Vacuum Drainage Research Articles

Uncemented hip arthroplasty for failed internal fixation of peritrochanteric fracture

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture. Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study. The patients aged 67.2 years(range, 41-80 years) composed 6 males and 11 females. There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture. The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients. Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation. Harris score was used for evaluation of the results of hip arthroplasty. Preoperative Harris score was (32.6±6.8)points. Results All the patients were followed up for 6 to 48 months. One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery. One patient had secondary subsidence of the femoral stem without pain and limitation of motion. One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation. Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening. Harris hip score significantly improved to (79.2±15.9)points at the final follow-up (P<0.01). Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture. The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability, and avoids the complications of bone cement use. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure

Does Tranexamic Acid Reduce Perioperative Bleeding in Short Segment Pedicle Screw Fixation in Thoracolumbar Spine Fractures?

Blood loss with spinal surgery is common potential cause of morbidity and often requires blood transfusion. Tranexamic acid (TXA), is effective in reducing bleeding in patients undergoing knee arthroplasty. TXA used in spine surgery studies have included different cases leading to inconsistence of surgical procedures. Purpose of this prospective observational study was to examine effect of TXA decreasing bleeding in short segment pedicle screw fixation for thoracolumbar fractures. 38 patients' undergoing short segment pedicle screw for thoracolumbar fractures were enrolled in study from July 2011 to August 2013. There were 28 male and 10 female patients, with an average age of 36.5 years. Patients received 10 mg/kg of TXA or a control 30 minutes intravenously before skin incision and 3 hours post-operative and oral medication for three days. Intraoperative bleeding was estimated by weighing surgical sponges, blood collected by suction container and by subtracting all irrigation fluid. Postoperative bleeding was measured from volume in vacuum drainage bag. Twenty (20) patients were in control group and eighteen(18) to TXA group. There were no statistical differences between groups in terms of age, gender, co-morbidities, and operating time, preoperative Hemoglobin, PT and INR. Intra-operative bleeding in TXA group was significant than in control group. Post-operative drainage and Hemoglobin in first 48 h was reduced compared with placebo in TXA group. Need for post-operative transfusion was nil in TXA group. Administration of TXA before surgery significantly reduces perioperative bleeding in patients undergoing short segment pedicle screw fixation for thoracolumbar spine fractures.

Thyroid surgery: comparison between ultrasonic scalpel-SonoSurg and classic clamp and tie technique

Objective: The purpose of this prospective study was to evaluate the efficacy and safety in the application of scalpel compared to conventional operative technique in open surgery of the thyroid gland. Methods: The study included 100 patients operated between May 2013 and August 2013. Patients were divided into two groups - 50 patients were operated using SonoSurg® and 50 patients were operated using classic “clamp and Tie” technique. We evaluated and compared the outcome between the two groups. Results: Both groups had a similar distribution in the demographic features such as gender, age, functional activity and malignant diseases of the thyroid gland. When comparing the results, we found a significant reduction in the duration of surgery in patients operated with SonoSurg® (SST group) (72 ± 20 min vs 100 ± 32 min, p = 0.01). There was no difference for fluid in the vacuum drainage during the first 24 hrs. Hospital stay of patients in both groups was similar - an average of 3 days stay into the clinic. Conclusion: Our results showed that ultrasonic scalpel” is an effective, easy to use and completely reliable method for achieving hemostasis with visible advantages over classical operational technique. J Clin Exp Invest 2015; 6 (3): 209-213 Key words: Total thyroidectomy, scalpel, clamp and tie technique

Complications associated with closure of defunctioning loop ileostomy in low anterior resection of rectal cancer

To analyze the complications of ileostomy closure and related risk factors. Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital from September 2006 to March 2013 were included in this study. Clinical features of these patients were reviewed, the complications rate was calculated, and univariate and multivariate analyses with regard to the risk factors of surgical site infection(SSI) were also conducted. A total of 245 consecutive patients were enrolled in the study. Thirty-nine complications were observed in thirty-three patients, the overall complication rate was 13.5%. Complication after primary closure of defunctioning ileostomy included surgical site infection (n=21, 8.6%), ileus (n=8, 3.3%), preoperatively undiagnosed anastomotic leakage or rectovaginal fistula (n=5, 2.0%), pulmonary infection (n=2, 0.8%), and anal sphincter dysfunction (n=2, 0.8%). No patient died in the perioperative period, and 5 patients (2.0%) underwent reoperation for ileus (n=3), anastomotic leakage (n=1) and rectovaginal fistula (n=1). Multivariate analysis showed that postoperative complications [OR=10.576, 95%CI:2.898-38.597, P=0.000] and total operation time>90 min[OR=4.862, 95% CI:1.758-13.451, P=0.002] were independent risk factors of SSI, and the presence of subcutaneous vacuum drainage [OR=0.063, 95%CI:0.007-0.540, P=0.012] was protective factor of SSI. Surgical site infection is the most common complication after primary closure of defunctioning ileostomy. Subcutaneous vacuum drainage is effective for reducing SSI in patients undergoing primary closure of ileostomy, and it is especially recommended for patients with operation time>90 min.

Focused Ultrasound Lipolysis in the Treatment of Abdominal Cellulite: An Open-Label Study.

Despite a growing popularity of noninvasive ultrasonic lipolysis procedure, there is a lack of evidence about the efficacy of this method. This study was performed to evaluate the efficacy of focused ultrasonic lipolysis on abdominal cellulite treatment. Twenty-eight consecutive subjects (age: 37.8 ± 8 years) underwent weekly transdermal focused ultrasonic lipolysis (Med Contour, General Project Ltd., Florence, Italy) and vacuum drainage for a maximum of eight sessions. Largest abdominal girth and 2 lines at 4 cm to 7 cm distance above and under it were located as fixed points of measurements. The mean value of the three fixed lines was considered as the abdominal circumference. Subjects were evaluated using measurements of circumference, immediately after and 3 weeks after the final treatment and compared using paired t test. One hundred ninety-four ultrasonic lipolysis procedures were performed on 28 subjects. A statistically significant (P < .001) average of 1.89 cm (95% CI: 1.63-2.02 cm) decrease of circumference value was observed in each session of ultrasonic lipolysis. The mean pretreatment to posttreatment circumference reduction was 8.21 cm (95% CI: 6.38-10.04, P < .001) that declined to 7 cm (95% CI: 3.2-10.8, P < .001) at the 3-month follow-up visit. Focused ultrasonic lipolysis appears to be an effective method for reduction of abdominal cellulite, although some amount of circumference reduction reversal may be observed in long term follow-up visit.

Comparison and care of two kinds of drainage method of thyroid cancer surgery

Objective To investigate the drainage method of thyroid cancer surgery and summarize the main points of care. Methods 80 patients with thyroid cancer were randomly divided into control and experimental groups, with 40 patients in each group. The control group was applied with ordinary ball drainage, while the experimental group with a one- time closing high vacuum drainage. The incidence of postoperative complications, the total drainage volume, drainage time and hospital stay were compared between two groups. Results Compared with the control group, the incidence of postoperative complications, total drainage volume, drainage time and hospital stay of the experimental group were significantly reduced(P< 0.05). Conclusion One-time closing high vacuum drainage appllication in thyroid cancer surgery, which could ensure adequate and effective drainage, significantly reduce the incidence of complications, shorten hospital stay. It is simple, satisfactory and worthy of promotion. Key words: Thyroid cancer; High-vacuum drainage; Care

Soil improvement by electroosmotic grouting of saline solutions with vacuum drainage at the cathode

Electroosmotic grouting is a ground improvement method for soft soils that is not widely accepted for common application because the improvement of soil strength is not uniform. This paper proposed a new method to improve the non-uniform effect of electroosmotic grouting. Such method is electroosmotic grouting coupled with vacuum drainage at the cathode. The experimental study shows that the treatment effect of electroosmotic grouting with vacuum drainage at the cathode is not only better than general electroosmosis methods but also more uniform than such methods. In this study, the soil strength increased by 362%, 350%, and 438% at the locations close to the anode, between the anode and cathode, and close to the cathode, respectively. The results demonstrate that this technique could improve the treatment effect of electroosmotic grouting in soft soils.

P065. Comparison of radial margins in therapeutic mammoplasty and wide local excisions for invasive breast cancer

P065. Comparison of radial margins in therapeutic mammoplasty and wide local excisions for invasive breast cancer

Pharyngocutaneous fistula after salvage laryngectomy

Conclusion: Preoperative chemoradiotherapy (CRT) was associated with a significantly higher rate of pharyngocutaneous fistula (PCF). Objective: PCF is the most frequent complication following total laryngectomy. Although organ-preserving radiotherapy (RT) or CRT offer good locoregional control, many patients still require salvage laryngectomy. The aim of this study was to evaluate the factors that predispose patients to PCF, with a focus on preoperative RT, induction chemotherapy (ICT), and CRT. Methods: This was a retrospective case series; 151 patients who underwent TL were reviewed. Preoperative RT, ICT, CRT, and some surgical parameters were analyzed as potential risk factors. Results: The overall PCF rate was 13%. CRT was the only preoperative treatment that had a significant effect on PCF (35.3%, p = 0.004, odds ratio (OR) = 10.75). Surgery extended to the pharynx (p = 0.005, OR = 8.34) and vacuum drain duration (p = 0.012, OR = 5.16) were observed to be associated with PCF.

Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy.

Surgical site infection (SSI) is the most common complication after primary closure of defunctioning ileostomy. We use a subcutaneous vacuum drain (SVD) in our institution to prevent infection. This study aimed to analyze the risk factors of SSI and to assess the utility of an SVD for preventing SSI in patients undergoing primary closure of ileostomy. Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital, from September 2006 to March 2013, were included in this study. The clinical features of these patients with or without a subcutaneous drain were reviewed, and the complication rate of SSI was analyzed. The primary endpoints were the incidence and risk factors of SSI, and the secondary endpoints were the rate of overall complications and their management. A total of 245 consecutive patients were enrolled in the study. The overall incidence of SSI was 8.6%. Eighty-five (34.7%) patients received placement of an SVD. The use of SVDs was associated with a significantly lower incidence of SSI compared with primary closure (PC) without an SVD (1.2 vs. 12.5%, p = 0.001). Multivariate analyses showed that the presence of an SVD (odds ratio (OR) 0.063, p = 0.012), total operation time >90 min (OR 4.862, p = 0.002), and postoperative complications (OR 10.576, p < 0.001) were independent risk factors of SSI. This study shows that an SVD is effective for reducing SSI in patients undergoing PC of ileostomy. Further randomized trials are required to confirm our findings and to compare SVDs with purse-string sutures.

Maximising vacuum drainage prior to wound closure.

Vacuum drains are used frequently in surgery to remove fluid accumulations and close dead spaces. Vacuums are only achieved by attaching a receiving device and opening the drainage tube to negative pressure. However, air from the cavity often fills the bottle, reducing the residual pressure of the receiving device and impairing its function. We overcome this problem by fitting a sucker tube inside an empty 10ml syringe barrel with the drain connected to the syringe tip (Fig 1). This technique removes dead space prior to drain connection, with the added advantage of being a useful sucker where a Yankauer suction tip may be too large. Figure 1 Vacuum drainage using a disposable 10ml syringe with the plunger removed

A Rare Complication of Lumbar Spine Surgery: Pneumocephalus

Purpose: Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology is not widely recognized. Incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown. We describe a case of symptomatic tension pneumocephalus in the postoperative period of lumbar arthrodesis surgery, causes, risk factors, treatment and a review of the literature about this uncommon complication. Methods: The clinical findings, radiological studies (Magnetic resonance imaging and CT scan), and treatment were presented. Results: We report a rare case of a 41 year old woman with diagnosis of L3-L4, L4- L5 discopathy and left discal herniation L4-L5. A posterior spinal arthrodesis L3-L5, L3-L4 and L4-L5 discectomies and release of the left L5 root, was performed without apparent complications. 24 hours after surgery the patient developed generalized headache, neck stiffness, and dysarthria. MRI and CT scan revealed a huge pneumocephalus in the subarachnoid space, predominantly in the left frontal lobe without midline shift, which originates in the lumbar spinal canal. Treatment: The patient was treated conservatively, featuring 72 hours from progressive neurological improvement, up to clinical and radiological normalization after 7 days. Conclusions: Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during surgery. Most collections are small, behave benign, and respond to conservative therapy. In the majority of patients with pneumocephalus, a conservative approach consisting of bedrest, hyperhydration, analgesics, sedatives, and antiemetics is adequate, and symptoms resolve in a few weeks. In the present case with inadvartent CSF fistula, the vacuum drainage system predisposed the patient to pneumocephalus. A high degree of suspicion is needed to make the diagnosis, prompt treatment, and remedy of the source of air to prevent unwanted morbidity and mortality.

Vinegar Liquid contained Closed Vacuum Drainage System managed the Deep Spinal Wound Methicillin-resistant Staphylococcus aureus Infection following Spinal Surgery

Vinegar Liquid contained Closed Vacuum Drainage System managed the Deep Spinal Wound Methicillin-resistant Staphylococcus aureus Infection following Spinal Surgery

Management of malignant pleural effusion by an indwelling pleural catheter: A cost-efficiency analysis.

BACKGROUND:For patients that are expected to survive for longer, the risk of complications combined with the need for more vacuum drainage bottles have become barriers to the placement of indwelling pleural catheter (IPC), since these could increase costs.OBJETIVES:The objective of the current article is to determine the cost and efficiency of treating malignant pleural effusion (MPE) with IPC in Spanish hospitals.METHODS:We compared the cost associated with the use of IPC per outpatient and per inpatient. We analyzed the number of consultations, length of hospital stay, and outcome of the procedure.RESULTS:Fifty-five patients were recruited. Spontaneous pleurodesis was achieved in 34.4% of the cases. Post-catheterization complications were observed in 7.2%. Supplementary procedures were unnecessary and 87.7% of the patients reported improved dyspnea. In 64.9% of the cases, the IPCs were inserted during hospitalization with a median hospitalization time of 4 days (1-7.5). There were differences in the number of visits with more consultations being observed in the outpatient group. There was no difference in the number of vacuum drainage bottles used. The complications supposed a cost increase of €1045.6 per outpatient and €432.54 per inpatient. The overall average cost of treatment per outpatient was €3310.2 and €5450.3 per inpatient.CONCLUSIONS:The treatment with IPC was effective, safe, without need of any more procedures and led to improved dyspnea in more than 85% of the patients. The cost is lower in the outpatient group, although complications represent an increased cost in both groups.

Methods of improving treatment results for patients with postoperative ventral hernia

Aim. To improve the results of surgical treatment for patients with postoperative ventral hernia by improving complex preoperative physical examination and better prevention of wound complications. Methods. Results of surgical treatment of 160 patients [mean age - 64 years, females - 120 (75%), males - 40 (25%)] with postoperative ventral hernia treated from 2003 to 2012 were analyzed. The surgeries were performed routinely. All patients were distributed to 2 groups depending on postoperative wound complications prevention. The main group included 60 patients who underwent a vacuum therapy (authors’ technology) during postoperative period for preventing wound complications. Perioperative management of patients with large and huge hernias in this group was performed according to recommendations of the European Society of Cardiologists and All-Russian Scientific Cardiologic Society for cardiovascular risk assessment at surgeries excluding heart surgery. Comparison group included 100 patients who underwent surgery for postoperative ventral hernias using a conventional vacuum drainage and common methods of patient examination according to recommended standards. Results. Using vacuum therapy in patients of the main group limited the number of Redon-drainage procedures, reduced the rate of local pyoinflammatory complications by 4.2 times (p 0.05). Cardiovascular risk identification and proper preoperative preparation allowed avoiding unfavorable outcomes associated with cardiovascular complications in patients with high cardiovascular risk. Conclusion. High efficiency of a complex approach in preventing postoperative complications after ventral hernias surgical treatment allows to recommend its use in clinical practice.

Endoscopic vacuum therapy of perforations and anastomotic insufficiency of the esophagus

The high morbidity and mortality of esophageal defects show that the clinical challenge in the treatment of this disease still remains. An innovative method which has been developed in recent years for esophageal leakage is endoscopic vacuum therapy. A retrospective analysis of all patients treated for esophageal perforation with endoscopic vacuum therapy in our department was carried out. From November 2006 to October 2013 a total of 35 patients were treated with this method and of these 21 had anastomotic leakage, 7 had iatrogenic perforation due to flexible or rigid endoscopy and 7 patients had esophageal defects of various other origins. Drainage systems with an open pore polyurethane tip were placed using a standard endoscope. The vacuum drainage may be positioned either in the esophageal lumen onto the defect or through the defect into the extraluminal wound cavity. The intraluminal or intracavitary vacuum drainage is connected to an electronically controlled vacuum device and a continuous negative pressure of 125mmHg is maintained for several days. The esophageal lumen or wound cavity collapses around the drainage resulting in intraluminal evacuation and closure of the defect. Under endoscopic monitoring the vacuum system is changed regularly until stable secondary healing of the intracorporeal wound or closure of the transmural defect is achieved. In 32 out of 35 patients (91.4 %) healing of defects was achieved after median treatment duration of 11 days (range 4-78 days). The postoperative anastomotic leakage healed in 20 out of 21 patients (95.2 %) after a median of 11 days (range 4-46 days) of therapy. The defects in the 7 patients who were treated for iatrogenic perforation all healed (100 %) after a median treatment time of 5 days (range 4-7 days). There was one case of a recurrent fistula 75 days after treatment. The 90-day mortality in this series of 35 patients was 5.7 %. The results of this retrospective study emphasize the increasing importance of endoscopic vacuum therapy in the current literature as an endoscopic treatment method in the management of esophageal perforation and anastomotic leakage.

Usefulness of a Negative Suction Drain for Reducing Postoperative Swelling in a Blowout Fracture

To identify whether a negative suction drain is more effective than a Penrose drain in the decrease of postoperative swelling from a blowout fracture. This was a retrospective study of patients who underwent surgical treatment for isolated orbital floor fracture. The population was categorized into 2 groups: one with a Penrose drain and the other with a negative suction drain in the surgical site. To evaluate the degree of swelling, the interlid length was measured. The predictor variable was the type of drain used. The outcome variable was the interlid length at postoperative days 1, 3, 5, and 7. The other study variables were patient characteristics, type of injury, time from injury to surgery, and operative duration. Bivariate, multivariate, and Pearson correlation analyses were used to assess the relation of the postoperative interlid length with the other study variables listed earlier. A generalized linear model was used to determine the relation between the type of drain and the postoperative interlid length. Ninety-five patients (45 patients received a Penrose drain and 50 patients received suction drainage) were included for the study. The postoperative interlid length was unrelated to the other study variables (P > .05). The suction drain group had a significantly longer interlid length than the Penrose drain group at every postoperative interval (P < .05). The use of closed vacuum drainage in blowout fractures is more effective in the decrease of postoperative swelling than the use of a conventional Penrose drain.

Treating Tropical Pyomyositis (Myositis Tropicans) Using Primary Closure and Vacuum Drainage

Introduction: Tropical pyomyositis refers to bacterial infection that affects skeletal muscles causing single or multiple abscesses filled with pus. Aim: The study seeks to find out the effectiveness in the use of primary closure and vacuum drainage in the treatment of pyomyositis. Materials and Methods: The study was conducted between March 1, 2007 and February 28, 2014 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana on patients with pyomyositis. Results: Seventy-seven patients comprising 58 (75.32%) males and 19 (24.68%) females were included in the study with their ages ranging from 15 to 68 years. There was improvement in patient’s healing outcome. Conclusion: Primary wound closure and vacuum drainage provides patients with much satisfaction and better outcome as well and it is also effective.

Comparison of treatment results for fractures of the distal humerus in children according to the indication for conservative or surgical solution.

Introduction:Records about the fractures of the distal humerus could be founds in the scriptures written long before Christ (Hippocrates 300 to 400 BC). During the twilight of science development and of any scientific work (the Middle Ages), little has been written about this problem. Between the 1700 and 1800 much was discussed about the controversies between the correct position and immobilization. In the early twentieth century view on the treatment of fractures of the distal humerus begins to change dramatically, from the former passive to active surgical treatment. The sudden turnaround followed thanks to the intensive development of technology, especially new imaging technology.Material and methods:We observed a period of 4 (four) years (1998 to 2002), and only hospital patients of certain age. As database are used the histories of the disease. The patients were followed for one year and at the same time, we analyzed (clinical) early complications after three (3) months and late complications (X ray), after a year. Among the early complications we observed most often lower motility and contraction, and of late we have followed the morphological deformation–cubitus varus and valgus.Results:Using x-ray images, we measured Baumann’s (en face) and lateral condylar angle (profile) after one year in the operated group and the group treated conservatively SPDH type III in children. We calculated the arithmetic mean (x) and a standard deviation (SD) in both groups. Using chi square and t–test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland.Conclusion:All humerus fracture type-III by Gartland in children should be surgically treated. Surgery should be undertaken in a time frame of 6 hours. Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre). The success of treatment in such institutions corresponds to the results achieved in the world (93.0%). We must be sure to adopt and implement a scheme of treatment of fractures of the distal humerus in children. Required is faint trail, OPF, lateral (Kaplan) approach, exceptionally for some articular fractures posterior approach by Campbell, fixation with two or more Kirchner’s needles, usually cross-set at an angle of 30°, vacuum drainage with cast immobilization.

Problems in application of portable disposable low pressure vacuum drainage system for modified radical mastectomy and the solutions

Objective To put forward the problems in applying portable disposable low pressure vacuum drainage system for modified radical mastectomy and to propose the solutions.Methods We retrospectively analyzed the clinical data of 268breast cancer patients who were treated with portable disposable low pressure vacuum drainage system after receiving modified radical mastectomy in Changhai Hospital from January 2013to September 2013.Based on the use of ordinary vacuum ball,the patients were divided into dual-chamber group and single-chamber group.The incidence of bleeding at the puncture sites,volume of post-operation drainage,indwelling time of drainage tube,and hospitalization stay were recorded for the two groups.Results A total of 23cases had puncture site bleeding,including 22early bleeding and one delayed bleeding.For the dual-chamber group,the indwelling time of parasternal drainage tube was significantly shorter than that of axillary drainage tube median:5.0dvs 9.0d,Z=-10.713,P=0.000).The drainage time(median:9.0dvs 10.0d)and hospitalization stays(median:9.0dvs 9.0d)of the two groups were not significantly different.It was found that 97.8%(262/268)of the patients in this study were discharged early with a drain,but with lack of discharge guidance.Conclusion Disadvantages of portable disposable low pressure vacuum drainage system include puncture site bleeding,drainage tube cannot be extubated independently and measurement cannot be done independently,and insufficient discharge guidance.Improvement of puncture device,use of double-lumen tube independent drainage,and improvement of discharge guidance should be made to improve the system.