatment of perforated duodenal ulcers is not controversial; however, the best surgical strategy is still up for debate. The perforation closure with an omental patch or without it during surgery is the basis of perforated duodenal ulcers treatment. Laparoscopic surgery can now be used to repair a perforated duodenal ulcer due to developments in minimal access surgery. Aim: In this analysis, the results of open versus laparoscopic repair of perforated duodenal ulcers were compared in terms of operating time, length of hospital stays, postoperative pain and complications after the operation, among other factors. Methods: This prospective comparative study was held at the surgical department of Agha Khan University Hospital, Karachi for one-year duration from January 2022 to December 2022. Patients were divided randomly into two groups, A and B, who underwent operations using laparoscopic and conventional methods, correspondingly, and results were compared. Results: This study found that men between the ages of 51 and 60 were most frequently affected. Laparoscopic group patients experienced much less post-operative pain, need less analgesics, minimum wound infection, and less stay in hospital than open group patients (p 0.05). Conclusions: Laparoscopic repair when performed on carefully chosen patients for perforated duodenal ulcers, it is safe, practical, and produces better outcomes than open surgery. Keywords: Omental patch, laparoscopic repair, open repair, perforated duodenal ulcer

Endoscopic pyloric exclusion—EUS-guided gastrojejunostomy combined with endoscopic suturing and closure of the pylorus: a novel approach to failed surgical repair of a perforated duodenal ulcer

Video 1Endoscopic pyloric exclusion: same-session EUS-guided gastro-jejunostomy combined with endoscopic suturing and closure of the pylorus.

Repair of a perforated duodenal ulcer using a Jejunal serosal patch: A case report

A 73-year-old gentleman was admitted to the hospital with ongoing abdominal pain, altered bowels habits, weight loss, and blood-stained vomitus. CT scan revealed evidence of duodenal perforation. The patient underwent laparotomy with repair of duodenal ulcer perforation using a jejunal serosal patch. Post-operatively, the patient required ITU support, TPN, and an extended course of antibiotics. A water-soluble swallow done approximately 1 month post-operatively did not show any evidence of continued leak.

Outcomes of operative intervention for ulcers over hemodialysis arteriovenous access.

The native arteriovenous fistula (AVF) is the gold standard for long-term hemodialysis access. When native vein options are exhausted, arteriovenous graft (AVG) becomes the next choice. An ulcer over an AVF or AVG is a serious condition with the potential for life-threatening hemorrhage. This study aims to present our experience with surgical management of ulcers over AVFs or AVGs. Electronic records of 26 patients who underwent 27 consecutive surgical procedures for ulcers over AVFs or AVGs from December 31, 2016 to December 31, 2021 at the Royal Liverpool University Hospital were retrospectively analyzed. The majority were males (14/26, 53.8%) and the median age was 64.5 years. Operative repair was required for 25 ulcers over 24 AVFs and 2 ulcers over 2 AVGs. Ten patients (37%) presented with bleeding. Seventeen (63%) had impending bleeding suggested by a thin soft tissue covering or a false aneurysm at the site of the ulcer. Previous endovascular intervention for fistula outflow stenosis was a significant predictor for presenting with bleeding (p=0.031). All ulcers (27/27, 100%) underwent excision and primary skin closure. Fistula wall defects were directly repaired in 18/27 (66.7%). Four/26 (14.8%) fistulas had to be ligated and 2 (7.4%) had end-to-end re-anastomosis after excision of damaged segments. Three/26 (11.53%) fistulas thrombosed immediately after the intervention. The overall fistula salvage rate was 73.08% (19/26). There was 1 (3.7%) patient mortality due to bleeding from wound breakdown after surgery. An acceptable fistula salvage rate can be expected following surgical repair of ulcers over AVFs and AVGs. A history of previous endovascular interventions for fistula outflow stenosis was a predictor of bleeding from these ulcers.

Single-session repair of multiple pressure ulcers in non-ambulatory patients

Pressure ulcers (PUs) are highly prevalent and challenging wounds. In this study, patients with either tetraplegia or paraplegia, all of whom had multiple grade 4 PUs and who underwent single-session surgical treatment were included. In order to increase the mobility of the musculocutaneous flap, the gluteus maximus muscle, which cannot be used by immobile patients, was detached and inserted into the flap. This was a retrospective case series and all PUs were reconstructed within the same surgical session. A total of nine patients participated in the study, all of whom were male. Mean age was 33 years (range: 20-42 years). Mean follow-up period was 14.3 months (range: 9-24 months). All patients had a successful single-session repair of all PUs. Total or partial flap losses were not observed. Mean and total number of reconstructed PUs were 2.55 and 23, respectively. The mean area of reconstructed open wounds per patient was 174.6cm2 and the mean operation duration was 253 minutes. The level of blood loss was acceptable as the decrease in haemoglobin levels was not more than 2g/dl for each patient. Multiple PUs can be repaired in one session using gluteus maximus musculocutaneous flaps in immobile patients. Based on the fact that the gluteus maximus is an essential muscle for ambulation, our approach can only be used in the treatment of patients with irreversible paraplegia or tetraplegia. When all prerequsities are met, the amount of blood loss and operation duration are acceptable, and returning the patient to a wound-free state can be achieved more quickly compared to multi-session repairs. Air-fluidised beds are vital tools for accomplishing single session repairs of multiple PUs. The data shows that the approach is safe and can be used in patients with multiple PUs.

The use of innovative targeted angiogenic therapies for ischemic diabetic foot ulcer repair: From nanomedicine and microRNAs toward hyperbaric oxygen therapy.

Diabetes mellitus is a metabolic disease that has a high prevalence worldwide and is characterized by chronic hyperglycemia leading to the development of vascular or nonvascular complications. It is these complications that result in huge mortality rates in patients with diabetes, especially vascular ones. This work focuses on diabetic foot ulcers (DFUs), which are one of the most common complications of type 2 diabetes mellitus (T2DM) and cause significant morbidity, mortality, and healthcare costs. The healing of DFUs is hindered by deregulation of nearly all phases of this process because of the hyperglycemic environment. Although therapies currently exist to treat a patient with DFU, they are proving inadequate. In the present work, angiogenesis is highlighted as part of the proliferative phase, which, when diminished, plays an important role in the impaired healing of DFU and other chronic wounds. Therefore, the search for new therapeutic strategies targeting angiogenesis is of great interest. In this study, we provide an overview of molecular targets with therapeutic potential and therapies that act on angiogenesis. To this end, a search of articles in PubMed and Scopus databases from 2018 to 2021 was performed to review angiogenesis as a therapeutic target for DFU. Growth factors, microRNAs, and signaling pathways were investigated as molecular targets, and negative pressure, hyperbaric oxygen therapy, and the use of nanomedicine were explored as therapies.

Laparoscopic versus laparoscopy-assisted suturing of perforated peptic ulcers (meta-analysis)

To compare laparoscopic and laparoscopy-assisted repair of perforated peptic ulcer using evidence-based methods. A systematic review and meta-analysis were carried out in accordance with the recommendations of the Ministry of Health of Russian Federation and Cochrane Handbook for Systematic Reviews. We found no randomized trials devoted to comparison of laparoscopic and laparoscopy-assisted surgeries in patients with perforated peptic ulcer. Meta-analysis was based on non-randomized trials with satisfactory methodological quality according to the I-ROBINS formalized assessment. Overall clinical material included 478 observations: 229 (47.9%) laparoscopic surgeries and 249 (52.1%) laparoscopy-assisted procedures via minimally invasive access. There were no conversions. Incidence of postoperative complications was 4.36 and 8.83% (OR=0.39, 95% CI 0.08, 1.87), postoperative mortality 0.87 and 0.81%, respectively (OR=1.26, 95% CI 0.08, 8.24). Laparoscopic surgeries were shorter (MD= -8 min, 95% CI -9.7, -6.4). Length of hospital-stay was also shorter after laparoscopic surgery (MD= -4.6, 95% CI -9.7, -6.4). Laparoscopic operations are shorter and accompanied by lower incidence of postoperative complications and less hospital-stay. Large statistical power is required to confirm these differences.

The Effectiveness of Ozone Therapy on Diabetic Ulcer Repair: A Systematic Review and Meta-analysis: Study of Changes in Wound Size

Introduction: Diabetic foot ulcer (DFU) is a typical dermatological complication often found in patients with diabetes mellitus (DM). Chronic hyperglycemia state causes microvascular impairment that leads to loss of peripheral sensory, motor, and autonomous functions. The current diabetic ulcer therapy has not yet provided a satisfactory reduction of the ulcer area; thus, several adjuvant therapies were tried, such as using ozone therapy, either systematically or topically. Ozone increases the cell membrane permeability to glucose, increases oxygen metabolism, improves oxidative preconditioning, stimulates endogenous antioxidant systems, and has anti-inflammatory and antibacterial effects. Methods: This study was an analytic observational study, with systematic review and meta-analysis. Data searching were conducted online at Pubmed-MEDLINE, Scopus, EBSCOhost, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar, as well as hand-searching from libraries in Indonesia. Five most relevant articles included in the qualitative (systematic review) (n = 449) and three of those five articles included in the quantitative analysis (meta-analysis) (n = 211). Reduction of ulcer area was assessed. Results: The meta-analysis of effectiveness of ozone intervention group compared to the control group showed a homogeneity in data (Q=95.547, df=2; p=0.000, Tau2=5.276). Meta-analysis showed the value of Q statistic was z value = -9.478; (p=0.000). This shows that the overall administration of ozone can significantly improve the diabetic ulcer repair. The overall standardized mean difference showed an increase in the reduction of ulcer area following ozone therapy was -1.740 (95% CI [-2.100 to -1.380], p=0.00). These results indicate that the ulcer healing of the intervention group was significantly better than the control group. Conclusion: Systematic review and meta-analysis results show that the application of ozone therapy significantly improves DFU repair.

Abstract 15668: Concurrent ST Elevation Myocardial Infarction and Gastric Perforation: A Management Dilemma

Case Presentation: A 62-year-old male with RBBB, hypertension, diabetes, and former tobacco use presented with nausea, vomiting, abdominal and chest pain which responded to Pepto-Bismol. Examination revealed tachycardia, hypertension, a rigid, tender abdomen with guarding and rebound. His ECG showed anterolateral STEMI with dynamic changes. Chest and abdomen CT revealed a perforated ulcer with free air and also noted a hypodense region of the LV in the vascular distribution of the LAD suggestive of an acute infarct. Echo revealed LAD territory wall motion abnormalities with an estimated LVEF of 35%. It was decided to proceed with coronary angiography first based a multidisciplinary team discussion between the patient, surgical, and cardiology team. This showed a totally occluded proximal LAD, felt to be the culprit lesion, 90% proximal stenosis of LCx, and diffuse disease of RCA (figure). Right heart catheterization showed mixed shock. Plain old balloon angioplasty of LAD was done, IABP placed, and pressors started. He then had an exploratory laparotomy with lysis of adhesions and Graham patch repair of perforated gastric ulcer. He ultimately had a DES to his LAD 15 days after tolerating DAPT. Repeat Echo done after 2 months of GDMT revealed a recovered LVEF of 55%. Discussion: STEMI and perforated viscus are two clinical emergencies with high mortality. Few case reports of simultaneous occurrence are documented in the literature with no guideline-directed management given the rarity of its presentation. In our patient, we preceded with coronary angiogram to attain moderate hemodynamic stability with POBA aiding in revascularization and IABP providing mechanical support. Furthermore, early revascularization in STEMI is known to have mortality benefits. Our approach led to a favorable outcome with resultant recovery in cardiac performance and can be considered as a strategy to tackle similar presentations with expert deliberation.

Preparation, optimization and in vivo study of gastric floating tablets of constunolide and dehydrocostus lactone with ideal therapeutic effect on gastric diseases

Costunolide (COS) and dehydrocostus lactone (DEH), as natural phytochemical components, mainly originated from Aucklandiae radix (AR) and Vladimiriae radix (VR) used in the treatment of gastric diseases in traditional Chinese medicine. The α-methylene-γ-butyrolactone ring structure is the same active part of COS and DEH, and shows good curative effects, such as breast cancer, leukemia and gastric related diseases. Furthermore, the previous research of the lab team found that the combination of COS and DEH promoted the repair of gastric ulcer and effectively alleviated intestinal metaplasia of gastric mucosa. Nevertheless, the rapid gastric emptying process and inefficient gastrointestinal absorption resulted in low oral bioavailability of COS and DEH. Based on floating and swelling technology, this study developed a gastric floating drug delivery system for prolonging gastric residence time to delay the drug release in the stomach and enhance the bioavailability of COS and DEH. The gastric floating tablets of COS and DEH were prepared by the direct powder compression method, and the optimized formulation contained 30% HPMC K15 M and 10% NaHCO3. The results of response variable showed that the floating lag time was 13.50 ± 1.87 s, total floating time was 11.83 ± 0.41 h, 2 h and 12 h cumulative drug release was 29.87 ± 2.22%, 70.89 ± 4.27%, respectively. Additionally, the physicochemical properties of the floating tablets were characterized by friability, hardness, weight variation, Fourier transform infrared spectrum (FT-IR), differential scanning calorimeter (DSC) and X-ray diffraction (X-RD). The study on release kinetics showed that the drug release mechanism of gastric floating tablets of COS and DEH was both diffusion and matrix erosion. Moreover, scanning electron microscope (SEM), swelling and erosion indexes studies further explained the release mechanism. Furthermore, in vivo X-ray imaging of male New Zealand rabbits proved the gastric retention effect of the gastric floating tablets in the stomach (10 ± 3.46 h). The results of these experiments demonstrated that the gastric floating tablets of COS and DEH had the potential for a good gastric residence time and sustained release effect.

Laparoscopic Repair Modality of Perforated Peptic Ulcer: Less Is More?

Perforation, per se, presents the most serious complication of peptic ulcer disease with a mortality rate that cannot be underestimated. Surgery is the only treatment option, which can be performed laparoscopically or via conventional laparotomy. The present study aimed to compare the short-term outcomes of laparoscopy and laparotomy techniques in the surgical treatment of peptic ulcer perforation. A retrospective study design was structured to compare the perioperative and short-term postoperative outcomes of 102 patients who had undergone laparoscopic and conventional repair of the perforated peptic ulcer over a six-year interval (January 1, 2016, to December 31, 2021). Of these, 44 (43.1%) had undergone laparoscopic repair while 58 (56.9%) had surgical repair via conventional laparotomy. The operative time and length of hospital stay were comparable in both subgroups (p=0.984 and p =0.585). Nevertheless, 30-day postoperative morbidity was significantly higher in the open surgery subgroup (75.9% vs. 59.1%, p= 0.032). The risk of relaparotomy was similar in both study subgroups; however, suture dehiscence as a reason for surgical revision was significantly more frequent in the laparoscopic subgroup (13.6% vs 3.4%). Of note, the mortality rate in the laparoscopic group of patients was 13.6%, and in the laparotomy group 41.4%. The laparoscopic approach to peptic ulcer perforation is the procedure of choice for low-risk patients. Conventional surgery seems to be associated with a significantly higher incidence of severe postoperative complications and mortality. However, the higher mortality in these patients is probably related to their worse initial clinical condition.

A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer.

The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis. There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18-0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18-0.42; p < 0.00001), and length of stay (mean difference, -2.84 days; 95% CI, -3.63 to -2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43-2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4-91.4%), while OOPR was mainly performed by trainees (range, 52.8-96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003). Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR. Systematic Review and Meta-Analysis; Level IV.

Clinical application of microdissected thin thoracodorsal artery perforator flaps for repair of diabetic foot ulcers

To explore the effectiveness of microdissected thin thoracodorsal arterial perforator flap (TDAP) in repairing diabetic foot ulcers (DFUs). The clinical data of 11 patients with DFUs admitted between March 2020 and February 2021 were retrospectively analyzed, including 5 males and 6 females, aged from 22 to 67 years, with an average of 49.3 years. There were 10 cases of type 2 diabetes and 1 case of type 1 diabetes; the duration of diabetes ranged from 3 months to 25 years (median, 8 months). The duration of DFUs ranged from 6 days to 120 months (median, 1 month). There were 6 cases of grade 3 and 5 cases of grade 4 according to Wagner classification. The tissue necrosis and purulent secretions were found in all ulcer wounds, as well as different degrees of tendon and bone exposure; skin defects ranged from 5 cm×3 cm to 17 cm×6 cm. The DFUs were repaired by microdissected thin TDAP, including 6 cases of flaps (including 1 case of lobulated flap), ranging from 10.0 cm×4.5 cm to 26.0 cm×7.0 cm; 5 cases of chimeric perforator flaps, the range of the flap was 10.0 cm×4.5 cm to 16.0 cm×5.5 cm, and the range of the muscle flap was 6 cm×2 cm to 10 cm×3 cm. The donor site was sutured directly. The operation time ranged from 3.42 to 11.17 hours, with an average of 5.92 hours. All 11 flaps survived and no vascular crisis occurred; 1 patient had a sinus at the edge of the flap, and the surgical area healed well after dressing change. All 11 patients were followed up 6-12 months, with an average of 9 months. The flap texture was good, the recipient site was in good shape, and there was no swelling; the foot contour was good, the shoes were comfortable to wear, and the movement was good. The incision at the donor site healed by first intention, leaving only linear and concealed scar, without obvious depression deformity, and the shoulder joint function was good. On the premise of ensuring sufficient blood supply to the lower extremities and strengthening perioperative management, the microdissected thin TDAP to repair DFUs wounds can achieve better effectiveness and appearance; however, the prolonged operation time increases the probability of anesthesia and surgical risks in patients with DFUs.

A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

Modifiable risk factors associated with procedure-related 30-day readmission after emergency general surgery (EGS) have not been comprehensively studied. We set out to determine risk factors associated with EGS procedure-related 30-day unplanned readmissions. A retrospective cohort study was conducted using the National Surgical Quality Improvement Project database (2013-2019). It included nine surgical procedures encompassing 80% of the burden of EGS diseases, performed on an urgent/emergent basis. The procedures were classified as low risk (open and laparoscopic appendectomy and laparoscopic cholecystectomy) and high risk (open cholecystectomy, laparoscopic and open colectomy, lysis of adhesions, perforated ulcer repair, small bowel resection, and exploratory laparotomy). Data on patient characteristics, admission status, procedure risk, hospital length of stay, and discharge disposition were analyzed by multivariate logistic regression. A total of 312,862 patients were included (16,306 procedure-related 30-day readmissions [5.2%]). Thirty-day readmission patients were older, had higher American Association of Anesthesiology scores, were more often underweighted or markedly obese, and were more frequently presented with sepsis. Risk factors associated with EGS procedure-related 30-day unplanned readmissions included age older than 40 years (adjusted odds ratio [AOR], 1.15), American Association of Anesthesiology ≥3 (AOR, 1.41), sepsis present at the time of surgery (AOR, 1.84), body mass index <18 kg/m 2 (AOR, 1.16), body mass index ≥40 kg/m 2 (AOR, 1.12), high-risk procedures (AOR, 1.51), LOS ≥4 d (AOR, 2.04), and discharge except to home (AOR, 1.33). Thirty-day readmissions following low-risk procedures occurred at a median of 5 days (interquartile range, 2-11 days) and 6 days (interquartile range, 3-11 days) after high-risk procedures. Surgical site infections, postoperative sepsis, wound disruption, and thromboembolic events were more prevalent in the 30-day readmission group. Mortality rate was fourfold higher in the 30-day readmission group (2.4% vs. 0.6%). We identified several unmodifiable patients and EGS disease-related factors associated with 30-day unplanned readmissions. Readmissions could be potentially reduced by the implementation of a postdischarge surveillance systems between hospitals and postdischarge destination facilities, leveraging telehealth and outpatient care. Prognostic and Epidemiological; Level IV.

Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion

BackgroundThe surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery.MethodsThis retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion.ResultsOf the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p < 0.0001), had more comorbidities (p < 0.0001), and more frequently had a previous laparotomy (p = 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012–0.626; p = 0.015), ulcer size (OR 0.045, 95% CI 0.010–0.210; p < 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001–0.400; p = 0.012) were predictive factors for conversion to an open approach.ConclusionThis study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair.

EFFECT OF AUTOLOGOUS PLATELET-RICH PLASMA TREATMENT ON REFRACTORY THIN ENDOMETRIUM DURING THE FROZEN-EMBRYO TRANSFER CYCLE: A SINGLE ARM SELF-CONTROLLED TRIAL IN 100 PATIENTS

Platelet-rich plasma (PRP), as cutting-edge technology, is widely applied in regenerative medicine, including cartilage repair, alopecia, and management of diabetic foot ulcers. Patients with refractory thin endometrium, defined as less than 7mm of the endometrial thickness (EMT) unresponsive to standard treatment options, were associated with reduced incidence of pregnancy rate and often resulted in cycle cancellation. PRP emerged as a new therapeutic option to improve implantation rate and pregnancy outcome.

Platelet-rich plasma promotes diabetic ulcer repair through inhibition of ferroptosis.

Ferroptosis, a newly discovered form of cell death, can accumulation activates lipid peroxidation and excessive oxidative stress in a high glucose environment. These phenomena suggest there may be ferroptosis pathways in the pathological processes associated with diabetic ulcer (DU). Platelet-rich plasma (PRP) promotes the healing of DU wounds, which may be achieved by the regulation of ferroptosis pathways. Hence, the present study aimed to investigate this association and uncover the potential underlying mechanisms. Cell injury models induced by high glucose were constructed using EA.HY926 (vascular endothelial cells), HSF (fibroblasts), and rat DU models. The MDA, total ROS, total SOD content, the gene and protein expression of GPX4, SLC7A11, and ACSL4, and the expression levels of inflammatory cytokines IL-1β, IL-10, and NLRP3 was subsequently used to evaluate the important role of ferroptosis in the pathological process of DU, and elucidating the molecular mechanism of PRP in ulcer repair. The results show that compared with the DU control group, the healing rate of the dorsal ulcer wound in the PRP intervention group was accelerated, and the expression levels of inflammatory cytokines IL-1β, IL-10, and NLRP3 in the granulation tissue of ulcer wounds was lower. Further, the expression levels of CD31 and VEGF were higher, the gene and protein expression levels of GPX4 and SLC7A11 were increased, the expression levels of ACSL4 were less, the SOD content was higher, and the MDA content was lower. In this study, ferroptosis was preliminarily verified in DUs at the cellular and animal levels, while PRP could inhibit ferroptosis and significantly improve the migration and regeneration ability of fibroblasts and vascular endothelial cells induced by high glucose.