Wound Suture Research Articles

Anesthesia with topical lidocaine hydrochloride gauze in acute traumatic wounds

Background: Using gauze soaked in lidocaine hydrochloride (2%) can induce anesthesia to suture wounds painlessly, without causing anxiety due to fear of injection in adult patients who referred to the emergency department with limb laceration. Methods: This is a triple-blind interventional study in which trauma patients with limb wounds enter the study. Distilled water impregnated gauze will be used for the control group and 2% lidocaine impregnated gauze will be used for the intervention group. The gauze will be placed on the wound for 5 minutes. The pain will be assessed with VAS. Results: A total of 180 people were enrolled in the study, which followed a normal distribution (Pv = 0.079) by Kolmogorov-Smirnov statistical test. The mean age of the participants is 32.02± 13.97 years. The pain intensity of patients in the case group based on VAS at the time of admission was 7.92 ±0.64. The severity of pain in patients after lidocaine-impregnated gauze anesthesia is 7.54±0.91. The severity of pain in patients based on VAS at the time of admission was 7.82± 0.61. The severity of patients' pain after anesthesia with lidocaine-impregnated gauze was 3.51±1.51. In the case group, the topical injection of lidocaine was repeated for anesthesia for all patients, while in the control group, the injection was repeated only for 3 patients. Pv≤0.0001) Conclusion: the pain intensity after anesthesia is significantly different and in the anesthesia group with local the injection has dropped dramatically

8 years vein glue therapy with VenaSeal® – 8 special cases

Since 1949 the chemical compound of cyanoacrylate glue is known, first being used in operative medicine in the early 60s. Tissue adhesive or replacement of wound sutures Nearly all operative disciplines were / are using cyanoacrylate i.e. dermatology, ophthalmology, orthopedics, surgery, orthodontics, interventional radiologists. The VenaSeal® - Closure System has been CE and ISO certified since 2011. The American health authority FDA announced the approval of the system in the USA in 2/2015. Until October 20th of 2020, vein glue is used successfully for the treatment of truncal varicose veins in over 160 000 cases worldwide. The authors have been working with the VenaSeal®-Closure System since August 1th. 2012, and have so far successfully treated 2840 saphenous veins in 1476 patients with the vein glue. Closure effectiveness of 96,09% achieved over 98 months.

Estimation of quality of life after operative treatment for venous trophic ulcers of the lower extremities

Objective. To study the patients’ quality of life after operative interventions, performed for venous trophic ulcers of the lower extremities.
 Маterials and methods. Analysis of data from 82 hospital cards of stationary patients was conducted. The patients were treated during 2010 - 2017 yrs in the Department of Vascular Surgery of Poltava Regional Clinical Hospital named after М. V. Sklifosovskyi for venous trophic ulcers of the lower extremities (Class С5 in accordance to Clinical-Etiological-Anatomical-Pathophysiological classification - СЕАР). The cause of trophic ulcers occurrence in all the patients was confirmed, using ultrasound duplex scanning of pelvic and the lower extremities arteries and veins. After conduction of certain conservative therapy the operative intervention, directed on elimination of the occurrence cause of trophic ulcers, was done. In all the patients the conduction of endovenous thermal ablations was not indicated, taking into account the anatomic peculiarities presented. Depending on the methods of operative interventions performed, the patients were distributed into two groups: Group I - 48 (58.5%) patients, surgical treatment of whom consisted of typical conventional open operative interventions, using a standard set of instruments, while Group II - 34 (41.5%) patients, to whom operative interventions were done, using elaborated own gadgets for the wounds edges opening, dissection and ligation of perforant and large subcutaneous veins, nontraumatic suturing of postoperative wounds. All operative interventions in the Group II patients were performed, using ultrasonographic support. In patients of both Groups a subjective estimation of quality of life was conducted, using questionnaire CIVIQ (Chronic Insufficiency Venous International Questions) for interviewing preoperatively and in 1, 3 and 6 mo postoperatively.
 Results. In accordance to data obtained, in patients of Group II the score in points of quality of life was higher, because in them the ulcers have healed faster, the pain sensation reduced, resulting in the psycho-emotional state improvement. Besides this, 29 (85.3%) patients of Group II have noted, that even while some symptoms persisted, their subjective signs reduced, leading to the well-being improvement. The conduction of treatment in accordance to own procedures proposed have promoted the raising of the quality of life score in patients, suffering trophic ulcers of the lower extremities.
 Conclusion. Application of gadgets of own elaboration during operative intervention on venous system of the lower extremities accelerates its performance and reduces traumaticity. This leads to reduction of the pain sensitivity intensity, raising of subjective estimation of quality of life in remote postoperative period.

Clinical effects of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck

Objective: To explore the clinical effects of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck. Methods: From January 2016 to August 2019, 10 male patients, aged from 20 to 52 years with post-burn facial and cervical scar deformities, were admitted to the First People's Hospital of Zhengzhou, with the size of scar ranging from 15 cm×7 cm to 23 cm×11 cm. In the first stage, a cylindrical skin and soft tissue expander with rated capacity ranging from 400 to 600 mL was placed in the frontal-parietal region. Another cylindrical expander with rated capacity ranging from 50 to 100 mL was placed in the temporal region of the patient with scars in front of the ear and in cheek. The injection time was 3 to 5 months with the total injection volume being 1.5 to 2.5 times of the rated capacity of expander. In the second stage, the superficial temporal artery frontal branch and its branches were explored, the expander was removed, the scars in the face and neck were conducted resection and contracture relaxation, and the single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region for reconstruction was performed. When the branches of the superficial temporal vessels were difficult to be detected by Doppler ultrasonic blood stream detector, the patient underwent computed tomography (CT) angiography and three-dimensional reconstruction. The donor site in frontal-parietal region was directly sutured, and the wound of the exposed donor site at the pedicle and temporal region was temporarily covered with scar skin. After the suture wound was healed and the hair in expanded flap grew out, hair removal and laser hair removal were performed. Three to four weeks after transplantation of expanded flap, the flap pedicle was cut off, restored, and trimmed in the third stage. The status about the completion of operation, the implantation of expander in the temporal region, CT angiography and three-dimensional reconstruction were recorded. The effective resection area of expanded flap, the length across the midline and the length of the pedicle, and the survival status of the expanded flap and complications after operation were observed. The appearance of donor and recipient sites, the scar recurrence, the appearance and function improvement of patients, and the satisfaction degree of patients were followed up. Results: All the 10 patients successfully completed three stages of operation, of which 6 patients had an auxiliary expander placement in the temporal region, and 5 patients underwent CT angiography and three-dimensional reconstruction. The effective resection area of expanded flap ranged from 18 cm×8 cm to 25 cm×13 cm. The distal end of the flap across the midline extended 4-6 cm to the opposite side, and the length of pedicle was 2-6 cm. All the expanded flaps of patients survived well after formation and transfer. The venous reflux disorder and obvious swelling occurred in 6 patients at the distal end of the flap after operation, and the blood supply recovered after acupuncture bloodletting, etc. Follow-up of 6 to 24 months showed that the color, texture, and thickness of the expanded flaps were similar to those of the facial skin, and no recurrence of scar was observed; the incision in the donor site of the frontal-parietal region was concealed, the hair growth of the temples and head was normal, and the reconstructed hairline was natural; compared with those before operation, the appearance, head-up, mouth-opening, and other functions of patients were significantly improved; the patients were satisfied with the effect of reconstruction. Conclusions: Clinical application of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck can achieve a good appearance and function, and the donor site shows good shape, which enriches the application range of the trans-regional blood supply flap. It is a reliable method for reconstruction of large scar deformities in the face and neck.

Successful treatment of xanthelasma palpebrarum with a combination of radiofrequency ablation and wound suturing.

Xanthelasma palpebrarum is a common disfiguring condition of eyelids often causing cosmetic concern and psychological distress. Various treatment modalities have been used to clear the lesions but none have been found to be fully satisfactory. To evaluate a novel combination of radiofrequency (RF) ablation and primary wound closure for treatment of xanthelasma palpebrarum (XP). Forty-five patients were selected after clinical examination and grading of lesions. Radiofrequency ablation was used to remove the lesion followed by suturing of the wound. Efficacy of treatment was evaluated on the basis of clinical examination and photographic images. Excellent response was seen in all patients. Of these, in 43 patients complete clearance could be achieved in a single sitting. In the other 2, an additional sitting of RF was done because of the presence of either multiple lesions or significant projection from the main lesion. Recurrence was seen in only two patients at the end of one year. Radiofrequency removal combined with wound closure showed excellent response with good cosmetic result, no scarring, and rare relapse at end of 1year. This was achieved in 43(96%) of the total 45 patients in a single sitting.

EXPERIENCE OF DEXMEDETOMIDINE USE IN SURGERY IN PATIENTS WITH THYROTOXICOSIS

In the past thyroid surgery has been the most common cause of thyroid storm, but recently, preoperative drugs that create a euthyroid state before surgery have somewhat improved treatment outcomes. An active treatment approach in the perioperative period can determine the effective clinical treatment of this life-threatening disease. Therefore, the anesthesia of such operations is very important.The aim of this work: The aim of the study was to evaluate the use of dexmedetomidine as an intravenous adjuvant for general anesthesia for thyroidectomy in patients with manifestations of thyrotoxicosis.Materials and methods. The study was conducted at State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” State Administrative Department, Kyiv, Ukraine. It was prospective, not randomized. The study involved 123 patients with thyrotoxicosis who underwent routine thyroidectomy under general anesthesia using sevoflurane (inhalation anesthetic) and fentanyl (narcotic analgesic) in low-flow artificial lung ventilation. Methods of perioperative monitoring (International Standards for a Safe Practice of Anesthesia 2010, WFSA) were supplemented using indirect calorimetry. The degree of preoperative risk of patients – ASA IІI-IV. Patients were divided into two groups. In the control group (I, n=64) during the operation was additionally administered intravenously esmolol hydrochloride at a heart rate ≥90 beats/min (the saturation dose was 500μg×kg-1×min-1 for 1-th minute and then – 25-50 μg×kg-1×min-1) under the control of the ECG and hemodynamic parameters before normalization of heart rate. In the main group (II, n=59) – intravenously dexmedetomidine (0,1 μg×kg-1×hr-1). At all stages of anesthesia, hemodynamic parameters, oxygen transport and metabolism were monitored, which was determined by indirect calorimetry. Blood cortisol levels were determined. The obtained information was processed using statistical packages MedStat v. 4. and Microsoft Office.Results and discussions. Baseline metabolic rates in both groups were quite high and were, respectively, 828±17 cal×min-1×m-2 in group I and 832±13 cal×min-1×m-2 in group II, which exceeded their Basal Metabolic Rate (BMR): in group I – by 54,5% and in group II – by 58,5% (p <0,01). At the stage of induction of anesthesia in group I revealed depression of the hemodynamic profile, probably associated with the effect of the introduction of esmolol hydrochloride, which led to a decrease in oxygen transport without metabolic disorders. At the stages of mobilization and removal of the thyroid gland, in both groups there were manifestations of hyperdynamics and hypermetabolism. At the same time, the metabolism in group II, at these stages, was lower by 9,3% and 10,1%, respectively, than in the control group (p <0,05). In both groups, there was an increase in blood cortisol levels, which, compared with baseline, reached maximum values at removal of the thyroid gland (19,12±1,49 μg/dl in the group I and 1,42±1,68 μg/dl in the group II), which indicates the corresponding activation of the adrenal system (p <0,05). In the group I at the stage of gland removal, wound suturing and awakening, the level of cortisol was higher than in the group II (p <0.05).Conclusions. The use of dexmedetomidine at a dose of 0,1 μg×kg-1×hour-1 in the scheme of anesthesia during thyroidectomy, suppresses the hemodynamic response caused by surgical stress, stabilizes oxygen consumption and maintains a stable metabolic rate. Carrying out perioperative energy monitoring with the use of indirect calorimetry during anesthesia allows to identify metabolic disorders and to carry out the appropriate pathogenetic correction.

Outcomes of laceration suture repair in the emergency department.

To assess patient satisfaction with laceration management, post-ED care, cosmesis and complication rates. We undertook a prospective observational study of adult patients with lacerations sutured in two EDs over a 4-month period. ED data included participant demographics, laceration characteristics and management. A telephone survey was undertaken approximately 14 days post-ED discharge. Patient satisfaction with post-ED pain management, advice on wound care and follow up, overall management and wound cosmesis were evaluated using a six-item satisfaction scale (very dissatisfied to very satisfied). Details of wound infection, dehiscence and suture failure were recorded. Eighty-nine patients participated. The number (% [95% confidence interval]) of patients very satisfied with their laceration management were: post-ED pain management 55 (62.5% [51.5-72.4]), wound care advice 51 (57.3% [46.4-67.6]), follow-up advice 39 (43.8% [33.5-54.7]), overall management 61 (68.5% [57.7-77.7]) and cosmetic appearance 46 (51.7% [40.9-62.3]). Infection, dehiscence and suture failure occurred in 5 (5.6%), 8 (9.0%) and 8 (9.0%) cases, respectively. These complications were not associated with being very satisfied overall (P = 0.96). Patients very satisfied with post-ED pain management, wound care advice, follow-up advice or wound cosmesis were much more likely to be very satisfied overall (P < 0.001). Most patients are very satisfied with their laceration management. However, there is scope for improvement, especially for follow-up and wound care advice. Complications are infrequent and not associated with overall satisfaction.

Optimization of the technique for removal of benign tumors and wound suturing in a general surgical hospital

Aim. To improve the results of surgical treatment in patients with large lipomas by using the device for closing the edges of wounds, allowing local preventive hemostasis in the surgical wound area, to create optimal conditions for atraumatic suturing and thereby reduce the amount of intraoperative bleeding and subsequently reduce the amount of postoperative wound complications.&#x0D; Methods. The results of treatment of 105 patients with different localization of large lipomas were analyzed. Lipomas ranged from 8.0 to 20 cm in diameter. All patients were divided into 2 groups: the control group consisted of 53 (50.5%) patients for which used the traditional technique of tumor excision with closing surgical wounds, and the study group with 52 (49.5%) patients, for which to reduce tissue damage during tumor removal and the edges of wound suturing, one of the device variants developed by us was used, approximation-distraction device. Fisher's exact test was used for the comparison of the outcomes rate, a p-value 0.05 was considered statistically significant.&#x0D; Results. Surgical wound complications occurred in 7 (6.7%) of 105 patients. In the study group, surgical wound complications occurred in 1.9% (1 observation), in the control group 11.3% (6 observations). Surgical wound complications were severity grade I and grade IIIa. Complications of the first grade did not require a debridement and will regress on its own; in grade IIIa complications, an opening, excision and drainage surgical wounds were performed without general anesthesia.&#x0D; Conclusion. Moderate local selective near-tumor tissue compression that occurs when the device branches come closer to each other accelerates spontaneous thrombus formation in damaged small vessels. This creates favorable conditions for the surgeon to work in a dry wound.

The use of intestinal exteriorization technology in the treatment of congenital diaphragmatic hernia in a newborn infant

The result of the surgical treatment of a newborn infant with congenital diaphragmatic hernia complicated by pulmonary hypertension and ischemic lesion of the small intestine is presented. Using the technology of intestinal exteriorization after conversion of thoracoscopic access to laparotomy, plastic surgery of the left dome of the diaphragm, and moving the changed loops of the small intestine into a silo sewn to the edges of the laparotomy wound allowed avoiding serious complications in the postoperative period. 7 days after the first operation, bowel loops were immersed in the abdominal cavity, and suturing of the laparotomy wound was performed. During the follow-up examination for 2 years after the operation, the diaphragm is usually located, there are no signs of impaired bowel function.

Head and neck/maxillofacial nurse-led clinical activity during COVID-19 Pandemic — experience of one unit

COVID-19 infection has changed the practice in the primary and secondary healthcare services worldwide.1Holmes S. Bhatti N. Bhandari R. et al.Toward a consensus view in the management of acute injuries during the Covid-19 pandemic.Br J Oral Maxillofac Surg. 2020; 58: 571-576Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 2Barca I. Cordaro R. Kallaverja E. et al.Management in Oral and Maxillofacial Surgery During the Covid-19 Pandemic: Our Experience.Br J Oral Maxillofac Surg. 2020; 27 (30177-7)Google Scholar Virtual clinics in the form of telephone or video consultation have become the new normal. Microsoft Teams is now used to conduct professional meetings and interdepartmental teaching. Nonetheless, there are certain steps in the patient journey which cannot be done on the virtual basis, and require face-to-face consultation. The most important of this is wound care and this essential activity generally falls into nurse-led clinics. Prior to the COVID-19 outbreak, there was reasonable support for suture removal, dressing changes and wound care in the primary care settings. During the pandemic, the workload in the nurse-led clinic has substantially increased due to the temporary closure of the primary settings. Furthermore, during the pandemic most of the NHS resources were channelled towards treating patients with COVID-19 infections and expanding intensive care units. The resources available to the nurse-led clinics, particularly the head and neck, have been put on the back burners. This has resulted in physical and psychological stress to the dedicated group of nurses. We carried out an audit of activity within the nurse-led clinics in head and neck/maxillofacial specialty and compared the results between 3 months prior to the pandemic and 3 months during the pandemic (Fig. 1). The results clearly indicate that during the pandemic there has been an increase in demand in this service. Due to the increased demand, there has been delay in patients obtaining regular and emergency wound care. The numbers are high and complications have increased. The increase in the complication rate is most likely multifactorial and can be affected by the general comorbidity of the patients, delay in receiving care in timely manner, COVID-19 infections, and challenges related to Personal Protection Equipment (PPE). Nurse-led dressing clinic is an important step in the patient journey when they are undergoing head and neck procedures. This specialised service was not easily available in the primary setting prior to COVID and has become depleted during the pandemic. This audit proves the need for development of this nurse-led service in the primary setting with funding and necessary training. Hospital-based tissue viability nurses input is minuscule and their expertise towards head and neck service is also questionable. Overall, there is a clear requirement for extra funding and increased resources. It is essential that this small subgroup of nurses get the recognition they deserve, as they are an essential part of patients' head and neck pathway. We have no conflicts of interest. Not required.

Hyperthermic intraperitoneal chemotherapy (HIPEC) for gynecological cancer.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a method of administering anticancer agents directly while heating the abdominal cavity. The aim of this review is to know the current position of HIPEC in ovarian cancer and uterine sarcoma and its future prospects. This article reviews the current literature and evidence for the clinical trial of HIPEC in ovarian cancer and uterine sarcoma with consideration of the cases treated in our department. In January 2018, van Driel et al. reported the results of their phase 3, randomized, controlled trial and the usefulness of neoadjuvant chemotherapy followed by interval debulking surgery. With respect to greater than grade 3 complications, such as suture failure, intestinal perforation, postoperative bleeding, wound issues and death, there were no significant differences between the HIPEC group and the no-HIPEC group. In a meta-analysis including two randomized, controlled studies and 11 observational studies in 2019, the addition of HIPEC to cytoreductive surgery significantly improved overall survival of ovarian cancer patients. Moreover, growing evidence of the efficacy of cytoreductive surgery with HIPEC has also been reported in uterine sarcoma with peritoneal sarcomatosis in a multi-institutional study. HIPEC could be one of the new therapeutic strategies for such disseminated peritoneal lesions. Since the usage regimen and temperature setting of HIPEC are not standardized, and its effectiveness and adverse events are greatly affected by the time of administration, it is necessary to consider clinical trials for the optimization and establishment of HIPEC in Japan in the future.

Doppler ultrasound contribution in vesico-peritoneal and vesico-cutaneous fistulas diagnosis: two case reports of a new sign

BackgroundReport cases of vesico-peritoneal and vesico-cutaneous fistulas suspected to Doppler ultrasound confirmed by CT scan/conventional cystography and successfully treated.Case presentationTwo male patients of 35- and 36-year-old, without any medical past history, had presented anuria and absence of miction respectively after a road traffic accident and a piece of wood penetrating the left thigh. The physical examination revealed lower limbs hematoma and severe abdominal pain in the man of 35 years and a sutured wound of the left thigh of 4 cm with a bright liquid flowing from it with the characteristic smell of urine in the man of 36 years. A Doppler ultrasound was made. The Doppler had shown normal ureteral jets but with a third abnormal flux which went from interior to exterior of the urinary bladder for the first patient and from the bladder to the left inguinal cutaneous tissue for the second patient. The treatment was a Foley’s catheter into the bladder with antibiotics in the two cases after excision and separate suture of the peritoneum and bladder during umbilical laparotomy in the first case. The suites were simples.ConclusionsThe diagnostic contribution of CT/conventional cystography is well known and undisputed, but for Doppler ultrasound, it is anecdotal like in these cases we report. Nevertheless, there is a need to evaluate the semiological value of Doppler ultrasound contribution on a greater sample.

Self-contracting oxidized starch/gelatin hydrogel for noninvasive wound closure and wound healing

Major challenges in traditional wound closure methods (e.g. using sutures and skin staplers) remain inadequately unaddressed; these invasive treatments induce extra puncture wounds, anesthetic side effects, and severe scarring. Herein, an oxidized starch/gelatin-based shape memory hydrogel (OSG) was fabricated as a self-contracting wound dressing to facilitate noninvasive wound closure. The self-contracting properties were attributed by introducing crosslink net-points in the hydrogel polymer structure through Schiff base reaction between oxidized starch (OS) and gelatin. We systematically investigated the self-contracting properties to determine the feasibility of the hydrogel to treat wounds and promote wound closure noninvasively. Following elongation, OSGs could be entirely fixed in a temporary shape at 4 °C, and then contracted under infrared irradiation (IR) for shape memory activation near human physiological temperature (38 °C), providing sufficient recovery force (4 kPa) for successful noninvasive wound closure. Additionally, H&E staining revealed that thicker epidermis and dermis layers were achieved upon OSG treatment, confirming that the OSG facilitated tissue reconstruction in an in vivo rabbit model. Moreover, the OSG-treated wounds displayed smoother skin and no visible scarring compared to sutured wounds. Such excellent performance suggests that OSG hydrogel exhibits high potential as an alternative to medical sutures to facilitate noninvasive would closure.

Randomized, controlled clinical trial to assess the effect of antimicrobial-impregnated suture on the incidence of surgical site infections in dogs and cats.

To evaluate the prophylactic efficacy of triclosan-coated (TC) suture in preventing surgical site infections (SSIs) in dogs and cats undergoing surgical procedures. 862 animals (794 dogs and 68 cats). Incidences of SSI of surgical wounds closed with TC suture and surgical wounds closed with non-TC suture occurring between the time of surgery and 1 month postoperatively were compared. Animals were randomly assigned to TC or non-TC suture groups. When TC suture was assigned, all suture available as TC material was used rather than non-TC suture. Presence of an SSI was determined by an owner questionnaire or direct examination. Overall, 50 of 862 (5.8%) animals developed SSIs. Incidence of SSI was 6% (24/428) in the non-TC suture group and 6% (26/434) in the TC suture group. No significant difference was found in the incidence of SSI between groups. No significant difference was detected in the incidence of incisional problems (eg, redness, dehiscence, and seroma formation) between animals in which TC suture was used and those in which non-TC suture was used. On multivariable analysis, other factors were associated with increased SSI rates, including an incision length > 10 cm, surgery performed by the soft tissue surgery department, and anesthesia duration of > 240 minutes. No significant difference in incidence of SSI was detected between animals undergoing surgical procedures performed with non-TC versus TC suture.

Clinical strategies for preservation of the exposed implant in chronic wounds and wound repair

Objective: To explore the clinical strategies for preservation of the exposed implant in chronic wounds and wound repair. Methods: From January 2016 to January 2019, totally 8 patients (4 males and 4 females, aged 10 to 73 years) sustaining postoperative chronic wounds with exposed implants were admitted to the Fourth Medical Center of PLA General Hospital. There were 2 cases of abdominal patch exposure after abdominal trauma surgery, 2 cases of titanium plate exposure post craniocerebral surgery, 3 cases of internal fixator exposure post orthopedic surgery, and 1 case of cerebrospinal fluid drainage tube exposure after craniocerebral surgery. The wound exudate was collected for bacterial culture on admission. On the basis of glycemic control and correction of anemia and hypoproteinemia, thorough wound debridement was performed as soon as possible and the wound area after debridement ranged from 2.0 cm×0.5 cm to 6.0 cm×5.0 cm. The wounds of 4 patients were immediately closed after debridement, including 1 case by primary closure, 1 case by primary closure after local filling of platelet rich plasma gel, and 2 cases by local flap transplantation, with flap size of 10.0 cm×8.0 cm and 12.0 cm×8.0 cm, respectively. The donor sites of flaps were sutured directly and all the incisions were treated with continuous vacuum sealing drainage (VSD) after surgery. The other 4 patients were treated with continuous VSD after debridement to improve the wound bed. The wound of 1 case healed gradually, 1 case received direct wound suturing, and the wounds of 2 cases were repaired with thin split-thickness skin grafts from the thigh or the head. The results of bacterial culture of wound exudate on admission, wound healing post surgery, and follow-up were observed and recorded. Results: The bacterial culture of wound exudate on admission was positive in 6 patients, and 10 strains of bacteria were isolated with Staphylococcus epidermidis as the main pathogen. All the skin grafts or flaps of patients survived post surgery, with the incisions and wounds healed and all the implants preserved. After 1 to 3 years of follow-up, no recurrence of wound was found in any patient. Conclusions: The postoperative chronic wounds with exposed implants can be closed in primary stage by direct suturing or flap transplantation if it is clean enough on the basis of thorough debridement. The wounds with large defects or serious infection can be treated with continuous VSD firstly and then closed with direct suturing or skin grafting for delayed wound closure, thereby to reach the treatment goal of preserving the implants and repairing the wounds simultaneously.

The use of grafting material biphasic calcium sulfate for the treatment of osseous defects resulting from radicular cysts. Clinical study and six-month follow up

Aim Surgical treatment of odontogenic cysts of the jaws accounts for a significant percentage of dental surgery procedures. Additionally, a wide range of procedures and augmentation materials are used in the reconstruction of these osseous defects. The authors present a study including histology of surgical treatment of odontogenic cysts using a biphasic calcium sulfate composite bone graft. Materials and methods Two groups, study and control, of 30 patients each with odontogenic cyst were treated for radicular cyst removal with reconstructive surgery using a deproteinized bovine bone graft (xenograft). A modified surgical procedure was performed in the control group, with different types of graft placed in the osseous defects. In the study group wound site closure was performed without periosteum cutting to allow stretching of the flap to attempt primary site closure, whereas in the control group primary wound closure was achieved to protect the xenograft material. Results In the study group complete wound healing and suture maintenance was reported in 29 patients (96.6%); in 1 case (3.4%), a postoperative wound dehiscence (I°) occurred on day 5. In the control group no wounds dehiscences were observed in 24 patients (80%), in 4 cases (12%) a wound dehiscence (I°) occurred on day 3 and 5 and in 2 cases (8%), IIo wound dehiscence over 10 mm with secondary inflammatory features were observed which required graft removal. Conclusions The use of the Bond Apatite® preparation proved to be a simple, inexpensive and effective reconstructive treatment of osseous defects after enucleation of odontogenic cysts.

Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials.

Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to August 2019. Finally, we identified 1,472 TKAs (1,270 patients) assessed in 13 randomized-controlled trials. Compared with conventional wound closure techniques, barbed sutures resulted in shorter total wound closure time (p < 0.001), fewer needle puncture injuries to members of the surgical team (p = 0.02). There were no significant differences in terms of blister formation (p = 1.0), superficial infection (p = 0.82), range of motion (p = 0.94), incisional exudate (p = 0.75), suture abscess (p = 0.26), or suture breakage (p = 0.11), wound-related complications (p = 0.10), ecchymosis (p = 0.08) between barbed and conventional wound closure. Based on the available level I evidence, we thus conclude that a knotless barbed suture is a safe and effective approach for wound closure in TKA. Given the relevant possible biases in our meta-analysis, more adequately powered and better-designed randomized-controlled trials studies with long-term follow-up are required to recommend barbed sutures for routine administration in TKA.

Cost factor "outpatient wound care" in the emergency department : Cost-revenue deficit of outpatient wound treatment in a German university hospital

HintergrundDie Erstversorgung von Wunden und kleinere chirurgische Eingriffe gehören neben der hochspezialisierten Medizin zu den allgemein notwendigen Grundleistungen der Notfallversorgung in den Kliniken. Die Vergütung der ambulanten Notfallleistungen für gesetzlich Versicherte erfolgt derzeit nach dem Einheitlichen Bewertungsmaßstab (EBM), welchem die betriebswirtschaftliche Aufwandserfassung des niedergelassenen Sektors als Kalkulationsgrundlage dient. Krankenhäuser haben im Vergleich zu Arztpraxen wesentlich höhere Vorhaltungskosten.Ziel der ArbeitIn dieser Arbeit wird das entstehende Kosten-Erlös-Verhältnis der ambulanten Wundversorgung in einer Notaufnahme durch die Vergütung nach EBM analysiert.Material und MethodenDie Daten wurden in der Notaufnahme des Universitätsklinikums Frankfurt am Main über 12 Monate erhoben. Eingeschlossen wurden alle Patienten, die in diesem Zeitraum eine Wundversorgung mittels Naht erhielten. Die Kosten wurden der Abrechnung nach EBM 01210 (bzw. 01212) mit der Zusatzpauschale für kleinchirurgische Eingriffe EBM 02301 gegenübergestellt.ErgebnisseIm Beobachtungszeitraum wurden 1548 Patienten versorgt; das entspricht 19,52 % aller unfallchirurgischen Fälle. Den Kosten einer Standardwundversorgung in Höhe von 45,40 € steht eine Vergütung von 31,83 € gegenüber. Die Berechnung des Gesamterlöses weist einen Defizitbetrag von 13,57 € pro ambulantem Fall auf; dies entspricht einem Jahresdefizit von 21.006,36 €.DiskussionEs konnte gezeigt werden, dass ohne Betrachtung der relevanten Vorhaltekosten in keinem Fall eine Kostendeckung erreicht werden kann.Die bisherige Vergütung der ambulanten Wundversorgung nach EBM erscheint unzureichend. Eine Anpassung bzw. Zusatzvergütung scheint notwendig, um eine ausreichende Versorgungsqualität in Zukunft sicherstellen zu können.

PMD15 ASSESSMENT OF THE RISK AND ECONOMIC BURDEN OF SURGICAL SITE INFECTION FOLLOWING COLORECTAL SURGERY USING A US LONGITUDINAL DATABASE: IS THERE A ROLE FOR INNOVATIVE ANTIMICROBIAL WOUND CLOSURE TECHNOLOGY TO REDUCE THE RISK OF INFECTION?

Colorectal surgical procedures place substantial burden on healthcare systems because of the high complication risk, especially surgical site infections. The purpose of this study was to determine the incidence and true cost of infections after colorectal surgery and potential economic impact of using antimicrobial wound closure to improve patient outcomes. This was a retrospective observational cohort analysis and probabilistic cost analysis, using the IBM® MarketScan® Commercial and Medicare Claims database. A total of 107,665 patients undergoing colorectal surgery between 2014 and 2018 in the United States were identified. Rate of infection was identified between 3-180 days postoperatively. Logistic models were used to evaluate risk for infection and generalized linear models were developed to estimate 2018 inflation-adjusted payer cost of infection within 24 months post surgery. Potential cost avoidance from avoided infections using antimicrobial sutures were further estimated using a probabilistic decision-tree using Monte Carlo simulation. Post-operative infections were diagnosed in 23.9% of patients (4.0% superficial incisional (SS) and 19.9% deep incisional/organ-space (DIOS)). Risk factors for DIOS infections included obesity, and admission type (emergency vs elective) among others. After 12-months, payer costs associated with superficial incisional and deep incisional/organ-space infections averaged $36,196 (9% confidence interval (CI): 32,840-39,691) and $77,043 (95%CI: $75,179-$78,941) for Commercial payers and $17,323 (95% CI: $12,805-$22,191) and $55,089 (95%CI: $52,340-$57,940) for Medicare, respectively. Use of antimicrobial suture wound closure for colorectal surgery was estimated to reduce mean payer costs by $1,435-$2,405 per patient compared with traditional wound closure. Infection cost burden was found to be higher than previously reported, with payer costs increasing over a 24-month postoperative period. Findings in this study were estimated using modeling techniques with inherent limitations, however, results suggest overall savings from use of antimicrobial sutures as a component of a comprehensive evidence-based surgical care bundle for reducing infection risk.

Midwifery Care for Postpartum Mothers With Discomfort Suture Wound Pain In Maternity Hospital

Postpartum is the period after delivery, the birth of the baby, the placenta and the complete membranes, which are needed to restore the reproductive organs and womb to their normal state before pregnancy, with a period of approximately 40-42 days or 6 months after delivery. During the puerperium, it is common to complain of pain at the stitches which can interfere with the comfort of the postpartum mother. This case study was conducted at RB &amp; Clinic Afifa Prambon Sidoarjo which was conducted on January 5, 2020. This midwifery care was carried out by interviewing and obtaining data using the SOAP method. The results obtained from the care of physiological postpartum mothers were no complications and there was a gap between theory and practice.