Wound Healing Complications Research Articles

The association of the perioperative fluid balance and cardiopulmonary complications in emergency gastrointestinal surgery: exploration of a randomized trial

BackgroundThe association between perioperative fluid administration and risk of complications following emergency surgery is poorly studied. We tested the association between the perioperative fluid balance and postoperative complications following emergency surgery for gastrointestinal obstruction or perforation.MethodsWe performed a re-assessment of data from the Goal-directed Fluid Therapy in Urgent Gastrointestinal Surgery Trial (GAS-ART) studying intra-operative stroke volume optimization and postoperative zero-balance fluid therapy versus standard fluid therapy. The cohort was divided into three groups at a perioperative fluid balance (FB) of low < 0 L, moderate 0–2 L, or high > 2 L. We used a propensity adjusted logistic regression to analyse the association with cardiopulmonary (primary outcome), renal, infectious, and wound healing complications. Further, the risk of complications was explored on a continuous scale of the FB.ResultsWe included 303 patients: 44 patients belonged to the low-FB group, 108 to the moderate-FB group, and 151 to the high-FB group. The median [interquartile range] perioperative FB was –0.9 L [–1.4, –0.6], 0.9 L [0.5, 1.3], and 3.8 L [2.7, 5.3]. The risk of cardiopulmonary complications was significantly higher in the High-FB group 3.4 (1.5–7.6), p = 0.002 (odds ratio (95% confidence interval). On a continuous scale of the fluid balance, the risk of cardiopulmonary complications was minimal at –1 L to 1 L.ConclusionFollowing emergency surgery for gastrointestinal obstruction or perforation, a fluid balance < 2.0 L was associated with decreased risk of cardiopulmonary complications without increasing renal complications.

Barbed versus conventional suture in elective posterior spine surgery.

Barbed sutures are tissue control devices that can reduce operating room time and costs. We analyzed the utility of barbed sutures in posterior spinal surgery in order to prove non-inferiority to conventional methods for wound closure. A cohort of patients undergoing elective posterior spinal surgery in which barbed (prospective) versus conventional sutures (retrospective) were used was analyzed. The primary endpoint was the occurrence of wound healing complications or the need for surgical revision. Secondary endpoints included postoperative stay, readmission rate, and duration and cost of wound closure. A total of 483 patients participated in the study, 183 in the Barbed group and 300 in the Conventional group. Wound dehiscence or seroma occurred in 3.8% and 2.7% of the Barbed and Conventional groups, respectively (p = 0.6588). Both superficial (1.6% versus 4.0%, P = 0.2378) and deep infections (2.7% versus 4.7%, p = 0.4124) occurred similarly in both groups. Overall, the rate of re-intervention due to wound healing problems was also similar (4.9% versus 5.3%, p = 0.9906), as well as, total median hospital stay, postoperative stay and 30-day re-admission rates. The average duration of wound closure (1.66 versus 4.16 min per level operated, p < 0.0001) strongly favored the Barbed group. The mean cost of wound closure per patient was higher in the Barbed group (43.23 € versus 22.67 €, p < 0.0001). In elective posterior spinal procedures, the use of barbed sutures significantly reduced the duration of wound closure. The wound healing process was not hindered and the added cost related to the suture material was small.

Concomitant Panniculectomy in Abdominal Wall Reconstruction: A Narrative Review Focusing on Obese Patients.

The global prevalence of obesity continues to rise, contributing to an increased frequency of abdominal wall reconstruction procedures, particularly ventral hernia repairs, in individuals with elevated body mass indexes. Undertaking these operations in obese patients poses inherent challenges. This review focuses on the current literature in this area, with special attention to the impact of concomitant panniculectomy. Obese individuals undergoing abdominal wall reconstruction face elevated rates of wound healing complications and hernia recurrence. The inclusion of concurrent panniculectomy heightens the risk of surgical site occurrences but does not significantly influence hernia recurrence rates. While this combined approach can be executed in obese patients, caution is warranted, due to the higher risk of complications. Physicians should carefully balance and communicate the potential risks, especially regarding the increased likelihood of wound healing complications. Acknowledging these factors is crucial in shared decision making and ensuring optimal patient outcomes in the context of abdominal wall reconstruction and related procedures in the obese population.

Influence of inframalleolar modifier P0/P1 on wound healing in bypass surgery vs endovascular therapy in patients with chronic limb-threatening ischemia

ObjectiveThis study aimed to compare the influence of inframalleolar (IM) P0/P1 on wound healing in bypass surgery vs endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI). MethodsWe retrospectively analyzed the multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. IM P represents target artery crossing into foot, with intact pedal arch (P0) and absent or severely diseased pedal arch (P1). The endpoints were wound healing, limb salvage (LS), and postoperative complications. ResultsWe analyzed 66 and 189 propensity score-matched pairs in the IM P0 and IM P1 cohorts, respectively. In the IM P0 cohort, the 1-year wound healing rates were 94.5% and 85.7% in the bypass surgery and EVT groups, respectively (P = .092), whereas those in the IM P1 cohort were 86.2% and 66.2% in the bypass surgery and EVT groups, respectively (P < .001). In the IM P0 cohort, the 2-year LS rates were 96.7% and 94.1% in the bypass surgery and EVT groups, respectively (P = .625), and those in the IM P1 cohort were 91.8% and 81.5% in the bypass surgery and EVT groups, respectively (P = .004). No significant differences were observed between the bypass surgery and EVT in terms of postoperative complication rates in either the IM P0 or P1 cohorts. ConclusionsBypass surgery facilitated better wound healing and LS than EVT in patients with IM P1. Conversely, no differences in wound healing or LS were observed between groups in patients with IM P0. Bypass surgery should be considered a better revascularization strategy than EVT in patients with tissue loss and IM P1 disease.

132 Detailed Characterization of a Novel Human Ex Vivo Model for Burn Injuries

Abstract Introduction Burn injuries belong to the most common soft tissue injuries and often result in extensive trauma but are also associated with cases of major emergency such as sepsis or systemic inflammatory response syndrome. The early phase after burn injury is critical and decides about later potential complications in wound healing. Burn injuries activate numerous processes, including heat shock, inflammation and tissue regeneration responses and thereby promote the release of cytokines and other signalling molecules such as miRNAs and metabolites. Despite extensive research, skin tissue reactions in the early phases after burn injuries still need to be investigated in more detail. Therefore, reliable burn models are needed to elucidate the exact sequence of events during the healing process and to monitor potential biomarkers that could give information about treatment success. Methods We induced contact burns on fresh human abdominal skin explants that were resected during abdominoplasty. Gene and miRNA expression patterns, cytokine production profiles of key mediators such as IL8 and IL6 and skin ultrastructure were analysed for 24 hours after the burn injury. Additionally, we used open flow microperfusion (OFM), a sampling technique that allows time and location dependent collection of dermal interstitial fluid (dISF), to also monitor the release of specific miRNAs, cytokines and metabolites. Results In burn injuries, we found significant changes in gene and miRNA expression as soon as one hour after burn injury. Inflammatory genes such as IL8 were significantly up-regulated whereas miRNAs were systematically down-regulated. miRNAs were actively released and mobilized into the dISF, while miR-497-5p could be identified stably downregulated in tissue and dISF in the early phase after a burn injury. Metabolome analysis of dISF showed a striking metabolic shift in burn injuries, linking burn injury to increased amino acid and glucose turnover in wounds. Conclusions By using this ex vivo human skin model for burn injuries we were able to study the immediate early responses to burns for up to 24 h. We found that miR-497-5p could serve as potential biomarker to assess burn severity since it is not only down-regulated in skin but also mobilized into the dISF after burn injury. Furthermore, we found distinct metabolite signatures after burn injury. Applicability of Research to Practice Identification and research on potential biomarkers to assess burn severity and treatment success.

Pericranial Flap Reconstruction in Pediatric Patients Undergoing Neuromodulatory Surgery: Impact on Wound Healing

Background: Pediatric patients with medically-intractable epilepsy may require modulation of seizure foci to reduce frequency and severity of seizures. These neuromodulatory procedures, which include responsive neurostimulator (RNS) and deep brain stimulator (DBS), involve the implantation of high-profile and long-term cranial hardware, placing patients at risk of wound healing complications, hardware exposure and infection. A multidisciplinary neurosurgical and plastic surgical approach utilizing pericranial flap coverage of hardware may decrease wound healing complications in these cases. This study compares the wound-healing outcomes in patients undergoing RNS/DBS insertion with and without pericranial flap coverage. Methods: A retrospective chart review was conducted of all patients who underwent RNS and DBS insertion with or without pericranial flap coverage at a level 1 pediatric medical center between 2014 and 2022. Wound healing outcomes at 60 days were evaluated. Data were compared using Fisher’s exact test. Results: Twenty-seven patients underwent 29 neuromodulatory epilepsy procedures (14 DBS, 15 RNS). Twenty of the procedures included a pericranial flap to cover hardware. Median length of stay was 2.0 days for both cohorts. Two subjects without pericranial flap reconstruction had a wound healing complication (22.2%), compared to none of the procedures that included a pericranial flap ( P = .09). Conclusion: In pediatric patients undergoing insertion of responsive neurostimulators and deep brain stimulators for medically-intractable epilepsy, a multidisciplinary neurosurgery and plastic surgery approach utilizing pericranial flap reconstruction may reduce the risk of postoperative wound complications.

Marijuana Use Increases Risk of Hematoma Formation in Patients Undergoing Abdominal Body Contouring Surgery

Abstract Goals/Purpose The physiological effect of marijuana is thought to include platelet inhibition and poor wound healing, however, there is mixed clinical evidence in the plastic surgery literature regarding this topic. As marijuana usage continues to increase, this study sought to identify the effect of marijuana on postoperative complication rates in patients undergoing abdominal body contouring surgery (ABCS) while controlling for tobacco consumption and other comorbidities. Methods/Technique A retrospective cohort study was conducted in patients who underwent panniculectomy or abdominoplasty at our institution between 2016 and 2021. Patients were separated into groups of active (at time of surgery), former, and no marijuana use. Demographic characteristics, smoking history, laboratory results, comorbidities, operative details, and postoperative complications including hematoma, deep vein thrombosis (DVT) and pulmonary embolism (PE), and wound healing complications were analyzed. Parametric, nonparametric, and multivariable regression modeling was used for analysis. Results/Complications 815 patients who underwent panniculectomy or abdominoplasty were included in the study. 61 patients (7.5%) reported active marijuana use at time of their surgery, and 31 patients (3.8%) reported former marijuana use (defined as last use &amp;gt;2 months prior). Patients who reported any marijuana use were significantly younger (40.5 years vs 45.9 years; p&amp;lt;0.0001) and more likely to identify as Black (OR=2.34; p=0.005). Any marijuana use was significantly associated with reported tobacco use (OR=4.80; p&amp;lt;0.001; 95% CI 1.69-12.69) After adjusting for age, BMI, tobacco use, platelet count, and comorbidity index, active marijuana use was associated with significantly higher risk of hematoma formation (OR=2.55; P= 0.03; 95% CI 1.12-6.55) as well as any complication combined (OR=1.73; p=0.02, 95% CI 1.15-3.56). Other complications, including venous thromboembolism, infection, seroma, umbilical necrosis, wound dehiscence, or anesthetic-related complications were not significantly associated with reported marijuana use. Conclusion When controlling for multiple confounders, marijuana use appears to be independently associated with increased risk of hematoma development in patients undergoing abdominal body contouring surgery with either abdominoplasty or panniculectomy. Further research is warranted to investigate the exact relationships and mechanisms of action behind this finding.

Managing incisional wounds with Prevena VAC therapy in lower-extremity vascular surgery: A comparative study.

Vascular surgical site infections have been reported with an overall incidence of 5-10% for patients undergoing arterial interventions and as high as 10-20% for lower-limb bypass grafting procedures. Given that vascular surgery patients are known to be at a higher risk of postoperative wound infections and other complications, our objective was to evaluate a potential method to reduce such complications. This study compares the rate of wound healing complications between incisional negative pressure wound therapy (NPWT) and conventional dressings in vascular surgery patients with infra-inguinal incisions. The primary endpoint is complete closure of the wound at the 2-week follow-up appointment. Secondary endpoints include frequency infections requiring antibiotics, need for wound revision, and wound dehiscence. A prospective cohort study with retrospective control group was performed following infra-inguinal vascular surgeries for peripheral arterial disease at the Mount Carmel Health System. The patients included in this study were those who underwent a lower-extremity vascular procedure with primary closure of an incision distal to the groin between January 2014 and July 2018. Patients that had received an infra-inguinal incision with primary closure were included. Patients in the experimental group who had a Prevena Wound VAC were compared with a retrospectively obtained control arm treated with conventional dressings. Data regarding wound healing and complications, specifically infections and wound dehiscence, were obtained. A total of 201 patients were recruited in our study: 64 in the Prevena group and 137 in the control group. There was a significant reduction in the number of open wounds in the Prevena group compared to the control group at the 2-week follow-up (10.9% Prevena vs 33.6% control; p = .0005). When evaluated in aggregate, there was a statistically significant reduction in the number of patients who succumbed to any complication in the Prevena arm compared with traditional dressings (13 (20.3%) Prevena vs 72 (52.6%) control; p < .0001). The results of our study suggest there should be a significant consideration for the use of NPWT as a prophylactic measure to reduce the risk of wound complications of primarily closed infra-inguinal incisions in vascular surgery patients following common vascular procedures. Its use is particularly effective for patients at enhanced risk of infection, especially those with poor vascularization from BMI, smoking, and diabetes. This leads to decreased trends in antibiotic use, ED visits, readmissions, and surgical revisions, which translates to decreased utilization of hospital resources and economic burden.

Perioperative intravenous dexamethasone use is not associated with periprosthetic joint infection or wound healing complications following shoulder arthroplasty

BackgroundPerioperative intravenous (IV) dexamethasone is commonly used in lower extremity total joint arthroplasty to manage postoperative pain and nausea/vomiting, and recent studies have demonstrated that its use may lower rates of acute postoperative medical complications. However, there is limited information regarding the safety and efficacy of IV dexamethasone in patients undergoing total shoulder arthroplasty (TSA). Additionally, there is concern surrounding corticosteroid use prior to surgery as preoperative corticosteroid injections have been associated with adverse outcomes after TSA, including periprosthetic joint infection (PJI) and revision surgery. Thus, the purpose of this study was to evaluate the effect of perioperative IV dexamethasone on 90-day rates of PJI, wound complications, and medical complications after TSA. MethodsThe Premiere national hospital database was used to identify adult patients undergoing elective TSA between 2016 and 2020; patients were excluded if they were under 18 years old, were undergoing revision TSA, or had a prior proximal humerus open reduction internal fixation (ORIF) procedure. Patients who did and did not receive perioperative IV dexamethasone were then compared in both univariate and multivariate analyses. A Bonferroni correction was utilized to adjust for multiple comparisons. The primary endpoint was risk of acute infectious complications within 90 days of surgery, including PJI and wound infection/dehiscence. Secondary endpoints included acute pulmonary, renal, and thromboembolic complications. ResultsA total of 135,333 patients underwent TSA during the study period; 61.2% underwent reverse total shoulder arthroplasty (RTSA), 33.8% underwent anatomic total shoulder arthroplasty (ATSA), and 5.0% underwent hemiarthroplasty (HA). From 2016 to 2020, perioperative IV dexamethasone use increased by 135%. Multivariate analysis revealed that patients who received perioperative IV dexamethasone did not have increased odds of PJI, superficial wound infection, or wound dehiscence (p = 0.15 – 0.47) but did have decreased odds of sepsis (OR 0.67, 95% CI 0.55-0.81) and other medical complications such as urinary tract infection (UTI) and acute kidney injury (AKI). Additionally, there was a trend towards decreased 90-day hospital readmission (OR 0.88, 95% CI 0.81-0.96, p=0.003). ConclusionsPerioperative IV dexamethasone was not associated with increased risk of acute infectious and wound healing complications. Moreover, patients who received perioperative IV dexamethasone had decreased odds of medical complications and trended towards lower rates of 90-day hospital readmission. The results of this study support the safety of perioperative IV dexamethasone use in patients undergoing elective TSA.

Analysis of risk factors affecting wound healing and wound infection after meningioma resection.

To analyse the risk factors affecting wound healing and infection after spinal meningioma resection surgery. The surgical incision healing of 137 patients who underwent spinal meningioma resection at our hospital from January 2021 to January 2024 was analysed. The data collected included physical examination findings, haematological and biochemical measurements, and various scales assessed upon admission and after surgery. These data were then analysed. The surgical wound healing, infection and postoperative complications were statistically analysed. Multiple logistic regression analysis method was used to conduct risk factor analysis on corresponding indicators; the odds ratio and p value of 95% confidence interval were calculated. Factors such as age and smoking history were significantly negatively correlated with wound healing after meningioma resection (odds ratio < 1.000, p < 0.05), while preoperative albumin and platelet count were significantly positively correlated with wound healing (odds ratio > 1.000, p < 0.05). Age, WHO Meningioma Grading, preoperative albumin and preoperative platelet were significantly negatively correlated with wound infection after meningioma resection (odds ratio < 1.000, p < 0.05). The history of virus infection and history of neurological disorders were significantly positively correlated with wound infection (odds ratio > 1.000, p < 0.05). The influence of each factor is different. Age, smoking history, WHO Meningioma Grading, preoperative albumin, preoperative platelets, history of virus infection and history of neurological disorders had the greatest influence on wound healing and infection after meningioma resection.

Flexor hallucis longus tendon transfer for Tendo Achillis reconstruction

Background: Tendo Achilles injuries are common in orthopaedic practice. Degenerative, Chronic and failed repaires requires some form of soft tissue sleeve augmentation like Flexor Hallucis longs (FHL), Peroneus Brevis (PB), Plantaris etc.. are used along with proximal Tendo Achilles advancement procedures lie V-Y plasty, musculo tendinous Recession or Turn Down Procedures. These advancement procedure leads to weakening of already compromised Tendon. So, wanted to evaluate functional outcome of FHL tendon Trans Tendinous Transfer without any Advancement procedures. Methods: 20 patients satisfying inclusion criteria underwent FHL Trans tendinous Transfer to Tendo Achilles which is secured with Interference screw into the prepared bone bed of calcaneum. Initially anterior slab in planter flexion was applied later converted to cast in neutral position which is removed at the end of 6 weeks and joint mobilization started. Results: Out of 20 patients,11 were male patients and 9 were females. Average age ranged from 22 to 65 years. 9 were chronic Tears,9 were Degenerative Tears and 2 were failed Repairs. Wound healing complications were seen in 4 cases, 1 with chronic tear, 1 with Degenerative Tear and Both Filed repairs, all of them healed eventually. ALL patients were assessed for AOFAS at 6th and 12thmonth. The mean AOFAS of each subgroup improved significantly from months 3 to 12 (Table). At the one-year follow-up, all patients achieved good functional outcome in terms of the AOFAS scoring system. Conclusions: Tendo Achilles is the common tendon injured in ankle region due to repetitive stress and degeneration. Degenerative, Chronic and failed repair injuries of Tendo Achilles requires some form of soft tissue augmentation for healing. Trans-Tendinous FHL tendon transfer for Tendo Achilles Reconstruction shows good results with minimal complications in these scenarios in non-Athletic Population.

Effects of anemia and peri-operative medication on wound healing in cleft lip and palate patients

Introduction: Wound healing complications among cleft lip and palate patients pose risks of additional surgeries, reduced scar quality, and increased patient morbidity. This literature review aims to explore the impact of anemia and drug usage associated with respiratory complications, frequently encountered in these patients, on wound healing. Materials and Method: We conducted an extensive literature search without time constraints using PubMed and Google Scholar databases. The investigation into the effects of anemia and medications on wound healing was divided into three stages. The first stage examined the general effects of anemia and medications on wound healing. The second and final stages assessed wound healing in craniofacial and cleft lip/palate surgeries, respectively. Results: Preoperative anemia exerts no substantial influence on wound healing unless hemoglobin levels drop below 5 g/dl. No studies reported detrimental effects of glucocorticoids on wound healing. The impact of salbutamol use on wound healing remains controversial, while data regarding ipratropium usage are insufficient. Conclusion: Severe anemia is the only significant concern for wound healing, necessitating transfusion or improvement in anemia. It appears that short-term use of glucocorticoids after surgery does not have a negative effect on wound healing.It is worth noting that salbutamol and ipratropium usage may have detrimental effects, and while complete avoidance may not be feasible, their potential impact on wound healing should be considered.

MAMAS (mastopexy–augmentation made applicable and safer): A standardized template of pre-operative marking and step-by-step surgical procedure

Simultaneous breast augmentation with mastopexy is growing in popularity. It is a complex procedure that can lead to post-operative complications, patient dissatisfaction, and increased risk of litigation. The aim of this study is to describe an approach for the inverted-T augmentation-mastopexy technique, which limits intraoperative modifications, minimizes errors, and decreases post-operative complications and patient dissatisfaction.The study included 107 patients with Regnault's grade I and II ptosis and severe pseudoptosis. All patients were marked according to our novel technique, Mastopexy Augmentation Made Applicable and Safer (MAMAS), and operated by a single surgeon. All patients underwent simultaneous breast augmentation with Siltex Mentor Round Silicone Gel breast implants and mastopexy. Pre-operatively and post-operatively, patients filled the BREAST-Q. The mean follow-up was 24 months.Hundred and seven women received treatment in this study. Sixteen presented with post-operative complications, eleven in the early stage of recovery, and five in the late stage. There were eight cases of minor wound healing complications, all treated conservatively. Two cases of infection were noted, both were treated with oral antibiotics. One patient experienced post-operative bleeding after 13 days, which required surgical revision. In the late stage of recovery, five cases of implant displacement occurred and required revision surgery. No cases of capsular contracture and seromas were reported. According to Breast-Q, all patients were satisfied.MAMAS surgical technique, focusing on precise pre-operative marking for augmentation-mastopexy, is simple and easily reproducible. The procedure has a low complication rate and high patient satisfaction. It provides predictable and stable results over time.

Sarcoma Size and Limb Dimensions Predict Complications, Recurrence, and Death in Patients with Soft Tissue Sarcoma in the Thigh: A Multidimensional Analysis.

Limb-sparing resections of thigh soft tissue sarcomas (STSs) can result in adverse outcomes. Identifying preoperative predictors for wound healing complications, tumor recurrence, and mortality is crucial for informed reconstructive decision-making. We hypothesized that preoperative measurements of thigh and tumor dimensions could serve as reliable indicators for postoperative complications, recurrence, and death. In this retrospective cohort study conducted from March 2016 to December 2021, we analyzed patients undergoing thigh STS excisions followed by reconstruction. Preoperative magnetic resonance imaging or computed tomography scans provided necessary thigh and tumor dimensions. Univariate and multivariate regression assessed relationships between these dimensions and postoperative outcomes, including complications, recurrence, and death. Upon the analysis of 123 thighs, we found thigh width to be highly predictive of postoperative complications, even surpassing body mass index (BMI) and retaining significance in multivariate regression [odds ratio (OR) 1.19; 95% CI 1.03-1.39; p = 0.03]. Sarcoma-to-thigh width and thickness ratios predicted STS recurrence, with the thickness ratio retaining significance in multivariate regression (OR 1.03; 95% CI 1.001-1.05; p = 0.041). Notably, greater thigh thickness was independently protective against mortality in multivariate analysis (OR 0.80; 95% CI 0.65-0.98; p = 0.030). Thigh width outperformed BMI in association with postoperative complications. This may create an opportunity for intervention, where weight loss can play a role during the neoadjuvant therapy period to potentially reduce complications. Sarcoma-to-thigh width and thickness ratios, particularly the latter, hold substantial predictive value in terms of STS recurrence. Moreover, thigh thickness is an independent predictor of survival.

Wound Healing and Cosmetic Outcomes in Neonatal Circumcision Using Three Different Techniques.

Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to compare conventional dissection (CD), Plastibell (PB) and Gomco (GM) techniques of circumcision in neonates in terms of wound healing, wound healing complications, cosmetic outcome and parental satisfaction. A total of 144 male neonates were randomised into three study groups: CD, GM and PB groups. All procedures were performed under local anaesthesia as day case. Superficial wound healing was assessed on the 7 th post-operative day. The cosmetic outcome of the three techniques was assessed by a plastic surgeon and the parents using a 4-point Likert scale on the 4 th post-operative week. The three groups were comparable in terms of age ( P = 0.207) and weight ( P = 0.098) at circumcision. There was satisfactory wound healing in 48 (100%) patients in the GM group, compared to 47 (97.8%) in the CD group and 45 (93.8%) in the PB group ( P = 0.324). Wound healing complications were recorded in seven patients, 1 (2.1%) in the CD group with wound infection, 5 (10.4%) in the PB group with moderate pain despite the use of analgesia and 1 (2.1%) patient with skin bridge in the CD group. The plastic surgeon and the parents rated the cosmetic outcome of CD higher than the other two techniques. There is no significant difference in superficial wound healing amongst the three circumcision techniques. The cosmetic outcome of CD was significantly better than that of GM and PB circumcisions.

Impact of Smoking in Postoperative Outcomes after Elective Surgery

Abstract Introduction: The hazard of smoking is not only limited to the general health risks but also makes the smokers more vulnerable to various perioperative complications ranging from pulmonary complications to delayed wound healing to cardiovascular events. Methodology: This is an observational study in the department of general surgery of a tertiary care teaching hospital over a period of 24 months (May 2019–April 2021). Patients between 18- and 60-year age undergoing noncardiac elective surgical procedures were included in the study. Results: A total of 240 patients, meeting the inclusion criteria, posted for elective, noncardiac surgery were enrolled in this prospective observational study. In smoker patients’ group (n = 138) undergoing surgery, 42 (30.4%) patients developed postoperative complications as compared to 12 (11.8%) patients in nonsmoker group (n = 102). The risk of postoperative complications among smokers was 3.2 times (odds ratio [OR], 95% confidence interval [CI]: 1.62–6.63) (P ≤ 0.0009). Smokers with pack-years &gt; 11 had 3.8 times increased risk of postoperative complications as compared to nonsmokers (OR, 95% CI: 1.85–8.098) (P ≤ 0.0003). Conclusion: Our study aims to add to existing evidence and improve our understanding of delayed wound healing and major complications in smoker patients as surgical cases. Nonsmokers are at a lesser risk than smokers in postoperative complications. Awareness regarding the harmful effects of smoking and its influence on postoperative wound healing, motivation for quitting, and abstinence from smoking will help in reducing postoperative complications and better treatment outcomes.

Surgical and histopathological study of quadruple nostrils in a Holstein calf

AbstractA female Holstein calf was presented with quadruple nostrils. In the normal nose, one of the nostrils was normal and another had an abnormal flexible structure in the upper region of the nose. The extra nose included one tube‐like structure, two accessory nostrils and narrow vestibules. Complete surgical removal was selected. Histopathologically, a normal cutaneous region of nostril structure and a small region of immature respiratory tissue were observed. The cutaneous region of the rostral portion was lined by a thick keratinised stratified squamous epithelium. At the caudal cutaneous region, the epithelium was thinner. Collagen fibres, vessels, serous glands, muscle and cartilage were seen in the submucosa. The epithelium lining the immature respiratory region was pseudostratified columnar. No recurrence or wound healing complication was observed 5 months following the surgical procedures.

Comparative study on wound healing and infection between open and minimally invasive surgical methods in pediatric otolaryngology surgery.

Pediatric otolaryngology surgeries are crucial interventions requiring careful consideration of surgical methods to optimize outcomes. The choice between open and minimally invasive surgical approaches in this context warrants thorough investigation. While both methods aim to address ear, nose, and throat conditions in children, a comparative study assessing their impact on crucial factors such as intraoperative parameters, wound healing, complications, and postoperative pain is essential. This study aims to compare the effects of open and minimally invasive surgical methods on wound healing and infection in pediatric otolaryngology surgery, and provide a scientific basis for the selection of surgical methods. Two groups of patients were selected, with 90 people in each group. One group received open surgery and the other received minimally invasive surgery. Recording the intraoperative time, anesthesia time, and intraoperative blood loss; the number of days required for wound healing; the occurrence of wound-related complications; the comparison of pain on postoperative Days 1, 3, and 7; and the factors influencing postoperative wound healing were analyzed. In the minimally invasive surgery group, the intraoperative time was shorter, the anesthesia time was relatively reduced, and the amount of bleeding was significantly reduced. Wounds also take fewer days to heal and have lower rates of wound-related complications. When comparing the pain on 1, 3, and 7 days after surgery, the minimally invasive surgery group had relatively mild pain. Analysis of postoperative wound healing factors showed that minimally invasive surgical methods have a positive impact on healing. In pediatric otolaryngology surgery, minimally invasive surgery performs better than open surgery in terms of intraoperative operation time, anesthesia time, blood loss, wound healing time, complication rate, and postoperative pain. Therefore, minimally invasive surgery may be a safer and more effective surgical method.

Superiority of a Silk Surgical Site Wound Closure Device Over Synthetic Dressings

Background: Silk fibroin is an emerging biomaterial with enhanced properties of cellular regeneration, growth and proliferation. The use of a silk fibroin wound dressing has the potential to decrease the incidence of wound healing complications and to improve patient outcomes compared to synthetic dressing alternatives. Methods: A prospective, randomized, single-blinded clinical trial was conducted on 50 patients who were dressed with a silk fibroin dressing on one side of their body and on the contralateral side with 3M Steri-Strips® after undergoing abdominoplasty, reduction mammaplasty, or brachioplasty procedures. Data was collected over 5 postoperative visits using photographs and an investigator administered questionnaire to monitor erythema, skin irritation, skin discomfort, the need for pharmaceutical intervention, wound dehiscence and mechanical skin injury. A comprehensive 75 patient statistical analysis was conducted combining the results with a previously published study comparing Dermabond® Prineo® to the silk dressing. Results: 20.8% (10/48) of patients were assessed by surgeons as having skin erythema (7-10) on the Steri-Strip® control side and 0% (0/48) on the silk dressing side (p=0.002). The frequency of breast triple point separation in 43 cases was 30.2% (13/43) on the Steri-Strip® side and 9.3% (4/43) on the silk side (p=0.012). 75% (36/48) of patients had partial or total detachment of Steri-Strips® while 0% (0/48) had total detachment of the silk dressing and 18.8% (9/48) had partial detachment of the silk dressing within the first two weeks (p&lt;0.001). Conclusion: A silk fibroin wound dressing significantly reduces the incidence of wound healing complications throughout the postoperative period. Clinical Relevance Statement: The adoption of a silk fibroin wound dressing into clinical practice has the potential to improve patient outcomes, decrease medical adhesive related skin injuries and reduce the rate of wound healing complications.

Total Hip Arthroplasty Using the AMIS Method: Surgical Technique, Suitability of This Method for Obese Patients, Evaluation of the Study Population

This manuscript aims to introduce our surgical technique, with an emphasis on the latest recommendations. The AMIS technique is discussed in more detail in patients with Class II and Class III obesity. We seek to prove the premise claiming that the anteversion and inclination values observed in this group of patients do not differ signifi cantly from those observed in patients with the recommended BMI index. We will also compare the risk of neurovascular bundle injury and postoperative complication rate regarding the surgical wound. Patients who underwent surgery using the AMIS method in the period between 1/2020 and 4/2023 were assessed retrospectively. The study included 1150 implantations. The entire study population was assessed for neurovascular bundle injury and surgical wound healing complications. For this purpose, the patients were divided into two groups based on the BMI, namely BMI < 35 kg/m2 (n=1042) and BMI > 35 kg/m2 (n=108). In patients with the BMI ≤ 25 kg/m2 (n=280) and BMI ≥ 35 kg/m2 (n=108), the inclination and anteversion values were compared. Standard centered AP view X-rays of their operated joints were assessed. The Liaw's method was used to calculate the anteversion and inclination. In group one of patients with BMI ≤ 25 kg/m2 (208 women and 72 men), the arithmetic mean of acetabular anteversion was 25.4° (median 25°) and inclination was 38.3° (median 38°). In group two, which consisted of patients with BMI ≥ 35 kg/m2 (59 women and 49 men), the total arithmetic mean of acetabular anteversion was 25.1° (median 25) and inclination was 37.6° (median 37.5°). The anteversion and inclination were assessed using the Mann-Whitney test for equality of medians. The value of 0.05 was chosen as the level of signifi cance. The resulting p-value was 0.5359 in anteversion and 0.3763 in inclination. Since the p-value of both anteversion and inclination was greater than the chosen level of signifi cance, their medians have not been confi rmed to differ signifi cantly. A total of 6 cases of femoral nerve injury was reported, i.e. 0.5% out of 1150. Therefore, the risk of injury was 0.4% in the group with BMI < 35 kg/m2 (n=1042). On the contrary, in the group of patients with BMI > 35 kg/m2 (n=108), the risk was 2%. No injury to femoral artery was reported. The surgical wound healing complications were seen in a total of 87 cases (7.6%). In the group with BMI < 35 kg/m2 , healing complications of the surgical wound were observed in 7.4% of cases, with the need for revision surgery in 7 patients. In the group with BMI > 35 kg/ m2 , healing complications occurred in 13% of patients and wound revision was necessary in 4 cases. Our results are consistent with those in the published studies that also show no signifi cant difference in anteversion and inclination of components in the compared groups of obese patients. We also agree with the other authors that the rate of complications regarding surgical wound healing is higher in these patients. The risk of neurovascular bundle injury in this study population is not higher than the standard. The results obtained in our study population show that this method can also be used in patients with higher BMI, with no concern about the implantation of components in malposition or a higher risk of neurovascular injury. Nonetheless, potentially higher risk of surgical wound healing should be considered when this approach is opted for. With the appropriate surgical technique, AMIS is a safe method and, in our view, the fi rst choice especially for obese patients. AMIS, anteversion, inclination, hip joint, obesity, BMI, implantation, total joint replacement.