Wound Healing Problems Research Articles

Long-Term Outcome Analysis and Technical Refinements after Autologous Breast Reconstruction with PAP Flap: What We Have Learnt

Introduction: The profunda artery perforator (PAP) flap represents a valuable alternative to the deep inferior epigastric artery perforator flap which, nowadays, is considered the golden standard for autologous breast reconstruction. The goal of this study was to evaluate the long-term satisfaction, functional outcomes of the donor site following PAP flap-based breast reconstruction and to present our personal learning experience along with suggestions for technique refinements. Methods: In this prospective single-center appraisal, 18 patients who underwent PAP flap-based breast reconstruction between January 2016 and November 2019 were enrolled. The Patient and Observer Scar Assessment Scale (POSAS) and the Breast-Q questionnaire were employed to evaluate the results 12 months postoperative. Data were analyzed with the Q-Score program. Complications were recorded in the medical database and classified with the Clavien-Dindo classification. Results: In the questionable time frame, 164 female patients underwent free flap breast reconstruction. Of those, 18 patients that received PAP flaps (9 bilateral) were included in this study. We recorded one flap loss because of venous failure. Most complications concerned the donor site, including hematoma, seroma, and wound healing problems. Patients’ satisfaction was high at 12 months post-surgery, despite critical evaluation of the donor site scar. Conclusion: The PAP flap serves as an excellent option for breast reconstruction in patients who do not have abundant abdominal tissue. The overall clinical outcome was good and patients’ evaluation showed high satisfaction after 12 months despite high complication rates. Modifications in planning and flap harvesting might improve the donor site outcome and the overall complication rate.

Long-term clinical and radiological outcomes following surgical treatment for symptomatic pediatric flexible flat feet: a systematic review.

Background and purposeAlbeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric patients with symptomatic FFF are largely unknown. In this systematic review, studies providing outcomes at a mean follow-up of at least 4 years after the procedure in these patients were analyzed.Material and methodsA PubMed search was undertaken involving original articles published up to July 2021 on outcome in children aged 6 to 14 with surgically treated FFF and mean (or minimum) follow-up of at least 4 years. Radiographic and clinical outcomes were analyzed.ResultsOf initially 541 entries, 10 could be included in the systematic review (all level IV), involving 846 pediatric patients with 1,536 symptomatic FFF. Pooled mean radiological (n = 8) and clinical follow-up (n = 10) was 5.3 (range 0.5–15) and 7.0 (range 4.1–15) years, respectively. Surgical procedures included arthroereisis (n = 8), lateral column lengthening (n = 1), and Horseman procedure (n = 1). Overall relative frequency of implant-associated complications and wound-healing problems was 3.2% and 1.3%, as well as 2.8% and 1.6% following subtalar arthroereisis only. From preoperative to latest radiological assessment following subtalar arthroereisis (including 3 studies with radiological follow-up < 48 months), pooled median decrease in talonavicular coverage angle (TNCA; –9.2°), anteroposterior talocalcaneal angle (A-TCA; –6.5°), lateral talocalcaneal angle (L-TCA; –3.5°), talar declination angle (TDA; –14°), Moreau Costa Bertani angle (MCB; –13°), and talo-firstmetatarsal angle (L-T1MA; –10°) was observed, as was an increase in calcaneal pitch (4.5°).InterpretationIn symptomatic pediatric FFF patients, surgery is associated with a manageable complication profile, and results in satisfactory long-term clinical as well as radiological outcome. Yet scientific evidence is low, warranting larger scaled studies in the future.

Donor Site Morbidity in Patients Undergoing Maxillofacial Reconstruction Using Free Fibula Flap Versus Deep Circumflex Artery Flap-A Systematic Review.

A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction. The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps. A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap. The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).

Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery.

Managing Wound Healing with a High-Risk Patient: A Case Report

Wound healing is a complex, multi-step process. This process begins immediately after skin damage. The outcome of wound healing depends on the quality of each stage of this process: a normal or pathological scar. Violation of wound healing entails a decrease in the function of scar tissue as well as aesthetic dissatisfaction with the patient. This problem is especially important in aesthetic surgery. Patients who have come for beauty feel frustration, obtaining pathological scars. We have been dealing with the problem of wound healing after plastic surgery for about 10 years. Our approach includes the assessment of the risk of pathological wound healing and the treatment of high-risk patients. The risk assessment includes historical data on wound healing, signs of connective tissue dysfunction (especially patients with connective tissue dysplasia), and genetic polymorphisms of genes responsible for the structure of the components of the extracellular matrix of the skin. In the future, patients with a high risk of pathological scarring can be prescribed treatment after surgery. This article presents a clinical case in which we demonstrate our approach.

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

De-epithelialized Dermal Flap to Reduce Sacral Wound Healing Complications After Lower Body Lift Procedure.

Lower or circumferential body lift procedures in the massive-weight-loss population have been associated with significant complication rates. Particularly, the sacral area is at risk of wound-healing problems due to high wound tension or shear forces. The authors introduced a de-epithelialized dermal flap to reinforce the sacral area. Within this retrospective study, outcomes of 40 consecutive patients who underwent lower body lift between 2017 and 2021 were analyzed. The patient population was divided into 2 study groups (sacral flap vs no flap) including 20 patients each. Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed. Thirty-seven female and 3 male patients with a median age of 36.5 years (range, 23-54 years) and a mean weight loss of 46.3 ± 12 kg participated in the study. The most common complication was sacral wound dehiscence (n = 7, 17.5%), and its occurrence was statistically significantly lower in the sacral flap group (P = 0.037). The odd ratios for complications when executing the sacral flap procedure were reduced to 0.306 (95% confidence interval = 0.075 to 1.246) and 0.261 (95% confidence interval = 0.055 to 1.250) for the uncorrected and corrected logistic regressions, respectively. In addition, findings showed a significantly shorter hospital stay as well as statistical trends towards a lower occurrence of overall complications in the sacral flap group. Concerning the remaining data, no statistically significant differences between study groups were detected. The presented de-epithelialized dermal flap leads to a significant reduction of sacral wound-healing complications and a shorter hospital stay for patients. This surgical technique is easily reproduceable, rapid, and effective; therefore, we would recommend it for each circumferential or lower body lift procedure.

New insight into old and new antimicrobial molecules targeting quorum sensing for MRSA wound infection.

MRSA represents one of the largest problems in wound healing as a result of its increasing incidence and the complex therapeutic approach required to treat it. The need for new solutions to overcome antibiotic resistance led to the development of antimicrobial molecules that are effective at blocking quorum sensing. This special report provides an up-to-date review, based on the latest evidence in the literature, of old and new molecules that can positively influence the process of wound healing via their action on MRSA quorum sensing. Quorum sensing-inhibiting molecules, applied topically or injected in situ, have excellent potential to improve both MRSA eradication and quality of wound healing, especially when combined with conventional systemic MRSA therapy. Further human studies are needed to evaluate the efficacy of these molecules.

Open lower extremity fractures in the geriatric population.

Open fractures in the elderly are distinct compared to younger populations. The purpose of this study is to follow a series of open fractures of the lower extremity in the geriatric population to better prognosticate outcomes. We performed a retrospective chart review of patients over the age of 65years old who were treated for an open, lower extremity fracture across two level I trauma medical systems. Patients were included if they had documented wound healing problems in the postoperative period, or 6months of follow-up, or if they had a definitive radiographic outcome. Sixty-four patients were included of an average age of 76.23, of whom 73.4% were female. The fracture types were midshaft femur in 3, distal femur in 9, patella in 2, proximal tibia in 3, proximal fibula in 1, midshaft tibia in 14, distil tibia in 8, ankle in 23, and talar neck/calcaneus in 1. Forty-two fractures were the result of low energy mechanism and 22 fractures were from high energy mechanism. Fourteen fractures were type 1, 32 were type 2, 11 were type 3A, 6 were type 3B, and 1 was type 3C. At final follow-up, 13 wounds were well healed, 39 wounds were healed following a delay of more than 6weeks to achieve healing, 3 were infected, 3 had been treated with amputation, 2 had chronic ulceration, 2 with active draining, and 2 had draining sinuses. Open lower extremity fractures are serious injuries with high rates of morbidity. Such risks are even higher in the geriatric population, particularly with regard to wound healing. This study provides important prognostic information in counseling geriatric patient with an open lower extremity fracture, as well as informs treatment in terms of wound surveillance and care in the postoperative period.

A Prospective Study Assessing Wound Complications in a Series of Foot and Ankle Patients Treated With Enoxaparin: A Baseline for Future Studies.

Background and objectiveLow-molecular-weight heparin (LMWH) prophylaxis has now become the gold-standard practice in patients requiring lower limb immobilization. We had noticed an increase in the incidence of wound-healing problems at our center, and the severity of the problems was found to be worse in patients undergoing foot and ankle surgery since we had adopted this practice. In this study, we aimed to describe the incidence and severity of wound-healing problems in this group of patients.MethodsThis was a prospective study and we collected data on the frequency and severity of wound problems occurring in patients undergoing a variety of foot and ankle operations. All patients underwent a standard agreed-on method of wound closure and dressings. Wounds were reviewed after two weeks and wound characteristics were noted using a rigid proforma. The primary outcome measure was to determine the incidence of delayed wound healing (DWH) and wound infections requiring antibiotics. Secondary outcomes were the characteristics of each delayed-healing wound.ResultsA total of 158 patients met the inclusion criteria of the study. One patient was not given postoperative LMWH and was excluded from the final analysis. Seven patients (4.5%) were noted to have DWH and four patients (2.6%) had a wound infection at the two-week postoperative follow-up. None of the patients required a second operation. Among patients with wound-healing problems, wound contour irregularities were noted in 51% and margin separation was noted in 65%.ConclusionThe overall incidence of wound-healing problems such as DWH and wound infections was low in patients receiving prophylactic LMWH for foot and ankle surgery. Where postoperative wound problems did occur, these were associated with poor wound characteristics such as margin separation or contour irregularity. Further studies should be conducted to ascertain if the use of LMWH leads to problems with wound appearance.

OP2: Breast Reconstruction with a DIEP Flap in Elderly (&gt;60 Years) Patients

INTRODUCTION: Breast cancer is primarily a diagnosis of older women. Many patients seeking breast reconstruction are elderly women, aged over 60 years. Free tissue transfer carries the risk of perioperative morbidity and mortality in elderly patients. To clarify this issue we performed a comparative study. MATERIALS AND METHODS: A retrospective cohort study composed of chart review of all deep inferior epigastric perforator flap breast reconstruction patients at a single institution divided into an elderly cohort (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. Primary outcomes were complete flap loss, partial flap loss, or need for flap re-exploration. Secondary outcomes included surgical site occurrence, such as wound healing problems, seroma, and others. RESULTS: There were 173 flaps in the nonelderly cohort and 37 flaps in the elderly cohort. The elderly cohort had higher rates of diabetes, hypertension, and hyperlipidemia. Chi-square analysis showed no significant differences in primary outcomes between the two cohorts (1.1% vs 2.7%, p=0.459). Breast wound dehiscence was slightly higher in the elderly cohort (7.4% vs 5.4%, p=0.663). On logistic regression, being elderly was seen not as a significant risk factor for complete flap loss. The overall success rate for the nonelderly cohort was 97.3 percent, whereas the success rate for the nonelderly cohort was 98.7 percent. CONCLUSION: Elderly women desire breast reconstruction. Free flap breast reconstruction is a viable and safe procedure in these patients.

Custom-made 3D-Printed Prosthesis in Periacetabular Resections Through a Novel Ileo-adductor Approach.

Resection of sarcomas around the acetabulum presents major challenges. The resulting bone effect can be reconstructed with personalized custom-made prostheses. Patient-specific instruments (PSIs) have been demonstrated to be of added value for bone-cutting accuracy, and they may improve pelvic surgery. The authors describe a novel ileo-adductor approach for pelvic tumor surgery and report the preliminary results of 5 reconstructions using custom 3D-printed prostheses associated with PSI surgical guides. This combined technique allows an optimal restoration of the anatomy with reduced surgical time and reduced postoperative complications such as infections and wound healing problems. [Orthopedics. 2022;45(2):e110-e114.].

Factors related to necrosis at the T junction in reduction mammoplasty

Backgrounds/Aim: Reduction mammoplasty is an effective and patient-satisfying operation in terms of relieving physical complaints such as back pain, shoulder collapse, and intertrigo due to macromastia. The most used incision is the wise pattern, which allows for easy intervention to the excess vertical and horizontal skin. However, long incisions may cause wound healing problems. The necessity of wide dissection may cause perfusion problems in the lateral and medial flaps at the T junction, where the tips of the flaps meet with the inframamarial sulcus. In the literature, T junction dehiscence is discussed under delayed healing complications. This study aimed to reveal the specific effects of the factors that were shown to cause delayed healing in general on the T junction area. Methods: In this retrospective cohort study, the effects of age, smoking habits, comorbidities, resection volume, and body mass index on T junction dehiscence were investigated among 56 patients who underwent reduction mammoplasty with wise pattern technique. The combined effects of all possible factors effective on dehiscence were investigated by multivariate logistic regression analysis. Results: The median age of the patients was 44.3 (12.5) years. Their mean body mass index was 26.0 (24.0-27.0) kg/m2, and 13% of the patients had comorbidities. The rate of dehiscence at the T junction was 28.6%. The most effective factors on the development of dehiscence were smoking and increased body mass index. Logistic regression analysis revealed that smoking increased the risk of T junction dehiscence by 8.543 times (95% Confidence Interval: 1.454-50.213) (P=0.018). No relationship was found between age, resection volume, comorbidities, and T junction dehiscence. Conclusion: The risk of dehiscence in the T junction increased in the patients who smoked and who had a high body mass index. The effect of smoking was much greater on T junction healing than its effect on general wound healing complications. T junction dehiscence should not be considered a delayed wound healing complication solely, but as a flap perfusion problem and preoperative measures should be taken accordingly.

Trombositten Zengin Plazma Uygulamasının Deri Grefti İyileşmesi Üzerine Etkisinin Deneysel Olarak Değerlendirilmesi

Objective: There is new information increasingly added about wound healing, which is one of the most complex physiological processes. In this study, it is aimed to evaluate the effect of plateletrich plasma on the wound healing process in pursuit of creation of skin defect on the back skin of the rat and application of graft to it. Material and Methods: The study was planned on 30 randomly selected inbred Sprague-Dawley rats. In the rats in the experimental group, 3x2 cm full-thickness skin defect was created after the back area was shaved. The skin taken from the defected area was thinned and turned into a full-thickness skin graft and sutured again to the area where it was taken. Platelet-rich plasma was applied under the graft to the rats in the 1st group, and physiological saline was applied to the 2nd group. The 3rd group did not undergo any surgical procedure, and it was created as the control group. Results: Significant differences were observed in glucose, lactate, glycerol, and pyruvate values in the tissue in Group 1, compared to other groups. In the histopathological evaluation, a significant decrease was detected in the rate of inflammation and edema in the Group 1, in comparison with the other groups. Conclusion: Based on the data obtained from this study, it was taken into consideration by us that platelet-rich plasma application is a method that can be applied in addition to the classical wound care, especially in the cases with wound healing problems.

Bioabsorbable magnesium screw fixation for tibial tubercle osteotomy; a preliminary study.

Background and aim:Metallic screws are commonly used to fix tibial tubercle osteotomies (TTO). However, hardware removal late after osteotomy union is one of the most common causes of reoperation following TTOs. The use of bioabsorbable screws may eliminate secondary surgeries, but there is no study on their use in this indication. The purpose of this retrospective study was to evaluate the safety and efficacy of bioabsorbable magnesium (Alloy: MgYREZr) screws in tibial tubercle osteotomy (TTO) fixation.Methods:Ten consecutive patients with objective patellar instability who underwent distal realignment procedure using Fulkerson TTO were retrospectively reviewed. The osteotomy was secured with two parallel 4.8 mm magnesium screws in all patients. Kujala score and Lysholm knee score were used to assess the functional outcomes before and after the operation. During the follow-up, the union of the osteotomy, displacement, and other imaging findings were evaluated with serial knee radiographs.Results:There were five male and five female patients with a mean age of 23.4±9.2 years (range, 15–45). The mean follow-up duration was 11.5±3.2 months (range,6–17 months). The osteotomy united in all cases at an average of 3 months. No infection or wound healing problems were seen. A significant increase in Kujala (p:.005) and Lysholm knee scores (p:.005) were recorded in all patients.Conclusion:Despite a limited number of patients were reviewed, the findings support that bioabsorbable magnesium screws can be safely used as an alternative fixation technique in TTO. Furthermore, it provides the advantage of eliminating the need for implant removal. (www.actabiomedica.it)

Quadrimalleolar Fractures of the Ankle: Principles and Medium-Term Results of Surgical Fixation

Category:Ankle; TraumaIntroduction/Purpose:Over the last decade, much attention has been paid to the fractures of the posterior malleolus as it became obvious that the mere presence of a posterior tibial fragment is associated with a less favorable prognosis in malleolar fractures. It seems logical to pay the anterior restraints of the ankle joint a similar attention as to the posterior ones. The anteriolateral distal tibia may be considered a 'fourth' or anterior malleolus. Here, we present a technique of fixation of trimalleolar fractures with additional fracture of the anterior tibial tubercle ('quadrimalleolar') or anterior fibular rim ('quadrimalleolar equivalent').Methods:Twenty-four patients with a mean age of 60 years were treated with open reduction and internal fixation of all 4 malleoli. There were 17 quadrimalleolar and 6 quadrimalleolar equivalent fractures. One patient had both anterior tibial and fibular avulsion fractures in addition to a trimalleolar ankle fracture. Surgical approaches and internal fixation were tailored individually. Twenty patients were operated in prone position with direct fixation of the posterior malleolus and 4 patients in supine position with indirect anterior to posterior screw fixation of the posterior malleolus under transfibular control of reduction.Results:After fixation of al 4 malleoli, only one patient (4%) required a syndesmotic screw for residual syndesmotic instability on intraoperative testing. There were no infections, and no wound healing problems. All patients went on to solid union. No late fusions were needed. Nineteen patients (79%) could be reevaluated after a mean of 77 months (range, 15 to 156 months) follow- up. The Foot Function Index averaged 15 (range, 50 to 0), the Olerud and Molander Score averaged 79 (range, 45 to 100) and the AOFAS Ankle and Hindfoot Scale averaged 87 (range, 39 to 100).Conclusion:Fixation of the anterior and posterior tibial fragments increases syndesmotic stability by providing a bone-to-bone fixation. Reduction of displaced anterior and posterior tibial rim fractures restores the physiological shape of the tibial incisura and therefore facilitates fibular reduction. In the majority of cases, this also restores articular congruity of the lateral tibial plafond.Anatomic reduction of the anterior and posterior malleolus in addition to medial and lateral malleolar fixation leads to favourable functional results despite a complex (quadrimalleolar) fracture pattern.

Posterior Hindfoot Endoscopy Using 1.9-mm Diameter Needle Arthroscopy: A Cadaveric Study

Category:Ankle; Arthroscopy; Hindfoot; SportsIntroduction/Purpose:Posterior hindfoot endoscopy is a safe and effective treatment for posterior ankle impingement syndrome (PAIS) and flexor hallucis longus (FHL) tendon disorders. As frequent coexistence of PAIS and FHL tenosynovitis has been reported, it is important to investigate FHL tendon pathology concomitantly when treating PAIS. However, the visualization of FHL tendon distal to the retinaculum is limited when using conventional rigid arthroscopy. Additionally, wound-healing problems following hindfoot endoscopy have been still reported. Recently, a novel 1.9-mm diameter needle-arthroscopic system has been introduced. Its small and semirigid features can help reduce the risk of wound complications and can make it easier to perform FHL tendoscopy. The purpose of this study was to assess whether 1.9-mm diameter needle-arthroscopy was useful for hindfoot endoscopy in a cadaveric model.Methods:A 1.9-mm diameter arthroscopic system (NanoScopeTM, Arthrex) was used to perform a hindfoot endoscopy in 6 human donor ankles (3 pairs). The arthroscope tube is 9.5-cm long and semi-rigid, and has a 1.9-mm outer diameter. The scope's direction of view is 0°, with a 120° field of view. Posteromedial and posterolateral portals were established. Visualization and operative reach with tailored arthroscopic instruments were recorded, including posterolateral talar process, posterior talofibular ligament, intermalleolar ligament, subtalar joint, ankle joint, and flexor hallucis longus (FHL) tendon. Finally, a conventional 4.0-mm diameter arthroscope with a 30° angle was used to compare the visualization of FHL tendon.Results:All significant structures were successfully visualized and reached in all specimens. In ankle joint, all of the tibial surface was visualized, but visualization of talar surface was limited. Due to its wide 120° field of view, there was no difficulty obtaining sufficient visualization in any structures. As this needle-arthroscopic system has the semirigid frame, FHL tendoscopy was easily performed via the posterolateral portal. In all specimens, the FHL tendon was visualized from the level of ankle joint to the Knot of Henry (Zone 1 and 2), and the flexor digitorum longus tendon crossing obliquely over the FHL tendon was observed (Figure). The conventional arthroscope could not be inserted into the tunnel underneath the sustentaculum tali in any specimens.Conclusion:Posterior hindfoot endoscopy using a 1.9-mm diameter needle-arthroscopy provides effective visualization and surgical reach of all significant structures for the treatment of PAIS. Its small and semirigid features also make the FHL tendoscopy less invasive and more accessible than conventional rigid arthroscope.

Learning from machine learning.

In this article, Squiers et al1 bring together two different ideas to help address the salient clinical problem of successful amputation wound healing. In this pilot study looking at the use of multispectral imaging (MSI) in predicting wound healing, the authors have introduced machine learning (ML) to develop an ideal prediction algorithm. Hidden underneath these ideas are the clinical factors surgeons knowingly or unknowingly use to determine when and where to amputate. I suggest that the readers interpret these findings while keeping in mind that the ultimate goal of a successful amputation is not just healing, but maintaining functionality of the longest residual limb possible.

THROMBOCYTES AND SOME BIOCHEMICAL PARAMETERS OF BLOOD IN PATIENTS WITH DIFFERENT RESULTS OF HEALING OF FACIAL SOFT TISSUES

The ability to regenerate is inherent in every tissue of the human body. The problem of pathological wound healing remains relevant due to the growing aesthetic requirements of patients. The regenerative ability of damaged tissues ensures the restoration of function. Purpose of the study. Analyze some biochemical parameters of blood in patients with different results of healing of wounds of soft tissues of the face. Material and methods of research. Based on the results of the conducted studies, the regenerative ability of damaged tissues was studied. During hospitalization, general clinical studies were conducted. A series of laboratory tests (general and biochemical blood tests) was performed in patients of the main and control groups (with and without complications, respectively). A comprehensive study of the course of the wound process was conducted in 30 patients with wounds of the skin and subcutaneous tissue. Patients range in age from 18 to 69 years. The average age of patients is 43.5 years. Statistical processing of the obtained results was performed using the Microsoft Excel program. Results and their discussion. The obtained results of statistical analysis p&lt;0.01 indicate a significant difference in biochemical parameters in patients with suture divergence and without complications of wound healing. Conclusions. Based on the conducted studies, the level of total blood protein and platelet count are important components of the body’s regeneration potential, as they reflect the body’s readiness to repair damaged tissues. A significant decrease in total blood protein levels and platelet count may be a risk factor for postoperative wound healing complications. Analysis of laboratory tests builds an important foundation for predicting possible complications, drawing up a treatment plan, and correcting existing somatic diseases. According to the author, it is important to conduct repeated studies, which makes it possible to determine the course of the infectious process and the effectiveness of treatment.

Operative versus non operative treatment for displaced intra articular fracture of calcaneus: A prospective study 58 patients

Background: Calcaneus fractures are the most common tarsal bone fractures, and displaced intra articular fractures account for 60% to &75% of all calcaneal fractures. Fractures of the calcaneus remain among the most challenging for the orthopedic surgeon to manage effectively as these injuries are more destructing and devastating. The management dilemma is still going on regarding conservative or operative treatment for such fractures as there is no clear evidence to delineate the gold standard treatment method, which is superior in every aspect. Material and Method: We have done a prospective study of 58 patients (2 had bilateral fracture) with displaced intra-articular calcaneus fracture after applying strict inclusion and exclusion criteria. We have randomly allocated patients into operative (A, n-30) and non-operative groups (B, n-30). We compared the clinical, functional and radiological outcomes of both groups. Results: The mean age in the operative group is 34.7 years and in the non-operative group is 36.03 years. The average follow-up is 12.4 months and the average time of union was 10.1 weeks in the operative group, while in a non-operative group it is 11.03 month and 10.6 weeks, respectively. The mean AOFAS score at the final follow up of the operative group is 84.2 and in the other group it is 79.4. Total of 8(39%) patients undergoing operative management have an excellent result, 15(50%) have good results,3(10%) have fair and 4(1%) have poor results as compared to the other group 4 (13%), 9 (30%), 8(27%), 9(30%) respectively. Conclusion: Operative management has a better radiological, clinical and functional score in comparison with conservatively managed patients of displaced intra articular calcaneal fracture. However, operative management is also associated with an increased number of surgery-related complications like long hospital stay, cost effectiveness, local wound healing problems, superficial and deep infection, implant related problems as compared to another group.